A LabVIEW model incorporating an open-loop arterial impedance and a closed-loop circulatory system.

Science.gov (United States)

Cole, R T; Lucas, C L; Cascio, W E; Johnson, T A

2005-11-01

While numerous computer models exist for the circulatory system, many are limited in scope, contain unwanted features or incorporate complex components specific to unique experimental situations. Our purpose was to develop a basic, yet multifaceted, computer model of the left heart and systemic circulation in LabVIEW having universal appeal without sacrificing crucial physiologic features. The program we developed employs Windkessel-type impedance models in several open-loop configurations and a closed-loop model coupling a lumped impedance and ventricular pressure source. The open-loop impedance models demonstrate afterload effects on arbitrary aortic pressure/flow inputs. The closed-loop model catalogs the major circulatory waveforms with changes in afterload, preload, and left heart properties. Our model provides an avenue for expanding the use of the ventricular equations through closed-loop coupling that includes a basic coronary circuit. Tested values used for the afterload components and the effects of afterload parameter changes on various waveforms are consistent with published data. We conclude that this model offers the ability to alter several circulatory factors and digitally catalog the most salient features of the pressure/flow waveforms employing a user-friendly platform. These features make the model a useful instructional tool for students as well as a simple experimental tool for cardiovascular research.

Implantable nuclear-fueled circulatory support system. V. Acute physiologic analyses

Energy Technology Data Exchange (ETDEWEB)

Huffman, F N; Migliore, J J; Hagen, K G; Daly, B D.T.; Robinson, W J; Ruggles, A E; Norman, J C

1973-01-01

Nuclear-Fueled circulatory assist systems have reached the stage of in vivo evaluation. Physiologic studies of the effects of intracorporeal heat and radiation as well as blood pumps indicate that these factors should not preclude clinical application of nuclear artificial hearts. In the circulatory system under consideration, a fraction of the heat from a 50 watt Plutonium-238 fuel capsule is converted into hydraulic power for driving a left ventricular assist pump via a miniature, electronically controlled steam (tidal regenerator) engine. The engine is pressurized (8-140 PSIA) by the displacement of a single drop of water between the condenser (150/sup 0/F) and the boiler (360/sup 0/F). The electrical power for sensing, logic and displacement is provided by a thermoelectric module interposed between the superheater (900/sup 0/F) and boiler. The pusher plate pump also functions as a blood-cooled heat exchanger and sensor for the control logic. The assist pump is connected between the apex of the left ventricle and the descending thoracic aorta. The power source module is suspended in the left retroperitoneal cavity from the psoas tendon. The blood interface of the pump is flocked with polyester fibers. A stable biologic lining develops in the pump using Dextran as the only anticoagulant. The longest in vivo testing period has been 4/sup 1///sub 2/ days. Plasma hemoglobinshave remained below 10 mg/sup 0///sub 0/. Although rectal temperatures have not increased, elevated respiratory rates have been noted. Reduction of left ventricular pressure and dp/dt have been demonstrated with maintenance of arterial pressure.

Low-frequency dynamics of autonomic regulation of circulatory system in healthy subjects

Science.gov (United States)

Skazkina, V. V.; Borovkova, E. I.; Galushko, T. A.; Khorev, V. S.; Kiselev, A. R.

2018-04-01

The paper is devoted to the analysis of dynamic of interactions between signals of autonomic circulatory regulation. We investigated two-hour experimental records of 30 healthy people. Phase synchronization was studied using the signals of the electrocardiogram and the photoplethysmogram of vessels. We found the presence of long synchronous intervals in some subjects. For analysis of the dynamic we calculated autocorrelation functions. The analysis made it possible to reveal indirect signs of the influence of the humoral regulation system.

Annular tidal regenerator engine for nuclear circulatory support systems

International Nuclear Information System (INIS)

Hagen, K.G.; Ruggles, A.E.; Fam, S.S.; Torti, V.A.

1975-01-01

In order to simplify the configuration of the tidal regenerator engine nuclear-powered circulatory support system, thereby drastically reducing its size and improving the intrinsic reliability, the engine has been redesigned. This redesign focuses on allowing power to be extracted at the low temperature end of the engine utilizing a piston-cylinder arrangement wherein all of the necessary heat transfer processes occur in the annular gap between the piston and cylinder. In all other respects the engine retains its basic characteristics as a hybrid between a Stirling engine and a Rankine engine. A significant advantage of the new arrangement is the ability to raise the superheat temperature limit from 650 0 F to over 900 0 F. This has yielded an increase in engine efficiency from 10 percent to 14 percent, and further increases are anticipated by utilizing an expansion and/or a binary version of the engine. The implantable system volume has been reduced by a factor of three and orientation insensitivity with respect to gravity has been demonstrated. Many system components have already demonstrated endurances of several thousand hours

Status of the Tidal Regenerator Engine for nuclear circulatory support systems

International Nuclear Information System (INIS)

Watelet, R.P.; Ruggles, A.E.; Torti, V.

1976-01-01

Based on the annular version of the Tidal Regenerator Engine, a packaged energy system for nuclear powered circulatory support systems was developed. Net power output of approximately 3 watts is delivered using a 33-watt heat source for an engine module volume of 0.7 liter and a weight of 1.6 kg. A higher efficiency dual cycle version of the annular engine using a Dowtherm A topping cycle on the basic steam cycle is also under development. Projected system output using this advanced engine is 5 watts for the same sized heat source. Life testing of critical components has demonstrated substantial reliability improvement over earlier designs. Of particular significance is the continuing operation of a complete implantable engine system after 1200 hours. Component life testing is continuing with over five thousand hours accumulated on two pump actuators employing welded metal bellows

Pediatric Donation After Circulatory Determination of Death: A Scoping Review.

Science.gov (United States)

Weiss, Matthew J; Hornby, Laura; Witteman, William; Shemie, Sam D

2016-03-01

Although pediatric donation after circulatory determination of death is increasing in frequency, there are no national or international donation after circulatory determination of death guidelines specific to pediatrics. This scoping review was performed to map the pediatric donation after circulatory determination of death literature, identify pediatric donation after circulatory determination of death knowledge gaps, and inform the development of national or regional pediatric donation after circulatory determination of death guidelines. Terms related to pediatric donation after circulatory determination of death were searched in Embase and MEDLINE, as well as the non-MEDLINE sources in PubMed from 1980 to May 2014. Seven thousand five hundred ninety-seven references were discovered and 85 retained for analysis. All references addressing pediatric donation after circulatory determination of death were considered. Exclusion criteria were articles that did not address pediatric patients, animal or laboratory studies, surgical techniques, and local pediatric donation after circulatory determination of death protocols. Narrative reviews and opinion articles were the most frequently discovered reference (25/85) and the few discovered studies were observational or qualitative and almost exclusively retrospective. Retained references were divided into themes and analyzed using qualitative methodology. The main discovered themes were 1) studies estimating the number of potential pediatric donation after circulatory determination of death donors and their impact on donation; 2) ethical issues in pediatric donation after circulatory determination of death; 3) physiology of the dying process after withdrawal of life-sustaining therapy; 4) cardiac pediatric donation after circulatory determination of death; and 5) neonatal pediatric donation after circulatory determination of death. Donor estimates suggest that pediatric donation after circulatory determination of death will

Mechanical circulatory treatment of advanced heart failure

DEFF Research Database (Denmark)

Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob

2016-01-01

Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements...... in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

The Impact of Ionospheric and Geomagnetic Changes on Mortality from Diseases of the Circulatory System

Czech Academy of Sciences Publication Activity Database

Podolská, Kateřina

2018-01-01

Roč. 27, č. 2 (2018), s. 404-417 ISSN 1052-3057 Institutional support: RVO:68378289 Keywords : mortality * circulatory system diseases * solar indices * cluster analysis using time Subject RIV: DN - Health Impact of the Environment Quality OBOR OECD: Public and environmental health Impact factor: 1.517, year: 2016 http://www.strokejournal.org/article/S1052-3057(17)30488-3/fulltext

Getting home with artifical heart – what is the everyday life experience of people with mechanical circulatory Support. A qualitative study

Science.gov (United States)

Braunsdorf, Sandy

2017-07-01

Background: The growing number of mechanical circulatory support systems implanted with successful results in terms of quality of life and physical resilience means that more and more people are being discharged from hospital to live at home with an artificial heart. This puts high requirements on affected persons’ disease and therapy management – a subject which has attracted very little qualitative research to date. Aim: This study therefore sought to shed light on how people with mechanical circulatory support experience their everyday lives. The aim was to document the subjective associations of those affected from an insider perspective. Methods: Following the interpretative phenomenological paradigm, narrative interviews were conducted with two female and eight male participants. For qualitative analysis, a multi-step process guided by the methodology of hermeneutic philosophy was used. Results: The qualitative data analysis revealed five main topic areas. These describe patients’ state of health after implantation and the various adjustments, constraints and pressures necessitated by their illness and therapeutic requirements. On this basis, coping and management strategies are identified. Other significant aspects of patients’ everyday lives are social interaction and environment and health care with an artificial heart. Conclusions: The findings add to our knowledge of the day-to-day lives of people with mechanical circulatory support systems, giving us a better understanding of their specific situation.

Numerical Models of Human Circulatory System under Altered Gravity: Brain Circulation

Science.gov (United States)

Kim, Chang Sung; Kiris, Cetin; Kwak, Dochan; David, Tim

2003-01-01

A computational fluid dynamics (CFD) approach is presented to model the blood flow through the human circulatory system under altered gravity conditions. Models required for CFD simulation relevant to major hemodynamic issues are introduced such as non-Newtonian flow models governed by red blood cells, a model for arterial wall motion due to fluid-wall interactions, a vascular bed model for outflow boundary conditions, and a model for auto-regulation mechanism. The three-dimensional unsteady incompressible Navier-Stokes equations coupled with these models are solved iteratively using the pseudocompressibility method and dual time stepping. Moving wall boundary conditions from the first-order fluid-wall interaction model are used to study the influence of arterial wall distensibility on flow patterns and wall shear stresses during the heart pulse. A vascular bed modeling utilizing the analogy with electric circuits is coupled with an auto-regulation algorithm for multiple outflow boundaries. For the treatment of complex geometry, a chimera overset grid technique is adopted to obtain connectivity between arterial branches. For code validation, computed results are compared with experimental data for steady and unsteady non-Newtonian flows. Good agreement is obtained for both cases. In sin-type Gravity Benchmark Problems, gravity source terms are added to the Navier-Stokes equations to study the effect of gravitational variation on the human circulatory system. This computational approach is then applied to localized blood flows through a realistic carotid bifurcation and two Circle of Willis models, one using an idealized geometry and the other model using an anatomical data set. A three- dimensional anatomical Circle of Willis configuration is reconstructed from human-specific magnetic resonance images using an image segmentation method. The blood flow through these Circle of Willis models is simulated to provide means for studying gravitational effects on the brain

Donations After Circulatory Death in Liver Transplant.

Science.gov (United States)

Eren, Emre A; Latchana, Nicholas; Beal, Eliza; Hayes, Don; Whitson, Bryan; Black, Sylvester M

2016-10-01

The supply of liver grafts for treatment of end-stage liver disease continues to fall short of ongoing demands. Currently, most liver transplants originate from donations after brain death. Enhanced utilization of the present resources is prudent to address the needs of the population. Donation after circulatory or cardiac death is a mechanism whereby the availability of organs can be expanded. Donations after circulatory death pose unique challenges given their exposure to warm ischemia. Technical principles of donations after circulatory death procurement and pertinent studies investigating patient outcomes, graft outcomes, and complications are highlighted in this review. We also review associated risk factors to suggest potential avenues to achieve improved outcomes and reduced complications. Future considerations and alternative techniques of organ preservation are discussed, which may suggest novel strategies to enhance preservation and donor expansion through the use of marginal donors. Ultimately, without effective measures to bolster organ supply, donations after circulatory death should remain a consideration; however, an understanding of inherent risks and limitations is necessary.

Circulatory mitochondrial DNA is a pro-inflammatory agent in maintenance hemodialysis patients.

Directory of Open Access Journals (Sweden)

Hongdi Cao

Full Text Available Chronic inflammation is highly prevalent in maintenance hemodialysis (MHD patients, and it has been shown to be a strong predictor of morbidity and mortality. Mitochondrial DNA (mtDNA released into circulation after cell damage can promote inflammation in patients and animal models. However, the role and mechanisms of circulatory mtDNA in chronic inflammation in MHD patients remain unknown. Sixty MHD patients and 20 health controls were enrolled in this study. The circulatory mtDNA was detected by quantitative real-time PCR assay. Plasma interleukin 6 (IL-6 and tumor necrosis factor α (TNF-α were quantitated by ELISA assay. Dialysis systems in MHD patients and in vitro were used to evaluate the effect of different dialysis patterns on circulatory mtDNA. Circulatory mtDNA was elevated in MHD patients comparing to that of health control. Regression analysis demonstrated that plasma mtDNA was positively associated with TNF-α and the product of serum calcium and phosphorus, while negatively associated with hemoglobin and serum albumin in MHD patients. MtDNA induced the secretion of IL-6 and TNF-α in the THP-1 cells. Single high-flux hemodialysis (HF-HD and on line hemodiafiltration (OL-HDF but not low-flux hemodialysis (LF-HD could partially reduce plasma mtDNA in MHD patients. In vitro, both HD and hemofiltration (HF could fractional remove mtDNA. Collectively, circulatory mtDNA is elevated and its level is closely correlated with chronic inflammation in MHD patients. HF-HD and HDF can partially reduce circulatory mtDNA in MHD patients.

Is there an association of circulatory hospitalizations independent of mining employment in coal-mining and non-coal-mining counties in west virginia?

Science.gov (United States)

Talbott, Evelyn O; Sharma, Ravi K; Buchanich, Jeanine; Stacy, Shaina L

2015-04-01

Exposures associated with coal mining activities, including diesel fuel exhaust, products used in coal processing, and heavy metals and other forms of particulate matter, may impact the health of nearby residents. We investigated the relationships between county-level circulatory hospitalization rates (CHRs) in coal and non-coal-mining communities of West Virginia, coal production, coal employment, and sociodemographic factors. Direct age-adjusted CHRs were calculated using West Virginia hospitalizations from 2005 to 2009. Spatial regressions were conducted to explore associations between CHR and total, underground, and surface coal production. After adjustment, neither total, nor surface, nor underground coal production was significantly related to rate of hospitalization for circulatory disease. Our findings underscore the significant role sociodemographic and behavioral factors play in the health and well-being of coal mining communities.

Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries

DEFF Research Database (Denmark)

Laursen, Thomas Munk; Wahlbeck, Kristian; Hällgren, Jonas

2013-01-01

Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac...... mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular...... disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause...

Diseases of the circulatory system among adult people diagnosed with infantile autism as children

DEFF Research Database (Denmark)

Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

2016-01-01

BACKGROUND: Research dealing with adult people with autism spectrum disorders (ASD) noticeably lags behind studies of children and young individuals with ASD. AIMS: The objective of this study was to compare the prevalence and types of diseases of the circulatory system in a clinical sample of 118...... adult people diagnosed with infantile autism (IA) as children with 336 sex and age matched controls from the general population. METHODS AND PROCEDURES: All participants were screened through the nationwide Danish National Hospital Register. The average observation time of both groups was 37.2 years...

Progression of Mortality due to Diseases of the Circulatory System and Human Development Index in Rio de Janeiro Municipalities

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Gabriel Porto Soares

Full Text Available Abstract Background: Diseases of the circulatory system (DCS are the major cause of death in Brazil and worldwide. Objective: To correlate the compensated and adjusted mortality rates due to DCS in the Rio de Janeiro State municipalities between 1979 and 2010 with the Human Development Index (HDI from 1970 onwards. Methods: Population and death data were obtained in DATASUS/MS database. Mortality rates due to ischemic heart diseases (IHD, cerebrovascular diseases (CBVD and DCS adjusted by using the direct method and compensated for ill-defined causes. The HDI data were obtained at the Brazilian Institute of Applied Research in Economics. The mortality rates and HDI values were correlated by estimating Pearson linear coefficients. The correlation coefficients between the mortality rates of census years 1991, 2000 and 2010 and HDI data of census years 1970, 1980 and 1991 were calculated with discrepancy of two demographic censuses. The linear regression coefficients were estimated with disease as the dependent variable and HDI as the independent variable. Results: In recent decades, there was a reduction in mortality due to DCS in all Rio de Janeiro State municipalities, mainly because of the decline in mortality due to CBVD, which was preceded by an elevation in HDI. There was a strong correlation between the socioeconomic indicator and mortality rates. Conclusion: The HDI progression showed a strong correlation with the decline in mortality due to DCS, signaling to the relevance of improvements in life conditions.

Progression of Mortality due to Diseases of the Circulatory System and Human Development Index in Rio de Janeiro Municipalities

Science.gov (United States)

Soares, Gabriel Porto; Klein, Carlos Henrique; Silva, Nelson Albuquerque de Souza e; de Oliveira, Glaucia Maria Moraes

2016-01-01

Background Diseases of the circulatory system (DCS) are the major cause of death in Brazil and worldwide. Objective To correlate the compensated and adjusted mortality rates due to DCS in the Rio de Janeiro State municipalities between 1979 and 2010 with the Human Development Index (HDI) from 1970 onwards. Methods Population and death data were obtained in DATASUS/MS database. Mortality rates due to ischemic heart diseases (IHD), cerebrovascular diseases (CBVD) and DCS adjusted by using the direct method and compensated for ill-defined causes. The HDI data were obtained at the Brazilian Institute of Applied Research in Economics. The mortality rates and HDI values were correlated by estimating Pearson linear coefficients. The correlation coefficients between the mortality rates of census years 1991, 2000 and 2010 and HDI data of census years 1970, 1980 and 1991 were calculated with discrepancy of two demographic censuses. The linear regression coefficients were estimated with disease as the dependent variable and HDI as the independent variable. Results In recent decades, there was a reduction in mortality due to DCS in all Rio de Janeiro State municipalities, mainly because of the decline in mortality due to CBVD, which was preceded by an elevation in HDI. There was a strong correlation between the socioeconomic indicator and mortality rates. Conclusion The HDI progression showed a strong correlation with the decline in mortality due to DCS, signaling to the relevance of improvements in life conditions. PMID:27849263

Effect of 5E Instructional Model in Student Success in Primary School 6th Year Circulatory System Topic

Science.gov (United States)

Cardak, Osman; Dikmenli, Musa; Saritas, Ozge

2008-01-01

The aim of this study is to research the effect of the 5E instructional model on primary (sixth grade) student success during the circulatory system unit. This study was conducted with 38 students in two different classes by the same researcher in 2006-2007. One of the classes was assigned as the control group and the other as the experimental…

Circulatory Arrest, Brain Arrest and Death Determination

Directory of Open Access Journals (Sweden)

Sam David Shemie

2018-03-01

Full Text Available Technological advances, particularly in the capacity to support, replace or transplant failing organs, continue to challenge and refine our understanding of human death. Given the ability to reanimate organs before and after death, both inside and outside of the body, through reinstitution of oxygenated circulation, concepts related to death of organs (e.g. cardiac death are no longer valid. This paper advances the rationale for a single conceptual determination of death related to permanent brain arrest, resulting from primary brain injury or secondary to circulatory arrest. The clinical characteristics of brain arrest are the permanent loss of capacity for consciousness and loss of all brainstem functions. In the setting of circulatory arrest, death occurs after the arrest of circulation to the brain rather than death of the heart. Correspondingly, any intervention that resumes oxygenated circulation to the brain after circulatory arrest would invalidate the determination of death.

Circulatory nucleosome levels are significantly increased in early and late-onset preeclampsia.

Science.gov (United States)

Zhong, Xiao Yan; Gebhardt, Stefan; Hillermann, Renate; Tofa, Kashefa Carelse; Holzgreve, Wolfgang; Hahn, Sinuhe

2005-08-01

Elevations in circulatory DNA, as measured by real-time PCR, have been observed in pregnancies with manifest preeclampsia. Recent reports have indicated that circulatory nucleosome levels are elevated in the periphery of cancer patients. We have now examined whether circulatory nucleosome levels are similarly elevated in cases with preeclampsia. Maternal plasma samples were prepared from 17 cases with early onset preeclampsia (34 weeks gestation) with 10 matched normotensive controls. Levels of circulatory nucleosomes were quantified by commercial ELISA (enzyme-linked immunosorbant assay). The level of circulatory nucleosomes was significantly elevated in both study preeclampsia groups, compared to the matched normotensive control group (p = 0.000 and p = 0.001, respectively). Our data suggests that preeclampsia is associated with the elevated presence of circulatory nucleosomes, and that this phenomenon occurs in both early- and late-onset forms of the disorder. Copyright 2005 John Wiley & Sons, Ltd.

Mechanical circulatory support in pediatrics.

Science.gov (United States)

Steffen, Robert J; Miletic, Kyle G; Schraufnagel, Dean P; Vargo, Patrick R; Fukamachi, Kiyotaka; Stewart, Robert D; Moazami, Nader

2016-05-01

End-stage heart failure affects thousands of children yearly and mechanical circulatory support is used at many points in their care. Extracorporeal membrane oxygenation supports both the failing heart and lungs, which has led to its use as an adjunct to cardiopulmonary resuscitation as well as in post-operative cardiogenic shock. Continuous-flow ventricular assist devices (VAD) have replaced pulsatile-flow devices in adults and early studies have shown promising results in children. The Berlin paracorporeal pulsatile VAD recently gained U.S. Food and Drug Administration approval and remains the only VAD approved in pediatrics. Failing univentricular hearts and other congenitally corrected lesions are new areas for mechanical support. Finding novel uses, improving durability, and minimizing complications are areas of growth in pediatric mechanical circulatory support.

Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries

Science.gov (United States)

Laursen, Thomas Munk; Wahlbeck, Kristian; Hällgren, Jonas; Westman, Jeanette; Ösby, Urban; Alinaghizadeh, Hassan; Gissler, Mika; Nordentoft, Merete

2013-01-01

Objective Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method. Results The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. Conclusion Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years. PMID:23826212

The human heart and the circulatory system as an interesting interdisciplinary topic in lessons of physics and biology

International Nuclear Information System (INIS)

Volná, M; Látal, F; Kubínek, R; Richterek, L

2014-01-01

Many topics which are closely related can be found in the national curriculum of the Czech Republic for physics and biology. One of them is the heart and the circulatory system in the human body. This topic was examined cross curriculum, a teaching module was created and the topic was chosen for our research. The task was to determine if the students of bachelor study are aware of connections between physics and biology within this topic and whether we can help them effectively to describe the corresponding physics phenomena in the human body connected, for example, with a heart attack or with the measurement of blood pressure. In this paper, the heart and the circulatory system are presented as suitable topics for an interdisciplinary teaching module which includes both theoretical and experimental parts. The module was evaluated by a group of first-year undergraduate students of physics at the Faculty of Science, Palacký University. The acquired knowledge was compared with another control group through a test. The highest efficiency of the module was evaluated on the basis of questions that covered the calculation problems. (paper)

[Mortality rates of circulatory system diseases and malignant neoplasms in Zagreb population younger than sixty-five--call for alarm].

Science.gov (United States)

Vizintin, Marina Polić; Mrcela, Nada Tomasović; Kovacić, Luka

2012-12-01

The aim of this work was to analyze the public health indicators for circulatory heart diseases and malignant neoplasms in the population younger than 65 in the City of Zagreb, Croatia, and compare them with the European Union (EU) countries. The purpose was to evaluate the situation and propose the public health preventive measures. The study population were Zagreb citizens aged 0-64 according to the 2001 census. Total Zagreb population was 779145, making 17.6% of total Croatian population. Data from the Croatian Bureau of Statistics and Dr Andrija Stampar Institute of Public Health were used. The standardized 0-64 mortality rates of the selected diseases 2006-2010 were used in the analysis. In 2010, the standardized mortality rates of all analyzed diseases were significantly higher in Zagreb population aged 0-64 than the EU averages except for cervical cancer. In 2010, the mortality rates in Zagreb population aged 0-64 were as follows: circulatory system diseases 61.22, ischemic heart disease 28.99, cerebrovascular diseases 12.51, malignant neoplasms 94.69, tracheal and lung cancer 24.92, breast cancer 21.08 and cervical cancer 2.05. Standardized mortality rates in Zagreb population aged 0-64 for circulatory system were lower than for Croatia (61.22 vs. 63.25), but higher for malignant neoplasms (94.69 vs. 91.2), except for cervical cancer (2.05 vs. 3.14). High standardized mortality rates for the selected diseases in the City of Zagreb, Croatia, were observed. The rates were higher in Zagreb population compared to EU averages except for cervical cancer. This situation urges revision of the public health strategy and implementation of more intensive preventive and screening measures to reduce the risk factors.

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

International Nuclear Information System (INIS)

Little, Mark P.; Zablotska, Lydia B.; Brenner, Alina V.; Lipshultz, Steven E.

2016-01-01

High-dose ionizing radiation is associated with circulatory disease. Risks from lower-dose fractionated exposures, such as from diagnostic radiation procedures, remain unclear. In this study we aimed to ascertain the relationship between fractionated low-to-medium dose radiation exposure and circulatory disease mortality in a cohort of 13,568 tuberculosis patients in Massachusetts, some with fluoroscopy screenings, between 1916 and 1961 and follow-up until the end of 2002. Analysis of mortality was in relation to cumulative thyroid (cerebrovascular) or lung (all other circulatory disease) radiation dose via Poisson regression. Over the full dose range, there was no overall radiation-related excess risk of death from circulatory disease (n = 3221; excess relative risk/Gy −0.023; 95 % CI −0.067, 0.028; p = 0.3574). Risk was somewhat elevated in hypertensive heart disease (n = 89; excess relative risk/Gy 0.357; 95 % CI −0.043, 1.030, p = 0.0907) and slightly decreased in ischemic heart disease (n = 1950; excess relative risk/Gy −0.077; 95 % CI −0.130, −0.012; p = 0.0211). However, under 0.5 Gy, there was a borderline significant increasing trend for all circulatory disease (excess relative risk/Gy 0.345; 95 % CI −0.032, 0.764; p = 0.0743) and for ischemic heart disease (excess relative risk/Gy 0.465; 95 % CI, −0.032, 1.034, p = 0.0682). Pneumolobectomy increased radiation–associated risk (excess relative risk/Gy 0.252; 95 % CI 0.024, 0.579). Fractionation of dose did not modify excess risk. In summary, we found no evidence of radiation-associated excess circulatory death risk overall, but there are indications of excess circulatory death risk at lower doses (<0.5 Gy). Although consistent with other radiation-exposed groups, the indications of higher risk at lower doses are unusual and should be confirmed against other data.

Angiographic examinations of the circulatory development of living chick embryos

International Nuclear Information System (INIS)

Stoeter, P.; Buchhoecker, M.; Bruzek, W.; Drews, U.; Schulze, K.; Tuebingen Univ.; Tuebingen Univ.

1980-01-01

In chick embryos of an age of incubation of 5-14 days, the physiological development of the circulation and the morphological differentation of the arterical system were studied by intravital and postmortal angiography. For the examinations of the living embryos, a special radiographic and injection technique had to be developed. The contrast medium was injected into the umbilical veins and transported by the actions of the embryonic heart. Continuous ECG recordings showed no marked interference of the injections with the cardiac activity. According to the angiographic findings, the circulation is relatively fast within the main arteries, but the capillary perfusion is prolonged and lasts up to several minutes. The average circulatory velocity of the blood stream within the carotid artery increases parallel to the arterial enlargement, whereas the circulatory time decreases and the number of heart beats during the period of carotid opacification does not change to a great extent. By this, a steady transport of gas and nutritional material may be achieved in the growing arterial system. (orig.) [de

A pacemaker powered by an implantable biofuel cell operating under conditions mimicking the human blood circulatory system--battery not included.

Science.gov (United States)

Southcott, Mark; MacVittie, Kevin; Halámek, Jan; Halámková, Lenka; Jemison, William D; Lobel, Robert; Katz, Evgeny

2013-05-07

Biocatalytic electrodes made of buckypaper were modified with PQQ-dependent glucose dehydrogenase on the anode and with laccase on the cathode and were assembled in a flow biofuel cell filled with serum solution mimicking the human blood circulatory system. The biofuel cell generated an open circuitry voltage, Voc, of ca. 470 mV and a short circuitry current, Isc, of ca. 5 mA (a current density of 0.83 mA cm(-2)). The power generated by the implantable biofuel cell was used to activate a pacemaker connected to the cell via a charge pump and a DC-DC converter interface circuit to adjust the voltage produced by the biofuel cell to the value required by the pacemaker. The voltage-current dependencies were analyzed for the biofuel cell connected to an Ohmic load and to the electronic loads composed of the interface circuit, or the power converter, and the pacemaker to study their operation. The correct pacemaker operation was confirmed using a medical device - an implantable loop recorder. Sustainable operation of the pacemaker was achieved with the system closely mimicking human physiological conditions using a single biofuel cell. This first demonstration of the pacemaker activated by the physiologically produced electrical energy shows promise for future electronic implantable medical devices powered by electricity harvested from the human body.

Mortality from Circulatory System Diseases among French Uranium Miners: A Nested Case-Control Study.

Science.gov (United States)

Drubay, Damien; Caër-Lorho, Sylvaine; Laroche, Pierre; Laurier, Dominique; Rage, Estelle

2015-05-01

A significant association has been observed between radon exposure and cerebrovascular disease (CeVD) mortality among French uranium miners, but risk factors for circulatory system diseases (CSD) have not been previously considered. We conducted new analyses in the recently updated (through 2007) French cohort of uranium miners (n = 5,086), which included 442 deaths from CSD, 167 of them from ischemic heart disease (IHD) and 105 from CeVD. A nested case-control study was then set up to collect and investigate the influence of these risk factors on the relationships between mortality from CSD and occupational external gamma ray and internal ionizing radiation exposure (radon and long-lived radionuclides) in this updated cohort. The nested case-control study included miners first employed after 1955, still employed in 1976 and followed up through 2007. Individual information about CSD risk factors was collected from medical files for the 76 deaths from CSD (including 26 from IHD and 16 from CeVD) and 237 miners who had not died of CSD by the end of follow-up. The exposure-risk relationships were assessed with a Cox proportional hazard model weighted by the inverse sampling probability. A significant increase in all CSD and CeVD mortality risks associated with radon exposure was observed in the total cohort [hazard ratios: HRCSD/100 working level months (WLM) = 1.11, 95% confidence interval (1.01; 1.22) and HRCeVD/100 WLM = 1.25 (1.09; 1.43), respectively]. A nonsignificant exposure-risk relationship was observed for every type of cumulative ionizing radiation exposure and every end point [e.g., HRCSD/100WLM = 1.43 (0.71; 2.87)]. The adjustment for each CSD risk factor did not substantially change the exposure-risk relationships. When the model was adjusted for overweight, hypertension, diabetes, hypercholesterolemia and smoking status, the HR/100WLM for CSD, for example, was equal to 1.21 (0.54; 2.75); and when it was adjusted for risk factors selected with the

CHF: circulatory homeostasis gone awry.

Science.gov (United States)

Weber, Karl T; Burlew, Brad S; Davis, Richard C; Newman, Kevin P; D'Cruz, Ivan A; Hawkins, Ralph G; Wall, Barry M; Parker, Robert B

2002-01-01

The role of the renin-angiotensin-aldosterone system (RAAS) is integral to salt and water retention, particularly by the kidneys. Over time, positive sodium balance leads first to intra- and then to extravascular volume expansion, with subsequent symptomatic heart failure. This report examines the role of the RAAS in regulating a less well recognized component essential to circulatory homeostasis--central blood volume. The regulation of central blood volume draws on integrative cardiorenal physiology and a key role played by the RAAS in its regulation. In presenting insights into the role of the RAAS in regulating central blood volume, this review also addresses other sodium-retaining states with a predisposition to edema formation, such as cirrhosis and nephrosis. (c)2002 CHF, Inc

The circulatory system: blood procurement, AIDS, and the social body in China.

Science.gov (United States)

Erwin, Kathleen

2006-06-01

The market for blood thrived in China for more than a decade, preying on rural villagers desperate for cash. Profit motives and unhygienic collection created an AIDS epidemic, where now up to 80 percent of adults in some villages are HIV infected. Today, illegal blood banks continue to operate in some areas. Moreover, better screening and blood testing do little to address the underlying cultural reluctance to give blood. This article examines what is at stake for blood donors in the circulation of blood through both the physical and the social bodies in China today. I argue that public health and social policy solutions require consideration of the symbolic meanings of blood and the body, kin relations, and gift exchange. China's HIV-contaminated blood procurement crisis demands a critical reexamination of the hidden processes embedded in a "circulatory system" that has inseparably bound the "gift of life" and a "commodity of death".

Pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension.

Science.gov (United States)

Tourneux, Pierre; Rakza, Thameur; Bouissou, Antoine; Krim, Gérard; Storme, Laurent

2008-09-01

To evaluate the respiratory and the pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension (PPHN)-induced cardiac dysfunction. Inclusion criteria were: 1) Newborn infants >35 weeks gestational age; 2) PPHN treated with inhaled nitric oxide; and 3) symptoms of circulatory failure despite adequate fluid resuscitation. Lung function and pulmonary hemodynamic variables assessed with Doppler echocardiography were recorded prospectively before and after starting norepinephrine. Eighteen newborns were included (gestational age: 37 +/- 3 weeks; birth weight: 2800 +/- 700 g). After starting norepinephrine, systemic pressure and left ventricular output increased respectively from 33 +/- 4 mm Hg to 49 +/- 4 mm Hg and from 172 +/- 79 mL/kg/min to 209+/-90 mL/kg/min (P ventilatory variables have not been changed, the post-ductal transcutaneous arterial oxygen saturation increased from 89% +/- 1% to 95% +/- 4%, whereas the oxygen need decreased from 51% +/- 24% to 41% +/- 20% (P newborn infants with PPHN through a decrease in pulmonary/systemic artery pressure ratio and improved cardiac performance.

Plasma coatings of nitrogen polymers on metal prostheses of the circulatory system

International Nuclear Information System (INIS)

Gomez J, L. M.

2016-01-01

This work has a study about the synthesis of poly aniline, poly allylamine and poly pyrrole doped with iodine onto metallic surfaces similar to stents for the circulatory system. Ar, water and hydrogen peroxide plasmas were used for eroding, conditioning and synthesizing polymers that potentially reduce some rejection reactions when stents are implanted in the human body. Stents are small metallic meshes that applied inside collapsed arteries or veins enlarge the diameter and restore the blood flow, however the metallic surfaces usually cause rejection reactions that obstruct the veins again. To give solutions to this problem, in this work is studied the synthesis of biocompatible polymer coatings on the stents that resist the blood flow forming a biocompatible interface between metal and blood. The metallic substrates were eroded and chemically prepared with Ar, H_2O and/or H_2O_2 glow discharges on which the polymers were synthesized by plasma. The coatings were morphologically characterized by optical, scanning electron and atomic force microscopy, the chemical structure was studied by infrared and photoelectron X-ray spectroscopy. The hydrophilicity was studied measuring the advance static contact angle and the adhesion was evaluated indirectly with scanning electron microscopy after two months submerged in buffered phosphate solutions. The results indicate that the polymers grew following the superficial morphology; that the conditioning with Ar ions erode the substrates and that the conditioning with H_2O or H_2O_2 erodes and activates the surface generating oxygen bridges which help in the polymer-metal adhesion. The chemical structure of the polymeric coatings contain crosslinked structures that correspond to links between monomers with the participation of all atoms, states that suggest monomer fragmentation and oxidation and states that indicate oxygen bridges in the polymers. The coatings had contact angles close to 90 degrees where is located the line

Generation of OH Radical by Ultrasonic Irradiation in Batch and Circulatory Reactor

Science.gov (United States)

Fang, Yu; Shimizu, Sayaka; Yamamoto, Takuya; Komarov, Sergey

2018-03-01

Ultrasonic technology has been widely investigated in the past as one of the advance oxidation processes to treat wastewater, in this process acoustic cavitation causes generation of OH radical, which play a vital role in improving the treatment efficiency. In this study, OH radical formation rate was measured in batch and circulatory reactor by using Weissler reaction at various ultrasound output power. It is found that the generation rate in batch reactor is higher than that in circulatory reactor at the same output power. The generation rate tended to be slower when output power exceeds 137W. The optimum condition for circulatory reactor was found to be 137W output and 4L/min flow rate. Results of aluminum foil erosion test revealed a strong dependence of cavitation zone length on the ultrasound output power. This is assumed to be one of the reasons why the generation rate of HO radicals becomes slower at higher output power in circulatory reactor.

Multidisciplinary approach to radiation late effects in the brain circulatory system: First results

International Nuclear Information System (INIS)

Keyeux, A.J.M.; Reinhold, H.S.; Gerber, G.B.; Maisin, J.R.; Reyners, H.; Gianfelici de Reyners, E.; Calvo, W.

1976-01-01

Although acute vascular damage and the early functional impairment of the central nervous system has been studied relatively frequently, the pathophysiological mechanisms of late radiation effects and their relevance to vascular damage, are less well investigated and are poorly understood. As the possibility of later radiation damage is a factor which limits the therapist in the radiation dose, he can give to effect a local tumour cure, it is essential that the mechanisms and importance of vascular irradiation damage be determined before late effects can either be treated or avoided. In view of the inconclusive results obtained by previous authors, it was felt that a multidisciplinary approach might better be suited to solve this problem. Thus, in 1973 a research project was initiated by EULEP to investigate the origins and consequences of radiation induced vascular changes after local irradiation of the brain. In this preliminary report, data on morphological, circulatory and biochemical parameters are presented and discussed. (GC)

Molecular mechanisms of circulatory dysfunction in cirrhotic portal hypertension

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Hsin-Ling Ho

2015-04-01

Full Text Available Acute or chronic insults to the liver are usually followed by a tissue repairing process. Unfortunately, this action, in most cases, is not effective enough to restore the normal hepatic structure and function. Instead, fibrogenesis and regenerative nodules formation ensue, which are relatively nonfunctioning. The common final stage of the process is liver cirrhosis with increased intrahepatic resistance to portal venous blood flow. Throughout the entire course, the extrahepatic circulatory dysfunction, including increased splanchnic blood flow, elevated portal venous blood flow and pressure, decreased splanchnic and peripheral vascular resistance, tachycardia, and increased cardiac output, are noted and denoted as portal hypertension with hyperdynamic circulatory dysfunction. When such a condition is established, patients may suffer from fatal complications such as gastroesophageal variceal hemorrhage, hepatic encephalopathy, or hepatorenal syndrome. The cause of such a circulatory dysfunction is not fully elucidated. Nevertheless, clarification of the pathophysiology definitely contributes to the control of portal hypertension-related complications. Herein, the molecular mechanism of this intriguing disaster is reviewed and discussed.

Antithrombin III is associated with acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support.

Science.gov (United States)

Hoefer, Judith; Ulmer, Hanno; Kilo, Juliane; Margreiter, Raimund; Grimm, Michael; Mair, Peter; Ruttmann, Elfriede

2017-06-01

There are few data on the role of liver dysfunction in patients with end-stage heart failure supported by mechanical circulatory support. The aim of our study was to investigate predictors for acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support. A consecutive 164 patients with heart failure with New York Heart Association class IV undergoing mechanical circulatory support were investigated for acute liver failure using the King's College criteria. Clinical characteristics of heart failure together with hemodynamic and laboratory values were analyzed by logistic regression. A total of 45 patients (27.4%) with heart failure developed subsequent acute liver failure with a hospital mortality of 88.9%. Duration of heart failure, cause, cardiopulmonary resuscitation, use of vasopressors, central venous pressure, pulmonary capillary wedge pressure, pulmonary pulsatility index, cardiac index, and transaminases were not significantly associated with acute liver failure. Repeated decompensation, atrial fibrillation (P failure in univariate analysis only. In multivariable analysis, decreased antithrombin III was the strongest single measurement indicating acute liver failure (relative risk per %, 0.84; 95% confidence interval, 0.77-0.93; P = .001) and remained an independent predictor when adjustment for the Model for End-Stage Liver Disease score was performed (relative risk per %, 0.89; 95% confidence interval, 0.80-0.99; P = .031). Antithrombin III less than 59.5% was identified as a cutoff value to predict acute liver failure with a corresponding sensitivity of 81% and specificity of 87%. In addition to the Model for End-Stage Liver Disease score, decreased antithrombin III activity tends to be superior in predicting acute liver failure compared with traditionally thought predictors. Antithrombin III measurement may help to identify patients more precisely who are developing acute liver failure during mechanical

Long-term Mechanical Circulatory Support System reliability recommendation by the National Clinical Trial Initiative subcommittee.

Science.gov (United States)

Lee, James

2009-01-01

The Long-Term Mechanical Circulatory Support (MCS) System Reliability Recommendation was published in the American Society for Artificial Internal Organs (ASAIO) Journal and the Annals of Thoracic Surgery in 1998. At that time, it was stated that the document would be periodically reviewed to assess its timeliness and appropriateness within 5 years. Given the wealth of clinical experience in MCS systems, a new recommendation has been drafted by consensus of a group of representatives from the medical community, academia, industry, and government. The new recommendation describes a reliability test methodology and provides detailed reliability recommendations. In addition, the new recommendation provides additional information and clinical data in appendices that are intended to assist the reliability test engineer in the development of a reliability test that is expected to give improved predictions of clinical reliability compared with past test methods. The appendices are available for download at the ASAIO journal web site at www.asaiojournal.com.

Aortic arch reconstruction: deep and moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion.

Science.gov (United States)

Wu, YanWen; Xiao, LiQiong; Yang, Ting; Wang, Lei; Chen, Xin

2017-07-01

To compare the effects of moderate and deep hypothermic circulatory arrest (DHCA) with selective antegrade cerebral perfusion (SACP) during aortic arch surgery in adult patients and to offer the evidence for the detection of the temperature which provides best brain protection in the subjects who accept aortic arch reconstruction surgery. A total of 109 patients undergoing surgery of the aortic arch were divided into the moderate hypothermic circulatory arrest group (Group I) and the deep hypothermic circulatory arrest group (Group II). We recorded the data of the patients and their cardiopulmonary bypass (CPB) time, aortic clamping time, SACP time and postoperative anesthetized recovery time, tracheal intubation time, time in the intensive care unit (ICU) and postoperative neurologic dysfunction. Patient characteristics were similar in the two groups. There were four patients who died in Group II and 1 patient in Group I. There were no significant differences in aortic clamping time of each group (111.4±58.4 vs. 115.9±16.2) min; SACP time (27.4±5.9 vs. 23.5±6.1) min of the moderate hypothermic circulatory arrest group and the deep hypothermic circulatory arrest group; there were significant differences in cardiopulmonary bypass time (207.4±20.9 vs. 263.8±22.6) min, postoperative anesthetized recovery time (19.0±11.1 vs. 36.8±25.3) hours, extubation time (46.4±15.1 vs. 64.4±6.0) hours; length of stay in the intensive care unit (ICU) (4.7±1.7 vs. 8±2.3) days and postoperative neurologic dysfunction in the two groups. Compared to deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest can provide better brain protection and achieve good clinical results.

Effects of Particulate Matter and Its Chemical Constituents on Elderly Hospital Admissions Due to Circulatory and Respiratory Diseases

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Tatiane Morais Ferreira

2016-09-01

Full Text Available Various fractions of particulate matter have been associated with increased mortality and morbidity. The purpose of our study is to analyze the associations between concentrations of PM2.5, PM2.5–10, PM10 and their chemical constituents (soluble ions with hospital admissions due to circulatory and respiratory diseases among the elderly in a medium-sized city in Brazil. A time series study was conducted using Poisson regression with generalized additive models adjusted for confounders. Statistically significant associations were identified between PM10 and PM2.5–10 and respiratory diseases. Risks of hospitalization increased by 23.5% (95% CI: 13.5; 34.3 and 12.8% (95% CI: 6.0; 20.0 per 10 μg/m3 of PM2.5-10 and PM10, respectively. PM2.5 exhibited a significant association with circulatory system diseases, with the risk of hospitalization increasing by 19.6% (95% CI: 6.4; 34.6 per 10 μg/m3. Regarding the chemical species; SO42−, NO3−, NH4+ and K+ exhibited specific patterns of risk, relative to the investigated outcomes. Overall, SO42− in PM2.5–10 and K+ in PM2.5 were associated with increased risk of hospital admissions due to both types of diseases. The results agree with evidence indicating that the risks for different health outcomes vary in relation to the fractions and chemical composition of PM10. Thus, PM10 speciation studies may contribute to the establishment of more selective pollution control policies.

Circulatory Markings at Double-Lane Traffic Roundabout.

NARCIS (Netherlands)

Bie, Jing; Lo, Hong K.; Wong, S.C.

2008-01-01

This paper compares two types of circulatory markings at a double-lane traffic roundabout: the concentric marking scheme and the Alberta marking scheme. The effects of these two marking schemes on drivers' lane choice behavior, delay, and safety, are compared based on data collected from before and

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death—Summary Report*

Science.gov (United States)

Hornby, Laura; Rochwerg, Bram; van Manen, Michael; Dhanani, ; Sonny; Sivarajan, V. Ben; Appleby, Amber; Bennett, Mary; Buchman, Daniel; Farrell, Catherine; Goldberg, Aviva; Greenberg, Rebecca; Singh, Ram; Nakagawa, Thomas A.; Witteman, William; Barter, Jill; Beck, Allon; Coughlin, Kevin; Conradi, Alf; Cupido, Cynthia; Dawson, Rosanne; Dipchand, Anne; Freed, Darren; Hornby, Karen; Langlois, Valerie; Mack, Cheryl; Mahoney, Meagan; Manhas, Deepak; Tomlinson, Christopher; Zavalkoff, Samara; Shemie, Sam D.

2017-01-01

Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. Results: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report.

Science.gov (United States)

Weiss, Matthew J; Hornby, Laura; Rochwerg, Bram; van Manen, Michael; Dhanani, Sonny; Sivarajan, V Ben; Appleby, Amber; Bennett, Mary; Buchman, Daniel; Farrell, Catherine; Goldberg, Aviva; Greenberg, Rebecca; Singh, Ram; Nakagawa, Thomas A; Witteman, William; Barter, Jill; Beck, Allon; Coughlin, Kevin; Conradi, Alf; Cupido, Cynthia; Dawson, Rosanne; Dipchand, Anne; Freed, Darren; Hornby, Karen; Langlois, Valerie; Mack, Cheryl; Mahoney, Meagan; Manhas, Deepak; Tomlinson, Christopher; Zavalkoff, Samara; Shemie, Sam D

2017-11-01

Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory

Application of a user-friendly comprehensive circulatory model for estimation of hemodynamic and ventricular variables

NARCIS (Netherlands)

Ferrari, G.; Kozarski, M.; Gu, Y. J.; De Lazzari, C.; Di Molfetta, A.; Palko, K. J.; Zielinski, K.; Gorczynska, K.; Darowski, M.; Rakhorst, G.

2008-01-01

Purpose: Application of a comprehensive, user-friendly, digital computer circulatory model to estimate hemodynamic and ventricular variables. Methods: The closed-loop lumped parameter circulatory model represents the circulation at the level of large vessels. A variable elastance model reproduces

Intraoperative care for aortic surgery using circulatory arrest.

Science.gov (United States)

Fernández Suárez, Félix Ezequiel; Fernández Del Valle, David; González Alvarez, Adrián; Pérez-Lozano, Blanca

2017-05-01

The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 °C) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

High speed phototimer and biplane II blanking method in 105 mm RSC photographing of circulatory system

International Nuclear Information System (INIS)

Kaga, Yuji; Kiuchi, Shigeo; Sato, Masami; Komatsuda, Yasushi; Nishio, Kosaku.

1979-01-01

A high speed phototimer as an autoexposure mechanism was developed for 105 mm II indirect continuous photographing of circulatory system. The phototimer can give repeated response of 12 times/sec and the shortest X-ray shut out of 1 m sec. The proper lighting field for the phototimer is 7 mm diameter (12%) of the II input area, equivalent to 80 mm in diameter), and the tube voltage, object property and the focus-II distance characteristics are all well corrected to give good photographs of optimal density. The mutual fog in biplane photographing can be removed by adopting II blanking method. As blanking can respond quite rapidly, photographing time plus 2 m sec is enough for blanking time. That means the positive phase can be brought close to 3 m sec. This mechanism can be applied for biplane cine-photographing. (Kobatake, H.)

Analysis of Dose Response for Circulatory Disease After Radiotherapy for Benign Disease

Energy Technology Data Exchange (ETDEWEB)

Little, Mark P., E-mail: mark.little@nih.gov [Radiation Epidemiology Branch, National Cancer Institute, Executive Plaza South, Rockville, Maryland (United States); Kleinerman, Ruth A. [Radiation Epidemiology Branch, National Cancer Institute, Executive Plaza South, Rockville, Maryland (United States); Stovall, Marilyn; Smith, Susan A. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mabuchi, Kiyohiko [Radiation Epidemiology Branch, National Cancer Institute, Executive Plaza South, Rockville, Maryland (United States)

2012-12-01

Purpose: To assess the shape of the dose-response for various circulatory disease endpoints, and modifiers by age and time since exposure. Methods and Materials: This was an analysis of the US peptic ulcer data testing for heterogeneity of radiogenic risk by circulatory disease endpoint (ischemic heart, cerebrovascular, other circulatory disease). Results: There were significant excess risks for all circulatory disease, with an excess relative risk Gy{sup -1} of 0.082 (95% CI 0.031-0.140), and ischemic heart disease, with an excess relative risk Gy{sup -1} of 0.102 (95% CI 0.039-0.174) (both p = 0.01), and indications of excess risk for stroke. There were no statistically significant (p > 0.2) differences between risks by endpoint, and few indications of curvature in the dose-response. There were significant (p < 0.001) modifications of relative risk by time since exposure, the magnitude of which did not vary between endpoints (p > 0.2). Risk modifications were similar if analysis was restricted to patients receiving radiation, although the relative risks were slightly larger and the risk of stroke failed to be significant. The slopes of the dose-response were generally consistent with those observed in the Japanese atomic bomb survivors and in occupationally and medically exposed groups. Conclusions: There were excess risks for a variety of circulatory diseases in this dataset, with significant modification of risk by time since exposure. The consistency of the dose-response slopes with those observed in radiotherapeutically treated groups at much higher dose, as well as in lower dose-exposed cohorts such as the Japanese atomic bomb survivors and nuclear workers, implies that there may be little sparing effect of fractionation of dose or low-dose-rate exposure.

Current Status of Mechanical Circulatory Support: A Systematic Review

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Kyriakos Spiliopoulos

2012-01-01

Full Text Available Heart failure is a major public health problem and its management requires a significant amount of health care resources. Even with administration of the best available medical treatment, the mortality associated with the disease remains high. As therapeutical strategies for heart failure have been refined, the number of patients suffering from the disease has expanded dramatically. Although heart transplantation still represents the gold standard therapeutical approach, the implantation of mechanical circulatory support devices (MCSDs evolved to a well-established management for this disease. The limited applicability of heart transplantation caused by a shortage of donor organs and the concurrent expand of the patient population with end-stage heart failure led to a considerable utilization of MCSDs. This paper outlines the current status of mechanical circulatory support.

External validation of prediction models for time to death in potential donors after circulatory death

NARCIS (Netherlands)

Kotsopoulos, A.M.M.; Böing-Messing, F.; Jansen, N.E.; Vos, P.; Abdo, W.F.

2018-01-01

Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life‐sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60 minutes after WSLT and

Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973–2008

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Backhans Mona

2012-11-01

Full Text Available Abstract Background Gender differences in mortality vary widely between countries and over time, but few studies have examined predictors of these variations, apart from smoking. The aim of this study is to investigate the link between gender policy and the gender gap in cause-specific mortality, adjusted for economic factors and health behaviours. Methods 22 OECD countries were followed 1973–2008 and the outcomes were gender gaps in external cause and circulatory disease mortality. A previously found country cluster solution was used, which includes indicators on taxes, parental leave, pensions, social insurances and social services in kind. Male breadwinner countries were made reference group and compared to earner-carer, compensatory breadwinner, and universal citizen countries. Specific policies were also analysed. Mixed effect models were used, where years were the level 1-units, and countries were the level 2-units. Results Both the earner-carer cluster (ns after adjustment for GDP and policies characteristic of that cluster are associated with smaller gender differences in external causes, particularly due to an association with increased female mortality. Cluster differences in the gender gap in circulatory disease mortality are the result of a larger relative decrease of male mortality in the compensatory breadwinner cluster and the earner-carer cluster. Policies characteristic of those clusters were however generally related to increased mortality. Conclusion Results for external cause mortality are in concordance with the hypothesis that women become more exposed to risks of accident and violence when they are economically more active. For circulatory disease mortality, results differ depending on approach – cluster or indicator. Whether cluster differences not explained by specific policies reflect other welfare policies or unrelated societal trends is an open question. Recommendations for further studies are made.

Sizable variations in circulatory disease mortality by region and country of birth in six European countries

DEFF Research Database (Denmark)

Rafnsson, Snorri B; Bhopal, Raj S; Agyemang, Charles

2013-01-01

BACKGROUND: Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. METHODS: We obtained national deat...

Scandinavian SSAI clinical practice guideline on choice of first-line vasopressor for patients with acute circulatory failure

DEFF Research Database (Denmark)

Møller, M H; Claudius, C; Junttila, E

2016-01-01

BACKGROUND: Adult critically ill patients often suffer from acute circulatory failure, necessitating use of vasopressor therapy. The aim of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force for Acute Circulatory Failure was to present clinically relevant...... to recommendations. We assessed the following subpopulations of patients with acute circulatory failure: 1) shock in general, 2) septic shock, 3) cardiogenic shock, 4) hypovolemic shock and 5) other types of shock, including vasodilatory shock. We assessed patient-important outcome measures, including mortality...

A cause of circulatory collapse that should be considered following trauma

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Omar Hesham R

2010-08-01

Full Text Available Abstract Management of poly-trauma patients presenting to the emergency room is usually a challenging and formidable task. Two of the common problems seen in those patients are shock and neurological dysfunction. A huge differential for post-traumatic circulatory collapse exist and timely identification of the etiology is of utmost importance to avoid complications. In this report we are describing 2 cases presenting with circulatory collapse following trauma. The first case was a 29 year old female who presented after a motor vehicle accident fully conscious with severe hypotension and bradycardia. The second case presented with severe hemodynamic instability after falling at home. Physical examination of both patients revealed weakness in all 4 limbs and CT cervical spine revealed complete anterior sublaxation of C5 over C6 cervical vertebrae in the first case and partial sublaxation of C5 over C6 cervical vertebrae in the second case confirming that spinal cord injury is the likely cause for these hemodynamic alterations. A high index of suspicion for spinal cord injuries is therefore mandatory when managing a trauma patient presenting with quadriparesis and hemodynamic instability that is otherwise unexplained especially when the ensuing hypotension is associated with bradycardia instead of reflex tachycardia. Awareness of this cause of circulatory collapse is particularly important in the unconscious patient where eliciting sensory and motor deficits looking for spinal cord injury is not always feasible. Both patients were transferred to the intensive care unit and were maintained on epinephrine till becoming hemodynamically stable. The report aims to sensitize readers to this cause of post-traumatic circulatory collapse.

A review of non-cancer effects, especially circulatory and ocular diseases

Energy Technology Data Exchange (ETDEWEB)

Little, Mark P. [National Cancer Institute, Radiation Epidemiology Branch, Bethesda, MD (United States)

2013-11-15

There is a well-established association between high doses (>5 Gy) of ionizing radiation exposure and damage to the heart and coronary arteries, although only recently have studies with high-quality individual dosimetry been conducted that would enable quantification of this risk adjusting for concomitant chemotherapy. The association between lower dose exposures and late occurring circulatory disease has only recently begun to emerge in the Japanese atomic bomb survivors and in various occupationally exposed cohorts and is still controversial. Excess relative risks per unit dose in moderate- and low-dose epidemiological studies are somewhat variable, possibly a result of confounding and effect modification by well-known (but unobserved) risk factors. Radiation doses of 1 Gy or more are associated with increased risk of posterior subcapsular cataract. Accumulating evidence from the Japanese atomic bomb survivors, Chernobyl liquidators, US astronauts, and various other exposed groups suggests that cortical cataracts may also be associated with ionizing radiation, although there is little evidence that nuclear cataracts are radiogenic. The dose-response appears to be linear, although modest thresholds (of no more than about 0.6 Gy) cannot be ruled out. A variety of other non-malignant effects have been observed after moderate/low-dose exposure in various groups, in particular respiratory and digestive disease and central nervous system (and in particular neuro-cognitive) damage. However, because these are generally only observed in isolated groups, or because the evidence is excessively heterogeneous, these associations must be treated with caution. (orig.)

Real-Time ECG Simulation for Hybrid Mock Circulatory Loops.

Science.gov (United States)

Korn, Leonie; Rüschen, Daniel; Zander, Niklas; Leonhardt, Steffen; Walter, Marian

2018-02-01

Classically, mock circulatory loops only simulate mechanical properties of the circulation. To connect the hydraulic world with electrophysiology, we present a real-time electrical activity model of the heart and show how to integrate this model into a real-time mock loop simulation. The model incorporates a predefined conduction pathway and a simplified volume conductor to solve the bidomain equations and the forward problem of electrocardiography, resulting in a physiological simulation of the electrocardiogram (ECG) at arbitrary electrode positions. A complete physiological simulation of the heart's excitation would be too CPU intensive. Thus, in our model, complexity was reduced to allow real-time simulation of ECG-triggered medical systems in vitro; this decreases time and cost in the development process. Conversely, the presented model can still be adapted to various pathologies by locally changing the properties of the heart's conduction pathway. To simulate the ECG, the heart is divided into suitable areas, which are innervated by the hierarchically structured conduction system. To distinguish different cardiac regions, a segmentation of the heart was performed. In these regions, Prim's algorithm was applied to identify the directed minimal spanning trees for conduction orientation. Each node of the tree was assigned to a cardiac action potential generated by its hybrid automaton to represent the heart's conduction system by the spatial distribution of action potentials. To generate the ECG output, the bidomain equations were implemented and a simple model of the volume conductor of the body was used to solve the forward problem of electrocardiography. As a result, the model simulates potentials at arbitrary electrode positions in real-time. To verify the developed real-time ECG model, measurements were made within a hybrid mock circulatory loop, including a simple ECG-triggered ventricular assist device control. The model's potential value is to simulate

Early Identification of Circulatory Shock in Critical Care Transport

Science.gov (United States)

2008-09-30

disclosure and community consultation. Early Identification of Circulatory Shock in Critical Care Transport 2 Community consultation for this...in two aircraft types (Eurocopter EC 135 and EC 145), in IFR weather conditions, and during both day and night operations. We calculated the

New Innovations in Circulatory Support With Ventricular Assist Device and Extracorporeal Membrane Oxygenation Therapy.

Science.gov (United States)

Sladen, Robert N

2017-04-01

The past decade has seen an exponential increase in the application and development of durable long-term as well as nondurable short-term mechanical circulatory support for cardiogenic shock and acute or chronic heart failure. Support has evolved from bridge-to-transplant to destination therapy, bridge to rescue, bridge to decision making, and bridge to a bridge. Notable trends include device miniaturization, minimally invasive and/or percutaneous insertion, and efforts to superimpose pulsatility on continuous flow. We can certainly anticipate that innovation will accelerate in the months and years to come. However, despite-or perhaps because of-the enhanced equipment now available, mechanical circulatory support is an expensive, complex, resource-intensive modality. It requires considerable expertise that should preferably be centralized to highly specialized centers. Formidable challenges remain: systemic inflammatory response syndromes and vasoplegia after device insertion; postoperative sepsis; optimal anticoagulation regimens to prevent device-induced thrombosis and cerebral thromboembolism; wound site, intracranial, and gastrointestinal bleeding; multisystem injury and failure; patient dissatisfaction (even when providers consider the procedure a "success"); and ethical decision making in conditions of futility.

Novel circulatory connection from the acupoint Zhong Wan(CV12 to pancreas

Directory of Open Access Journals (Sweden)

Minsoo Kim

2008-03-01

Full Text Available Objectives : Demonstrating a novel circulatory path from the acupoint(CV12 to the pancreas. Method : Alcian blue(1% solution, 20μl, pH 7.4 was injected into the acupoint(CV12. Two hours later the surfaces of internal organs were observed by using a stereomicroscope. Results : Alcian blue arrived and colored the omental fat band(OFB on the pancreas. The OFB connected the head and tail of the pancreas, the pancreas and the spleen, and the pancreas and the stomach. Conclusion : The existence of a novel circulatory path from the acupoint CV12 to the pancreas and its OFB was demonstrated.

Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation

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Luiz Fernando Canêo

2015-01-01

Full Text Available Background: Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure. Objective: To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy. Methods: Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy. Results: We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n=10, eight died waiting and 2 patients (20% were transplanted, but none was discharged. In group B (n=9, 6 patients (66.7% were transplanted and three were discharged.The mean support time was 21,8 days (6 to 984h. The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B. Conclusion: Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.

Plasma FITC-dextran exchange between the primary and secondary circulatory systems in the Atlantic cod, Gadus Morhua

DEFF Research Database (Denmark)

Fischer, Claes; Steffensen, John Fleng

2008-01-01

Fluorescein isothiocyanate dextran (FITC-dextran) exchange between the primary (PCS) and secondary (SCS) circulatory systems in the Atlantic cod, Gadus morhua (Linnaeus, 1752), were studied using 20-kDa (n = 4) and 500-kDa (n = 4) FITC-dextran. In order to give a qualitative perspective...... of the general connection between the PCS and SCS, distribution of plasma-borne tracers (FITC-dextran) in the PCS and SCS were examined. In this study, a total of eight cod were cannulated in the ventral aorta (PCS) and dorsal cutaneous vessel (SCS), for investigation of FITC-dextran disappearance in the PCS...... and its subsequent appearance in the SCS. FITC-dextran of both sizes was found to be in equilibrium between the PCS and SCS in less than 20 min. This indicates a profound connection between the PCS and SCS in the Atlantic cod, and rapid mixing of tracers between the PCS and SCS. The destination...

High-risk medical devices, children and the FDA: regulatory challenges facing pediatric mechanical circulatory support devices.

Science.gov (United States)

Almond, Christopher S D; Chen, Eric A; Berman, Michael R; Less, Joanne R; Baldwin, J Timothy; Linde-Feucht, Sarah R; Hoke, Tracey R; Pearson, Gail D; Jenkins, Kathy; Duncan, Brian W; Zuckerman, Bram D

2007-01-01

Pediatric mechanical circulatory support is a critical unmet need in the United States. Infant- and child-sized ventricular assist devices are currently being developed largely through federal contracts and grants through the National Heart, Lung, and Blood Institute (NHLBI). Human testing and marketing of high-risk devices for children raises epidemiologic and regulatory issues that will need to be addressed. Leaders from the US Food and Drug Administration (FDA), NHLBI, academic pediatric community, and industry convened in January 2006 for the first FDA Workshop on the Regulatory Process for Pediatric Mechanical Circulatory Support Devices. The purpose was to provide the pediatric community with an overview of the federal regulatory process for high-risk medical devices and to review the challenges specific to the development and regulation of pediatric mechanical circulatory support devices. Pediatric mechanical circulatory support present significant epidemiologic, logistic, and financial challenges to industry, federal regulators, and the pediatric community. Early interactions with the FDA, shared appreciation of challenges, and careful planning will be critical to avoid unnecessary delays in making potentially life-saving devices available for children. Collaborative efforts to address these challenges are warranted.

The European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

DEFF Research Database (Denmark)

de By, Theo M M H; Mohacsi, Paul; Gummert, Jan

2015-01-01

other founding international members. It aims to promote scientific research to improve care of end-stage heart failure patients with ventricular assist device or a total artificial heart as long-term mechanical circulatory support. Likewise, the organization aims to provide and maintain a registry...

The OregonHeart Total Artificial Heart: Design and Performance on a Mock Circulatory Loop.

Science.gov (United States)

Glynn, Jeremy; Song, Howard; Hull, Bryan; Withers, Stanley; Gelow, Jill; Mudd, James; Starr, Albert; Wampler, Richard

2017-10-01

Widespread use of heart transplantation is limited by the scarcity of donor organs. Total artificial heart (TAH) development has been pursued to address this shortage, especially to treat patients who require biventricular support. We have developed a novel TAH that utilizes a continuously spinning rotor that shuttles between two positions to provide pulsatile, alternating blood flow to the systemic and pulmonary circulations without artificial valves. Flow rates and pressures generated by the TAH are controlled by adjusting rotor speed, cycle frequency, and the proportion of each cycle spent pumping to either circulation. To validate the design, a TAH prototype was placed in a mock circulatory loop that simulates vascular resistance, pressure, and compliance in normal and pathophysiologic conditions. At a systemic blood pressure of 120/80 mm Hg, nominal TAH output was 7.4 L/min with instantaneous flows reaching 17 L/min. Pulmonary artery, and left and right atrial pressures were all maintained within normal ranges. To simulate implant into a patient with severe pulmonary hypertension, the pulmonary vascular resistance of the mock loop was increased to 7.5 Wood units. By increasing pump speed to the pulmonary circulation, cardiac output could be maintained at 7.4 L/min as mean pulmonary artery pressure increased to 56 mm Hg while systemic blood pressures remained normal. This in vitro testing of a novel, shuttling TAH demonstrated that cardiac output could be maintained across a range of pathophysiologic conditions including pulmonary hypertension. These experiments serve as a proof-of-concept for the design, which has proceeded to in vivo testing. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Optoacoustic measurement of central venous oxygenation for assessment of circulatory shock: clinical study in cardiac surgery patients

Science.gov (United States)

Petrov, Irene Y.; Prough, Donald S.; Kinsky, Michael; Petrov, Yuriy; Petrov, Andrey; Henkel, S. Nan; Seeton, Roger; Salter, Michael G.; Esenaliev, Rinat O.

2014-03-01

Circulatory shock is a dangerous medical condition, in which blood flow cannot provide the necessary amount of oxygen to organs and tissues. Currently, its diagnosis and therapy decisions are based on hemodynamic parameters (heart rate, blood pressure, blood gases) and mental status of a patient, which all have low specificity. Measurement of mixed or central venous blood oxygenation via catheters is more reliable, but highly invasive and associated with complications. Our previous studies in healthy volunteers demonstrated that optoacoustic systems provide non-invasive measurement of blood oxygenation in specific vessels, including central veins. Here we report our first results of a clinical study in coronary artery bypass graft (CABG) surgery patients. We used a medical-grade OPO-based optoacoustic system developed in our laboratory to measure in real time blood oxygenation in the internal jugular vein (IJV) of these patients. A clinical ultrasound imaging system (GE Vivid e) was used for IJV localization. Catheters were placed in the IJV as part of routine care and blood samples taken via the catheters were processed with a CO-oximeter. The optoacoustic oxygenation data were compared to the CO-oximeter readings. Good correlation between the noninvasive and invasive measurements was obtained. The results of these studies suggest that the optoacoustic system can provide accurate, noninvasive measurements of central venous oxygenation that can be used for patients with circulatory shock.

Immediate or deferred adjustment of drug regimens in multidose drug dispensing systems.

Science.gov (United States)

Mertens, Bram J; Kwint, Henk-Frans; van Marum, Rob J; Bouvy, Marcel L

2018-05-18

Multidose drug dispensing (MDD) is used to help patients take their medicines appropriately. Little is known about drug regimen changes within these MDD systems and how they are effectuated by the community pharmacist. Manual immediate adjustments of the MDD system could introduce dispensing errors. MDD guidelines therefore recommend to effectuate drug regimen changes at the start of a new MDD system. The aim of this study was to investigate the frequency, type, procedure followed, immediate necessity, and time taken to make MDD adjustments. This was a cross-sectional study in eight community pharmacies in the Netherlands. All adjustments to MDD systems were systematically documented for 3 weeks by the community pharmacist. Overall, 261 MDD adjustments involving 364 drug changes were documented for 250 patients: 127 (35%) drug changes involved the addition of a new drug, 124 (34%) a change in dosage, and 95 (26%) drug discontinuation. Of the MDD adjustments, 135 (52%) were effectuated immediately: 81 (31%) by adjusting the MDD system manually, 49 (19%) by temporarily dispensing the drug separately from the MDD system, and 5 (2%) by ordering a new MDD system. Pharmacists considered that 36 (27%) of the immediate MDD adjustments could have been deferred until the next MDD system was produced. Immediate adjustment took significantly longer than deferred adjustment (p < 0.001). This study shows that in patients using MDD systems, over half of the drug regimen changes are adjusted immediately. The necessity of these immediate changes should be critically evaluated. Copyright © 2018. Published by Elsevier Inc.

Contribution of Circulatory Disturbances in Subchondral Bone to the Pathophysiology of Osteoarthritis.

Science.gov (United States)

Aaron, Roy K; Racine, Jennifer; Dyke, Jonathan P

2017-08-01

This review describes the contributions of abnormal bone circulation to the pathophysiology of osteoarthritis. Combining dynamic imaging with MRI and PET with previous observations reveals that venous stasis and a venous outlet syndrome is most likely the key circulatory pathology associated with the initiation or progression of osteoarthritis. MRI and PET have revealed that venous outflow obstruction results in physicochemical changes in subchondral bone to which osteoblasts are responsive. The osteoblasts express an altered pattern of cytokines, many of which can serve as structural or signaling molecules contributing to both bone remodeling and cartilage degeneration. The patterns of circulatory changes are associated with alterations in the physicochemical environment of subchondral bone, including hypoxia. Osteoblast cytokines can transit the subchondral bone plate and calcified cartilage and communicate with chondrocytes.

The risk mortality of the population of azerbaijan from circulatory diseases, depending on the season

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A. J. Rzayeva

2015-06-01

Azerbaijan State Advanced Training Institute for doctors named after A. Aliyev, Baku   ABSTRACT The Objective.  To obtain evidence-based data about the role of seasons of the year in the formation of the population mortality risk from the circulatory system diseases  (CSD in Azerbaijan and its regions with specific climate. Materials of the study. A case of mortality was a unit of statistical observation. The fatalities from all reasons, including CSD have been distributed by the days of every month in the year. Daily average amount of fatalities by months and seasons ( from 20 December to 19 March – winter; from 20 March to 19 June- spring; from 20 June to 16 September; from 20 September to 19 December - autumn have been determined. Results.  In Azerbaijan the risk of general mortality and mortality from CSD is the highest in winter, it decreases in spring but nonuniformly (the general mortality rate is less than that from CSD. That is why the share of CSD increases among mortality reasons. Conclusions. Seasonal change of mortality risks from CSD is multivariant. Winter-spring increase of risk predominates in Azerbaijan. In some regions of Azerbaijan the mortality risk from CSD increases only once either in spring or in summer or winter. Key words: seasonal dynamics, risk of mortality, circulatory system diseases.

Diagnostic Risk Adjustment for Medicaid: The Disability Payment System

Science.gov (United States)

Kronick, Richard; Dreyfus, Tony; Lee, Lora; Zhou, Zhiyuan

1996-01-01

This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored. PMID:10172665

[Temperature that modifies the effect of air pollution on emergency room visits for circulatory and respiratory diseases in Beijing, China].

Science.gov (United States)

Wang, L L; Zhang, Q; Bai, R H; Mi, B B; Yan, H

2017-08-10

Objective: To analyze the temperature modification effect on emergency room visits for circulatory and respiratory diseases caused by air pollution, in Beijing. Methods: Data on both circulatory and respiratory diseases in 2010 and 2011 were collected, Both meteorological and air pollutants related data were obtained from the National Scientific Data Sharing Platform for Population and Health. By using the stratified time-series models, we analyzed the effects of air pollution on emergency room visits for circulatory and respiratory diseases under different temperature zones, from 2010 to 2011, in Beijing. Results: Low temperature (daily average temperatureeffect of air pollution index (API) on emergency room visits for circulatory diseases, Under 10 units of API, the relative risks and confidence interval appeared as 1.067 (1.054-1.080). However, high (daily average temperature between 24.4 ℃ and 28.5 ℃) and extra-high temperature (daily average temperature >28.5 ℃) could enhance the effect of API on emergency room visits for respiratory diseases, Under 10 units of API, the relative risks and confidence interval were 1.021 (1.015-1.028) and 1.006 (1.003-1.008), respectively. Conclusion: Temperature seemed to have modified the association between air pollution and both circulatory and respiratory diseases.

Dose-response relationship analysis for cancer and circulatory system disease mortality risks among uranium miners

International Nuclear Information System (INIS)

Drubay, Damien

2015-01-01

The relation between lung cancer risk and radon exposure has been clearly established, especially from the studies on uranium miner cohorts. But the association between radon exposure and extrapulmonary cancers and non-cancer diseases remains not well known. Moreover, the health risks associated with the other mining-related ionizing radiation exposures are still under consideration. The aim of this thesis is to contribute to the estimation of the radio-induced health risks at low-doses through the analysis of the kidney cancer and Circulatory System Disease (CSD) mortality risks among uranium miners. Kidney cancer mortality risk analyses were performed from the French cohort of uranium miners (n=5086; follow-up period: 1946-2007), the post-55 cohort (n=3,377; follow-up period: 1957-2007) and the German cohort of the Wismut (n=58,986; follow-up period: 1946-2003) which included 24, 11 and 174 deaths from kidney cancer, respectively. The exposures to radon and its short-lived progeny (expressed in Working Level Month WLM), to uranium ore dust (kBqh.m -3 ) and to external gamma rays (mSv) were estimated for each miners and the equivalent kidney dose was calculated. The dose-response relation was refined considering two responses: the instantaneous risk of kidney cancer mortality (corresponding to the classical analysis, Cause specific Hazard Ratio (CSHR) estimated with the Cox model) and its occurrence probability during the followup (Sub-distribution Hazard Ratio (SHR) estimated with the Fine and Gray model). An excess of kidney cancer mortality was observed only in the French cohort (SMR = 1.62 CI95%[1.04; 2.41]). In the Wismut cohort, a decrease of the kidney cancer mortality was observed (0.89 [0.78; 0.99]). For these three cohorts, the occupational radiological exposures (or the equivalent kidney dose) were significantly associated neither with the risk of kidney cancer mortality (e.g. CSHRWismut-radon/100 WLM=1.023 [0.993; 1.053]), nor with its occurrence

Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

International Nuclear Information System (INIS)

Haneya, Assad; Philipp, Alois; Foltan, Maik; Camboni, Daniele; Rupprecht, Leopold; Puehler, Thomas; Hirt, Stephan; Hilker, Michael; Kobuch, Reinhard; Schmid, Christof; Arlt, Matthias; Mueller, Thomas

2009-01-01

Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation. From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4. All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO. Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care. (author)

The Implications of the Shift Toward Donation After Circulatory Death in Australia

Directory of Open Access Journals (Sweden)

Janske Reiling, MD, PhD

2017-12-01

Discussion. This study shows that livers donated after circulatory death are an underused resource in Australia. Better use of these currently available organs would be a highly cost-effective way of reducing waiting list mortality in liver transplantation.

Preliminary assessment of adjuster system performance in CANDU-6 RUFIC core

International Nuclear Information System (INIS)

Kim, Soon Young; Suk, Ho Chun

2002-07-01

Four operational transients in CANDU-6 RUFIC core have been simulated to assess the adjuster system performance. These transients included startup after a short shutdown, startup after a poison-out shutdown, shim mode operation, and a stepback to 60% full power. Also, an alternative adjuster-banking scheme has been assessed in this report. The alternative adjuster-banking scheme involves rods in Bank 1 and Bank 7 being re-distributed within the two banks. In the alternative adjuster-banking scheme, Bank 1 becomes the heaviest one. The results of the preliminary assessment indicated that the adjuster system as currently designed and installed in the NU core will adequately meet the functional requirements in the RUFIC core. Comparing to the adjuster system performance in the NU core, the total worth of the adjuster in the RUFIC core is reduced, leading to less xenon override capability and shimming capability. However, the overall performance is expected to still be satisfactory. The overall results from the transient studied indicated that the alternative banking scheme does show some better performance characteristics and merits further detailed studies

Highly Adjustable Systems: An Architecture for Future Space Observatories

Science.gov (United States)

Arenberg, Jonathan; Conti, Alberto; Redding, David; Lawrence, Charles R.; Hachkowski, Roman; Laskin, Robert; Steeves, John

2017-06-01

Mission costs for ground breaking space astronomical observatories are increasing to the point of unsustainability. We are investigating the use of adjustable or correctable systems as a means to reduce development and therefore mission costs. The poster introduces the promise and possibility of realizing a “net zero CTE” system for the general problem of observatory design and introduces the basic systems architecture we are considering. This poster concludes with an overview of our planned study and demonstrations for proving the value and worth of highly adjustable telescopes and systems ahead of the upcoming decadal survey.

[Cerebral oximetry in pulmonary thromboendarterectomy with circulatory arrest].

Science.gov (United States)

Catalán Escudero, P; González Román, A; Serra Ruiz, C N; Barbero Mielgo, M; García Fernández, J

2014-02-01

Pulmonary thromboendarterectomy is an uncommon procedure and should be performed with circulatory arrest. One of the major concerns is the postoperative central neurological injuries. Perioperative brain oxygen monitoring is advisable in this surgical procedure for the early detection of brain hypoperfusion episodes and their intensity as well as any other postoperative episodes that can deteriorate the neurological outcome. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Selective cerebral perfusion prevents abnormalities in glutamate cycling and neuronal apoptosis in a model of infant deep hypothermic circulatory arrest and reperfusion.

Science.gov (United States)

Kajimoto, Masaki; Ledee, Dolena R; Olson, Aaron K; Isern, Nancy G; Robillard-Frayne, Isabelle; Des Rosiers, Christine; Portman, Michael A

2016-11-01

Deep hypothermic circulatory arrest is often required for the repair of complex congenital cardiac defects in infants. However, deep hypothermic circulatory arrest induces neuroapoptosis associated with later development of neurocognitive abnormalities. Selective cerebral perfusion theoretically provides superior neural protection possibly through modifications in cerebral substrate oxidation and closely integrated glutamate cycling. We tested the hypothesis that selective cerebral perfusion modulates glucose utilization, and ameliorates abnormalities in glutamate flux, which occur in association with neuroapoptosis during deep hypothermic circulatory arrest. Eighteen infant male Yorkshire piglets were assigned randomly to two groups of seven (deep hypothermic circulatory arrest or deep hypothermic circulatory arrest with selective cerebral perfusion for 60 minutes at 18℃) and four control pigs without cardiopulmonary bypass support. Carbon-13-labeled glucose as a metabolic tracer was infused, and gas chromatography-mass spectrometry and nuclear magnetic resonance were used for metabolic analysis in the frontal cortex. Following 2.5 h of cerebral reperfusion, we observed similar cerebral adenosine triphosphate levels, absolute levels of lactate and citric acid cycle intermediates, and carbon-13 enrichment among three groups. However, deep hypothermic circulatory arrest induced significant abnormalities in glutamate cycling resulting in reduced glutamate/glutamine and elevated γ-aminobutyric acid/glutamate along with neuroapoptosis, which were all prevented by selective cerebral perfusion. The data suggest that selective cerebral perfusion prevents these modifications in glutamate/glutamine/γ-aminobutyric acid cycling and protects the cerebral cortex from apoptosis. © The Author(s) 2016.

Predicting Circulatory Diseases from Psychosocial Safety Climate: A Prospective Cohort Study from Australia

Directory of Open Access Journals (Sweden)

Harry Becher

2018-02-01

Full Text Available Circulatory diseases (CDs (including myocardial infarction, angina, stroke or hypertension are among the leading causes of death in the world. In this paper, we explore for the first time the impact of a specific aspect of organizational climate, Psychosocial Safety Climate (PSC, on CDs. We used two waves of interview data from Australia, with an average lag of 5 years (excluding baseline CDs, final n = 1223. Logistic regression was conducted to estimate the prospective associations between PSC at baseline on incident CDs at follow-up. It was found that participants in low PSC environments were 59% more likely to develop new CD than those in high PSC environments. Logistic regression showed that high PSC at baseline predicts lower CD risk at follow-up (OR = 0.98, 95% CI 0.96–1.00 and this risk remained unchanged even after additional adjustment for known job design risk factors (effort reward imbalance and job strain. These results suggest that PSC is an independent risk factor for CDs in Australia. Beyond job design this study implicates organizational climate and prevailing management values regarding worker psychological health as the genesis of CDs.

CIRCULATORY FAILURE DURING NON-INHALED FORMS OF CYANIDE INTOXICATION

Science.gov (United States)

Haouzi, Philippe; Tubbs, Nicole; Rannals, Matthew D.; Judenherc-Haouzi, Annick; Cabell, Larry A.; McDonough, Joe A.; Sonobe, Takashi

2016-01-01

Our objective was to determine how circulatory failure develops following systemic administration of potassium cyanide (KCN). We used a non-inhaled modality of intoxication, wherein the change in breathing pattern would not influence the diffusion of CN into the blood, akin to the effects of ingesting toxic levels of CN. In a group of 300–400 g rats, CN-induced coma (CN IP, 7 mg/kg) produced a central apnea within 2–3 minutes along with a potent and prolonged gasping pattern leading to auto-resuscitation in 38% of the animals. Motor deficits and neuronal necrosis were nevertheless observed in the surviving animals. To clarify the mechanisms leading to potential auto-resuscitation versus asystole, 12 urethane-anesthetized rats were then exposed to the lowest possible levels of CN exposure that would lead to breathing depression within 7–8 minutes; this dose averaged 0.375 mg/kg/min iv. At this level of intoxication, a cardiac depression developed several minutes only after the onset of the apnea, leading to cardiac asystole as PaO2 reached value around 15 Torr, unless breathing was maintained by mechanical ventilation or through spontaneous gasping. Higher levels of KCN exposure in 10 animals provoked a primary cardiac depression, which led to a rapid cardiac arrest by pulseless electrical activity despite the maintenance of PaO2 by mechanical ventilation. These effects were totally unrelated to the potassium contained in KCN. It is concluded that circulatory failure can develop as a direct consequence of CN induced apnea but in a narrow range of exposure. In this “low” range, maintaining pulmonary gas exchange after exposure, through mechanical ventilation (or spontaneous gasping) can reverse cardiac depression and restore spontaneous breathing. At higher level of intoxication, cardiac depression is to be treated as a specific and spontaneously irreversible consequence of CN exposure, leading to a pulseless electrical activity. PMID:27513083

Theological reflections on donation after circulatory death: the wisdom of Paul Ramsey and Moshe Feinstein.

Science.gov (United States)

Jotkowitz, A

2008-10-01

Due to the worldwide shortage of organs for transplantation, there has been an increased use of organs obtained after circulatory death alone. A protocol for this procedure has recently been approved by a major transplant consortium. This development raises serious moral and ethical concerns. Two renowned theologians of the previous generation, Paul Ramsey and Moshe Feinstein, wrote extensively on the ethical issues relating to transplantation, and their work has much relevance to current moral dilemmas. Their writings relating to definition of death, organ transplantation and the care of the terminally ill are briefly presented, and their potential application to the moral problem of organ donation after circulatory death is discussed.

The application of multiple intelligence approach to the learning of human circulatory system

Science.gov (United States)

Kumalasari, Lita; Yusuf Hilmi, A.; Priyandoko, Didik

2017-11-01

The purpose of this study is to offer an alternative teaching approach or strategies which able to accommodate students’ different ability, intelligence and learning style. Also can gives a new idea for the teacher as a facilitator for exploring how to teach the student in creative ways and more student-center activities, for a lesson such as circulatory system. This study was carried out at one private school in Bandung involved eight students to see their responses toward the lesson that delivered by using Multiple Intelligence approach which is include Linguistic, Logical-Mathematical, Visual-Spatial, Musical, Bodily-Kinesthetic, Interpersonal, Intrapersonal, and Naturalistic. Students were test by using MI test based on Howard Gardner’s MI model to see their dominant intelligence. The result showed the percentage of top three ranks of intelligence are Bodily-Kinesthetic (73%), Visual-Spatial (68%), and Logical-Mathematical (61%). The learning process is given by using some different multimedia and activities to engaged their learning style and intelligence such as mini experiment, short clip, and questions. Student response is given by using self-assessment and the result is all students said the lesson gives them a knowledge and skills that useful for their life, they are clear with the explanation given, they didn’t find difficulties to understand the lesson and can complete the assignment given. At the end of the study, it is reveal that the students who are learned by Multiple Intelligence instructional approach have more enhance to the lesson given. It’s also found out that the students participated in the learning process which Multiple Intelligence approach was applied enjoyed the activities and have great fun.

DoubleFace: Adjustable translucent system to improve thermal comfort

Directory of Open Access Journals (Sweden)

Michela Turrin

2014-11-01

Full Text Available The DoubleFace project aims at developing a new product that passively improves thermal comfort of indoor and semi-indoor spaces by means of lightweight materials for latent heat storage, while simultaneously allowing daylight to pass through as much as possible. Specifically, the project aims at designing and prototyping an adjustable translucent modular system featuring thermal insulation and thermal absorption in a calibrated manner, which is adjustable according to different heat loads during summer- and wintertime. The output consists of a proof of concept, a series of performance simulations and measurement and a prototype of an adjustable thermal mass system based on lightweight and translucent materials: phase-changing materials (PCM for latent heat storage and translucent aerogel particles for thermal insulation.

Circulatory Arrest: A Surgical Option for Adult Window Ductus Closure

Directory of Open Access Journals (Sweden)

Vithalkumar Malleshi Betigeri

2012-03-01

Full Text Available The window ductus , an atypical type of patent ductus arteriosus(PDA is a characteristically large in size(>2cm with no recognizable length, characteristic continuation of main pulmonary artery with aortic arch and absence of internal ductal tissue. Surgical safety and effectiveness of its closure can be increased by using cardiopulmonary bypass (CPB and hypothermic total circulatory arrest (HTCA via median sternotomy.

Pathophysiology of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus

International Nuclear Information System (INIS)

Takeuchi, Totaro; Goto, Hiromi; Izaki, Kenji

2007-01-01

This study was conducted to elucidate the pathologic conditions of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus (iNPH). Among 44 possible iNPH patients, 40 patients underwent shunt surgery based on diagnostic flow charts plotted by the Southern Tohoku method and were evaluated to be shunt-effective at the end of the first post-surgical month. The cerebral blood flow (CBF) was measured by N-isopropyl-( 123 I)-P-iodo-amphetamine single photon emission computed tomography (mean, mCBF; cortical region, cCBF; thalamus-basal ganglia region, tbCBF on autoradiography [ARG] method) and the perfusion patterns of the cerebral cortex were measured based on three-dimensional stereotactic surface projection (3D-SSP) Z-score images, before and 1 month after the surgery in all 40 subjects. The mCBF rose significantly from 32.1±2.74 ml/100 g/min before surgery to 39.8±3.02 ml/100 g/min after surgery (p<0.03). Investigation of the change of CBF revealed reductions in the cCBF (3 cases), tbCBF (9 cases), and cCBF+tbCBF (28 cases), with the reduced-cCBF group totaling 31 cases and the reduced-tbCBF group totaling 37 cases. Investigation of cerebral cortex hypoperfusion by 3D-SSP Z-score revealed 31 cases with hypoperfusion (frontal lobe type [19 cases], occipitotemporal lobe type [5 cases], mixed type [7 cases]) and nine cases with cortical normoperfusion (N). The pattern of reduction of the cortical blood flow on ARG method was favorably correlated with the pattern of hypoperfusion of the cerebral cortex on 3D-SSP Z-score images before surgery. A reduction of blood flow was found in the thalamus-basal ganglia region of all N type cases. The blood flow improved in 19 of 31 (61.3%) cases of the reduced-cCBF group and in 32 of 37 (86.5%) cases of the reduced-tbCBF group. All of the cases without detectable improvement exhibited increased blood flow in non-reduction areas. Investigation of the hypoperfusion patterns of the cerebral cortex on 3D-SSP Z

Heart Transplant and Mechanical Circulatory Support in Patients With Advanced Heart Failure.

Science.gov (United States)

Sánchez-Enrique, Cristina; Jorde, Ulrich P; González-Costello, José

2017-05-01

Patients with advanced heart failure have a poor prognosis and heart transplant is still the best treatment option. However, the scarcity of donors, long waiting times, and an increasing number of unstable patients have favored the development of mechanical circulatory support. This review summarizes the indications for heart transplant, candidate evaluation, current immunosuppression strategies, the evaluation and treatment of rejection, infectious prophylaxis, and short and long-term outcomes. Regarding mechanical circulatory support, we distinguish between short- and long-term support and the distinct strategies that can be used: bridge to decision, recovery, candidacy, transplant, and destination therapy. We then discuss indications, risk assessment, management of complications, especially with long-term support, and outcomes. Finally, we discuss future challenges and how the widespread use of long-term support for patients with advanced heart failure will only be viable if their complications and costs are reduced. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock

NARCIS (Netherlands)

A.A.P. Lima (Alexandre ); M.E. van Genderen (Michel); J. van Bommel (Jasper); E. Klijn (Elko); T. Jansem (Tim); J. Bakker (Jan)

2014-01-01

textabstractIntroduction: Recent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock. Nitroglycerin is effective in restoring alterations in microcirculatory blood flow. The aim of this study was to

[Mechanical circulatory support in pediatrics. Experience at the Dr. Juan P. Garrahan Pediatric Hospital. Argentina].

Science.gov (United States)

Moreno, Guillermo E; Magliola, Ricardo; Pilán, María Luisa; Althabe, María; Balestrini, María; Lenz, Ana Miriam; Krysnki, Mariela; Rodríguez, Ricardo; Salgado, Gladys; Martin, Analía; Cardoso, Hugo; Ruffa, Pablo; Cornelis, Carlos Javier; Barreta, Jorge; García Delucis, Pablo

2014-01-01

Mechanical circulatory support provides oxygen to the tissues in patients with cardiac and/or respiratory reversible disease refractory to conventional treatments. The aim of this study is to show our initial results of mechanical circulatory support in children with heart disease. Retrospective cohort between March 2006 and March 2012. Demographic data (age, sex, weight, cardiac diagnosis), surgery (technique, pump, aortic cross clamping time) and mechanical circulatory support (type of assistance, indication, duration, complications and outcome) were collected. Thirty-three patients were supported (1.3% of all surgeries), extracorporeal membrane oxygenation 32 cases and one ventricular assist device. The median age 7.4 months (one day-18 years) and weight 6kg (2.3-75). The most frequent cardiac malformations supported were the transpositions of the great arteries associated with other anomalies and the corrected transpositions (ventricular inversion or double discordance). The most common reason for admission was post-cardiotomy biventricular dysfunction. Twenty-eight patients were supported in the postoperative period, 4 in the preoperative period and in one with myocarditis. Median days of support were 3 days (1-10). The most common complications were infection (21%), bleeding (21%). Elective decannulation was achieved in 94% of cases. Hospital discharge survival: 52%. The mechanical circulatory support in our institution is a safe and standard procedure. We have been using it in a small number of cases with a similar survival to that reported internationally. This complex procedure is widely justified because it allows for the recovery of more than half of the patients who otherwise would have died. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Tracking Behavioral Progress within a Children's Mental Health System: The Vermont Community Adjustment Tracking System.

Science.gov (United States)

Bruns, Eric J.; Burchard, John D.; Froelich, Peter; Yoe, James T.; Tighe, Theodore

1998-01-01

Describes the Vermont Community Adjustment Tracking System (VT-CATS), which utilizes four behavioral instruments to allow intensive, ongoing, and interpretable behavioral assessment of a service system's most challenging children and adolescents. Also explains the adjustment indicator checklists and the ability of VT-CATS to address agencies'…

SECURING DIGITIZED LIBRARY CIRCULATORY SYSTEM

African Journals Online (AJOL)

user

The widespread application of the developed system on smart library circulation .... database management system; [9] through securing .... system running on a Windows 8 Operating system .... mini library for their support, advice and unlimited.

Enhancement of Arterial Pressure Pulsatility by Controlling Continuous-Flow Left Ventricular Assist Device Flow Rate in Mock Circulatory System.

Science.gov (United States)

Bozkurt, Selim; van de Vosse, Frans N; Rutten, Marcel C M

Continuous-flow left ventricular assist devices (CF-LVADs) generally operate at a constant speed, which reduces pulsatility in the arteries and may lead to complications such as functional changes in the vascular system, gastrointestinal bleeding, or both. The purpose of this study is to increase the arterial pulse pressure and pulsatility by controlling the CF-LVAD flow rate. A MicroMed DeBakey pump was used as the CF-LVAD. A model simulating the flow rate through the aortic valve was used as a reference model to drive the pump. A mock circulation containing two synchronized servomotor-operated piston pumps acting as left and right ventricles was used as a circulatory system. Proportional-integral control was used as the control method. First, the CF-LVAD was operated at a constant speed. With pulsatile-speed CF-LVAD assistance, the pump was driven such that the same mean pump output was generated. Continuous and pulsatile-speed CF-LVAD assistance provided the same mean arterial pressure and flow rate, while the index of pulsatility increased significantly for both arterial pressure and pump flow rate signals under pulsatile speed pump support. This study shows the possibility of improving the pulsatility of CF-LVAD support by regulating pump speed over a cardiac cycle without reducing the overall level of support.

Generalized derivation of the added-mass and circulatory forces for viscous flows

Science.gov (United States)

Limacher, Eric; Morton, Chris; Wood, David

2018-01-01

The concept of added mass arises from potential flow analysis and is associated with the acceleration of a body in an inviscid irrotational fluid. When shed vorticity is modeled as vortex singularities embedded in this irrotational flow, the associated force can be superimposed onto the added-mass force due to the linearity of the governing Laplace equation. This decomposition of force into added-mass and circulatory components remains common in modern aerodynamic models, but its applicability to viscous separated flows remains unclear. The present work addresses this knowledge gap by presenting a generalized derivation of the added-mass and circulatory force decomposition which is valid for a body of arbitrary shape in an unbounded, incompressible fluid domain, in both two and three dimensions, undergoing arbitrary motions amid continuous distributions of vorticity. From the general expression, the classical added-mass force is rederived for well-known canonical cases and is seen to be additive to the circulatory force for any flow. The formulation is shown to be equivalent to existing theoretical work under the specific conditions and assumptions of previous studies. It is also validated using a numerical simulation of a pitching plate in a steady freestream flow, conducted by Wang and Eldredge [Theor. Comput. Fluid Dyn. 27, 577 (2013), 10.1007/s00162-012-0279-5]. In response to persistent confusion in the literature, a discussion of the most appropriate physical interpretation of added mass is included, informed by inspection of the derived equations. The added-mass force is seen to account for the dynamic effect of near-body vorticity and is not (as is commonly claimed) associated with the acceleration of near-body fluid which "must" somehow move with the body. Various other consequences of the derivation are discussed, including a concept which has been labeled the conservation of image-vorticity impulse.

Delayed Referral Results in Missed Opportunities for Organ Donation After Circulatory Death.

Science.gov (United States)

Krmpotic, Kristina; Payne, Clare; Isenor, Cynthia; Dhanani, Sonny

2017-06-01

Rates of organ donation and transplantation have steadily increased in the United States and Canada over the past decade, largely attributable to a notable increase in donation after circulatory death. However, the number of patients awaiting solid organ transplantation continues to remain much higher than the number of organs transplanted each year. The objective of this study was to determine the potential to increase donation rates further by identifying gaps in the well-established donation after circulatory death process in Ontario. Retrospective cohort study. Provincial organ procurement organization. Patients who died in designated donation hospitals within the province of Ontario, Canada between April 1, 2013, and March 31, 2015. None. Of 1,407 patient deaths following planned withdrawal of life-sustaining therapy, 54.0% (n = 760) were medically suitable for donation after circulatory death. In 438 cases where next of kin was approached, consent rates reached 47.5%. A total of 119 patients became actual organ donors. Only 66.2% (n = 503) of suitable patients were appropriately referred, resulting in 251 missed potential donors whose next of kin could not be approached regarding organ donation because referral occurred after initiation of withdrawal of life-sustaining therapy or not at all. The number of medically suitable patients who die within 2 hours of planned withdrawal of life-sustaining therapy is nearly six times higher than the number of actual organ donors, with the greatest loss of potential due to delayed referral until at the time of or after planned withdrawal of life-sustaining therapy. Intensive care teams are not meeting their ethical responsibility to recognize impending death and appropriately refer potential organ donors to the local organ procurement organization. In cases where patients had previously registered their consent decision, they were denied a healthcare right.

Nuclear-fueled circulatory support systems

Energy Technology Data Exchange (ETDEWEB)

Norman, J C [Texas Heart Inst. (USA)

1975-08-01

Experiments on calves using two types of systems for nuclear left ventricular assist pumps are described. These two systems use a nuclear heat source containing 120 g, 1600 Ci Pu-238 in the form of plutonium oxide. The heat source for the first system is the tidal regenerator engine with no valve or seal and is controlled using a hall effect displacement sensor. The second left ventricular assist system uses heat generated by nuclear decay for producing high gas pressure which is converted into a high hydraulic pressure for pumping. The engine efficiency amounts to 7 to 16%, and the measurement value of the pump efficiency obtained is 85%. How these two systems are synchronized with the left ventricle of vital body is described. IN a transplant experiment for a short period (175 hours) in the initial stage, the possibility of the present method was demonstrated. A long-term performance experiment and improvement of the systems are anticipated. However, there still remain many problems, such as improvement of efficiency, reliability, and performance and diminution of the size.

Design amp Validation Of E-Rpm Adjustment Assembly For Mechanical Governor System

Directory of Open Access Journals (Sweden)

Shashi kumar manhotra

2017-11-01

Full Text Available This paper detailing the problem of speed fluctuation of IDI engine Rpm i.e. hunting and dipping. It is due to E-RPM adjustment assembly for mechanical centrifugal flyweight governor system. E-RPM adjustment assembly works mainly for high speed adjustment ampidle speed adjustment. In mechanical centrifugal flyweight governor system of IDI engine issue at idle rpm hunting and dipping issue was reported in field.New designs of plunger type stopper cover with compressed coil spring are proposed for E-RPM adjustment assembly for mechanical centrifugal fly-weight governor system. 3D-Modeling of new design is done on Seimens NX. Kinematic simulation was done with the help of Altairs Motion-View amp Motion-Solver. Based on the results from MBD the prototype is made and tested in engine. As per the test results from engine testing with new design there is no hunting and dipping problem is reported at idle rpm.

Cardiorespiratory interactions in neural circulatory control in humans.

Science.gov (United States)

Shamsuzzaman, A S; Somers, V K

2001-06-01

The reflex mechanisms and interactions described in this overview provide some explanation for the range of neural circulatory responses evident during changes in breathing. The effects described represent the integrated responses to activation of several reflex mechanisms, including peripheral and central chemoreflexes, arterial baroreflexes, pulmonary stretch receptors, and ventricular mechanoreceptors. These interactions occur on a dynamic basis and the transfer characteristics of any single interaction are, in all likelihood, also highly dynamic. Nevertheless, it is only by attempting to understand individual reflexes and their modulating influences that a more thorough understanding of the responses to complex phenomena such as hyperventilation, apnea, and obstructive sleep apnea can be better understood.

Belgium: risk adjustment and financial responsibility in a centralised system.

Science.gov (United States)

Schokkaert, Erik; Van de Voorde, Carine

2003-07-01

Since 1995 Belgian sickness funds are partially financed through a risk adjustment system and are held partially financially responsible for the difference between their actual and their risk-adjusted expenditures. However, they did not get the necessary instruments for exerting a real influence on expenditures and the health insurance market has not been opened for new entrants. At the same time the sickness funds have powerful tools for risk selection, because they also dominate the market for supplementary health insurance. The present risk-adjustment system is based on the results of a regression analysis with aggregate data. The main proclaimed purpose of this system is to guarantee a fair treatment to all the sickness funds. Until now the danger of risk selection has not been taken seriously. Consumer mobility has remained rather low. However, since the degree of financial responsibility is programmed to increase in the near future, the potential profits from cream skimming will increase.

Self-adjusting house-heating control system

Energy Technology Data Exchange (ETDEWEB)

Hacker, O; Ott, M

1983-01-01

Only small expenditure in terms of hard- and software is needed for the heating-control system described here to keep the house-room temperature in day- and night (reduced temperature)-operation precisely at the desired degree C. No control adjustment is needed as the computer - in this case an EMUF-model - adapts itself to changing conditions like type of house, weather conditions etc. Perfect control and good control dynamic lead to considerable savings of energy.

Energy transmission and power sources for mechanical circulatory support devices to achieve total implantability.

Science.gov (United States)

Wang, Jake X; Smith, Joshua R; Bonde, Pramod

2014-04-01

Left ventricular assist device therapy has radically improved congestive heart failure survival with smaller rotary pumps. The driveline used to power today's left ventricular assist devices, however, continues to be a source of infection, traumatic damage, and rehospitalization. Previous attempts to wirelessly power left ventricular assist devices using transcutaneous energy transfer systems have been limited by restrictions on separation distance and alignment between the transmit and receive coils. Resonant electrical energy transfer allows power delivery at larger distances without compromising safety and efficiency. This review covers the efforts to wirelessly power mechanical circulatory assist devices and the progress made in enhancing their energy sources. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

FEATURES OF LONG-TERM MECHANICAL CIRCULATORY SUPPORT WITH CONTINUOUS-FLOW PUMP

Directory of Open Access Journals (Sweden)

G. P. Itkin

2012-01-01

Full Text Available In a review of the comparative analysis of methods and tools for long-term mechanical circulatory support with continuous flow and pulsatile flow implantable pumps. Particular attention is paid to the choice of the optimal modes of the operation of pumps based on the physical principles of the interaction between a the steady flow of blood to the pulsatile mechanics of the heart chambers. 

The First Organ-Based Ontology for Arthropods (Ontology of Arthropod Circulatory Systems - OArCS) and its Integration into a Novel Formalization Scheme for Morphological Descriptions.

Science.gov (United States)

Wirkner, Christian S; Göpel, Torben; Runge, Jens; Keiler, Jonas; Klussmann-Fricke, Bastian-Jesper; Huckstorf, Katarina; Scholz, Stephan; Mikó, István; J Yoder, Matthew; Richter, Stefan

2017-09-01

Morphology, the oldest discipline in the biosciences, is currently experiencing a renaissance in the field of comparative phenomics. However, morphological/phenotypic research still suffers on various levels from a lack of standards. This shortcoming, first highlighted as the "linguistic problem of morphology", concerns the usage of terminology and also the need for formalization of morphological descriptions themselves, something of paramount importance not only to the field of morphology but also when it comes to the use of phenotypic data in systematics and evolutionary biology. We therefore argue, that for morphological descriptions, the basis of all systematic and evolutionary interpretations, ontologies need to be utilized which are based exclusively on structural qualities/properties and which in no case include statements about homology and/or function. Statements about homology and function constitute interpretations on a different or higher level. Based on these "anatomy ontologies", further ontological dimensions (e.g., referring to functional properties or homology) may be exerted for a broad use in evolutionary phenomics. To this end we present the first organ-based ontology for the most species-rich animal group, the Arthropoda. Our Ontology of Arthropod Circulatory Systems (OArCS) contains a comprehensive collection of 383 terms (i.e., labels) tied to 296 concepts (i.e., definitions) collected from the literature on phenotypic aspects of circulatory organ features in arthropods. All of the concepts used in OArCS are based exclusively on structural features, and in the context of the ontology are independent of homology and functional assumptions. We cannot rule out that in some cases, terms are used which in traditional usage and previous accounts might have implied homology and/or function (e.g. heart, sternal artery). Concepts are composed of descriptive elements that are used to classify observed instances into the organizational framework of the

Hypothermic Oxygenated Machine Perfusion in Porcine Donation After Circulatory Determination of Death Liver Transplant

NARCIS (Netherlands)

Fondevila, Constantino; Hessheimer, Amelia J.; Maathuis, Mark-Hugo J.; Munoz, Javier; Taura, Pilar; Calatayud, David; Leuvenink, Henri; Rimola, Antoni; Garcia-Valdecasas, Juan C.; Ploeg, Rutger J.

2012-01-01

Background. Livers from donation after circulatory determination-of-death (DCD) donors suffer ischemic injury during a preextraction period of cardiac arrest and are infrequently used for transplantation; they have the potential, however, to considerably expand the donor pool. We aimed to determine

Comparison of outcomes of kidney transplantation from donation after brain death, donation after circulatory death, and donation after brain death followed by circulatory death donors.

Science.gov (United States)

Chen, Guodong; Wang, Chang; Ko, Dicken Shiu-Chung; Qiu, Jiang; Yuan, Xiaopeng; Han, Ming; Wang, Changxi; He, Xiaoshun; Chen, Lizhong

2017-11-01

There are three categories of deceased donors of kidney transplantation in China, donation after brain death (DBD), donation after circulatory death (DCD), and donation after brain death followed by circulatory death (DBCD) donors. The aim of this study was to compare the outcomes of kidney transplantation from these three categories of deceased donors. We retrospectively reviewed 469 recipients who received deceased kidney transplantation in our hospital from February 2007 to June 2015. The recipients were divided into three groups according to the source of their donor kidneys: DBD, DCD, or DBCD. The primary endpoints were delayed graft function (DGF), graft loss, and patient death. The warm ischemia time was much longer in DCD group compared to DBCD group (18.4 minutes vs 12.9 minutes, P < .001). DGF rate was higher in DCD group than in DBD and DBCD groups (22.5% vs 10.2% and 13.8%, respectively, P = .021). Urinary leakage was much higher in DCD group (P = .049). Kaplan-Meier analysis showed that 1-, 2-, and 3-year patient survivals were all comparable among the three groups. DBCD kidney transplantation has lower incidences of DGF and urinary leakage than DCD kidney transplant. However, the overall patient and graft survival were comparable among DBD, DCD, and DBCD kidney transplantation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Surface Modifications of Polymeric Materials for Application in Artificial Heart and Circulatory Assist Devices

NARCIS (Netherlands)

Feijen, J.; Engbers, G.H.M.; Terlingen, J.G.A.; van Delden, C.J.; Poot, A.A.; Vaudaux, P.; Akutsu, Tetsuzo; Koyanagi, Hitoshi

1996-01-01

Several methods have been developed to modify the surfaces of materials used in artificial hearts and circulatory assist devices to suppress the host response, especially with respect to the occurrence of clotting, cellular damage, and infections. In this review, special attention is paid to

Development and adjustment of programs for solving systems of linear equations

International Nuclear Information System (INIS)

Fujimura, Toichiro

1978-03-01

Programs for solving the systems of linear equations have been adjusted and developed in expanding the scientific subroutine library SSL. The principal programs adjusted are based on the congruent method, method of product form of the inverse, orthogonal method, Crout's method for sparse system, and acceleration of iterative methods. The programs developed are based on the escalator method, direct parallel residue method and block tridiagonal method for band system. Described are usage of the programs developed and their future improvement. FORTRAN lists with simple examples in tests of the programs are also given. (auth.)

Adjusting the Danish industrial relations system after Laval

DEFF Research Database (Denmark)

Refslund, Bjarke

2015-01-01

Adjusting the Danish IR-system after Laval: Re-calibration rather than erosion Following some significant rulings that later became known as the Laval-quartet from the European Court of Justice (ECJ) many analyses have been concerned with the future implications for the highly regulated Nordic...

Minimal alteration in the ratio of circulatory fetal DNA to fetal corticotropin-releasing hormone mRNA level in preeclampsia.

Science.gov (United States)

Zhong, Xiao Yan; Holzgreve, Wolfgang; Gebhardt, Stefan; Hillermann, Renate; Tofa, Kashefa Carelse; Gupta, Anurag Kumar; Huppertz, Berthold; Hahn, Sinuhe

2006-01-01

We have recently observed that fetal DNA and fetal corticotropin-releasing hormone (CRH) mRNA are associated with in vitro generated syncytiotrophoblast-derived microparticles, and that the ratio of fetal DNA to mRNA (CRH) varied according to whether the particles were derived by predominantly apoptotic, apo-necrotic or necrotic pathways. Hence, we examined whether these ratios varied in maternal plasma samples taken from normotensive and preeclamptic pregnancies in vivo. Maternal plasma samples were collected from 18 cases with preeclampsia and 29 normotensive term controls. Circulatory fetal CRH mRNA and DNA levels were quantified by real-time PCR and RT-PCR. Circulatory fetal mRNA and fetal DNA levels were significantly elevated in the preeclampsia study group when compared to normotensive controls. Alterations in the fetal mRNA to DNA ratio between the study and control groups were minimal, even when stratified into early (34 weeks of gestation) onset preeclampsia. Our data suggest that although circulatory fetal DNA and mRNA levels are significantly elevated in preeclampsia, the ratios in maternal plasma are not dramatically altered. Copyright 2006 S. Karger AG, Basel.

Hemocompatibility of Axial Versus Centrifugal Pump Technology in Mechanical Circulatory Support Devices.

Science.gov (United States)

Schibilsky, David; Lenglinger, Matthias; Avci-Adali, Meltem; Haller, Christoph; Walker, Tobias; Wendel, Hans Peter; Schlensak, Christian

2015-08-01

The hemocompatible properties of rotary blood pumps commonly used in mechanical circulatory support (MCS) are widely unknown regarding specific biocompatibility profiles of different pump technologies. Therefore, we analyzed the hemocompatibility indicating markers of an axial flow and a magnetically levitated centrifugal device within an in vitro mock loop. The HeartMate II (HM II; n = 3) device and a CentriMag (CM; n = 3) adult pump were investigated in a human whole blood mock loop for 360 min using the MCS devices as a driving component. Blood samples were analyzed by enzyme-linked immunosorbent assay for markers of coagulation, complement system, and inflammatory response. There was a time-dependent activation of the coagulation (thrombin-antithrombin complexes [TAT]), complement (SC5b-9), and inflammation system (polymorphonuclear [PMN] elastase) in both groups. The mean value of TAT (CM: 4.0 μg/L vs. 29.4 μg/L, P technologies and a magnetically levitated centrifugal pump design might be superior. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals Inc.

Surgical thromboendarterectomy for chronic thromboembolic pulmonary hypertension using circulatory arrest with selective antegrade cerebral perfusion

NARCIS (Netherlands)

Zeebregts, CJAM; Dossche, KM; Morshuis, WJ; Knaepen, PJ; Schepens, MAAM

The use of circulatory arrest with selective antegrade cerebral perfusion is described in a 59-year-old man who underwent thrombendarterectomy for chronic thromboembolic pulmonary hypertension. The postoperative course was uneventful. The described surgical technique may prevent the patient from

Adjustable speed drives improve circulating water system

International Nuclear Information System (INIS)

Dent, R.A.; Dicic, Z.

1994-01-01

This paper illustrates the integration of electrical and mechanical engineering requirements to produce a solution to past problems and future operating demands. The application of adjustable speed drives in the modifications of the circulating water system at Indian Point No. 3 Nuclear Power Plant provided increased operating flexibility, efficiency and avoided otherwise costly renovations to the plant electrical systems. Rectification of the original inadequate design of the circulating water system, in addition to maximizing plant efficiency consistent with environmental considerations, formed the basis for this modification. This entailed replacement of all six circulating water pumps and motors and physical modifications to the intake system. This paper details the methodology used in this engineering task. The new system was installed successfully and has been operating reliably and economically for the past eight years

Circulatory Responses to Operative Stress in Females with Gestosis

Directory of Open Access Journals (Sweden)

I. V. Mikhno

2007-01-01

Full Text Available Objective: to study the specific features of hemodynamic responses in females with gestosis in the perioperative period; to evaluate the impact of intensive care on the basis of co-administration of dalargin, dexamethasone, pen-toxifylline, and reamberin.Materials and methods. A Diamant KM-AP-01 rheograph (Saint Petersburg was used to study hemodynamic parameters in 142 patients in whom surgical delivery was made under spinal anesthesia. A control group comprised 30 patients with uncomplicated pregnancy; Group 1 included 26 females with moderate gestosis; Group 2 consisted of 27 females with moderate gestosis who received the developed intensive care regimen; Group 3 comprised 29 females with severe gestosis; Group 4 included 30 females to whom the developed intensive care regimen was applied on the basis of the concurrent use of dalargin, dexamethasone, pentoxifylline, and reamberin.Results: A neurogenic mechanism prevails in females with moderate gestosis. The decreased baseline cardiac index is mostly due to a high postload. Surgical stress does not deteriorate postoperative circulatory parameters, which suggests that females with moderate gestosis have adequate capacities for self-regulation. As gestosis progresses to a severe degree, a role of humoral mechanisms increases in the maintenance of arteriolar spasm. Arteriolar spasm and hypokinetic hemodynamics are retained within 5 postoperative days, which is indicative of the inadequacy of self-regulation and compensatory mechanisms in overcoming two stressors: severe gestosis and surgical aggression.Conclusion: the intensive care regimen developed on the basis of combined use of dalargin, dexamethasone, pentoxifylline, and reamberin favors a more intensive (the promptest normalization of circulatory parameters after surgical delivery in females with moderate and severe gestosis. 

Transfusion-associated circulatory overload in adult, medical emergency patients with perspectives on early warning practice

DEFF Research Database (Denmark)

Gosmann, Fanny; Nørgaard, Astrid; Rasmussen, Maj-Britt

2018-01-01

of transfusion-associated dyspnoea. Vital signs and changes in dyspnoea and blood pressure were registered within the frame of the Early Warning Score, and one case was documented as being transfusion-related in the medical record. No cases were reported to the haemovigilance system. DISCUSSION: The incidence...... to the haemovigilance system. The clinical implications are discussed within the frame of the Early Warning Score. METHODS: We conducted a retrospective audit of electronic hospital medical records of patients receiving blood transfusion in a single medical emergency unit. Patients were admitted during a 6-month period...... and data on symptoms and vital signs were extracted from the records. RESULTS: Of 4,353 consecutively admitted patients, 156 patients were transfused with a total of 411 blood components. The audit identified five cases of transfusion-associated circulatory overload (incidence 3.2%) and four cases...

Dendrimer Brain Uptake and Targeted Therapy for Brain Injury in a Large Animal Model of Hypothermic Circulatory Arrest

Science.gov (United States)

2015-01-01

Treatment of brain injury following circulatory arrest is a challenging health issue with no viable therapeutic options. Based on studies in a clinically relevant large animal (canine) model of hypothermic circulatory arrest (HCA)-induced brain injury, neuroinflammation and excitotoxicity have been identified as key players in mediating the brain injury after HCA. Therapy with large doses of valproic acid (VPA) showed some neuroprotection but was associated with adverse side effects. For the first time in a large animal model, we explored whether systemically administered polyamidoamine (PAMAM) dendrimers could be effective in reaching target cells in the brain and deliver therapeutics. We showed that, upon systemic administration, hydroxyl-terminated PAMAM dendrimers are taken up in the brain of injured animals and selectively localize in the injured neurons and microglia in the brain. The biodistribution in other major organs was similar to that seen in small animal models. We studied systemic dendrimer–drug combination therapy with two clinically approved drugs, N-acetyl cysteine (NAC) (attenuating neuroinflammation) and valproic acid (attenuating excitotoxicity), building on positive outcomes in a rabbit model of perinatal brain injury. We prepared and characterized dendrimer-NAC (D-NAC) and dendrimer-VPA (D-VPA) conjugates in multigram quantities. A glutathione-sensitive linker to enable for fast intracellular release. In preliminary efficacy studies, combination therapy with D-NAC and D-VPA showed promise in this large animal model, producing 24 h neurological deficit score improvements comparable to high dose combination therapy with VPA and NAC, or free VPA, but at one-tenth the dose, while significantly reducing the adverse side effects. Since adverse side effects of drugs are exaggerated in HCA, the reduced side effects with dendrimer conjugates and suggestions of neuroprotection offer promise for these nanoscale drug delivery systems. PMID:24499315

Dendrimer brain uptake and targeted therapy for brain injury in a large animal model of hypothermic circulatory arrest.

Science.gov (United States)

Mishra, Manoj K; Beaty, Claude A; Lesniak, Wojciech G; Kambhampati, Siva P; Zhang, Fan; Wilson, Mary A; Blue, Mary E; Troncoso, Juan C; Kannan, Sujatha; Johnston, Michael V; Baumgartner, William A; Kannan, Rangaramanujam M

2014-03-25

Treatment of brain injury following circulatory arrest is a challenging health issue with no viable therapeutic options. Based on studies in a clinically relevant large animal (canine) model of hypothermic circulatory arrest (HCA)-induced brain injury, neuroinflammation and excitotoxicity have been identified as key players in mediating the brain injury after HCA. Therapy with large doses of valproic acid (VPA) showed some neuroprotection but was associated with adverse side effects. For the first time in a large animal model, we explored whether systemically administered polyamidoamine (PAMAM) dendrimers could be effective in reaching target cells in the brain and deliver therapeutics. We showed that, upon systemic administration, hydroxyl-terminated PAMAM dendrimers are taken up in the brain of injured animals and selectively localize in the injured neurons and microglia in the brain. The biodistribution in other major organs was similar to that seen in small animal models. We studied systemic dendrimer-drug combination therapy with two clinically approved drugs, N-acetyl cysteine (NAC) (attenuating neuroinflammation) and valproic acid (attenuating excitotoxicity), building on positive outcomes in a rabbit model of perinatal brain injury. We prepared and characterized dendrimer-NAC (D-NAC) and dendrimer-VPA (D-VPA) conjugates in multigram quantities. A glutathione-sensitive linker to enable for fast intracellular release. In preliminary efficacy studies, combination therapy with D-NAC and D-VPA showed promise in this large animal model, producing 24 h neurological deficit score improvements comparable to high dose combination therapy with VPA and NAC, or free VPA, but at one-tenth the dose, while significantly reducing the adverse side effects. Since adverse side effects of drugs are exaggerated in HCA, the reduced side effects with dendrimer conjugates and suggestions of neuroprotection offer promise for these nanoscale drug delivery systems.

The physiology of dinosaurs: circulatory and respiratory function in the largest animals ever to walk the earth.

Science.gov (United States)

Pierson, David J

2009-07-01

The cardiopulmonary physiology of dinosaurs-and especially of the long-necked sauropods, which grew much larger than any land animals before or since-should be inherently fascinating to anyone involved in respiratory care. What would the blood pressure be in an animal 12 m (40 ft) tall? How could airway resistance and dead space be overcome while breathing through a trachea 9 m (30 ft) long? The last decade has seen a dramatic increase in evidence bearing on these questions. Insight has come not only from new fossil discoveries but also from comparative studies of living species, clarification of evolutionary relationships, new evaluation techniques, computer modeling, and discoveries about the earth's ancient atmosphere. Pumping a vertical column of blood 8 m (26 ft) above the heart would probably require an arterial blood pressure > 600 mm Hg, and the implications of this for cardiac size and function have led to the proposal of several alternative cardiopulmonary designs. Diverse lines of evidence suggest that the giant sauropods were probably warm-blooded and metabolically active when young, but slowed their metabolism as they approached adult size, which diminished the load on the circulatory system. Circulatory considerations leave little doubt that the dinosaurs had 4-chambered hearts. Birds evolved from dinosaurs, and the avian-type air-sac respiratory system, which is more efficient than its mammalian counterpart, may hold the answer to the breathing problems posed by the sauropods' very long necks. Geochemical and other data indicate that, at the time the dinosaurs first appeared, the atmospheric oxygen concentration was only about half of what it is today, and development of the avian-type respiratory system may have been key in the dinosaurs' evolutionary success, enabling them to out-compete the mammals and dominate the land for 150 million years.

Engine control system having fuel-based adjustment

Science.gov (United States)

Willi, Martin L [Dunlap, IL; Fiveland, Scott B [Metamora, IL; Montgomery, David T [Edelstein, IL; Gong, Weidong [Dunlap, IL

2011-03-15

A control system for an engine having a cylinder is disclosed having an engine valve configured to affect a fluid flow of the cylinder, an actuator configured to move the engine valve, and an in-cylinder sensor configured to generate a signal indicative of a characteristic of fuel entering the cylinder. The control system also has a controller in communication with the actuator and the sensor. The controller is configured to determine the characteristic of the fuel based on the signal and selectively regulate the actuator to adjust a timing of the engine valve based on the characteristic of the fuel.

Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death

NARCIS (Netherlands)

van Loo, Ellen S.; Krikke, Christina; Hofker, Hendrik S.; Berger, Stefan P.; Leuvenink, Henri G. D.; Pol, Robert A.

Introduction: To overcome the gap of organ shortage grafts from donation after circulatory death (DCD) can be used. This review evaluates the outcomes after DCD pancreas donation compared to donation after brain death (DBD). Materials and methods: A literature search was performed using Medline,

Relevances between cerebral circulatory disorder and symptom in idiopathic normal pressure hydrocephalus

International Nuclear Information System (INIS)

Takeuchi, Totaro; Shimizu, Tsuneo; Watanabe, Kazuo

2010-01-01

The subjects were shunt-effective idiopathic normal pressure hydrocephalus (iNPH) 40 patients. Before and one year after surgery, measurements of the cerebral circulatory dynamics (the cerebral blood flow pattern by region of interest (ROI) setting using 123 I-iofetamine (IMP) single photon emission computed tomography (SPECT)), and an evaluation of symptoms (gait disturbance: G, dementia: D, urinary incontinence: U) by grading scale (JNPHGS-R). Preoperative cerebral circulation and symptoms: As for the each symptoms and blood flow patterns, the seventies of G (p=0.017) in whole cortex non-reduction group (thalamus-basal ganglia reduction group) and D (p=0.021) in whole cortex reduction group were obviously high compared with other symptoms particularly. Circulation and symptoms one year after surgery: As the circulatory dynamics at different improvement sites and each symptoms, it was obviously mild for G (p=0.003) in the group with an increased only thalamus-basal ganglia blood flow and increased both whole cortex and thalamus-basal ganglia blood flow and tend to mild for D (p=0.091) in the group with an increased only whole cortex blood flow and increased both whole cortex and thalamus-basal ganglia blood flow compared with other symptoms. (author)

Receptor-mediated oral delivery of a bioencapsulated green fluorescent protein expressed in transgenic chloroplasts into the mouse circulatory system.

Science.gov (United States)

Limaye, Arati; Koya, Vijay; Samsam, Mohtashem; Daniell, Henry

2006-05-01

Oral delivery of biopharmaceutical proteins expressed in plant cells should reduce their cost of production, purification, processing, cold storage, transportation, and delivery. However, poor intestinal absorption of intact proteins is a major challenge. To overcome this limitation, we investigate here the concept of receptor-mediated oral delivery of chloroplast-expressed foreign proteins. Therefore, the transmucosal carrier cholera toxin B-subunit and green fluorescent protein (CTB-GFP), separated by a furin cleavage site, was expressed via the tobacco chloroplast genome. Polymerase chain reaction (PCR) and Southern blot analyses confirmed site-specific transgene integration and homoplasmy. Immunoblot analysis and ELISA confirmed expression of monomeric and pentameric forms of CTB-GFP, up to 21.3% of total soluble proteins. An in vitro furin cleavage assay confirmed integrity of the engineered furin cleavage site, and a GM1 binding assay confirmed the functionality of CTB-GFP pentamers. Following oral administration of CTB-GFP expressing leaf material to mice, GFP was observed in the mice intestinal mucosa, liver, and spleen in fluorescence and immunohistochemical studies, while CTB remained in the intestinal cell. This report of receptor-mediated oral delivery of a foreign protein into the circulatory system opens the door for low-cost production and delivery of human therapeutic proteins.

Adjustment and Optimization of the Cropping Systems under Water Constraint

Directory of Open Access Journals (Sweden)

Pingli An

2016-11-01

Full Text Available The water constraint on agricultural production receives growing concern with the increasingly sharp contradiction between demand and supply of water resources. How to mitigate and adapt to potential water constraint is one of the key issues for ensuring food security and achieving sustainable agriculture in the context of climate change. It has been suggested that adjustment and optimization of cropping systems could be an effective measure to improve water management and ensure food security. However, a knowledge gap still exists in how to quantify potential water constraint and how to select appropriate cropping systems. Here, we proposed a concept of water constraint risk and developed an approach for the evaluation of the water constraint risks for agricultural production by performing a case study in Daxing District, Beijing, China. The results show that, over the whole growth period, the order of the water constraint risks of crops from high to low was wheat, rice, broomcorn, foxtail millet, summer soybean, summer peanut, spring corn, and summer corn, and the order of the water constraint risks of the cropping systems from high to low was winter wheat-summer grain crops, rice, broomcorn, foxtail millet, and spring corn. Our results are consistent with the actual evolving process of cropping system. This indicates that our proposed method is practicable to adjust and optimize the cropping systems to mitigate and adapt to potential water risks. This study provides an insight into the adjustment and optimization of cropping systems under resource constraints.

Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands.

Science.gov (United States)

Wind, Jentina; van Mook, Walther N K A; Dhanani, Sonny; van Heurn, Ernest W L

2016-02-01

Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation. The Determination of Cardiac Death Practices in Intensive Care Survey was sent to all intensive care physicians. Fifty-five percent of 568 Dutch intensive care physicians responded. Most respondents learned death determination from clinical practice. The most commonly used tests for death determination were flat arterial line tracing, flat electrocardiogram (standard 3-lead electrocardiogram), and fixed and dilated pupils. Rarely used tests were absence pulse by echo Doppler, absent blood pressure by noninvasive monitoring, and unresponsiveness to painful stimulus. No diagnostic test or procedure was uniformly performed, but 80% of respondents perceived a need for standardization of death determination. Autoresuscitation was witnessed by 37%, after withdrawal of treatment or after unsuccessful resuscitation. Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies. Copyright © 2015 Elsevier Inc. All rights reserved.

Adjustment of gripping force by optical systems

Science.gov (United States)

Jalba, C. K.; Barz, C.

2018-01-01

With increasing automation, robotics also requires ever more intelligent solutions in the handling of various tasks. In this context, many grippers must also be re-designed. For this, they must always be adapted for different requirements. The equipment of the gripper systems with sensors should help to make the gripping process more intelligent. In order to achieve such objectives, optical systems can also be used. This work analyzes how the gripping force can be adjusted by means of an optical recognition. The result of this work is the creation of a connection between optical recognition, tolerances, gripping force and real-time control. In this way, algorithms can be created, with the aid of which robot grippers as well as other gripping systems become more intelligent.

Circulatory shear flow alters the viability and proliferation of circulating colon cancer cells

Science.gov (United States)

Fan, Rong; Emery, Travis; Zhang, Yongguo; Xia, Yuxuan; Sun, Jun; Wan, Jiandi

2016-06-01

During cancer metastasis, circulating tumor cells constantly experience hemodynamic shear stress in the circulation. Cellular responses to shear stress including cell viability and proliferation thus play critical roles in cancer metastasis. Here, we developed a microfluidic approach to establish a circulatory microenvironment and studied circulating human colon cancer HCT116 cells in response to a variety of magnitude of shear stress and circulating time. Our results showed that cell viability decreased with the increase of circulating time, but increased with the magnitude of wall shear stress. Proliferation of cells survived from circulation could be maintained when physiologically relevant wall shear stresses were applied. High wall shear stress (60.5 dyne/cm2), however, led to decreased cell proliferation at long circulating time (1 h). We further showed that the expression levels of β-catenin and c-myc, proliferation regulators, were significantly enhanced by increasing wall shear stress. The presented study provides a new insight to the roles of circulatory shear stress in cellular responses of circulating tumor cells in a physiologically relevant model, and thus will be of interest for the study of cancer cell mechanosensing and cancer metastasis.

Evaluation of exercise-respiratory system modifications and integration schemes for physiological systems

Science.gov (United States)

Gallagher, R. R.

1974-01-01

Exercise subroutine modifications are implemented in an exercise-respiratory system model yielding improvement of system response to exercise forcings. A more physiologically desirable respiratory ventilation rate in addition to an improved regulation of arterial gas tensions and cerebral blood flow is observed. A respiratory frequency expression is proposed which would be appropriate as an interfacing element of the respiratory-pulsatile cardiovascular system. Presentation of a circulatory-respiratory system integration scheme along with its computer program listing is given. The integrated system responds to exercise stimulation for both nonstressed and stressed physiological states. Other integration possibilities are discussed with respect to the respiratory, pulsatile cardiovascular, thermoregulatory, and the long-term circulatory systems.

Circulatory shock in horses / Choque circulatório em equinos

Directory of Open Access Journals (Sweden)

José Monteira da Silva Filho

2010-04-01

Full Text Available Circulatory shock can be defined as an acute circulatory failure with an inadequate tissue delivery of oxygen and nutritive substrates to the tissues, resulting in generalised cellular hypoxia. Shock can be classified as cardiogenic, obstructive, hypovolaemic, or distributive. The pathophysiologic consequences of inadequate tissue perfusion are directly related to cell ischemia, inadequate O2 delivery, and the production of proinflammatory mediators. If abnormalities of tissue perfusion are allowed to persist, the function of vital organs will be impaired. The subsequent reperfusion will exacerbate organ dysfunction and, in severe cases, may culminate in multiple organ dysfunction syndrome. Early recognition of equine that are shocked and immediate provision of effective circulatory support is therefore essential. In all cases the objective is to restore oxygen delivery to the tissues while correcting the underlying cause. Delays in making the diagnosis and initiating treatment, as well as suboptimal resuscitation, contribute to the development of peripheral vascular failure and irreversible defects in oxygen use which can culminate in vital organ dysfunction.Choque circulatório pode ser definido como uma falha circulatória aguda com liberação inadequada de oxigênio e nutrientes aos tecidos, resultando em hipóxia celular. O choque pode ser classificado como cardiogênico, obstrutivo, hipovolêmico ou distributivo. As consequências fisiopatológicas da perfusão tecidual inadequada estão diretamente relacionadas à isquemia celular, liberação inadequada de O2 e produção de potentes mediadores inflamatórios. Caso as anormalidades de perfusão tecidual se perpetuem, a função de vários órgãos se torna inadequada. A consequente reperfusão poderá exacerbar a disfunção orgânica e, nos casos graves, culminar na síndrome da disfunção orgânica múltipla. O reconhecimento precoce de equinos em choque circulatório e o

Pancreas transplantation with grafts from donors deceased after circulatory death (DCD) : 5 years single center experience

NARCIS (Netherlands)

Kopp, Wouter H; Lam, Hwai-Ding; Schaapherder, Alexander F M; Huurman, Volkert A L; van der Boog, Paul; de Koning, Eelco; de Fijter, Johan W; Baranski, Andrzej; Braat, Andries E

2017-01-01

INTRODUCTION: Donation after circulatory death (DCD) pancreas transplantation has been shown to be an additional way to deal with donor organ shortages. The results of 5-year DCD pancreas transplantation are presented. METHODS: A retrospective, single center analysis (2011 - 2015) was performed to

A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

Science.gov (United States)

Juhnke, Christin; Bethge, Susanne

2016-01-01

Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

Maintenance and adjustment of control systems of central heating turbines

International Nuclear Information System (INIS)

Karasyuk, V.A.; Balashov, A.M.

1994-01-01

Principles of operation and design of systems of automatic control of steam turbines with controlled heating stem extraction are described. Specific features of maintenance and adjustment of the most common domestic turbines are considered. Recommendations on testing state of turbine control systems and improving reliability of their operation are given. 22 refs., 51 refs

Functional stability of cerebral circulatory system

Science.gov (United States)

Moskalenko, Y. Y.

1980-01-01

The functional stability of the cerebral circulation system seems to be based on the active mechanisms and on those stemming from specific of the biophysical structure of the system under study. This latter parameter has some relevant criteria for its quantitative estimation. The data obtained suggest that the essential part of the mechanism for active responses of cerebral vessels which maintains the functional stability of this portion of the vascular system, consists of a neurogenic component involving central nervous structures localized, for instance, in the medulla oblongata.

Spectral line intensity irreversibility in circulatory plasma magnetization processes

Science.gov (United States)

Qu, Z. Q.; Dun, G. T.

2012-01-01

Spectral line intensity variation is found to be irreversible in circulatory plasma magnetization process by experiments described in this paper, i.e., the curves illustrating spectral line photon fluxes irradiated from a light source immerged in a magnetic field by increasing the magnetic induction cannot be reproduced by decreasing the magnetic induction within the errors. There are two plasma magnetization patterns found. One shows that the intensities are greater at the same magnetic inductions during the magnetic induction decreasing process after the increasing, and the other gives the opposite effect. This reveals that the magneto-induced excitation and de-excitation process is irreversible like ferromagnetic magnetization. But the two irreversible processes are very different in many aspects stated in the text.

Constraint propagation of C2-adjusted formulation: Another recipe for robust ADM evolution system

International Nuclear Information System (INIS)

Tsuchiya, Takuya; Yoneda, Gen; Shinkai, Hisa-aki

2011-01-01

With a purpose of constructing a robust evolution system against numerical instability for integrating the Einstein equations, we propose a new formulation by adjusting the ADM evolution equations with constraints. We apply an adjusting method proposed by Fiske (2004) which uses the norm of the constraints, C 2 . One of the advantages of this method is that the effective signature of adjusted terms (Lagrange multipliers) for constraint-damping evolution is predetermined. We demonstrate this fact by showing the eigenvalues of constraint propagation equations. We also perform numerical tests of this adjusted evolution system using polarized Gowdy-wave propagation, which show robust evolutions against the violation of the constraints than that of the standard ADM formulation.

Calibration and adjustment of the EGRET coincidence/time-of-flight system

International Nuclear Information System (INIS)

Hunter, S.D.

1991-01-01

The coincidence/time-of-flight system of the energetic gamma ray experiment telescope (EGRET) on NASA's Gamma Ray Observatory (GRO) consists of two layers of sixteen scintillator tiles. These tiles are paired into 96 coincidence telescopes. Valid coincidence and time-of-flight values (indicating downward moving particles) from one of these telescopes are two of the requirements for an EGRET event trigger. To maximize up-down discrimination, variations in the mean timing value of the telescopes must be minimized. The timing values of the 96 telescopes are not independent, hence they cannot be individually adjusted to calibrate the system. An iterative approach was devised to determine adjustments to the length of the photomultiplier signal cables. These adjustments were made directly in units of time using a time domain reflectometry technique, by timing the reflection of a fast pulse from the unterminated end of eable, and observing the charge in signal propagation time as the length of the cable was shortened. Two constant fraction discriminators, a time-to-amplitude converter and a pulse height analyzer were used for these measurements. Using this direct time measuring approach, the timing values for the 96 EGRET coincidence/time-of-flight telescopes were adjusted with an FWHM variation of less than 450 ps (± 1 TOF timing channel). (orig.)

Colloids Versus Albumin in Large Volume Paracentesis to Prevent Circulatory Dysfunction: Evidence-based Case Report.

Science.gov (United States)

Widjaja, Felix F; Khairan, Paramita; Kamelia, Telly; Hasan, Irsan

2016-04-01

Large volume paracentesis may cause paracentesis induced circulatory dysfunction (PICD). Albumin is recommended to prevent this abnormality. Meanwhile, the price of albumin is too expensive and there should be another alternative that may prevent PICD. This report aimed to compare albumin to colloids in preventing PICD. Search strategy was done using PubMed, Scopus, Proquest, dan Academic Health Complete from EBSCO with keywords of "ascites", "albumin", "colloid", "dextran", "hydroxyethyl starch", "gelatin", and "paracentesis induced circulatory dysfunction". Articles was limited to randomized clinical trial and meta-analysis with clinical question of "In hepatic cirrhotic patient undergone large volume paracentesis, whether colloids were similar to albumin to prevent PICD". We found one meta-analysis and four randomized clinical trials (RCT). A meta analysis showed that albumin was still superior of which odds ratio 0.34 (0.23-0.51). Three RCTs showed the same results and one RCT showed albumin was not superior than colloids. We conclude that colloids could not constitute albumin to prevent PICD, but colloids still have a role in patient who undergone paracentesis less than five liters.

OUTCOMES OF LIVER TRANSPLANTATION USING DONATIONS AFTER CIRCULATORY DEATH : A SINGLE-CENTER EXPERIENCE

OpenAIRE

MEURISSE, Nicolas; VANDEN BUSSCHE, S; JOCHMANS, I; FRANCOIS, J; DESSCHANS, B; LALEMAN, W; VAN DER MERWE, S; VAN STEENBERGEN, W; CASSIMAN, D; VERSLYPE, C; AERTS, R; NEVENS, F; PIRENNE, J; MONBALIU, D

2012-01-01

Introduction Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT. Patients and Methods Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze bil...

EVAHEART: an implantable centrifugal blood pump for long-term circulatory support.

Science.gov (United States)

Yamazaki, Kenji; Kihara, Shinichiro; Akimoto, Takehide; Tagusari, Osamu; Kawai, Akihiko; Umezu, Mitsuo; Tomioka, Jun; Kormos, Robert L; Griffith, Bartley P; Kurosawa, Hiromi

2002-11-01

We developed "EVAHEART": a compact centrifugal blood pump system as an implantable left ventricular assist device for long-term circulatory support. The 55 x 64 mm pump is made from pure titanium, and weighs 370 g. The entire blood-contacting surface is covered with an anti-thrombogenic coating of diamond like carbon (DLC) or 2-methacryloyloxyethyl phosphorylcholine (MPC) to improve blood compatibility. Flows exceeding 12 L/min against 100 mmHg pressure at 2600 rpm was measured. A low-temperature mechanical seal with recirculating cooling system is used to seal the shaft. EVAHEART demonstrated an acceptably low hemolysis rate with normalized index of hemolysis of 0.005 +/- 0.002 g/100L. We evaluated the pump in long-term in-vivo experiments with seven calves. Via left thoracotomy, we conducted left ventricular apex-descending aorta bypass, placing the pump in the left thoracic cavity. Pump flow rates was maintained at 5-9 L/min, pump power consumption remained stable at 9-10 W in all cases, plasma free Hb levels were less than 15 mg/dl, and the seal system showed good seal capability throughout the experiments. The calves were sacrificed on schedule on postoperative day 200, 222, 142, 90, 151, 155, and 133. No thrombi formed on the blood contacting surface with either the DLC or MPC coating, and no major organ thromboembolisms occurred except for a few small renal infarcts. EVAHEART centrifugal blood pump demonstrated excellent performance in long-term in-vivo experiments.

Plasma coatings of nitrogen polymers on metal prostheses of the circulatory system; Recubrimientos por plasma de polimeros nitrogenados sobre protesis metalicas del sistema circulatorio

Energy Technology Data Exchange (ETDEWEB)

Gomez J, L. M.

2016-07-01

This work has a study about the synthesis of poly aniline, poly allylamine and poly pyrrole doped with iodine onto metallic surfaces similar to stents for the circulatory system. Ar, water and hydrogen peroxide plasmas were used for eroding, conditioning and synthesizing polymers that potentially reduce some rejection reactions when stents are implanted in the human body. Stents are small metallic meshes that applied inside collapsed arteries or veins enlarge the diameter and restore the blood flow, however the metallic surfaces usually cause rejection reactions that obstruct the veins again. To give solutions to this problem, in this work is studied the synthesis of biocompatible polymer coatings on the stents that resist the blood flow forming a biocompatible interface between metal and blood. The metallic substrates were eroded and chemically prepared with Ar, H{sub 2}O and/or H{sub 2}O{sub 2} glow discharges on which the polymers were synthesized by plasma. The coatings were morphologically characterized by optical, scanning electron and atomic force microscopy, the chemical structure was studied by infrared and photoelectron X-ray spectroscopy. The hydrophilicity was studied measuring the advance static contact angle and the adhesion was evaluated indirectly with scanning electron microscopy after two months submerged in buffered phosphate solutions. The results indicate that the polymers grew following the superficial morphology; that the conditioning with Ar ions erode the substrates and that the conditioning with H{sub 2}O or H{sub 2}O{sub 2} erodes and activates the surface generating oxygen bridges which help in the polymer-metal adhesion. The chemical structure of the polymeric coatings contain crosslinked structures that correspond to links between monomers with the participation of all atoms, states that suggest monomer fragmentation and oxidation and states that indicate oxygen bridges in the polymers. The coatings had contact angles close to 90

CALCULATION METHODS OF OPTIMAL ADJUSTMENT OF CONTROL SYSTEM THROUGH DISTURBANCE CHANNEL

Directory of Open Access Journals (Sweden)

I. M. Golinko

2014-01-01

Full Text Available In the process of automatic control system debugging the great attention is paid to determining formulas’ parameters of optimal dynamic adjustment of regulators, taking into account the dynamics of Objects control. In most cases the known formulas are oriented on design of automatic control system through channel “input-output definition”. But practically in all continuous processes the main task of all regulators is stabilization of output parameters. The Methods of parameters calculation for dynamic adjustment of regulations were developed. These methods allow to optimize the analog and digital regulators, taking into account minimization of regulated influences. There were suggested to use the fact of detuning and maximum value of regulated influence. As the automatic control system optimization with proportional plus reset controllers on disturbance channel is an unimodal task, the main algorithm of optimization is realized by Hooke – Jeeves method. For controllers optimization through channel external disturbance there were obtained functional dependences of parameters calculations of dynamic proportional plus reset controllers from dynamic characteristics of Object control. The obtained dependences allow to improve the work of controllers (regulators of automatic control on external disturbance channel and so it allows to improve the quality of regulation of transient processes. Calculation formulas provide high accuracy and convenience in usage. In suggested method there are no nomographs and this fact expels subjectivity of investigation in determination of parameters of dynamic adjustment of proportional plus reset controllers. Functional dependences can be used for calculation of adjustment of PR controllers in a great range of change of dynamic characteristics of Objects control.

Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery.

Science.gov (United States)

Brown, Katherine L; Rogers, Libby; Barron, David J; Tsang, Victor; Anderson, David; Tibby, Shane; Witter, Thomas; Stickley, John; Crowe, Sonya; English, Kate; Franklin, Rodney C; Pagel, Christina

2017-07-01

When considering early survival rates after pediatric cardiac surgery it is essential to adjust for risk linked to case complexity. An important but previously less well understood component of case mix complexity is comorbidity. The National Congenital Heart Disease Audit data representing all pediatric cardiac surgery procedures undertaken in the United Kingdom and Ireland between 2009 and 2014 was used to develop and test groupings for comorbidity and additional non-procedure-based risk factors within a risk adjustment model for 30-day mortality. A mixture of expert consensus based opinion and empiric statistical analyses were used to define and test the new comorbidity groups. The study dataset consisted of 21,838 pediatric cardiac surgical procedure episodes in 18,834 patients with 539 deaths (raw 30-day mortality rate, 2.5%). In addition to surgical procedure type, primary cardiac diagnosis, univentricular status, age, weight, procedure type (bypass, nonbypass, or hybrid), and era, the new risk factor groups of non-Down congenital anomalies, acquired comorbidities, increased severity of illness indicators (eg, preoperative mechanical ventilation or circulatory support) and additional cardiac risk factors (eg, heart muscle conditions and raised pulmonary arterial pressure) all independently increased the risk of operative mortality. In an era of low mortality rates across a wide range of operations, non-procedure-based risk factors form a vital element of risk adjustment and their presence leads to wide variations in the predicted risk of a given operation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

The role of perfusion lung scanning and diffusion capacity for early diagnosis of micro circulatory disturbances in chronic obstructive pulmonary disease

International Nuclear Information System (INIS)

Petrova, D.; Shoshlov, P.; Hadjikostova, H.

2002-01-01

The development of chronic obstructive pulmonary disease (COPD) and the frequent inflammatory exacerbations with development of respiratory failure lead to changes in the micro circulatory and an increased risk of lung thrombotic and thromboembolic complication. The aim of the study was to establish the possibility of the perfusion lung scanning and diffusion capacity for early diagnosis of pulmonary micro circulatory disturbances in COPD with mild and moderate respiratory failure. 59 COPD patients were investigated. The data presented significant segmental disorders. Only in 5 (8.47%) of them the perfusion lung scintigrams were normal. In 23 of the patients, single-breath diffusing capacity (DICO) and its two components: membranous component (Dm) and capillary blood component (Vc) were determined. DICO was lower especially Vc the mean sign of micro circulatory disorders. A relationship between the degree of hypoxaemia and the changes found in the perfusion scintigraphy was found. Changes in the pulmonary lung scanning and in the diffusion capacity in COPD with mild respiratory failure seem to be an early diagnostic test. The early anticoagulant and desaggregant prevention may decrease the risk of thrombotic complications in the development of the disease. (authors)

Sensitivity Analysis of Median Lifetime on Radiation Risks Estimates for Cancer and Circulatory Disease amongst Never-Smokers

Science.gov (United States)

Chappell, Lori J.; Cucinotta, Francis A.

2011-01-01

Radiation risks are estimated in a competing risk formalism where age or time after exposure estimates of increased risks for cancer and circulatory diseases are folded with a probability to survive to a given age. The survival function, also called the life-table, changes with calendar year, gender, smoking status and other demographic variables. An outstanding problem in risk estimation is the method of risk transfer between exposed populations and a second population where risks are to be estimated. Approaches used to transfer risks are based on: 1) Multiplicative risk transfer models -proportional to background disease rates. 2) Additive risk transfer model -risks independent of background rates. In addition, a Mixture model is often considered where the multiplicative and additive transfer assumptions are given weighted contributions. We studied the influence of the survival probability on the risk of exposure induced cancer and circulatory disease morbidity and mortality in the Multiplicative transfer model and the Mixture model. Risks for never-smokers (NS) compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for NS, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity, esophagus, colon, a portion of the solid cancer remainder, and leukemia. Greater improvements in risk estimates for NS s are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Active Sensing System with In Situ Adjustable Sensor Morphology

Science.gov (United States)

Nurzaman, Surya G.; Culha, Utku; Brodbeck, Luzius; Wang, Liyu; Iida, Fumiya

2013-01-01

Background Despite the widespread use of sensors in engineering systems like robots and automation systems, the common paradigm is to have fixed sensor morphology tailored to fulfill a specific application. On the other hand, robotic systems are expected to operate in ever more uncertain environments. In order to cope with the challenge, it is worthy of note that biological systems show the importance of suitable sensor morphology and active sensing capability to handle different kinds of sensing tasks with particular requirements. Methodology This paper presents a robotics active sensing system which is able to adjust its sensor morphology in situ in order to sense different physical quantities with desirable sensing characteristics. The approach taken is to use thermoplastic adhesive material, i.e. Hot Melt Adhesive (HMA). It will be shown that the thermoplastic and thermoadhesive nature of HMA enables the system to repeatedly fabricate, attach and detach mechanical structures with a variety of shape and size to the robot end effector for sensing purposes. Via active sensing capability, the robotic system utilizes the structure to physically probe an unknown target object with suitable motion and transduce the arising physical stimuli into information usable by a camera as its only built-in sensor. Conclusions/Significance The efficacy of the proposed system is verified based on two results. Firstly, it is confirmed that suitable sensor morphology and active sensing capability enables the system to sense different physical quantities, i.e. softness and temperature, with desirable sensing characteristics. Secondly, given tasks of discriminating two visually indistinguishable objects with respect to softness and temperature, it is confirmed that the proposed robotic system is able to autonomously accomplish them. The way the results motivate new research directions which focus on in situ adjustment of sensor morphology will also be discussed. PMID:24416094

Active sensing system with in situ adjustable sensor morphology.

Science.gov (United States)

Nurzaman, Surya G; Culha, Utku; Brodbeck, Luzius; Wang, Liyu; Iida, Fumiya

2013-01-01

Despite the widespread use of sensors in engineering systems like robots and automation systems, the common paradigm is to have fixed sensor morphology tailored to fulfill a specific application. On the other hand, robotic systems are expected to operate in ever more uncertain environments. In order to cope with the challenge, it is worthy of note that biological systems show the importance of suitable sensor morphology and active sensing capability to handle different kinds of sensing tasks with particular requirements. This paper presents a robotics active sensing system which is able to adjust its sensor morphology in situ in order to sense different physical quantities with desirable sensing characteristics. The approach taken is to use thermoplastic adhesive material, i.e. Hot Melt Adhesive (HMA). It will be shown that the thermoplastic and thermoadhesive nature of HMA enables the system to repeatedly fabricate, attach and detach mechanical structures with a variety of shape and size to the robot end effector for sensing purposes. Via active sensing capability, the robotic system utilizes the structure to physically probe an unknown target object with suitable motion and transduce the arising physical stimuli into information usable by a camera as its only built-in sensor. The efficacy of the proposed system is verified based on two results. Firstly, it is confirmed that suitable sensor morphology and active sensing capability enables the system to sense different physical quantities, i.e. softness and temperature, with desirable sensing characteristics. Secondly, given tasks of discriminating two visually indistinguishable objects with respect to softness and temperature, it is confirmed that the proposed robotic system is able to autonomously accomplish them. The way the results motivate new research directions which focus on in situ adjustment of sensor morphology will also be discussed.

[Mechanical circulatory support saves lives -- three years' experience of the newly established assist device program at Semmelweis University, Budapest, Hungary].

Science.gov (United States)

Fazekas, Levente; Sax, Balázs; Hartyánszky, István; Pólos, Miklós; Horkay, Ferenc; Varga, Tamás; Rácz, Kristóf; Németh, Endre; Székely, Andrea; Paulovich, Erzsébet; Heltai, Krisztina; Zima, Endre; Szabolcs, Zoltán; Merkely, Béla

2015-03-29

Since the celebration of the 20th anniversary of the first heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need. The aim of the authors was to report their initial experience obtained in this new cardiac assist device program. Since May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure. Treatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insufficiency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted. The available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support and destination therapy. These conditions made possible the successful start of a new cardiac assist device program.

Novel Method for Exchange of Impella Circulatory Assist Catheter: The "Trojan Horse" Technique.

Science.gov (United States)

Phillips, Colin T; Tamez, Hector; Tu, Thomas M; Yeh, Robert W; Pinto, Duane S

2017-07-01

Patients with an indwelling Impella may require escalation of hemodynamic support or exchange to another circulatory assistance platform. As such, preservation of vascular access is preferable in cases where anticoagulation cannot be discontinued or to facilitate exchange to an alternative catheter or closure device. Challenges exist in avoiding bleeding and loss of wire access in these situations. We describe a single-access "Trojan Horse" technique that minimizes bleeding while maintaining arterial access for rapid exchange of this percutaneous ventricular assist device.

CT screening of vertebrarterial circulatory disorder

Energy Technology Data Exchange (ETDEWEB)

Yoshida, Shigeru; Toyoda, Keiko; Moriyama, Hiroshi [Jikei Univ., Tokyo (Japan). School of Medicine

2001-09-01

The frequency of MR angiography (MRA) used to diagnose vertebrobasiliar insufficiency appears high. Findings of abnormality by MRA show cases with maldescription of hemivertebral artery. In such cases, it is unclear whether these are due to anaplasia of the vertebral artery or to the existence of morbid constriction, thus requiring confirmation by a vertebral arteriography (VAG). We observe the vascular morphology of vertebral artery by Computed tomography (CT) scanning for screening circulatory disorders. In photography and CT scan reading, the region was severally photographed between foramen magnum and aortic arch by plain CT and contrast CT at a slice of 5 mm. The constrictive region of the vertebral artery was estimated by comparing plain and contrast CT. Subjects were 34 clinical cases of vascular maldescription in the vertebrobasilar artery, nearly no blood vessel description, or blood vessel winding or inclination. We determined the constrictive morbid state of the vertebral or subclavian artery and cervical vertebra deformity. In findings of maldescription by MRA, it was suggested that discrimination is feasible to a certain degree, whether the vertebral artery has a morbid constrictive region or due to anaplasia. Our results suggest that screening by CT scanning may be more efficient than that by MRA. (author)

CT screening of vertebrarterial circulatory disorder

International Nuclear Information System (INIS)

Yoshida, Shigeru; Toyoda, Keiko; Moriyama, Hiroshi

2001-01-01

The frequency of MR angiography (MRA) used to diagnose vertebrobasiliar insufficiency appears high. Findings of abnormality by MRA show cases with maldescription of hemivertebral artery. In such cases, it is unclear whether these are due to anaplasia of the vertebral artery or to the existence of morbid constriction, thus requiring confirmation by a vertebral arteriography (VAG). We observe the vascular morphology of vertebral artery by Computed tomography (CT) scanning for screening circulatory disorders. In photography and CT scan reading, the region was severally photographed between foramen magnum and aortic arch by plain CT and contrast CT at a slice of 5 mm. The constrictive region of the vertebral artery was estimated by comparing plain and contrast CT. Subjects were 34 clinical cases of vascular maldescription in the vertebrobasilar artery, nearly no blood vessel description, or blood vessel winding or inclination. We determined the constrictive morbid state of the vertebral or subclavian artery and cervical vertebra deformity. In findings of maldescription by MRA, it was suggested that discrimination is feasible to a certain degree, whether the vertebral artery has a morbid constrictive region or due to anaplasia. Our results suggest that screening by CT scanning may be more efficient than that by MRA. (author)

Peripheral Circulatory Features during High-Frequency Jet Ventilation

Directory of Open Access Journals (Sweden)

M. B. Kontorovich

2010-01-01

Full Text Available The paper gives the results of a study of peripheral circulatory features during high-frequency jet ventilation (HFJV. The main specific features of peripheral circulation and oxygen transport during HFJV are formulated on the basis of a study of cardiac output (impedance cardiography, peripheral vascular resistance, peripheral vascular blood filling (photoplethysmogram analysis, adaptive peripheral blood flow reactions (spectral analysis of peripheral vascular pulsation. HFJV gives rise to the peculiar pattern of peripheral hemodynamics and tissue gas exchange, which is characterized by higher oxygen uptake without a decrease in mixed venous blood saturation, with normal extraction coefficient and preserved low peripheral vascular resistance. During HFJV, unlike traditional ventilation, the main peripheral hemodynamic feature is the increased capillary bed blood volume caused by the blood flow involvement of reserve capillaries under control of volume (parasympathetic regulation of adaptive peripheral hemodynamic reactions. Key words: high-frequency jet ventilation, oxygen transport, peripheral hemodynamics.

Occlusive ascending aorta and arch atheroma treated with deep hypothermic circulatory arrest and thromboendarterectomy.

LENUS (Irish Health Repository)

O' Sullivan, Katie E

2013-12-01

We describe an uncommon presentation of severely advanced aortic atherosclerosis in a 48-year old man with a history of hypertension and heavy smoking. Initial presentation with upper limb ischaemia led to the diagnosis of an aortic arch atheroma occluding 90% of the aortic lumen, managed with deep hypothermic circulatory arrest and aortic thromboendarterectomy. To our knowledge, this is the first reported case of atherosclerotic plaque resulting in aortic occlusion and requiring emergent operative intervention.

Oxidative Stress and Methods for Its Correction in Patients with Acute Coronary Circulatory Disorders During Perioperative Direct Myocardial Revascularization

Directory of Open Access Journals (Sweden)

M. V. Chumakov

2008-01-01

Full Text Available Objective: to study the effect of the antioxidant and cardioprotector mexicor on oxidative stress in patients with acute coronary circulatory disorders (ACCD during perioperative direct myocardial revascularization. Subjects and methods. The study included 33 patients with ACCD who had undergone coronary bypass surgery. Two groups (a study group and a control one were formed. Prior to surgery, all the patients received the maximum doses of antianginal and antihypertensive drugs. The study group patients additionally took mexicor. All patients were operated on under extracorporeal circulation and moderate hypothermia. Lipid peroxidation (LPO indices were estimated via measurements of the serum levels of dienic conjugates, malonic dialdehyde, and the degree of serum lipid oxidability. The serum antioxidative system (AOS was judged from the concentration of а-tocopherol and cerulo-plasmin. The oxidative stress coefficient K, an integral index, was calculated to evaluate LPO-AOS imbalance. Results. High oxidative stress was found to be detectable in patients with ACCD. Mexicor lowers oxidative stress, diminishes LPO-AOS imbalance, improves oxygen balance and cardiac contractility, and reduces the number of life-threatening cardiac arrhythmias. Conclusion. Mexicor diminishes oxidative stress in patients with ACCD in the perioperative period of coronary bypass surgery. Mexicor-induced stabilization of LPO positively affects better oxygen balance and cardiac contractility, thus reducing the number of perioperative complications. Key words: oxidative stress, dienic conjugates, malonic dialdehyde, а-tocopherol, ceruloplasmin, coronary bypass, acute coronary circulatory disorder, hemodynamics.

Time synchronization algorithm of distributed system based on server time-revise and workstation self-adjust

International Nuclear Information System (INIS)

Zhou Shumin; Sun Yamin; Tang Bin

2007-01-01

In order to enhance the time synchronization quality of the distributed system, a time synchronization algorithm of distributed system based on server time-revise and workstation self-adjust is proposed. The time-revise cycle and self-adjust process is introduced in the paper. The algorithm reduces network flow effectively and enhances the quality of clock-synchronization. (authors)

SECURING DIGITIZED LIBRARY CIRCULATORY SYSTEM | Olaniyi ...

African Journals Online (AJOL)

Journal Home > Vol 35, No 3 (2016) > ... Despite the potential benefits of Information and Communication Technology (ICT) in library automation, ... The widespread application of the developed system on smart library circulation unit would ...

Simulation of dilated heart failure with continuous flow circulatory support.

Directory of Open Access Journals (Sweden)

Yajuan Wang

Full Text Available Lumped parameter models have been employed for decades to simulate important hemodynamic couplings between a left ventricular assist device (LVAD and the native circulation. However, these studies seldom consider the pathological descending limb of the Frank-Starling response of the overloaded ventricle. This study introduces a dilated heart failure model featuring a unimodal end systolic pressure-volume relationship (ESPVR to address this critical shortcoming. The resulting hemodynamic response to mechanical circulatory support are illustrated through numerical simulations of a rotodynamic, continuous flow ventricular assist device (cfVAD coupled to systemic and pulmonary circulations with baroreflex control. The model further incorporated septal interaction to capture the influence of left ventricular (LV unloading on right ventricular function. Four heart failure conditions were simulated (LV and bi-ventricular failure with/without pulmonary hypertension in addition to normal baseline. Several metrics of LV function, including cardiac output and stroke work, exhibited a unimodal response whereby initial unloading improved function, and further unloading depleted preload reserve thereby reducing ventricular output. The concept of extremal loading was introduced to reflect the loading condition in which the intrinsic LV stroke work is maximized. Simulation of bi-ventricular failure with pulmonary hypertension revealed inadequacy of LV support alone. These simulations motivate the implementation of an extremum tracking feedback controller to potentially optimize ventricular recovery.

Development and Performance Evaluation of a Re-Circulatory Vegetable Moisturizer

Directory of Open Access Journals (Sweden)

M. O. Sunmonu

2016-08-01

Full Text Available A re-circulatory vegetable moisturizer for preventing wilting in vegetables was developed and its performance evaluation carried out. Freshly harvested Amaranthus vegetables were used for the experiments. The temperature and relative humidity were monitored daily. The vitamin A of this produce was determined at intervals of two days for 9 days. The effects of the storage parameters (temperature and relative humidity on the nutritional value of the produce were determined using statistical analysis of variance (ANOVA. Further analysis by Duncan’s New Multiple Range Test (DNMRT was carried out to compare the means. The vegetable moisturizer was evaluated by comparing the change in nutritional (vitamin A of Amaranthus vegetable with hand wetting system and no wetting condition. The results showed that the moisturizer had higher mean vitamin A content (4.93mg/100gcompared to the mean vitamin A content of the manual wetting (4.88mg/100g and no wetting condition (4.57mg/100g. The sensory characteristics showed that the Moisturizer was more desirable when compared to the manual wetting and no wetting condition after nine days. It was concluded that the Moisturizer preserved the nutritional and sensory characteristics (texture and colour better than the manual and no wetting condition as a result of lower temperature, higher relative humidity and better water draining of the Moisturizer.

Dynamics of Short-Term Phosphorus Uptake by Intact Mycorrhizal and Non-mycorrhizal Maize Plants Grown in a Circulatory Semi-Hydroponic Cultivation System.

Science.gov (United States)

Garcés-Ruiz, Mónica; Calonne-Salmon, Maryline; Plouznikoff, Katia; Misson, Coralie; Navarrete-Mier, Micaela; Cranenbrouck, Sylvie; Declerck, Stéphane

2017-01-01

A non-destructive cultivation system was developed to study the dynamics of phosphorus (Pi) uptake by mycorrhizal and non-mycorrhizal maize plantlets. The system consisted of a plant container connected via silicon tubes to a glass bottle containing a nutrient solution supplemented with Pi. The nutrient solution is pumped with a peristaltic pump to the upper part of the container via the silicon tubes and the solution percolate through the plantlet container back into the glass bottle. Pi is sampled from the glass bottle at regular intervals and concentration evaluated. Maize plantlets were colonized by the AMF Rhizophagus irregularis MUCL 41833 and Pi uptake quantified at fixed intervals (9, 21, and 42 h) from the depletion of the Pi in the nutrient solution flowing through the plantlets containers. Plants and fungus grew well in the perlite substrate. The concentration of Pi in the bottles followed an almost linear decrease over time, demonstrating a depletion of Pi in the circulating solution and a concomitant uptake/immobilization by the plantlet-AMF associates in the containers. The Pi uptake rate was significantly increased in the AMF-colonized plantlets (at 9 and 21 h) as compared to non-colonized plantlets, although no correlation was noticed with plant growth or P accumulation in shoots. The circulatory semi-hydroponic cultivation system developed was adequate for measuring Pi depletion in a nutrient solution and by corollary Pi uptake/immobilization by the plant-AMF associates. The measurements were non-destructive so that the time course of Pi uptake could be monitored without disturbing the growth of the plant and its fungal associate. The system further opens the door to study the dynamics of other micro and macro-nutrients as well as their uptake under stressed growth conditions such as salinity, pollution by hydrocarbon contaminants or potential toxic elements.

Dynamics of Short-Term Phosphorus Uptake by Intact Mycorrhizal and Non-mycorrhizal Maize Plants Grown in a Circulatory Semi-Hydroponic Cultivation System

Directory of Open Access Journals (Sweden)

Mónica Garcés-Ruiz

2017-08-01

Full Text Available A non-destructive cultivation system was developed to study the dynamics of phosphorus (Pi uptake by mycorrhizal and non-mycorrhizal maize plantlets. The system consisted of a plant container connected via silicon tubes to a glass bottle containing a nutrient solution supplemented with Pi. The nutrient solution is pumped with a peristaltic pump to the upper part of the container via the silicon tubes and the solution percolate through the plantlet container back into the glass bottle. Pi is sampled from the glass bottle at regular intervals and concentration evaluated. Maize plantlets were colonized by the AMF Rhizophagus irregularis MUCL 41833 and Pi uptake quantified at fixed intervals (9, 21, and 42 h from the depletion of the Pi in the nutrient solution flowing through the plantlets containers. Plants and fungus grew well in the perlite substrate. The concentration of Pi in the bottles followed an almost linear decrease over time, demonstrating a depletion of Pi in the circulating solution and a concomitant uptake/immobilization by the plantlet-AMF associates in the containers. The Pi uptake rate was significantly increased in the AMF-colonized plantlets (at 9 and 21 h as compared to non-colonized plantlets, although no correlation was noticed with plant growth or P accumulation in shoots. The circulatory semi-hydroponic cultivation system developed was adequate for measuring Pi depletion in a nutrient solution and by corollary Pi uptake/immobilization by the plant-AMF associates. The measurements were non-destructive so that the time course of Pi uptake could be monitored without disturbing the growth of the plant and its fungal associate. The system further opens the door to study the dynamics of other micro and macro-nutrients as well as their uptake under stressed growth conditions such as salinity, pollution by hydrocarbon contaminants or potential toxic elements.

History of Bioelectrical Study and the Electrophysiology of the Primo Vascular System

Directory of Open Access Journals (Sweden)

Sang Hyun Park

2013-01-01

Full Text Available Background. Primo vascular system is a new anatomical structure whose research results have reported the possibility of a new circulatory system similar to the blood vascular system and cells. Electrophysiology, which measures and analyzes bioelectrical signals tissues and cells, is an important research area for investigating the function of tissues and cells. The bioelectrical study of the primo vascular system has been reported by using modern techniques since the early 1960s by Bonghan Kim. This paper reviews the research result of the electrophysiological study of the primo vascular system for the discussion of the circulatory function. We hope it would help to study the electrophysiology of the primo vascular system for researchers. This paper will use the following exchangeable expressions: Kyungrak system = Bonghan system = Bonghan circulatory system = primo vascular system = primo system; Bonghan corpuscle = primo node; Bonghan duct = primo vessel. We think that objective descriptions of reviewed papers are more important than unified expressions when citing the papers. That said, this paper will unify the expressions of the primo vascular system.

Infectious and inflammatory disorders of the circulatory system as risk factors for stroke in Saudi children

International Nuclear Information System (INIS)

Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Kentab, Anal Y.; Zahraa, Jihad N.; Abdel-Gader, Mohamed O.; Gadelrab, Mohamed O.; Alorainy, Ibrahim A.; Hassan, Hamdy H.

2006-01-01

Objective was to report on the role of infectious and inflammatory disorders as risk factors for stroke in a prospective and retrospective cohort of Saudi children. Children, who presented with stroke, were evaluated at the Division of Pediatric Neurology or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the periods July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study). Investigations for suspected cases included haemostatic assays, microbiological and serological tests. Neuroimaging included cranial CT, MRI magnetic resonance angiography (MRA), magnetic resonance venography (MRV) and single photon emission computed tomography (SPECT) brain scan. Of the 104 Saudi children with stroke, seen during the combined study periods of 10 years and 7 months, infectious and inflammatory disorders of the circulatory systems were identified risk factors in 18 (17.3%). Five children had stroke following acute bacterial meningitis at ages ranging between 5-21 months. The causative organism was identified in 3 of them and consisted of Haemophilus influenza (in a 5-months-old girl), Streptococcus pneumonia (in a 21-months-old girl complicated by subdural empyema and sinovenous thrombosis), and Staphylococcus aureus in a 6-months-old boy who had an underlying chronic granulomatous disease. Unspecified meningitis/meningoencephalitis affected 4 patients, whereas 3 children had an underlying congenital infection as a cause for their stroke. Two of the latter 3 children were diagnosed to have congenital toxoplasmosis, and the third had congenital rubella syndrome. Two girls had stroke following septicemia at ages of one and 2 months. Neurobrucellosis caused stroke in 2 boys at the ages of 4 1/2 and 4 years. In both patients, neuroimaging revealed lacunar and other infects involving mainly the deep cerebral nuclei, secondary to occlusion of small penetrating end

Clinical trial design and rationale of the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) investigational device exemption clinical study protocol.

Science.gov (United States)

Heatley, Gerald; Sood, Poornima; Goldstein, Daniel; Uriel, Nir; Cleveland, Joseph; Middlebrook, Don; Mehra, Mandeep R

2016-04-01

The HeartMate 3 left ventricular assist system (LVAS; St. Jude Medical, Inc., formerly Thoratec Corporation, Pleasanton, CA) was recently introduced into clinical trials for durable circulatory support in patients with medically refractory advanced-stage heart failure. This centrifugal, fully magnetically levitated, continuous-flow pump is engineered with the intent to enhance hemocompatibility and reduce shear stress on blood elements, while also possessing intrinsic pulsatility. Although bridge-to-transplant (BTT) and destination therapy (DT) are established dichotomous indications for durable left ventricular assist device (LVAD) support, clinical practice has challenged the appropriateness of these designations. The introduction of novel LVAD technology allows for the development of clinical trial designs to keep pace with current practices. The prospective, randomized Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) clinical trial aims to evaluate the safety and effectiveness of the HeartMate 3 LVAS by demonstrating non-inferiority to the HeartMate II LVAS (also St. Jude Medical, Inc.). The innovative trial design includes patients enrolled under a single inclusion and exclusion criteria , regardless of the intended use of the device, with outcomes ascertained in the short term (ST, at 6 months) and long term (LT, at 2 years). This adaptive trial design includes a pre-specified safety phase (n = 30) analysis. The ST cohort includes the first 294 patients and the LT cohort includes the first 366 patients for evaluation of the composite primary end-point of survival to transplant, recovery or LVAD support free of debilitating stroke (modified Rankin score >3), or re-operation to replace the pump. As part of the adaptive design, an analysis by an independent statistician will determine whether sample size adjustment is required at pre-specified times during the study. A further 662

Arrangement for adjusting the load of a turbine system

International Nuclear Information System (INIS)

Aanstadt, O.J.

1974-01-01

The invention relates to an adjustment arrangement for steam turbines with at least two stages. The inlet of steam into the two stages is adjusted by means of independant valves, and an adjustment circuit is provided for each of said valves for adjusting same so as to ensure a suitable distribution of power between the stages. The adjustment is carried out by measuring the power generated between the stages thus eliminating the influence of inaccuracies in the valves. This can be applied, in particular, to nuclear power stations [fr

Modeling the heart and the circulatory system

CERN Document Server

2015-01-01

The book comprises contributions by some of the most respected scientists in the field of mathematical modeling and numerical simulation of the human cardiocirculatory system. The contributions cover a wide range of topics, from the preprocessing of clinical data to the development of mathematical equations, their numerical solution, and both in-vivo and in-vitro validation. They discuss the flow in the systemic arterial tree and the complex electro-fluid-mechanical coupling in the human heart. Many examples of patient-specific simulations are presented. This book is addressed to all scientists interested in the mathematical modeling and numerical simulation of the human cardiocirculatory system.

An original valveless artificial heart providing pulsatile flow tested in mock circulatory loops.

Science.gov (United States)

Tozzi, Piergiorgio; Maertens, Audrey; Emery, Jonathan; Joseph, Samuel; Kirsch, Matthias; Avellan, François

2017-11-24

We present the test bench results of a valveless total artificial heart that is potentially compatible with the pediatric population. The RollingHeart is a valveless volumetric pump generating pulsatile flow. It consists of a single spherical cavity divided into 4 chambers by 2 rotating disks. The combined rotations of both disks produce changes in the volumes of the 4 cavities (suction and ejection). The blood enters/exits the spherical cavity through 4 openings that are symmetrical to the fixed rotation axis of the first disk.Mock circulatory system: The device pumps a 37% glycerin solution through 2 parallel circuits, simulating the pulmonary and systemic circulations. Flow rates are acquired with a magnetic inductive flowmeter, while pressure sensors collect pressure in the left and right outflow and inflow tracts.In vitro test protocol: The pump is run at speeds ranging from 20 to 180 ejections per minute. The waveform of the pressure generated at the inflow and outflow of the 4 chambers and the flow rate in the systemic circulation are measured. At an ejection rate of 178 min-1, the RollingHeart pumps 5.3 L/min for a systemic maximal pressure gradient of 174 mmHg and a pulmonary maximal pressure gradient of 75 mmHg. The power input was 14 W, corresponding to an efficiency of 21%. The RollingHeart represents a new approach in the domain of total artificial heart. This preliminary study endorses the feasibility of a single valveless device acting as a total artificial heart.

Monitoring and assay procedures for krypton-85 used in circulatory tests

Energy Technology Data Exchange (ETDEWEB)

Brown, Jr., J. M.; Williams, K. D.

1963-11-15

During the past five years, krypton-85 has been used extensively at the National Institutes of health and by the heart Catheterization laboratory in the identification of circulatory shunts. Several methods of assaying the incoming shipments of radioactive gas are given. These consist of ionization chamber measurements, gamma ray spectrometry, and gross photon counting of the cylinder surface with an end-window Geiger-Mueller tube. A device (consisting of a log-count-rate meter, recorder, and G.M. tube) is used to continuously monitor the laboratory. The method of calibrating this device is presented. A means for removing contaminated air from the vicinity of the operating table was devised. The results of air clearance studies of the room are included. (auth)

Bridge to recovery in two cases of dilated cardiomyopathy after long-term mechanical circulatory support

OpenAIRE

Pacholewicz, Jerzy; Zakliczy?ski, Micha?; Kowalik, Violetta; Nadziakiewicz, Pawe?; Kowalski, Oskar; Kalarus, Zbigniew; Zembala, Marian

2014-01-01

Ventricular assist devices (VADs) have become an established therapeutic option for patients with end-stage heart failure. Achieving the potential for recovery of native heart function using VADs is an established form of treatment in a selected group of patients with HF. We report two cases of VAD patients with different types of pump used for mechanical circulatory support, a continuous flow pump (Heart-Ware?) and a pulsatile pump (POLVAD MEV?), which allow regeneration of the native heart....

Evolutionary morphology of the hemolymph vascular system of basal araneomorph spiders (Araneae: Araneomorphae).

Science.gov (United States)

Huckstorf, Katarina; Michalik, Peter; Ramírez, Martín; Wirkner, Christian S

2015-11-01

The superfamily Austrochiloidea (Austrochilidae and Gradungulidae) take a pivotal position in araneomorph spider phylogeny. In this discussion crevice weaver spiders (Filistatidae) are of equal interest. Especially data from these phylogenetically uncertain yet basal off branching groups can enlighten our understanding on the evolution of organ systems. In the course of a survey on the evolutionary morphology of the circulatory system in spiders we therefore investigated the hemolymph vascular system in two austrochiloid and one filistatid species. Additionally some data on a hypochilid and a gradungulid species are included. Using up-to-date morphological methods, the vascular systems in these spiders are visualized three dimensionally. Ground pattern features of the circulatory systems in austrochiloid spiders are presented and the data discussed along recent lines of phylogenetic hypotheses. Special topics highlighted are the intraspecific variability of the origins of some prosomal arteries and the evolutionary correlation of respiratory and circulatory systems in spiders. Copyright © 2015 Elsevier Ltd. All rights reserved.

The analysis of the cases of circulatory and respiratory arrest in the work of the Regional Unit of Ambulance Service - Sródmieście Station.

Science.gov (United States)

Chemperek, Ewa; Mikuła, Agnieszka; Goniewicz, Mariusz; Krawczyk, Wojciech

2004-01-01

The major causes of deaths all over the world are circulatory system diseases, neoplasms and injuries. Each man can become a participant of the event which results in life-threatening emergencies and the most immediate possible actions are essential. The period of time for starting efficient life-restoration actions is very short, estimated at 4-5 minutes. Ambulance Service is a medical organization created to apply aid in life-threatening emergencies. The standards of the developed western countries determine the arrival time at 7-10 minutes from the call time. Both first-aid applied by the accident witnesses and efficient actions of ambulance service have significance for effective pre-hospital aid and increasing the chances of survival of people in need. The study analysed emergency records of the ambulance cars of the Regional Unit of Ambulance Service - Sródmieście Station in Lublin in the year 2000. 3,723 calls were recorded. In 142 cases complete resuscitation actions were carried out due to circulatory and respiratory arrest. The records selected this way went through a detailed analysis. In 3.8% of the interventions of emergency teams the necessity of applying advanced life support was observed. The time of arrival at the scene, transport of the patient to the admission room as well as efficiency of resuscitation comply with the European standards. The efficiency of resuscitation actions estimated at 51.4% depended on the age of the patient, the cause of circulatory and respiratory arrest and ambulance arrival time. Taking up basic life support by witnesses of the event was observed in 2.8% of cases, in 8.5% aid was applied by the medical staff members who happened to be at the scene.

A study on performance of adjuster rod system and banking scheme in operational transient of CANDU-6 RUFIC core

International Nuclear Information System (INIS)

Kim, Soon Young; Suk, Ho Chun

2002-01-01

The performance of adjuster rod system in four operational transients of CANDU-6 RUFIC (Recovered Uranium Fuel In CANDU) core was preliminarily assessed, where the operational transients include startup after a short shutdown, startup after a poison-out shutdown, shim mode operation, and a stepback to 60% full power. The results of the preliminary assessment indicated that the adjuster rod system as currently designed and installed in the CANDU-6 NU (Natural Uranium) core will adequately meet the functional requirements in the RUFIC core. Comparing to the performance of adjuster rod system in the NU core, the total worth of the adjuster system in the RUFIC core is reduced, leading to less xenon override capability and shimming capability. In spite of the reduction of total worth, however, the overall performance of adjuster rod system in the operation transient of the RUFIC core is expected to still be satisfied. An alternative adjuster-banking scheme is also included in the assessment. The alternative adjuster-banking scheme involves rods in Bank 1 and Bank 7 being re-distributed within the two banks. The overall results from the transients studied indicated that the alternative banking scheme does show some better performance characteristics and merits

Design and adjustment on test bed of replacing subassembly machine control system for China experimental fast reactor

International Nuclear Information System (INIS)

Dong Shengguo; Ma Hongsheng; Zhao Lixia

2008-01-01

The present research concerns in the design and adjustment of replacing sub- assembly machine control system of China Experimental Fast Reactor. The design of replacing subassembly machine control system adopts some electric equipments, such as programmable controllers, digital DC drivers. The designed control system was adjusted on the test bed. The results indicate that the operation of the control system is steady and reliable, and designed control system can meet the needs of the design specification. (authors)

Hyperdynamic circulatory changes in liver cirrhosis: Comparative evaluation by doppler ultrasonography with normal subjects

International Nuclear Information System (INIS)

Im, Dae Wook; Baik, Soon Koo; Suh, Jung In; Kim, Jae Woo; Park, Yong Soon; Kim, Hyun Soo; Lee, Dong Ki; Kwon, Sang Ok

2001-01-01

To evaluate the cardiovascular and splanchnic hemodynamic changes in patients with liver cirrhosis and to compare with those of the normal controls using doppler ultrasonography. A total of 129 patients including 23 of Child-Pugh class A, 24 of class A, 24 of class B, 30 of class C, and 52 of the control group were included. Cardiac output (CO), systemic vascular resistance index (SVRI), and blood flow and pulsatility index (PI) of the superior mesenteric artery (SMA) were evaluated and compared among each groups. CO and SMA blood flow in the cirrhotic group were significantly higher than those in the control group, and the increase in CO and SMA blood flow showed a statistically significant correlation with the degree of liver dysfunction (p 2 =0.230). Hyperdynamic circulatory changes such as increases in CO and splanchnic blood flow were present in patients with liver cirrhosis. These changes may contribute to the development and maintenance of the portal hypertension due to an increase in portal blood flow an increase in portal blood flow.

A modification design and adjusting test for instruments and control system of critical assembly

International Nuclear Information System (INIS)

Wu Manrong; Li Guangjian

1996-12-01

A more reliable and safe control system and it's instruments for HFETRCA (high flux engineering test reactor critical assembly) have been built. In the system high performance CMOS unit was used, which has high integration, strong anti-interference and high trigger threshold. In the design of control rod driving circuit, the speed negative feedback principle was applied that results in more stable rotating rate of motors of transmission mechanism and more flexibility of adjusting rod speed. In order to improve reactor safety in accident, additional control circuit is equipped, by which not only control rods with electromagnet will rapidly drop but also other control rods will insert at the speed of 2∼6 times faster than the normal inserting speed. The key technique in the adjustment and new method of anti-interference are also introduced. After more than 40 times physical experiments with (4 x 4 - 4) fuel element in HFETRC, it is proved that the design and adjustment of the system is successful and they can be used as a reference to others. (3 figs., 2 tabs.)

Social networks and mortality based on the Komo-Ise cohort study in Japan.

Science.gov (United States)

Iwasaki, Motoki; Otani, Tetsuya; Sunaga, Rumiko; Miyazaki, Hiroko; Xiao, Liu; Wang, Naren; Yosiaki, Sasazawa; Suzuki, Shosuke

2002-12-01

No prospective studies have examined the association between social networks and all-cause and cause-specific mortality among middle-aged Japanese. The study of varied populations may contribute to clarifying the robustness of the observed effects of social networks and extend their generalizability. To clarify the association between social networks and mortality among middle-aged and elderly Japanese, a community-based prospective study, the Komo-Ise Study, was conducted in two areas of Gunma Prefecture, Japan. A total of 11 565 subjects aged 40-69 years at baseline in 1993 completed a self-administered questionnaire. During the 7-year follow-up period, 335 men and 155 women died and the relative risk (RR) of each social network item was estimated by the Cox proportional hazard model. Single women had significantly increased risks of all-cause (multivariate RR = 2.2), and all circulatory system disease (age-area adjusted RR = 2.6) mortality. Men who did not participate in hobbies, club activities, or community groups had significantly higher multivariate RR for all-cause (RR = 1.5), all circulatory system disease (RR = 1.6) and non-cancer and non-circulatory system disease (RR = 2.3) mortality. Urban women who rarely or never met close relatives had significantly elevated risks of all-cause (RR = 2.4), all cancer (RR = 2.6), and non-cancer and non-circulatory system disease (RR = 2.7) mortality after adjustment for established risk factors. This study provides evidence that social networks are an important predictor of mortality risk for middle-aged and elderly Japanese men and women. Lack of participation, for men, and being single and lack of meeting close relatives, for women, were independent risk factors for mortality.

Neighbouring green space and mortality in community-dwelling elderly Hong Kong Chinese: a cohort study.

Science.gov (United States)

Wang, Dan; Lau, Kevin Ka-Lun; Yu, Ruby; Wong, Samuel Y S; Kwok, Timothy T Y; Woo, Jean

2017-08-01

Green space has been shown to be beneficial for human wellness through multiple pathways. This study aimed to explore the contributions of neighbouring green space to cause-specific mortality. Data from 3544 Chinese men and women (aged ≥65 years at baseline) in a community-based cohort study were analysed. Outcome measures, identified from the death registry, were death from all-cause, respiratory system disease, circulatory system disease. The quantity of green space (%) within a 300 m radius buffer was calculated for each subject from a map created based on the Normalised Difference Vegetation Index. Cox proportional hazard models adjusted for demographics, socioeconomics, lifestyle, health conditions and housing type were used to estimate the HRs and 95% CIs. During a mean of 10.3 years of follow-up, 795 deaths were identified. Our findings showed that a 10% increase in coverage of green space was significantly associated with a reduction in all-cause mortality (HR 0.963, 95% CI 0.930 to 0.998), circulatory system-caused mortality (HR 0.887, 95% CI 0.817 to 0.963) and stroke-caused mortality (HR 0.661, 95% CI 0.524 to 0.835), independent of age, sex, marital status, years lived in Hong Kong, education level, socioeconomic ladder, smoking, alcohol intake, diet quality, self-rated health and housing type. The inverse associations between coverage of green space with all-cause mortality (HR 0.964, 95% CI 0.931 to 0.999) and circulatory system disease-caused mortality (HR 0.888, 95% CI 0.817 to 0.964) were attenuated when the models were further adjusted for physical activity and cognitive function. The effects of green space on all-cause and circulatory system-caused mortality tended to be stronger in females than in males. Higher coverage of green space was associated with reduced risks of all-cause mortality, circulatory system-caused mortality and stroke-caused mortality in Chinese older people living in a highly urbanised city. © Article author(s) (or their

The Risk of Neurological Dysfunctions after Deep Hypothermic Circulatory Arrest with Retrograde Cerebral Perfusion.

Science.gov (United States)

Gatti, Giuseppe; Benussi, Bernardo; Currò, Placido; Forti, Gabriella; Rauber, Elisabetta; Minati, Alessandro; Gabrielli, Marco; Tognolli, Umberto; Sinagra, Gianfranco; Pappalardo, Aniello

2017-12-01

Retrograde cerebral perfusion (RCP) is a brain protection technique that is adopted generally for anticipated short periods of deep hypothermic circulatory arrest (DHCA). However, the real impact of this technique on cerebral protection during DHCA remains a controversial issue. For 344 (59.5%) of 578 consecutive patients (mean age, 66.9 ± 10.9 years) who underwent cardiovascular surgery under DHCA at the present authors' institution (1999-2015), RCP was the sole technique of cerebral protection that was adopted in addition to deep hypothermia. Surgery of the thoracic aorta was performed in 95.9% of these RCP patients; in 92 cases there was an aortic arch involvement. Outcomes were reviewed retrospectively. The focus was on postoperative neurological dysfunctions. There were 33 (9.6%) in-hospital deaths. Thirty-one (9%) patients had permanent neurological dysfunctions and 66 (19.1%) transitory neurological dysfunctions alone. Age older than 74 years (odds ratio [OR], 1.88, P = .023), surgery for acute aortic dissection (OR, 2.57; P = .0009), and DHCA time longer than 25 minutes (OR, 2.44; P = .0021) were predictors of neurological dysfunctions. The 10-year nonparametric estimate of freedom from all-cause death was 61.8% (95% confidence interval, 57.8%-65.8%). Permanent postoperative neurological dysfunctions were risk factors for cardiac or cerebrovascular death (hazard ratio, 2.6; P = .039) even after an adjusted survival analysis (P RCP, in addition to deep hypothermia, combines with a low risk of neurological dysfunctions provided that DHCA length is 25 minutes or less. Permanent postoperative neurological dysfunctions are predictors of poor late survival. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Neonatal aortic arch reconstruction avoiding circulatory arrest and direct arch vessel cannulation.

Science.gov (United States)

Tchervenkov, C I; Korkola, S J; Shum-Tim, D; Calaritis, C; Laliberté, E; Reyes, T U; Lavoie, J

2001-11-01

Aortic arch reconstruction in neonates routinely requires deep hypothermic circulatory arrest. We reviewed our experience with techniques of continuous low-flow cerebral perfusion (LFCP) avoiding direct arch vessel cannulation. Eighteen patients, with a median age of 11 days (range 1 to 85 days) and a mean weight of 3.2 +/- 0.8 kg, underwent aortic arch reconstruction with LFCP. Seven had biventricular repairs with arch reconstruction, 9 underwent the Norwood operation and 2 had isolated arch repairs. In 1 Norwood and 7 biventricular repair patients, LFCP was maintained by advancing the cannula from the distal ascending aorta into the innominate artery. In 8 of 9 Norwood patients, LFCP was maintained by directing the arterial cannula into the pulmonary artery confluence and perfusing the innominate artery through the right modified Blalock-Taussig shunt fully constructed before cannulation for cardiopulmonary bypass. In 2 patients requiring isolated arch reconstruction, the ascending aorta was cannulated and the cross-clamp was applied just distal to the innominate artery. LFCP was maintained at 0.6 +/- 0.2 L x min(-1) x m(-2) for 41.0 +/- 13.9 minutes at 18.5 degrees C +/- 1.1 degrees C. In 10 of the 18 patients, blood pressure during LFCP was 15 +/- 8 mm Hg remote from the innominate artery (left radial, umbilical or femoral arteries). In 8 of the 18 patients, right radial pressure during LFCP was 24 +/- 10 mm Hg. The mean mixed-venous saturation was 79.8% +/- 10% during LFCP. Two patients had preoperative seizures, whereas none had seizures postoperatively. One patient died. Neonatal aortic arch reconstruction is possible without circulatory arrest or direct arch vessel cannulation. These techniques maintained adequate mixed-venous oxygen saturations with no associated adverse neurologic outcomes.

Prophenoloxidase system, lysozyme and protease inhibitor distribution in the common cuttlefish Sepia officinalis.

Science.gov (United States)

Le Pabic, Charles; Safi, Georges; Serpentini, Antoine; Lebel, Jean-Marc; Robin, Jean-Paul; Koueta, Noussithé

2014-01-01

The immune system of cephalopods remains poorly understood. The aim of this study was to determine the specific activity of immune enzymes in epithelial barriers, circulatory and digestive systems of the common cuttlefish Sepia officinalis. Three enzyme groups with putative functions in immunity were investigated: phenoloxidases (POs), lysozymes and protease inhibitors (PIs). Consistent with a role in immunity, highest PO activities were found in the integument as well as the respiratory and circulatory organs under zymogenic (proPO) and active form. Surprisingly, high PO activities were also found in the digestive gland and its appendages. Similarly, high lysozyme activities were detected in the integument and circulatory organs, but also in the posterior salivary glands, highlighting the implication of this antibacterial enzyme group in most tissues exposed to the environment but also within the circulatory system. Albeit highest in digestive organs, the ubiquitous detection of PI activity in assayed compartments suggests immune function(s) in a wide range of tissues. Our study reports proPO/PO, lysozyme and PI distributions in S. officinalis body compartments for the first time, and thus provides the fundamental basis for a better understanding of the humoral immune system in cephalopods as well as invertebrates. Copyright © 2014 Elsevier Inc. All rights reserved.

FY2000 report of the research results of medical/engineering cooperative research project, basic research on systems for minimally invasive diagnostic/treatment of circulatory system diseases, including prognostic diagnosis; 2000 nendo igaku kogaku renkeigata kenkyu jigyo, junkankikei shikkan ni taisuru yogo shindan wo fukumu teishinshu shindan chiryo system ni kansuru kiso kenkyu seika hokokusho

Energy Technology Data Exchange (ETDEWEB)

NONE

2001-07-01

The basic researches on minimally invasive diagnostic/treatment systems are conducted for circulatory system diseases, and the FY 2000 results are reported. The program for developing the heart surgery supporting manipulator includes development of the manipulator of 7 degree of freedom and fail-safe mechanisms to be incorporated in the patient-side system, and research and development of the heart motion compensation type robot system. The program for developing the diagnosis/treatment system aided by intravascular optical analysis includes development of intravascular endoscopy by the aid of LED emitting blue color of high brightness, and automatic analyzer for the in vivo vascular endothelial cell functions. The program for the minimally invasive diagnostic system includes development of superimposing system for integrating the images by the NOGA system and cine-coronary angiography. The other R and D items include artificial vascular systems to be put in the blood vessels, adhesives for a living body, suture instruments for fine blood vessels, heart surgery supporting system, based on the infrared spectroscopy, endoscopic system for the cranical bones, arterialization method, and gene-aided treatment. (NEDO)

Transfusion-associated circulatory overload (TACO: prevention, management, and patient outcomes

Directory of Open Access Journals (Sweden)

Roubinian NH

2015-04-01

Full Text Available Nareg H Roubinian,1,2 Edward L Murphy1–3 1Blood Systems Research Institute, 2Department of Laboratory Medicine, 3Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA Abstract: Transfusion-associated circulatory overload (TACO is acute pulmonary edema associated with left atrial hypertension or volume overload occurring within 6 hours following a blood transfusion. Recognized by physicians as a common complication of blood transfusion, its incidence has been difficult to measure because active surveillance is required to counteract underreporting; active surveillance indicates overall incidence rates as high as 1% per transfused patient. Recent clinical and translational research has focused on the development of electronic alert systems to measure TACO incidence and provide alerts to physicians regarding patients at high risk. Translational research regarding the utility of biomarkers such as brain natriuretic protein (BNP or N-terminal pro-BNP (NT-proBNP as diagnostic tools for TACO has been only moderately successful, but the search for other biomarkers continues. Prevention strategies can be developed based upon evidence derived from both observational studies and might include: using documented risk factors to highlight patients at risk, preferably using real-time analysis of electronic medical records; implementation of modified transfusion strategies to minimize the volume and infusion rate of blood products; consideration of prophylactic diuretic therapy; and heightened diagnostic awareness combined with rapid implementation of treatment. Randomized clinical trials will be required to test such strategies before they are widely implemented. Finally, the occurrence of TACO ought to be considered as a potentially avoidable medical complication that could be used to benchmark transfusion and critical care practice across hospitals. Keywords: blood transfusion, pulmonary edema, risk

Russian mortality beyond vital statistics

Directory of Open Access Journals (Sweden)

2004-04-01

Full Text Available Analyses of routine data have established that the extreme mortality fluctuations among young and middle-aged men are the most important single component of both temporal changes in Russian life expectancy at birth and in the gap between male and female life expectancy. It is also responsible for the largest share of the life expectancy gap between Russia and other industrialised countries. A case-control study has been used to identify factors associated with mortality among men aged 20 to 55 in the five major cities of the Udmurt Republic in 1998-99. Men dying from external causes and circulatory disease are taken as cases. Matched controls were selected from men of the same age living in the same neighbourhood of residence. Information about characteristics of cases and controls was obtained by interviewing proxies who were family members or friends of the subjects. After exclusion of those deaths for which proxy informant could not be identified, a total of 205 circulatory disease and 333 external cause cases were included together with the same number of controls. Educational level was significantly associated with mortality from circulatory diseases and external causes in a crude analysis. However, this could largely be explained by adjustment for employment, marital status, smoking and alcohol consumption. Smoking was associated with mortality from circulatory disease (crude OR=2.44, 95% CI 1.36-4.36, this effect being slightly attenuated after adjustment for socio-economic factors and alcohol consumption. Unemployment was associated with a large increase in the risk of death from external causes (crude OR=3.63, 95% CI 2.17-6.08, an effect that was still substantial after adjustment for other variables (adjusted OR=2.52, 95% CI 1.43-4.43. A reported history of periods of heavy drinking was linked to both deaths from circulatory disease (crude OR=4.21, 95% CI 2.35-7.55 and external cause mortality (crude OR=2.65, 95% CI 1

The ‘abdominal circulatory pump’: an auxiliary heart during exercise?

Directory of Open Access Journals (Sweden)

Barbara eUva

2016-01-01

Full Text Available Apart from its role as a flow generator for ventilation the diaphragm has a circulatory role. The cyclical abdominal pressure variations from its contractions cause swings in venous return from the splanchnic venous circulation. During exercise the action of the abdominal muscles may enhance this circulatory function of the diaphragm. Eleven healthy subjects (25±7yr, 70±11kg, 1.78±0.1m, 3F performed plantar flexion exercise at ∼4 METs. Changes in body volume (ΔVb and trunk volume (ΔVtr were measured simultaneously by double body plethysmography. Volume of blood shifts between trunk and extremities (Vbs was determined non-invasively as ΔVtr-ΔVb. Three types of breathing were studied: spontaneous (SE, rib cage (RCE, voluntary emphasized inspiratory rib cage breathing and abdominal (ABE, voluntary active abdominal expiration breathing.. During SE and RCE blood was displaced from the extremities into the trunk (on average 0.16± 0.33L and 0.48±0.55L, p<0.05 SE vs RCE, while during ABE it was displaced from the trunk to the extremities (0.22±0.20L p<0.001, p<0.05 RCE and SE vs ABE respectively. At baseline, Vbs swings (maximum to minimum amplitude were bimodal and averaged 0.13±0.08L. During exercise, Vbs swings consistently increased (0.42±0.34L, 0.40±0.26L, 0.46±0.21L, for SE, RCE and ABE respectively, all p<0.01 vs. baseline. It follows that during leg exercise significant bi-directional blood shifting occurs between the trunk and the extremities. The dynamics and partitioning of these blood shifts strongly depend on the relative predominance of the action of the diaphragm, the rib cage and the abdominal muscles. Depending on the partitioning between respiratory muscles for the act of breathing, the distribution of blood between trunk and extremities can vary by up to 1 L. We conclude that during exercise the abdominal muscles and the diaphragm might play a role of an ‘auxiliary heart’.

Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support

Directory of Open Access Journals (Sweden)

Peek Giles J

2007-01-01

Full Text Available Abstract Background Veno-arterial extracorporeal membrane oxygenation (ECMO is a common modality of circulatory assist device used in children. We assessed the outcome of children who had ECMO following repair of congenital cardiac defects (CCD and identified the risk factors associated with hospital mortality. Methods From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis. Results Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66% and of these 83% were survival to hospital-discharge. 37.7% of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality. On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79% and 21% of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031. Conclusion ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival.

Utilization of organs from donors after circulatory death for vascularized pancreas and islet of Langerhans transplantation : recommendations from an expert group

NARCIS (Netherlands)

Berney, Thierry; Boffa, Catherine; Augustine, Titus; Badet, Lionel; de Koning, Eelco; Pratschke, Johann; Socci, Carlo; Friend, Peter

2015-01-01

Donation after circulatory death (DCD) donors are increasingly being used as a source of pancreas allografts for vascularized organ and islet transplantation. We provide practice guidelines aiming to increase DCD pancreas utilization. We review risk assessment and donor selection criteria. We report

Metric-adjusted skew information

DEFF Research Database (Denmark)

Liang, Cai; Hansen, Frank

2010-01-01

on a bipartite system and proved superadditivity of the Wigner-Yanase-Dyson skew informations for such states. We extend this result to the general metric-adjusted skew information. We finally show that a recently introduced extension to parameter values 1 ...We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...... of (unbounded) metric-adjusted skew information....

Behavioral Risk Factor Surveillance System (BRFSS) Age-Adjusted Prevalence Data (2011 to present)

Data.gov (United States)

U.S. Department of Health & Human Services — 2011 to present. BRFSS combined land line and cell phone age-adjusted prevalence data. The BRFSS is a continuous, state-based surveillance system that collects...

Transplantation of Hearts Donated after Circulatory Death

Directory of Open Access Journals (Sweden)

Christopher W. White

2018-02-01

Full Text Available Cardiac transplantation has become limited by a critical shortage of suitable organs from brain-dead donors. Reports describing the successful clinical transplantation of hearts donated after circulatory death (DCD have recently emerged. Hearts from DCD donors suffer significant ischemic injury prior to organ procurement; therefore, the traditional approach to the transplantation of hearts from brain-dead donors is not applicable to the DCD context. Advances in our understanding of ischemic post-conditioning have facilitated the development of DCD heart resuscitation strategies that can be used to minimize ischemia-reperfusion injury at the time of organ procurement. The availability of a clinically approved ex situ heart perfusion device now allows DCD heart preservation in a normothermic beating state and minimizes exposure to incremental cold ischemia. This technology also facilitates assessments of organ viability to be undertaken prior to transplantation, thereby minimizing the risk of primary graft dysfunction. The application of a tailored approach to DCD heart transplantation that focuses on organ resuscitation at the time of procurement, ex situ preservation, and pre-transplant assessments of organ viability has facilitated the successful clinical application of DCD heart transplantation. The transplantation of hearts from DCD donors is now a clinical reality. Investigating ways to optimize the resuscitation, preservation, evaluation, and long-term outcomes is vital to ensure a broader application of DCD heart transplantation in the future.

The effects of aprotinin on blood product transfusion associated with thoracic aortic surgery requiring deep hypothermic circulatory arrest.

LENUS (Irish Health Repository)

Seigne, P W

2012-02-03

OBJECTIVE: To compare the effects of aprotinin on blood product use and postoperative complications in patients undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest. DESIGN: A retrospective study. SETTING: A university hospital. PARTICIPANTS: Nineteen patients who underwent elective or urgent thoracic aortic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The total number of units of packed red blood cells, fresh frozen plasma, and platelets was significantly less in the group that received aprotinin (p = 0.01, 0.04, and 0.01). The intraoperative transfusion of packed red blood cells and platelets, collection and retransfusion of cell saver, and postoperative transfusion of fresh frozen plasma were also significantly less in the aprotinin group (p = 0.01, 0.02, 0.01, and 0.05). No patient in either group sustained renal dysfunction or a myocardial infarction. Two patients who had not received aprotinin suffered from chronic postoperative seizures, and one patient who had received aprotinin sustained a perioperative stroke. CONCLUSIONS: Low-dose aprotinin administration significantly decreases blood product transfusion requirements in the setting of thoracic aortic surgery requiring deep hypothermic circulatory arrest, and it does not appear to be associated with renal or myocardial dysfunction.

A Multicenter Study on Long-Term Outcomes After Lung Transplantation Comparing Donation After Circulatory Death and Donation After Brain Death

NARCIS (Netherlands)

van Suylen, Vincent; Luijk, B.; Hoek, R A S; van de Graaf, E. A.; Verschuuren, E A; Van De Wauwer, C; Bekkers, J A; Meijer, R C A; van der Bij, W; Erasmus, M E

2017-01-01

The implementation of donation after circulatory death category 3 (DCD3) was one of the attempts to reduce the gap between supply and demand of donor lungs. In the Netherlands, the total number of potential lung donors was greatly increased by the availability of DCD3 lungs in addition to the

Asymmetric adjustment

NARCIS (Netherlands)

2010-01-01

A method of adjusting a signal processing parameter for a first hearing aid and a second hearing aid forming parts of a binaural hearing aid system to be worn by a user is provided. The binaural hearing aid system comprises a user specific model representing a desired asymmetry between a first ear

Astragalus Extract Mixture HT042 Increases Longitudinal Bone Growth Rate by Upregulating Circulatory IGF-1 in Rats

Directory of Open Access Journals (Sweden)

Donghun Lee

2017-01-01

Full Text Available Astragalus extract mixture HT042 is a standardized ingredient of health functional food approved by Korean FDA with a claim of “height growth of children.” HT042 stimulates bone growth rate and increases local IGF-1 expression in growth plate of rats which can be considered as direct stimulation of GH and its paracrine/autocrine actions. However, it remains unclear whether HT042 stimulates circulatory IGF-1 which also plays a major role to stimulate bone growth. To determine the effects on circulatory IGF-1, IGF-1 and IGFBP-3 expressions and phosphorylation of JAK2/STAT5 were evaluated in the liver after 10 days of HT042 administration. HT042 upregulated liver IGF-1 and IGFBP-3 mRNA expression, IGF-1 protein expression, and phosphorylation of JAK2/STAT5. HT042 also increased bone growth rate and proliferative zonal height in growth plate. In conclusion, HT042 stimulates bone growth rate via increment of proliferative rate by upregulation of liver IGF-1 and IGFBP-3 mRNA followed by IGF-1 protein expression through phosphorylation of JAK2/STAT5, which can be regarded as normal functioning of GH-dependent endocrine pathway.

Evaluation of cerebro-circulatory metabolic conditions and prognosis in hypertensive putaminal hemorrhage by 31P-MRS

International Nuclear Information System (INIS)

Deguchi, Itaru

2000-01-01

Phosphorus-31 nuclear magnetic resonance spectroscopy ( 31 P-MRS) provides a non-invasive means to obtain metabolic information. We studied cerebro-circulatory metabolic conditions in the subacute phase of hypertensive putaminal hemorrhage with 31 P-MRS and N-isopropyl-I-(123)-p-Iodoamphetamine single photon emission computed tomography ( 123 I-IMP SPECT). The subjects consisted of 33 cases of hypertensive putaminal hemorrhage. Upon evaluation of cerebral blood flow (CBF) around the ipsilateral frontal lobe cortex and examination by 123 I-IMP SPECT, they would broadly divided into the following three groups: (A) a group with high uptake on both the early image and delayed image, (B) a group with low uptake on the early image but with good redistribution, and (C) a group with low uptake on both images. In these groups 31 P-MRS in the ipsilateral frontal lobe cortex was measured for comparative analysis. In group A, the PCr/Pi ratio was 3.12±0.14 as opposed to 2.87±0.13 in group B, and the ratio was extremely depressed in group C, 1.96±0.16. These observations implied that a high level circulatory metabolic disorder was present in group C and that local viability or metabolic activity was relatively well maintained despite the low perfusion in group B with a satisfactory prognosis being expected due to their high functional level. (author)

Study on the adjustment capability of the excitation system located inside superconducting machine electromagnetic shield

Science.gov (United States)

Xia, D.; Xia, Z.

2017-12-01

The ability for the excitation system to adjust quickly plays a very important role in maintaining the normal operation of superconducting machines and power systems. However, the eddy currents in the electromagnetic shield of superconducting machines hinder the exciting magnetic field change and weaken the adjustment capability of the excitation system. To analyze this problem, a finite element calculation model for the transient electromagnetic field with moving parts is established. The effects of three different electromagnetic shields on the exciting magnetic field are analyzed using finite element method. The results show that the electromagnetic shield hinders the field changes significantly, the better its conductivity, the greater the effect on the superconducting machine excitation.

Use and Outcomes of Kidneys from Donation after Circulatory Death Donors in the United States.

Science.gov (United States)

Gill, John; Rose, Caren; Lesage, Julie; Joffres, Yayuk; Gill, Jagbir; O'Connor, Kevin

2017-12-01

Donation after circulatory death (DCD) donors are an important source of kidneys for transplantation, but DCD donor transplantation is less common in the United States than in other countries. In this study of national data obtained between 2008 and 2015, recovery of DCD kidneys varied substantially among the country's 58 donor service areas, and 25% of DCD kidneys were recovered in only four donor service areas. Overall, 20% of recovered DCD kidneys were discarded, varying from 3% to 33% among donor service areas. Compared with kidneys from neurologically brain dead (NBD) donors, DCD kidneys had a higher adjusted odds ratio of discard that varied from 1.25 (95% confidence interval [95% CI], 1.16 to 1.34) in kidneys with total donor warm ischemic time (WIT) of 10-26 minutes to 2.67 (95% CI, 2.34 to 3.04) in kidneys with total donor WIT >48 minutes. Among the 12,831 DCD kidneys transplanted, kidneys with WIT≤48 minutes had survival similar to that of NBD kidneys. DCD kidneys with WIT>48 minutes had a higher risk of allograft failure (hazard ratio, 1.23; 95% CI, 1.07 to 1.41), but this risk was limited to kidneys with cold ischemia time (CIT) >12 hours. We conclude that donor service area-level variation in the recovery and discard of DCD kidneys is large. Additional national data collection is needed to understand the potential to increase DCD donor transplantation in the United States. Strategies to minimize cold ischemic injury may safely allow increased use of DCD kidneys with WIT>48 minutes. Copyright © 2017 by the American Society of Nephrology.

Adjustable Pitot Probe

Science.gov (United States)

Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

1991-01-01

Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

Controlling chaos based on an adaptive adjustment mechanism

International Nuclear Information System (INIS)

Zheng Yongai

2006-01-01

In this paper, we extend the ideas and techniques developed by Huang [Huang W. Stabilizing nonlinear dynamical systems by an adaptive adjustment mechanism. Phys Rev E 2000;61:R1012-5] for controlling discrete-time chaotic system using adaptive adjustment mechanism to continuous-time chaotic system. Two control approaches, namely adaptive adjustment mechanism (AAM) and modified adaptive adjustment mechanism (MAAM), are investigated. In both case sufficient conditions for the stabilization of chaotic systems are given analytically. The simulation results on Chen chaotic system have verified the effectiveness of the proposed techniques

Acute resistance exercise modulates microRNA expression profiles: Combined tissue and circulatory targeted analyses.

Directory of Open Access Journals (Sweden)

Randall F D'Souza

Full Text Available A subset of short non-coding RNAs, microRNAs (miRs, have been identified in the regulation of skeletal muscle hypertrophy and atrophy. Expressed within cells, miRs are also present in circulation (c-miR and have a putative role in cross-tissue signalling. The aim of this study was to examine the impact of a single bout of high intensity resistance exercise (RE on skeletal muscle and circulatory miRs harvested simultaneously. Resistance trained males (n = 9, 24.6 ± 4.9 years undertook a single bout of high volume RE with venous blood and muscle biopsies collected before, 2 and 4hr post-exercise. Real time polymerase chain reaction (Rt-PCR analyses was performed on 30 miRs that have previously been shown to be required for skeletal muscle function. Of these, 6 miRs were significantly altered within muscle following exercise; miR-23a, -133a, -146a, -206, -378b and 486. Analysis of these same miRs in circulation demonstrated minimal alterations with exercise, although c-miR-133a (~4 fold, p = 0.049 and c-miR-149 (~2.4 fold; p = 0.006 were increased 4hr post-exercise. Thus a single bout of RE results in the increased abundance of a subset of miRs within the skeletal muscle, which was not evident in plasma. The lack a qualitative agreement in the response pattern of intramuscular and circulating miR expression suggests the analysis of circulatory miRs is not reflective of the miR responses within skeletal muscle after exercise.

Fluoro jade-C staining in the assessment of brain injury after deep hypothermia circulatory arrest.

Science.gov (United States)

Wang, Ren; Ma, Wei-Guo; Gao, Guo-Dong; Mao, Qun-Xia; Zheng, Jun; Sun, Li-Zhong; Liu, Ying-Long

2011-02-04

To evaluate the efficacy of Fluoro Jade-C staining (FJC) in the assessment of brain injury after deep hypothermia circulatory arrest (DHCA). Six healthy adult miniature male pigs underwent DHCA, the rectal temperature was down to 18°C, circulation was stopped , circulatory arrest was maintained for 60 minutes. On postoperative day 1, perfusion-fixation was performed on brain tissue. Cerebral cortex, hippocampus, cerebellum were taken for sampling. FJC, hematoxylin-eosin staining (HE), nissl staining (NISSL), terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) were performed to detect the histological and pathological changes. Histological scores of all slices were ranked. Comparison between the FJC and other techniques was done by analysis of variance (ANOVA) according to histological scores. All animals survived the operation. On the cerebral cortex, in comparison of FJC between HE, NISSL and TUNEL, the p value was 0.90, 0.40, 0.16 respectively (p>0.05). On the hippocampus, the comparison of FJC with HE, NISSL and TUNEL had a p value of 0.12, 0.23, 0.62 respectively (p>0.05). On the cerebellum, in comparing FJC with HE, NISSL and TUNEL, the p value was 0.96, 0.77, 0.96 respectively (p>0.05). On representative regions, the results of FJC were in accordance with that of TUNEL, NISSL and HE. Furthermore, ascertainment of brain injury is easier with FJC. FJC is a reliable and convenient method to assess brain injury after DHCA. Copyright © 2010 Elsevier B.V. All rights reserved.

Adjustable collimator

International Nuclear Information System (INIS)

Carlson, R.W.; Covic, J.; Leininger, G.

1981-01-01

In a rotating fan beam tomographic scanner there is included an adjustable collimator and shutter assembly. The assembly includes a fan angle collimation cylinder having a plurality of different length slots through which the beam may pass for adjusting the fan angle of the beam. It also includes a beam thickness cylinder having a plurality of slots of different widths for adjusting the thickness of the beam. Further, some of the slots have filter materials mounted therein so that the operator may select from a plurality of filters. Also disclosed is a servo motor system which allows the operator to select the desired fan angle, beam thickness and filter from a remote location. An additional feature is a failsafe shutter assembly which includes a spring biased shutter cylinder mounted in the collimation cylinders. The servo motor control circuit checks several system conditions before the shutter is rendered openable. Further, the circuit cuts off the radiation if the shutter fails to open or close properly. A still further feature is a reference radiation intensity monitor which includes a tuning-fork shaped light conducting element having a scintillation crystal mounted on each tine. The monitor is placed adjacent the collimator between it and the source with the pair of crystals to either side of the fan beam

Adjustable Nyquist-rate System for Single-Bit Sigma-Delta ADC with Alternative FIR Architecture

Science.gov (United States)

Frick, Vincent; Dadouche, Foudil; Berviller, Hervé

2016-09-01

This paper presents a new smart and compact system dedicated to control the output sampling frequency of an analogue-to-digital converters (ADC) based on single-bit sigma-delta (ΣΔ) modulator. This system dramatically improves the spectral analysis capabilities of power network analysers (power meters) by adjusting the ADC's sampling frequency to the input signal's fundamental frequency with a few parts per million accuracy. The trade-off between straightforwardness and performance that motivated the choice of the ADC's architecture are preliminary discussed. It particularly comes along with design considerations of an ultra-steep direct-form FIR that is optimised in terms of size and operating speed. Thanks to compact standard VHDL language description, the architecture of the proposed system is particularly suitable for application-specific integrated circuit (ASIC) implementation-oriented low-power and low-cost power meter applications. Field programmable gate array (FPGA) prototyping and experimental results validate the adjustable sampling frequency concept. They also show that the system can perform better in terms of implementation and power capabilities compared to dedicated IP resources.

Sewerage force adjustment technology for energy conservation in vacuum sanitation systems

Science.gov (United States)

Guo, Zhonghua; Li, Xiaoning; Kagawa, Toshiharu

2013-03-01

The vacuum sanitation is the safe and sound disposal approach of human excreta under the specific environments like flights, high speed trains and submarines. However, the propulsive force of current systems is not adjustable and the energy consumption does not adapt to the real time sewerage requirement. Therefore, it is important to study the sewerage force adjustment to improve the energy efficiency. This paper proposes an energy conservation design in vacuum sanitation systems with pneumatic ejector circuits. The sewerage force is controlled by changing the systematic vacuum degree according to the amount of the excreta. In particular, the amount of the excreta is tested by liquid level sensor and mass sensor. According to the amount of the excreta, the relationship between the excreta amount and the sewerage force is studied to provide proper propulsive force. In the other aspect, to provide variable vacuum degrees for different sanitation requirements, the suction and discharge system is designed with pneumatic vacuum ejector. On the basis of the static flow-rate characteristics and the vacuum generation model, the pressure response in the ejector circuit is studied by using the static flow rate characteristics of the ejector and air status equation. The relationship is obtained between supplied compressed air and systematic vacuum degree. When the compressed air is supplied to the ejector continuously, the systematic vacuum degree increases until the vacuum degree reaches the extreme value. Therefore, the variable systematic vacuum degree is obtained by controlling the compressed air supply of the ejector. To verify the effect of energy conservation, experiments are carried out in the artificial excreta collection, and the variable vacuum-degree design saves more than 30% of the energy supply. The energy conservation is realized effectively in the new vacuum sanitation systems with good application prospect. The proposed technology provides technological

Intracorporeal Heat Distribution from Fully Implantable Energy Sources for Mechanical Circulatory Support: A Computational Proof-of-Concept Study

OpenAIRE

Biasetti, Jacopo; Pustavoitau, Aliaksei; Spazzini, Pier Giorgio

2017-01-01

Mechanical circulatory support devices, such as total artificial hearts and left ventricular assist devices, rely on external energy sources for their continuous operation. Clinically approved power supplies rely on percutaneous cables connecting an external energy source to the implanted device with the associated risk of infections. One alternative, investigated in the 70s and 80s, employs a fully implanted nuclear power source. The heat generated by the nuclear decay can be converted into ...

How to design a border adjustment for the European Union Emissions Trading System?

International Nuclear Information System (INIS)

Monjon, Stephanie; Quirion, Philippe

2010-01-01

Border adjustments are currently discussed to limit the possible adverse impact of climate policies on competitiveness and carbon leakage. We discuss the main choices that will have to be made if the European Union implements such a system alongside the EU ETS. Although more analysis is required on some issues, on others some design options seem clearly preferable to others. First, the import adjustment should be a requirement to surrender allowances rather than a tax. Second, the general rule to determine the amount of allowances per ton imported should be the product-specific benchmarks that the European Commission is currently elaborating for a different purpose (i.e. to determine the amount of free allowances). Third, this obligation should apply when the imported product is registered at the EU border, and not after the end of the year as is the case for domestic emitters. Fourth, the export adjustment should take the form of a rebate on the amount of allowances a domestic emitter has to surrender. Five, this rebate should equal the above-mentioned product-specific benchmarks, not the emissions of the particular exporting plant or firm. Finally, the adjustment does not have to apply to consumer products but mostly to basic products. (author)

Circulatory adaptation to long-term high altitude exposure in Aymaras and Caucasians.

Science.gov (United States)

Stuber, Thomas; Scherrer, Urs

2010-01-01

About 30 million people live above 2500 m in the Andean Mountains of South America. Among them are 5.5 million Aymaras, an ethnic group with its own language, living on the altiplano of Bolivia, Peru, and northern Chile at altitudes of up to 4400 m. In this high altitude region traces of human population go back for more than 2000 years with constant evolutionary pressure on its residents for genetic adaptation to high altitude. Aymaras as the assumed direct descendents of the ancient cultures living in this region were the focus of much research interest during the last decades and several distinctive adaptation patterns to life at high altitude have been described in this ethnic group. The aim of this article was to review the physiology and pathophysiology of circulatory adaptation and maladaptation to longtime altitude exposure in Aymaras and Caucasians.

Trends in prevalence of patient case-mix adjusters used in the Medicare dialysis payment system.

Science.gov (United States)

Hollenbeak, Christopher S; Rubin, Robert J; Tzivelekis, Spiros; Stephens, J Mark

2015-06-01

The Medicare End-Stage Renal Disease Prospective Payment System (PPS) used data from 2006-08 to set weights for each case-mix adjuster that is part of the bundled payment formula. The details of the population case-mix were not made public, and little is known about consistency of case-mix over time. This study estimated the prevalence of case-mix adjusters during 2006-2008 and analyzed changes in case-mix prevalence from 2000-2008. Cross-sectional cohort study using United States Renal Data System data for Medicare dialysis patients. Three 3-year cohorts (2000-02, 2003-05, 2006-08) were analyzed for changes over time in case-mix prevalence. Double-digit trends were observed in many case-mix categories between 2000-02 and 2006-08. Large declines were observed in prevalence of patients with low BMI, pericarditis, new to dialysis, and ages 18-44. Large increases were observed in chronic co-morbidities, pneumonia and age cohort 80+. Substantial changes in case-mix adjuster prevalence suggest the PPS payment formula should be regularly updated.

Ion transport in circulatory and/or septic shock

International Nuclear Information System (INIS)

Sayeed, M.M.

1987-01-01

This review surveys investigations of membrane ion transport in animals in hemorrhagic, endotoxic, or bacteremic shock. The focus of the review is on ion transport studies in the skeletal muscle and liver. Skeletal muscle Na + -K + transport alterations have been shown during the induction of shock via hemorrhage, endotoxin, or live Gram-negative bacteria in the rodent, canine, and primate species. These alterations include impairment of active cellular K + accumulation, increased permeability to 24 Na + and Cl - , and membrane depolarization. The ion transport alterations in the skeletal muscle are compatible with movement of extracellular fluid into the intracellular compartment. Such fluid movements can potentially lead to decreases in circulating plasma volume and thus to circulatory deficits in shock. Studies in the liver of rats subjected to hemorrhagic or endotoxic shock indicated the failure of electrogenic Na + pump. Although the hepatic cellular membrane permeability to Na + relative to permeability to K + appeared unaltered in hemorrhagic shock, endotoxic shock caused an increase in permeability to Na + . Hepatic cellular 45 Ca + regulation also appeared to be adversely affected during endotoxic shock. Alterations in hepatic Na + -K + transport and Ca + regulation could contribute to impairment in hepatic glucose production during shock. Although mechanisms of altered membrane ion transport during shock states remain unknown, such changes could occur prior to any substantial loss of cellular metabolic energy

Effective System for Automatic Bundle Block Adjustment and Ortho Image Generation from Multi Sensor Satellite Imagery

Science.gov (United States)

Akilan, A.; Nagasubramanian, V.; Chaudhry, A.; Reddy, D. Rajesh; Sudheer Reddy, D.; Usha Devi, R.; Tirupati, T.; Radhadevi, P. V.; Varadan, G.

2014-11-01

Block Adjustment is a technique for large area mapping for images obtained from different remote sensingsatellites.The challenge in this process is to handle huge number of satellite imageries from different sources with different resolution and accuracies at the system level. This paper explains a system with various tools and techniques to effectively handle the end-to-end chain in large area mapping and production with good level of automation and the provisions for intuitive analysis of final results in 3D and 2D environment. In addition, the interface for using open source ortho and DEM references viz., ETM, SRTM etc. and displaying ESRI shapes for the image foot-prints are explained. Rigorous theory, mathematical modelling, workflow automation and sophisticated software engineering tools are included to ensure high photogrammetric accuracy and productivity. Major building blocks like Georeferencing, Geo-capturing and Geo-Modelling tools included in the block adjustment solution are explained in this paper. To provide optimal bundle block adjustment solution with high precision results, the system has been optimized in many stages to exploit the full utilization of hardware resources. The robustness of the system is ensured by handling failure in automatic procedure and saving the process state in every stage for subsequent restoration from the point of interruption. The results obtained from various stages of the system are presented in the paper.

Effect of Withania Somnifera Root Powder on the Levels of Circulatory Lipid Peroxidation and Liver Marker Enzymes in Chronic Hyperammonemia

Directory of Open Access Journals (Sweden)

B. Harikrishnan

2008-01-01

Full Text Available Withania somnifera (L Dunal (Solanaceae, commonly called Ashwagandha (Sanskrit is an Ayurvedic Indian medicinal plant, which has been widely used as a home remedy for several ailments. We have investigated the influence of W.somnifera root powder on the levels of circulatory ammonia, urea, lipid peroxidation products such as TBARS (thiobarbituric acid and reactive substances, HP (hydroperoxides and liver marker enzymes such as AST (aspartate transaminase, ALT (alanine transaminase and ALP (alkaline phosphatase, for its hepatoprotective effect in ammonium chloride induced hyperammonemia. Ammonium chloride treated rats showed a significant increase in the levels of circulatory ammonia, urea, AST, ALT, ALP, TBARS and HP. These changes were significantly decreased in rats treated with W.somnifera root powder and ammonium chloride. Our results indicate that W.somnifera offers hepatoprotection by influencing the levels of lipid peroxidation products and liver markers in experimental hyperammonemia and this could be due to (i the presence of alkaloids, withanolids and flavonoids, (ii normalizing the levels of urea and urea related compounds, (iii its free radical scavenging property and (iv its antioxidant property. The exact underlying mechanism is still unclear and further research needed.

Clinical comparison of radionuclide cisternography and computed tomography in CSF circulatory disturbance

International Nuclear Information System (INIS)

Tanabe, Masaya; Futatsuki, Minoru; Tanaka, Hiroshi.

1980-01-01

Forty-three patients with abnormal cisternograms were classified into (1) NPH, (2) Postmeningitic hydrocephalus, (3) Posttraumatic hydrocephalus, (4) Postoperative hydrocephalus (tumor) (5) Postoperative hydrocephalus (vascular disease), (6) Meningitis, (7) Tumor, (8) Vascular disease, (9) Degenerative disease and (10) Miscellaneous. Cisternography was done by a scinticamera with 111 In-DTPA and all groups were scanned by IInd generation CT scanner. The result of the cisternography was not always compatible with the CT findings. We found a case of anatomically normal but functionally abnormal cisterns and ventricular system. In all classified disorder groups, the cisternography detected functioning cisterns in CSF dynamics but the CT visualized anatomically open cisterns. By the combined use of these two examinations, a local cisternal block was detected. Ten in 20 cases with operated (V-P shunt) hydrocephalus clinically improved. But the result of these techniques, failed to assess the effectiveness of the V-P shunt. V-P shunt was effective in 8 out of 14 cases with persistent ventricular reflux and delayed clearance, and in 9 out of 17 cases with total ventricular dilatation. We concluded that the combined use of the RI cisternography and the computed tomography was better than single examination to detect CSF circulatory disturbance but we were not satisfied with the joint use in the evaluation of the effect of V-P shunt. No adverse reaction was experienced in the 43 patients with 111 In-DTPA. (author)

Clinical comparison of radionuclide cisternography and computed tomography in CSF circulatory disturbance

Energy Technology Data Exchange (ETDEWEB)

Tanabe, M.; Futatsuki, M. (Tazuke Kofukai Medical Research Inst., Osaka (Japan). Kitano Hospital); Tanaka, H.

1980-12-01

Forty-three patients with abnormal cisternograms were classified into (1) NPH, (2) Postmeningitic hydrocephalus, (3) Posttraumatic hydrocephalus, (4) Postoperative hydrocephalus (tumor) (5) Postoperative hydrocephalus (vascular disease), (6) Meningitis, (7) Tumor, (8) Vascular disease, (9) Degenerative disease and (10) Miscellaneous. Cisternography was done by a scinticamera with /sup 111/In-DTPA and all groups were scanned by IInd generation CT scanner. The result of the cisternography was not always compatible with the CT findings. We found a case of anatomically normal but functionally abnormal cisterns and ventricular system. In all classified disorder groups, the cisternography detected functioning cisterns in CSF dynamics but the CT visualized anatomically open cisterns. By the combined use of these two examinations, a local cisternal block was detected. Ten in 20 cases with operated (V-P shunt) hydrocephalus clinically improved. But the result of these techniques, failed to assess the effectiveness of the V-P shunt. V-P shunt was effective in 8 out of 14 cases with persistent ventricular reflux and delayed clearance, and in 9 out of 17 cases with total ventricular dilatation. We concluded that the combined use of the RI cisternography and the computed tomography was better than single examination to detect CSF circulatory disturbance but we were not satisfied with the joint use in the evaluation of the effect of V-P shunt. No adverse reaction was experienced in the 43 patients with /sup 111/In-DTPA.

A systematic review and meta-analysis of the circulatory, erythrocellular and CSF selenium levels in Alzheimer's disease: A metal meta-analysis (AMMA study-I).

Science.gov (United States)

Reddy, Varikasuvu Seshadri; Bukke, Suman; Dutt, Naveen; Rana, Puneet; Pandey, Arun Kumar

2017-07-01

Available studies in the literature on the selenium levels in Alzheimer's disease (AD) are inconsistent with some studies reporting its decrease in the circulation, while others reported an increase or no change as compared to controls. The objective of this study was to perform a meta-analysis of circulatory (plasma/serum and blood), erythrocyte and cerebrospinal fluid (CSF) selenium levels in AD compared controls. We also performed a meta-analysis of the correlation coefficients (r) to demonstrate the associations between selenium and glutathione peroxidase (GPx) in AD patients. All major databases were searched for eligible studies. We included 12 case-control/observational studies reporting selenium concentrations in AD and controls. Pooled-overall effect size as standardized mean difference (SMD) and pooled r-values were generated using Review Manager 5.3 and MedCalc 15.8 software. Random-effects meta-analysis indicated a decrease in circulatory (SMD=-0.44), erythrocellular (SMD=-0.52) and CSF (SMD=-0.14) selenium levels in AD patients compared to controls. Stratified meta-analysis demonstrated that the selenium levels were decreased in both the subgroups with (SMD=-0.55) and without (SMD=-0.37) age matching between AD and controls. Our results also demonstrated a direct association between decreased selenium levels and GPx in AD. This meta-analysis suggests that circulatory selenium concentration is significantly lower in AD patients compared to controls and this decrease in selenium is directly correlated with an important antioxidant enzyme, the GPx, in AD. Copyright © 2017 Elsevier GmbH. All rights reserved.

A novel combination technique of cold crystalloid perfusion but not cold storage facilitates transplantation of canine hearts donated after circulatory death.

Science.gov (United States)

Rosenfeldt, Franklin; Ou, Ruchong; Salamonsen, Robert; Marasco, Silvana; Zimmet, Adam; Byrne, Joshua; Cosic, Filip; Saxena, Pankaj; Esmore, Donald

2016-11-01

Donation after circulatory death (DCD) represents a potential new source of hearts to increase the donor pool. We showed previously that DCD hearts in Greyhound dogs could be resuscitated and preserved by continuous cold crystalloid perfusion but not by cold static storage and could demonstrate excellent contractile and metabolic function on an in vitro system. In the current study, we demonstrate that resuscitated DCD hearts are transplantable. Donor Greyhound dogs (n = 12) were divided into perfusion (n = 8) and cold static storage (n = 4) groups. General anesthesia was induced and ventilation ceased for 30 minutes to achieve circulatory death. Donor cardiectomy was performed, and for 4 hours the heart was preserved by controlled reperfusion, followed by continuous cold perfusion with an oxygenated crystalloid perfusate or by static cold storage, after which orthotopic heart transplantation was performed. Recovery was assessed over 4 hours by hemodynamic monitoring. During cold perfusion, hearts showed continuous oxygen consumption and low lactate levels, indicating aerobic metabolism. The 8 dogs in the perfusion group were weaned off bypass, and 4 hours after bypass produced cardiac output of 4.73 ± 0.51 liters/min, left ventricular power of 7.63 ± 1.32 J/s, right ventricular power of 1.40 ± 0.43 J/s, and left ventricular fractional area shortening of 39.1% ± 5.2%, all comparable to pre-transplant values. In the cold storage group, 3 of 4 animals could not be weaned from cardiopulmonary bypass, and the fourth exhibited low-level function. Cold crystalloid perfusion, but not cold static storage, can resuscitate and preserve the DCD donor heart in a canine model of heart transplantation, thus rendering it transplantable. Controlled reperfusion and cold crystalloid perfusion have potential for clinical application in DCD transplantation. Copyright © 2016. Published by Elsevier Inc.

A first-in-man study of the Reitan catheter pump for circulatory support in patients undergoing high-risk percutaneous coronary intervention.

Science.gov (United States)

Smith, Elliot J; Reitan, Oyvind; Keeble, Thomas; Dixon, Kerry; Rothman, Martin T

2009-06-01

To investigate the safety of a novel percutaneous circulatory support device during high-risk percutaneous coronary intervention (PCI). The Reitan catheter pump (RCP) consists of a catheter-mounted pump-head with a foldable propeller and surrounding cage. Positioned in the descending aorta the pump creates a pressure gradient, reducing afterload and enhancing organ perfusion. Ten consecutive patients requiring circulatory support underwent PCI; mean age 71 +/- 9; LVEF 34% +/- 11%; jeopardy score 8 +/- 2.3. The RCP was inserted via the femoral artery. Hemostasis was achieved using Perclose sutures. PCI was performed via the radial artery. Outcomes included in-hospital death, MI, stroke, and vascular injury. Hemoglobin (Hb), free plasma Hb (fHb), platelets, and creatinine (cre) were measured pre PCI and post RCP removal. The pump was inserted and operated successfully in 9/10 cases (median 79 min). Propeller rotation at 10,444 +/- 1,424 rpm maintained an aortic gradient of 9.8 +/- 2 mm Hg. Although fHb increased, there was no significant hemolysis (4.7 +/- 2.4 mg/dl pre vs. 11.9 +/- 10.5 post, P = 0.04, reference 20 mg/dl). Platelets were unchanged (pre 257 +/- 74 x 10(9) vs. 245 +/- 63, P = NS). Renal function improved (cre pre 110 +/- 27 micromol/l vs. 99 +/- 28, P = 0.004). The RCP was not used in one patient following femoral introducer sheath related aortic dissection. All PCI procedures were successful with no deaths or strokes, one MI, and no vascular complications following pump removal. The RCP can be used safely in high-risk PCI patients. This device may be an alternative to other percutaneous systems when substantial cardiac support is needed. (c) 2009 Wiley-Liss, Inc.

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

Science.gov (United States)

Chang, Hsien-Yen; Weiner, Jonathan P

2010-01-18

Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory

Capture of circulatory endothelial progenitor cells and accelerated re-endothelialization of a bio-engineered stent in human ex vivo shunt and rabbit denudation model

NARCIS (Netherlands)

K. Larsen (Katarína); C. Cheng (Caroline (Ka Lai)); D. Tempel (Dennie); S. Parker (Sherry); S. Yazdani (Saami); W.K. den Dekker (Wijnand); H.J. Houtgraaf (Jaco); R. de Jong (Renate); S. Swager-ten Hoor (Stijn); E. Ligtenberg (Erik); S.R. Hanson (Stephen); R. Rowland (Steve); F. Kolodgie (Frank); P.W.J.C. Serruys (Patrick); R. Virmani (Renu); H.J. Duckers (Henricus)

2012-01-01

textabstractThe Genous™ Bio-engineered R™ stent (GS) aims to promote vascular healing by capture of circulatory endothelial progenitor cells (EPCs) to the surface of the stent struts, resulting in accelerated re-endothelialization. Here, we assessed the function of the GS in comparison to bare-metal

Development of mechanical circulatory support devices in China.

Science.gov (United States)

Wang, Wei; Zhu, De-Ming; Ding, Wen-Xiang

2009-11-01

Myocardial dysfunction leading to low cardiac output syndrome is a common clinical pathophysiological state. Currently, the use of mechanical circulatory support (MCS) is an essential aspect of the treatment of patients with cardiac failure. Several groups in China are engaged in the design and development of MCS devices. These devices can be classified as pulsatile, rotary, and total artificial heart (TAH). There are two types of pulsatile pump, which are driven by air (pneumatic). One of these pumps, the Luo-Ye pump, has been used clinically for short-term support since 1998. The other is a push-plate left ventricular device, which has a variable rate mode. Various rotary devices are classified into axial and centrifugal pumps, depending on the impeller geometry. Most rotary pumps are based on the maglev principle, and some types have been used clinically. Others are still being studied in the laboratory or in animal experiments. Furthermore, certain types of total implantable pump, such as the UJS-III axial pump and the UJS-IV aortic valvo-pump, have been developed. Only one type of TAH has been developed in China. The main constituents of this artificial heart are two axial pumps, two reservoir tanks mimicking the right and left atria, flow meters, two pressure gauges, and a resistance adaptor. Although the development of mechanical assist devices in China is still in a nascent stage, a number of different types of MCS devices are currently being studied.

Development of plasma current waveform adjusting system ZLJ for tokamak device HL-1

International Nuclear Information System (INIS)

Wang Shangbing; Hu Haotian; Tang Fangqun; Zhou Yongzheng; Chu Xiuzhong; Cheng Jiashun; Gao Yunxia

1989-12-01

The control of some typical Tokamak discharge waveforms has been achieved by using plasma current waveform adjusting system ZLJ in the ohmic heating of HL-1. The discharge waveforms include a series of regular plasma current waveforms with various slow rising rate, such as 80 kA, 450 ms long flat-topping; 100 kA, 200 ms rising; 200 ms falt-topping and 180 kA, 400 ms slow rising etc. The design principle of the system and the initial experimental results are described

Adjustment of automatic control systems of production facilities at coal processing plants using multivariant physico- mathematical models

Science.gov (United States)

Evtushenko, V. F.; Myshlyaev, L. P.; Makarov, G. V.; Ivushkin, K. A.; Burkova, E. V.

2016-10-01

The structure of multi-variant physical and mathematical models of control system is offered as well as its application for adjustment of automatic control system (ACS) of production facilities on the example of coal processing plant.

Local expansion in circulatory death kidney transplant activity improves wait-listed outcomes and addresses inequities of access to transplantation

OpenAIRE

Mirshekar-Syahkal, Bahar; Summers, Dominic; Bradbury, Lisa L; Aly, Mohamed; Bardsley, Victoria; Berry, Miriam; Norris, Joseph M; Torpey, Nick; Clatworthy, Menna Ruth; Bradley, J Andrew; Pettigrew, Gavin John

2016-01-01

In the UK, circulatory death (DCD) kidney transplant activity has increased rapidly, but marked regional variation persists. We report how increased DCD kidney transplant activity influenced wait-listed outcomes for a single centre. Between 2002/03 and 2011/12, 430 (54%) DCD and 361 (46%) DBD kidney-only transplants were performed in the Cambridge Transplant Centre, with a higher proportion of DCD donors fulfilling expanded criteria status (41% DCD vs 32% DBD; $\\small \\textit{P}$=0.01). Compa...

A Water Hammer Protection Method for Mine Drainage System Based on Velocity Adjustment of Hydraulic Control Valve

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Yanfei Kou

2016-01-01

Full Text Available Water hammer analysis is a fundamental work of pipeline systems design process for water distribution networks. The main characteristics for mine drainage system are the limited space and high cost of equipment and pipeline changing. In order to solve the protection problem of valve-closing water hammer for mine drainage system, a water hammer protection method for mine drainage system based on velocity adjustment of HCV (Hydraulic Control Valve is proposed in this paper. The mathematic model of water hammer fluctuations is established based on the characteristic line method. Then, boundary conditions of water hammer controlling for mine drainage system are determined and its simplex model is established. The optimization adjustment strategy is solved from the mathematic model of multistage valve-closing. Taking a mine drainage system as an example, compared results between simulations and experiments show that the proposed method and the optimized valve-closing strategy are effective.

Method, system and apparatus for monitoring and adjusting the quality of indoor air

Science.gov (United States)

Hartenstein, Steven D.; Tremblay, Paul L.; Fryer, Michael O.; Hohorst, Frederick A.

2004-03-23

A system, method and apparatus is provided for monitoring and adjusting the quality of indoor air. A sensor array senses an air sample from the indoor air and analyzes the air sample to obtain signatures representative of contaminants in the air sample. When the level or type of contaminant poses a threat or hazard to the occupants, the present invention takes corrective actions which may include introducing additional fresh air. The corrective actions taken are intended to promote overall health of personnel, prevent personnel from being overexposed to hazardous contaminants and minimize the cost of operating the HVAC system. The identification of the contaminants is performed by comparing the signatures provided by the sensor array with a database of known signatures. Upon identification, the system takes corrective actions based on the level of contaminant present. The present invention is capable of learning the identity of previously unknown contaminants, which increases its ability to identify contaminants in the future. Indoor air quality is assured by monitoring the contaminants not only in the indoor air, but also in the outdoor air and the air which is to be recirculated. The present invention is easily adaptable to new and existing HVAC systems. In sum, the present invention is able to monitor and adjust the quality of indoor air in real time by sensing the level and type of contaminants present in indoor air, outdoor and recirculated air, providing an intelligent decision about the quality of the air, and minimizing the cost of operating an HVAC system.

Effects of 12 days exposure to simulated microgravity on central circulatory hemodynamics in the rhesus monkey

Science.gov (United States)

Convertino, V. A.; Koenig, S. C.; Krotov, V. P.; Fanton, J. W.; Korolkov, V. I.; Trambovetsky, E. V.; Ewert, D. L.; Truzhennikov, A.; Latham, R. D.

1998-01-01

Central circulatory hemodynamic responses were measured before and during the initial 9 days of a 12-day 10 degrees head-down tilt (HDT) in 4 flight-sized juvenile rhesus monkeys who were surgically instrumented with a variety of intrathoracic catheters and blood flow sensors to assess the effects of simulated microgravity on central circulatory hemodynamics. Each subject underwent measurements of aortic and left ventricular pressures, and aortic flow before and during HDT as well as during a passive head-up postural test before and after HDT. Heart rate, stroke volume, cardiac output, and left ventricular end-diastolic pressure were measured, and dP/dt and left ventricular elastance was calculated from hemodynamic measurements. The postural test consisted of 5 min of supine baseline control followed by 5 minutes of 90 degrees upright tilt (HUT). Heart rate, stroke volume, cardiac output, and left ventricular end-diastolic pressure showed no consistent alterations during HDT. Left ventricular elastance was reduced in all animals throughout HDT, indicating that cardiac compliance was increased. HDT did not consistently alter left ventricular +dP/dt, indicating no change in cardiac contractility. Heart rate during the post-HDT HUT postural test was elevated compared to pre-HDT while post-HDT cardiac output was decreased by 52% as a result of a 54% reduction in stroke volume throughout HUT. Results from this study using an instrumented rhesus monkey suggest that exposure to microgravity may increase ventricular compliance without alternating cardiac contractility. Our project supported the notion that an invasively-instrumented animal model should be viable for use in spaceflight cardiovascular experiments to assess potential changes in myocardial function and cardiac compliance.

Adjusting water resources management to climate change

Energy Technology Data Exchange (ETDEWEB)

Riebsame, W E

1988-01-01

The nature of climate impacts and adjustment in water supply and flood management is discussed, and a case study of water manager response to climate fluctuation in California's Sacramento Basin is presented. The case illuminates the effect on climate impact and response of traditional management approaches, the dynamic qualities of maturing water systems, socially imposed constraints, and climate extremes. A dual pattern of crisis-response and gradual adjustment emerges, and specific mechanisms for effecting adjustment of water management systems are identified. The case study, and broader trends in US water development, suggest that oversized structural capacity, the traditional adjustment to climate variability in water resources, may prove less feasible in the future as projects become smaller and new facilities are delayed by economic and environmental concerns.

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

Directory of Open Access Journals (Sweden)

Weiner Jonathan P

2010-01-01

Full Text Available Abstract Background Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. Methods A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234, while those in both 2002 and 2003 were included for prospective analyses (n = 164,562. Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. Results The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster. When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Conclusions Given the

Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related Cardiac Arrest.

Science.gov (United States)

Zgleszewski, Steven E; Graham, Dionne A; Hickey, Paul R; Brustowicz, Robert M; Odegard, Kirsten C; Koka, Rahul; Seefelder, Christian; Navedo, Andres T; Randolph, Adrienne G

2016-02-01

Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon but potentially preventable adverse event. Infants and children with more severe underlying disease are at highest risk. We aimed to identify system- and anesthesiologist-related risk factors for ARCA. We analyzed a prospectively collected patient cohort data set of anesthetics administered from 2000 to 2011 to children at a large tertiary pediatric hospital. Pre-procedure systemic disease level was characterized by ASA physical status (ASA-PS). Two reviewers independently reviewed cardiac arrests and categorized their anesthesia relatedness. Factors associated with ARCA in the univariate analyses were identified for reevaluation after adjustment for patient age and ASA-PS. Cardiac arrest occurred in 142 of 276,209 anesthetics (incidence 5.1/10,000 anesthetics); 72 (2.6/10,000 anesthetics) were classified as anesthesia-related. In the univariate analyses, risk of ARCA was much higher in cardiac patients and for anesthesiologists with lower annual caseload and/or fewer annual days delivering anesthetics (all P risk adjustment for ASA-PS ≥ III and age ≤ 6 months, however, the association with lower annual days delivering anesthetics remained (P = 0.03), but the other factors were no longer significant. Case-mix explained most associations between higher risk of pediatric ARCA and anesthesiologist-related variables at our institution, but the association with fewer annual days delivering anesthetics remained. Our findings highlight the need for rigorous adjustment for patient risk factors in anesthesia patient safety studies.

Utilization of organs from donors after circulatory death for vascularized pancreas and islet of Langerhans transplantation: recommendations from an expert group.

Science.gov (United States)

Berney, Thierry; Boffa, Catherine; Augustine, Titus; Badet, Lionel; de Koning, Eelco; Pratschke, Johann; Socci, Carlo; Friend, Peter

2016-07-01

Donation after circulatory death (DCD) donors are increasingly being used as a source of pancreas allografts for vascularized organ and islet transplantation. We provide practice guidelines aiming to increase DCD pancreas utilization. We review risk assessment and donor selection criteria. We report suggested factors in donor and recipient clinical management and provide an overview of the activities and outcomes of vascularized pancreas and islet transplantation. © 2015 Steunstichting ESOT.

Circulatory CNP Rescues Craniofacial Hypoplasia in Achondroplasia.

Science.gov (United States)

Yamanaka, S; Nakao, Kazumasa; Koyama, N; Isobe, Y; Ueda, Y; Kanai, Y; Kondo, E; Fujii, T; Miura, M; Yasoda, A; Nakao, Kazuwa; Bessho, K

2017-12-01

Achondroplasia is the most common genetic form of human dwarfism, characterized by midfacial hypoplasia resulting in occlusal abnormality and foramen magnum stenosis, leading to serious neurologic complications and hydrocephalus. Currently, surgery is the only way to manage jaw deformity, neurologic complications, and hydrocephalus in patients with achondroplasia. We previously showed that C-type natriuretic peptide (CNP) is a potent stimulator of endochondral bone growth of long bones and vertebrae and is also a potent stimulator in the craniofacial region, which is crucial for midfacial skeletogenesis. In this study, we analyzed craniofacial morphology in a mouse model of achondroplasia, in which fibroblast growth factor receptor 3 (FGFR3) is specifically activated in cartilage ( Fgfr3 ach mice), and investigated the mechanisms of jaw deformities caused by this mutation. Furthermore, we analyzed the effect of CNP on the maxillofacial area in these animals. Fgfr3 ach mice exhibited midfacial hypoplasia, especially in the sagittal direction, caused by impaired endochondral ossification in craniofacial cartilage and by premature closure of the spheno-occipital synchondrosis, an important growth center in craniomaxillofacial skeletogenesis. We crossed Fgfr3 ach mice with transgenic mice in which CNP is expressed in the liver under the control of the human serum amyloid-P component promoter, resulting in elevated levels of circulatory CNP ( Fgfr3 ach /SAP-Nppc-Tg mice). In the progeny, midfacial hypoplasia in the sagittal direction observed in Fgfr3 ach mice was improved significantly by restoring the thickness of synchondrosis and promoting proliferation of chondrocytes in the craniofacial cartilage. In addition, the foramen magnum stenosis observed in Fgfr3 ach mice was significantly ameliorated in Fgfr3 ach /SAP-Nppc-Tg mice due to enhanced endochondral bone growth of the anterior intraoccipital synchondrosis. These results clearly demonstrate the therapeutic

Accuracy of two face-bow/semi-adjustable articulator systems in transferring the maxillary occlusal cant.

Science.gov (United States)

Nazir, Nazia; Sujesh, M; Kumar, Ravi; Sreenivas, P

2012-01-01

The precision of an arbitrary face-bow in accurately transferring the orientation of the maxillary cast to the articulator has been questioned because the maxillary cast is mounted in relation to arbitrary measurements and anatomic landmarks that vary among individuals. This study was intended to evaluate the sagittal inclination of mounted maxillary casts on two semi-adjustable articulator/face-bow systems in comparison to the occlusal cant on lateral cephalograms. Maxillary casts were mounted on the Hanau and Girrbach semi-adjustable articulators following face-bow transfer with their respective face-bows. The sagittal inclination of these casts was measured in relation to the fixed horizontal reference plane using physical measurements. Occlusal cant was measured on lateral cephalograms. SPSS software (version 11.0, Chicago, IL, USA) was used for statistical analysis. Repeated measures analysis of variance and Tukey's tests were used to evaluate the results (P occlusal cant on the articulators and cephalogram revealed statistically significant differences. Occlusal plane was steeper on Girrbach Artex articulator in comparison to the Hanau articulator. Within the limitations of this study, it was found that the sagittal inclination of the mounted maxillary cast achieved with Hanau articulator was closer to the cephalometric occlusal cant as compared to that of the Girrbach articulator. Among the two articulators and face-bow systems, the steepness of sagittal inclination was greater on Girrbach semi-adjustable articulator. Different face-bow/articulator systems could result in different orientation of the maxillary cast, resulting in variation in stability, cuspal inclines and cuspal heights.

Space Radiation Cancer, Circulatory Disease and CNS Risks for Near Earth Asteroid and Mars Missions: Uncertainty Estimates for Never-Smokers

Science.gov (United States)

Cucinotta, Francis A.; Chappell, Lori J.; Wang, Minli; Kim, Myung-Hee

2011-01-01

The uncertainties in estimating the health risks from galactic cosmic rays (GCR) and solar particle events (SPE) are a major limitation to the length of space missions and the evaluation of potential risk mitigation approaches. NASA limits astronaut exposures to a 3% risk of exposure induced cancer death (REID), and protects against uncertainties in risks projections using an assessment of 95% confidence intervals after propagating the error from all model factors (environment and organ exposure, risk coefficients, dose-rate modifiers, and quality factors). Because there are potentially significant late mortality risks from diseases of the circulatory system and central nervous system (CNS) which are less well defined than cancer risks, the cancer REID limit is not necessarily conservative. In this report, we discuss estimates of lifetime risks from space radiation and new estimates of model uncertainties are described. The key updates to the NASA risk projection model are: 1) Revised values for low LET risk coefficients for tissue specific cancer incidence, with incidence rates transported to an average U.S. population to estimate the probability of Risk of Exposure Induced Cancer (REIC) and REID. 2) An analysis of smoking attributable cancer risks for never-smokers that shows significantly reduced lung cancer risk as well as overall cancer risks from radiation compared to risk estimated for the average U.S. population. 3) Derivation of track structure based quality functions depends on particle fluence, charge number, Z and kinetic energy, E. 4) The assignment of a smaller maximum in quality function for leukemia than for solid cancers. 5) The use of the ICRP tissue weights is shown to over-estimate cancer risks from SPEs by a factor of 2 or more. Summing cancer risks for each tissue is recommended as a more accurate approach to estimate SPE cancer risks. 6) Additional considerations on circulatory and CNS disease risks. Our analysis shows that an individual s

Alkaline Phosphatase for the Prevention of Intestinal and Renal Injury in a Rat Model of Cardiopulmonary Bypass with Deep Hypothermic Circulatory Arrest

Science.gov (United States)

2017-09-01

prevention of intestinal and kidney injury after pediatric cardiopulmonary bypass with deep hypothermic circulatory arrest. In this model, we place 5-10kg...first abstract submissions to either Pediatric Academic Society or American Thoracic Society meetings by November. Secondary analysis of serum...rats. Transition to the piglet model also had multiple benefits beyond greater consistency of surgical approach. We now have a true pediatric model and

Evaluation of an adjustable epidemiologic information system.

Directory of Open Access Journals (Sweden)

Jiunn-Shyan Julian Wu

Full Text Available BACKGROUND: In order to facilitate public health response and to achieve early control of infectious disease epidemics, an adjustable epidemiologic information system (AEIS was established in the Taiwan public health network in February 2006. METHODOLOGY/PRINCIPAL FINDINGS: The performance of AEIS for the period 2006 through 2008 was evaluated based on a number of response times (RT and the public health impact. After implementation of the system, the apparent overall shortened RT was mainly due to the shortening of personnel response time (PRT and the time needed to draft a new questionnaire that incurred as personnel-system interface (PSI; PRT dropped from a fluctuating range of 9.8 ∼28.8 days in the first four months to <10 days in the following months and remained low till 2008 (0.88±1.52 days. The PSIs for newly emerged infectious diseases were 2.6 and 3.4 person-hours for H5N1 in 2007 and chikungunya in 2008, respectively, a much improvement from 1142.5 person-hours for SARS in 2003. The duration of each rubella epidemic cluster was evaluated as public health impact and showed a shortening trend (p = 0.019 that concurred with the shortening of PRT from 64.8±47.3 to 25.2±38.2 hours per cluster (p<0.0001. CONCLUSIONS/SIGNIFICANCE: The first evaluation of the novel instrument AEIS that had been used to assist Taiwan's multi-level government for infectious diseases control demonstrated that it was well integrated into the existing public health infrastructure. It provided flexible tools and computer algorithms with friendly interface for timely data collection, integration, and analysis; as a result, it shortened RTs, filled in gaps of personnel lacking sufficient experiences, created a more efficient flow of response, and identified asymptomatic/mild cases early to minimize further spreading. With further development, AEIS is anticipated to be useful in the application of other acute public health events needing immediate

NASA Models of Space Radiation Induced Cancer, Circulatory Disease, and Central Nervous System Effects

Science.gov (United States)

Cucinotta, Francis A.; Chappell, Lori J.; Kim, Myung-Hee Y.

2013-01-01

The risks of late effects from galactic cosmic rays (GCR) and solar particle events (SPE) are potentially a limitation to long-term space travel. The late effects of highest concern have significant lethality including cancer, effects to the central nervous system (CNS), and circulatory diseases (CD). For cancer and CD the use of age and gender specific models with uncertainty assessments based on human epidemiology data for low LET radiation combined with relative biological effectiveness factors (RBEs) and dose- and dose-rate reduction effectiveness factors (DDREF) to extrapolate these results to space radiation exposures is considered the current "state-of-the-art". The revised NASA Space Risk Model (NSRM-2014) is based on recent radio-epidemiology data for cancer and CD, however a key feature of the NSRM-2014 is the formulation of particle fluence and track structure based radiation quality factors for solid cancer and leukemia risk estimates, which are distinct from the ICRP quality factors, and shown to lead to smaller uncertainties in risk estimates. Many persons exposed to radiation on earth as well as astronauts are life-time never-smokers, which is estimated to significantly modify radiation cancer and CD risk estimates. A key feature of the NASA radiation protection model is the classification of radiation workers by smoking history in setting dose limits. Possible qualitative differences between GCR and low LET radiation increase uncertainties and are not included in previous risk estimates. Two important qualitative differences are emerging from research studies. The first is the increased lethality of tumors observed in animal models compared to low LET radiation or background tumors. The second are Non- Targeted Effects (NTE), which include bystander effects and genomic instability, which has been observed in cell and animal models of cancer risks. NTE's could lead to significant changes in RBE and DDREF estimates for GCR particles, and the potential

Lateral Vibration Attenuation by the Dynamic Adjustment of Bias Currents in Magnetic Suspension System

International Nuclear Information System (INIS)

Mizuno, Takeshi; Takasaki, Masaya; Ishino, Yuji

2016-01-01

Switching stiffness control is applied to attenuate vibration in the lateral directions in an active magnetic suspension system with electromagnets operated in differential mode. The magnetic suspension system using the attractive force between magnetized bodies is inherently unstable in the normal direction so that feedback control is necessary to achieve stable suspension. In contrast, it can be stable in the lateral directions due to the edge effects in the magnetic circuits. In several applications, such passive suspension is used in combination with the active one to reduce cost and space. However, damping in the lateral directions is generally small. As a result, induced vibrations in these directions are hardly attenuated. To suppress such vibration without any additional actuator (electromagnet), switching stiffness control is applied to an magnetic suspension system operated in the differential mode. The stiffness in the lateral direction is adjusted by varying the bias currents of an opposed pair of electromagnets located in the normal direction simultaneously according to the motion of the suspended object. When the varied bias currents are adjusted for the additive normal forces cancel each other, such control does not affect the suspension in the normal direction. The effectiveness of the proposed control methods is confirmed experimentally. (paper)

Harms of unsuccessful donation after circulatory death: An exploratory study.

Science.gov (United States)

Taylor, Lauren J; Buffington, Anne; Scalea, Joseph R; Fost, Norman; Croes, Kenneth D; Mezrich, Joshua D; Schwarze, Margaret L

2018-02-01

While donation after circulatory death (DCD) has expanded options for organ donation, many who wish to donate are still unable to do so. We conducted face-to-face interviews with family members (N = 15) who had direct experience with unsuccessful DCD and 5 focus groups with professionals involved in the donation process. We used qualitative content analysis to characterize the harms of nondonation as perceived by participants. Participants reported a broad spectrum of harms affecting organ recipients, donors, and donor families. Harms included waste of precious life-giving organs and hospital resources, inability to honor the donor's memory and character, and impaired ability for families to make sense of tragedy and cope with loss. Donor families empathized with the initial hope and ultimate despair of potential recipients who must continue their wait on the transplant list. Focus group members reinforced these findings and highlighted the struggle of families to navigate the uncertainty regarding the timing of death during the donation process. While families reported significant harm, many appreciated the donation attempt. These findings highlight the importance of organ donation to donor families and the difficult experiences associated with current processes that could inform development of alternative donation strategies. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Intracellular Signaling Mediators in the Circulatory and Ventilatory Systems

CERN Document Server

Thiriet, Marc

2013-01-01

The volumes in this authoritative series present a multidisciplinary approach to modeling and simulation of flows in the cardiovascular and ventilatory systems, especially multiscale modeling and coupled simulations. The cardiovascular and respiratory systems are tightly coupled, as their primary function is to supply oxygen to and remove carbon dioxide from the body's cells. Because physiological conduits have deformable and reactive walls, macroscopic flow behavior and prediction must be coupled to phenomenological models of nano- and microscopic events in a corrector scheme of regulated mechanisms when the vessel lumen caliber varies markedly. Therefore, investigation of flows of blood and air in physiological conduits requires an understanding of the biology, chemistry, and physics of these systems together with the mathematical tools to describe their functioning. Volume 4 is devoted to major sets of intracellular mediators that transmit signals upon stimulation of cell-surface receptors.  Activation of...

Adaptive Kalman Filter Based on Adjustable Sampling Interval in Burst Detection for Water Distribution System

Directory of Open Access Journals (Sweden)

Doo Yong Choi

2016-04-01

Full Text Available Rapid detection of bursts and leaks in water distribution systems (WDSs can reduce the social and economic costs incurred through direct loss of water into the ground, additional energy demand for water supply, and service interruptions. Many real-time burst detection models have been developed in accordance with the use of supervisory control and data acquisition (SCADA systems and the establishment of district meter areas (DMAs. Nonetheless, no consideration has been given to how frequently a flow meter measures and transmits data for predicting breaks and leaks in pipes. This paper analyzes the effect of sampling interval when an adaptive Kalman filter is used for detecting bursts in a WDS. A new sampling algorithm is presented that adjusts the sampling interval depending on the normalized residuals of flow after filtering. The proposed algorithm is applied to a virtual sinusoidal flow curve and real DMA flow data obtained from Jeongeup city in South Korea. The simulation results prove that the self-adjusting algorithm for determining the sampling interval is efficient and maintains reasonable accuracy in burst detection. The proposed sampling method has a significant potential for water utilities to build and operate real-time DMA monitoring systems combined with smart customer metering systems.

Physiological system integrations with emphasis on the respiratory-cardiovascular system

Science.gov (United States)

Gallagher, R. R.

1975-01-01

The integration of two types of physiological system simulations is presented. The long term model is a circulatory system model which simulates long term blood flow variations and compartmental fluid shifts. The short term models simulate transient phenomena of the respiratory, thermoregulatory, and pulsatile cardiovascular systems as they respond to stimuli such as LBNP, exercise, and environmental gaseous variations. An overview of the interfacing approach is described. Descriptions of the variable interface for long term to short term and between the three short term models are given.

Accuracy of two face-bow/semi-adjustable articulator systems in transferring the maxillary occlusal cant

Directory of Open Access Journals (Sweden)

Nazia Nazir

2012-01-01

Full Text Available Context: The precision of an arbitrary face-bow in accurately transferring the orientation of the maxillary cast to the articulator has been questioned because the maxillary cast is mounted in relation to arbitrary measurements and anatomic landmarks that vary among individuals. Aim: This study was intended to evaluate the sagittal inclination of mounted maxillary casts on two semi-adjustable articulator/face-bow systems in comparison to the occlusal cant on lateral cephalograms. Materials and Methods: Maxillary casts were mounted on the Hanau and Girrbach semi-adjustable articulators following face-bow transfer with their respective face-bows. The sagittal inclination of these casts was measured in relation to the fixed horizontal reference plane using physical measurements. Occlusal cant was measured on lateral cephalograms. SPSS software (version 11.0, Chicago, IL, USA was used for statistical analysis. Repeated measures analysis of variance and Tukey′s tests were used to evaluate the results (P < 0.05. Results: Comparison of the occlusal cant on the articulators and cephalogram revealed statistically significant differences. Occlusal plane was steeper on Girrbach Artex articulator in comparison to the Hanau articulator. Conclusion: Within the limitations of this study, it was found that the sagittal inclination of the mounted maxillary cast achieved with Hanau articulator was closer to the cephalometric occlusal cant as compared to that of the Girrbach articulator. Among the two articulators and face-bow systems, the steepness of sagittal inclination was greater on Girrbach semi-adjustable articulator. Different face-bow/articulator systems could result in different orientation of the maxillary cast, resulting in variation in stability, cuspal inclines and cuspal heights.

The method and program system CABEI for adjusting consistency between natural element and its isotopes data

Energy Technology Data Exchange (ETDEWEB)

Tingjin, Liu; Zhengjun, Sun [Chinese Nuclear Data Center, Beijing, BJ (China)

1996-06-01

To meet the requirement of nuclear engineering, especially nuclear fusion reactor, now the data in the major evaluated libraries are given not only for natural element but also for its isotopes. Inconsistency between element and its isotopes data is one of the main problem in present evaluated neutron libraries. The formulas for adjusting to satisfy simultaneously the two kinds of consistent relationships were derived by means of least square method, the program system CABEI were developed. This program was tested by calculating the Fe data in CENDL-2.1. The results show that adjusted values satisfy the two kinds of consistent relationships.

Hyperdynamic circulatory changes in liver cirrhosis: Comparative evaluation by doppler ultrasonography with normal subjects

Energy Technology Data Exchange (ETDEWEB)

Im, Dae Wook; Baik, Soon Koo; Suh, Jung In; Kim, Jae Woo; Park, Yong Soon; Kim, Hyun Soo; Lee, Dong Ki; Kwon, Sang Ok [Yonsei University, Wonju College of Medicine, Wonju (Korea, Republic of)

2001-12-15

To evaluate the cardiovascular and splanchnic hemodynamic changes in patients with liver cirrhosis and to compare with those of the normal controls using doppler ultrasonography. A total of 129 patients including 23 of Child-Pugh class A, 24 of class A, 24 of class B, 30 of class C, and 52 of the control group were included. Cardiac output (CO), systemic vascular resistance index (SVRI), and blood flow and pulsatility index (PI) of the superior mesenteric artery (SMA) were evaluated and compared among each groups. CO and SMA blood flow in the cirrhotic group were significantly higher than those in the control group, and the increase in CO and SMA blood flow showed a statistically significant correlation with the degree of liver dysfunction (p<0.01). SVRI and SMA PI reflecting vascular resistance in the cirrhotic group were significantly lower than those in the control group, and the decrease in SVRI and SMA PI also showed a statistically significant correlation with the degree of liver dysfunction (p<0.01). SMA blood flow showed a statistically significant inverse relationship with SMA PI (R{sup 2}=0.230). Hyperdynamic circulatory changes such as increases in CO and splanchnic blood flow were present in patients with liver cirrhosis. These changes may contribute to the development and maintenance of the portal hypertension due to an increase in portal blood flow an increase in portal blood flow.

Pediatric donation after circulatory determination of death (pDCD): A narrative review.

Science.gov (United States)

Weiss, Matthew J; Sherry, Wendy; Hornby, Laura

2018-04-14

Pediatric donation after circulatory death (pDCD) is an established pathway for organ donation. It remains, however, a relatively rare event worldwide, and most clinicians outside of the pediatric intensive care unit (PICU) are unfamiliar with it. The goal of this review is to introduce the processes and concepts of pDCD. While most children die in circumstances that would not allow pDCD, many children that die after withdrawal of life sustaining therapy (WLST) may be eligible for donation of some organs. The potential benefits of this practice to patients on the wait list are well known, but donation can also be an opportunity to honor a patient's or family's desire to altruistically improve the lives of others. Offering the possibility of donation requires careful attention to ethical principles to ensure that conflicts of interest are avoided and that the family is free to make an independent, fully informed decision. Doing so allows families and decision makers the autonomy to decide if donation is something they wish to incorporate into end-of-life care. Copyright © 2018 Elsevier Ltd. All rights reserved.

State of cardiovascular system during exercise in sportsmen

Directory of Open Access Journals (Sweden)

Usanov D.A.

2013-03-01

Full Text Available The purpose of the article is to study the state of cardiovascular system of sportsmen involved in rowing and canoeing, both before and after training. Material et methods: The research has been performed by means of the developed mobile devices that allow non-invasive screening assessment of the potential risk of collapse complications. Results: The article outlines the results of the survey carried out to determine the presence of vagotonic tone with deficient activity supply and abnormal pulse wave that may lead to circulatory collapse in exercise. Conclusion: The technique of pulse wave and vegetative regulation assessment before and after training enables to prevent the circulatory collapse development in stressful physical exertion in sportsmen.

Modelling of cardiovascular system: development of a hybrid (numerical-physical) model.

Science.gov (United States)

Ferrari, G; Kozarski, M; De Lazzari, C; Górczyńska, K; Mimmo, R; Guaragno, M; Tosti, G; Darowski, M

2003-12-01

Physical models of the circulation are used for research, training and for testing of implantable active and passive circulatory prosthetic and assistance devices. However, in comparison with numerical models, they are rigid and expensive. To overcome these limitations, we have developed a model of the circulation based on the merging of a lumped parameter physical model into a numerical one (producing therefore a hybrid). The physical model is limited to the barest essentials and, in this application, developed to test the principle, it is a windkessel representing the systemic arterial tree. The lumped parameters numerical model was developed in LabVIEW environment and represents pulmonary and systemic circulation (except the systemic arterial tree). Based on the equivalence between hydraulic and electrical circuits, this prototype was developed connecting the numerical model to an electrical circuit--the physical model. This specific solution is valid mainly educationally but permits the development of software and the verification of preliminary results without using cumbersome hydraulic circuits. The interfaces between numerical and electrical circuits are set up by a voltage controlled current generator and a voltage controlled voltage generator. The behavior of the model is analyzed based on the ventricular pressure-volume loops and on the time course of arterial and ventricular pressures and flow in different circulatory conditions. The model can represent hemodynamic relationships in different ventricular and circulatory conditions.

Assessment of apically extruded debris produced by the self-adjusting file system.

Science.gov (United States)

De-Deus, Gustavo André; Nogueira Leal Silva, Emmanuel João; Moreira, Edson Jorge; de Almeida Neves, Aline; Belladonna, Felipe Gonçalves; Tameirão, Michele

2014-04-01

This study was designed to quantitatively evaluate the amount of apically extruded debris by the Self-Adjusting-File system (SAF; ReDent-Nova, Ra'anana, Israel). Hand and rotary instruments were used as references for comparison. Sixty mesial roots of mandibular molars were randomly assigned to 3 groups (n = 20). The root canals were instrumented with hand files using a crown-down technique. The ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) and SAF systems were used according to the manufacturers' instructions. Sodium hypochlorite was used as an irrigant, and the apically extruded debris was collected in preweighted glass vials and dried afterward. The mean weight of debris was assessed with a microbalance and statistically analyzed using 1-way analysis of variance and the post hoc Tukey multiple comparison test. Hand file instrumentation produced significantly more debris compared with the ProTaper and SAF systems (P system produced significantly more debris compared with the SAF system (P systems caused apical debris extrusion. SAF instrumentation was associated with less debris extrusion compared with the use of hand and rotary files. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The peculiarities of formation of circulatory system pathology of evacuated adult population exposed to ionizing radiation on thyroid gland after the accident at the Chernobyl Nuclear Power Plant

Directory of Open Access Journals (Sweden)

Kapustinskaia O.A.

2014-11-01

Full Text Available The aim of the research - analysis of the structure and dynamics of the morbidity among eva¬cuated population, the peculiarities of pathogenesis of the most widespread forms of circulatory system (CS pathology in the remote period after the accident at the Chernobyl Nuclear Power Plant. Materials and methods. Three groups of persons evacuated from Chernobyl zone of alienation were researched: persons aged 10-17 (6517 persons, 18-39 (496 persons, 40-60 (458 persons. The data on the individual radiation doses which affected thyroid gland were selected at the State Register of Ukraine on persons affected by the Chernobyl disaster. Morbidity rate was estimated per 103 man-year for 5-years periods of monitoring. The main results: Time from the moment of Chernobyl accident affected the formation of morbidity structure of evacuated population. It was fixed two peaks of morbidity incidence - initial and in 12 years. The most essential changes in CS morbidity of evacuated population were fixed 26 years later mainly in cere¬brovascular diseases. The coronary artery disease takes the first place in the morbidity structure. Significant dif¬ferences were detected at age-specific aspect. The evacuated adult population aged 18-39 years was the most vulnerable for the development of CS diseases. Adverse health effects confirmed the necessity of further research of CS morbidity with the differentiation of doses affected thyroid gland.

Computer-aided system of evaluation for population-based all-in-one service screening (CASE-PASS): from study design to outcome analysis with bias adjustment.

Science.gov (United States)

Chen, Li-Sheng; Yen, Amy Ming-Fang; Duffy, Stephen W; Tabar, Laszlo; Lin, Wen-Chou; Chen, Hsiu-Hsi

2010-10-01

Population-based routine service screening has gained popularity following an era of randomized controlled trials. The evaluation of these service screening programs is subject to study design, data availability, and the precise data analysis for adjusting bias. We developed a computer-aided system that allows the evaluation of population-based service screening to unify these aspects and facilitate and guide the program assessor to efficiently perform an evaluation. This system underpins two experimental designs: the posttest-only non-equivalent design and the one-group pretest-posttest design and demonstrates the type of data required at both the population and individual levels. Three major analyses were developed that included a cumulative mortality analysis, survival analysis with lead-time adjustment, and self-selection bias adjustment. We used SAS AF software to develop a graphic interface system with a pull-down menu style. We demonstrate the application of this system with data obtained from a Swedish population-based service screen and a population-based randomized controlled trial for the screening of breast, colorectal, and prostate cancer, and one service screening program for cervical cancer with Pap smears. The system provided automated descriptive results based on the various sources of available data and cumulative mortality curves corresponding to the study designs. The comparison of cumulative survival between clinically and screen-detected cases without a lead-time adjustment are also demonstrated. The intention-to-treat and noncompliance analysis with self-selection bias adjustments are also shown to assess the effectiveness of the population-based service screening program. Model validation was composed of a comparison between our adjusted self-selection bias estimates and the empirical results on effectiveness reported in the literature. We demonstrate a computer-aided system allowing the evaluation of population-based service screening

Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

Directory of Open Access Journals (Sweden)

SONG Yingchun

2015-02-01

Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.

A cholinergic contribution to the circulatory responses evoked at the onset of handgrip exercise in humans

DEFF Research Database (Denmark)

Vianna, Lauro C; Fadel, Paul J; Secher, Niels H

2015-01-01

A cholinergic (muscarinic) contribution to the initial circulatory response to exercise in humans remains controversial. Herein, we posit that this may be due to exercise mode with a cholinergic contribution being important during isometric handgrip exercise, where the hyperemic response......-induced fall in SVR and, thereby, augmented the pressor response (+13 ± 3 mmHg at 10 s; P exercise. These findings suggest that a cholinergic mechanism is important for the BP...... resistance (SVR) in young healthy males, while performing either 20 s of isometric handgrip contraction at 40% maximum voluntary contraction (protocol 1; n = 9) or 20 s of low-intensity leg cycling exercise (protocol 2; n = 8, 42 ± 8 W). Exercise trials were conducted under control (no drug) conditions...

Long-term results after lung transplantation using organs from circulatory death donors: a propensity score-matched analysis†.

Science.gov (United States)

Sabashnikov, Anton; Patil, Nikhil P; Popov, Aron-Frederik; Soresi, Simona; Zych, Bartlomiej; Weymann, Alexander; Mohite, Prashant N; García Sáez, Diana; Zeriouh, Mohamed; Wahlers, Thorsten; Choi, Yeong-Hoon; Wippermann, Jens; Wittwer, Thorsten; De Robertis, Fabio; Bahrami, Toufan; Amrani, Mohamed; Simon, André R

2016-01-01

Due to organ shortage in lung transplantation (LTx), donation after circulatory death (DCD) has been implemented in several countries, contributing to an increasing number of organs transplanted. We sought to assess long-term outcomes after LTx with organs procured following circulatory death in comparison with those obtained from donors after brain death (DBD). Between January 2007 and November 2013, 302 LTxs were performed in our institution, whereby 60 (19.9%) organs were retrieved from DCD donors. We performed propensity score matching (DCD:DBD = 1:2) based on preoperative donor and recipient factors that were significantly different in univariate analysis. After propensity matching, there were no statistically significant differences between the groups in terms of demographics and preoperative donor and recipient characteristics. There were no significant differences regarding intraoperative variables and total ischaemic time. Patients from the DCD group had significantly higher incidence of primary graft dysfunction grade 3 at the end of the procedure (P = 0.014), and significantly lower pO2/FiO2 ratio during the first 24 h after the procedure (P = 0.018). There was a trend towards higher incidence of the need for postoperative extracorporeal life support in the DCD group. Other postoperative characteristics were comparable. While the overall cumulative survival was not significantly different, the DCD group had significantly poorer results in terms of bronchiolitis obliterans syndrome (BOS)-free survival in the long-term follow-up. Long-term results after LTx with organs procured following DCD are in general comparable with those obtained after DBD LTx. However, patients transplanted using organs from DCD donors have a predisposition for development of BOS in the longer follow-up. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Circulatory and Renal Consequences of Pregnancy in Diabetic NOD Mice

Science.gov (United States)

Burke, S.D.; Barrette, V.F.; David, S.; Khankin, E. V.; Adams, M.A.; Croy, B.A.

2011-01-01

Objectives Women with diabetes have elevated gestational risks for severe hemodynamic complications, including preeclampsia in mid- to late pregnancy. This study employed continuous, chronic radiotelemetry to compare the hemodynamic patterns in non-obese diabetic (NOD) mice who were overtly diabetic or normoglycemic throughout gestation. We hypothesized that overtly diabetic, pregnant NOD mice would develop gestational hypertension and provide understanding of mechanisms in progression of this pathology. Study Design Telemeter-implanted, age-matched NOD females with and without diabetes were assessed for six hemodynamic parameters (mean, systolic, diastolic, pulse pressures, heart rate and activity) prior to mating, over pregnancy and over a 72 hr post-partum interval. Urinalysis, serum biochemistry and renal histopathology were also conducted. Results Pregnant, normoglycemic NOD mice had a hemodynamic profile similar to other inbred strains, despite insulitis. This pattern was characterized by an interval of pre-implantation stability, post implantation decline in arterial pressure to mid gestation, and then a rebound to pre-pregnancy baseline during later gestation. Overtly diabetic NOD mice had a blood pressure profile that was normal until mid-gestation then become mildly hypotensive (−7mmHg, Ppost-partum (−10% pre-pregnancy pressure and HR, P<0.05). Conclusions Pregnancy accelerates circulatory and renal pathologies in overtly diabetic NOD mice and is characterized by depressed arterial pressure from mid-gestation and birth of growth 45 restricted offspring. PMID:22014504

Kinematic synthesis of adjustable robotic mechanisms

Science.gov (United States)

Chuenchom, Thatchai

1993-01-01

Conventional hard automation, such as a linkage-based or a cam-driven system, provides high speed capability and repeatability but not the flexibility required in many industrial applications. The conventional mechanisms, that are typically single-degree-of-freedom systems, are being increasingly replaced by multi-degree-of-freedom multi-actuators driven by logic controllers. Although this new trend in sophistication provides greatly enhanced flexibility, there are many instances where the flexibility needs are exaggerated and the associated complexity is unnecessary. Traditional mechanism-based hard automation, on the other hand, neither can fulfill multi-task requirements nor are cost-effective mainly due to lack of methods and tools to design-in flexibility. This dissertation attempts to bridge this technological gap by developing Adjustable Robotic Mechanisms (ARM's) or 'programmable mechanisms' as a middle ground between high speed hard automation and expensive serial jointed-arm robots. This research introduces the concept of adjustable robotic mechanisms towards cost-effective manufacturing automation. A generalized analytical synthesis technique has been developed to support the computational design of ARM's that lays the theoretical foundation for synthesis of adjustable mechanisms. The synthesis method developed in this dissertation, called generalized adjustable dyad and triad synthesis, advances the well-known Burmester theory in kinematics to a new level. While this method provides planar solutions, a novel patented scheme is utilized for converting prescribed three-dimensional motion specifications into sets of planar projections. This provides an analytical and a computational tool for designing adjustable mechanisms that satisfy multiple sets of three-dimensional motion specifications. Several design issues were addressed, including adjustable parameter identification, branching defect, and mechanical errors. An efficient mathematical scheme for

Designs for mechanical circulatory support device studies.

Science.gov (United States)

Neaton, James D; Normand, Sharon-Lise; Gelijns, Annetine; Starling, Randall C; Mann, Douglas L; Konstam, Marvin A

2007-02-01

There is increased interest in mechanical circulatory support devices (MCSDs), such as implantable left ventricular assist devices (LVADs), as "destination" therapy for patients with advanced heart failure. Because patient availability to evaluate these devices is limited and randomized trials have been slow in enrolling patients, a workshop was convened to consider designs for MCSD development including alternatives to randomized trials. A workshop was jointly planned by the Heart Failure Society of America and the US Food and Drug Administration and was convened in March 2006. One of the panels was asked to review different designs for evaluating new MCSDs. Randomized trials have many advantages over studies with no controls or with nonrandomized concurrent or historical controls. These advantages include the elimination of bias in the assignment of treatments and the balancing, on average, of known and unknown baseline covariates that influence response. These advantages of randomization are particularly important for studies in which the treatments may not differ from one another by a large amount (eg, a head-to-head study of an approved LVAD with a new LVAD). However, researchers have found it difficult to recruit patients to randomized studies because the number of clinical sites that can carry out the studies is not large. Also, there is a reluctance to randomize patients when the control device is considered technologically inferior. Thus ways of improving the design of randomized trials were discussed, and the advantages and disadvantages of alternative designs were considered. The panel concluded that designs should include a randomized component. Randomized designs might be improved by allowing the control device to be chosen before randomization, by first conducting smaller vanguard studies, and by allowing crossovers in trials with optimal medical management controls. With use of data from completed trials, other databases, and registries, alternative

Adjustment model of thermoluminescence experimental data

International Nuclear Information System (INIS)

Moreno y Moreno, A.; Moreno B, A.

2002-01-01

This model adjusts the experimental results for thermoluminescence according to the equation: I (T) = I (a i * exp (-1/b i * (T-C i )) where: a i , b i , c i are the i-Th peak adjusted to a gaussian curve. The adjustments of the curve can be operated manual or analytically using the macro function and the solver.xla complement installed previously in the computational system. In this work it is shown: 1. The information of experimental data from a LiF curve obtained from the Physics Institute of UNAM which the data adjustment model is operated in the macro type. 2. A LiF curve of four peaks obtained from Harshaw information simulated in Microsoft Excel, discussed in previous works, as a reference not in macro. (Author)

Clinical antibacterial effectiveness of the self-adjusting file system.

Science.gov (United States)

Neves, M A S; Rôças, I N; Siqueira, J F

2014-04-01

To evaluate in vivo the antibacterial effectiveness of the self-adjusting file (SAF) using molecular methods. Root canals from single-rooted teeth with apical periodontitis were instrumented using the SAF system under continuous irrigation with 2.5% NaOCl. DNA extracts from samples taken before and after instrumentation were subjected to quantitative analysis of total bacteria counts and levels of streptococci by quantitative real-time polymerase chain reaction (qPCR). The reverse-capture checkerboard assay was also used to identify 28 bacterial taxa before (S1) and after (S2) SAF instrumentation. SAF was also compared with a conventional hand nickel-titanium instrumentation technique for total bacterial reduction. Data from qPCR were analysed statistically within groups using the Wilcoxon matched pairs test and between groups using the Mann-Whitney U-test and the Fisher's exact test, with significance level set at P file significantly reduced the total bacterial counts from a mean number of 1.96 × 10(7) cells to 1.34 × 10(4) cells (P system was significantly superior to the 95.1% reduction obtained by hand instrumentation (P system succeeded in significantly reducing the streptococcal levels, but four cases still harboured these bacteria in S2. Checkerboard analysis revealed that not only streptococci but also some anaerobic and even as-yet-uncultivated bacteria may resist the effects of chemomechanical procedures. The SAF instrumentation system was highly effective in reducing bacterial populations from infected root canals and performed significantly better than hand instrumentation. However, because half of the samples still had detectable bacteria after preparation with SAF, supplementary disinfection is still required to maximize bacterial elimination. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Congenital malformation of the systemic heart of Sepia officinalis l ...

African Journals Online (AJOL)

Numerous preparations of the circulatory system of Sepia officinalis L. caught from the Bay of Arcachon (Atlantic Coast of France) in 1989 and 1996 showed an obvious congenital malformation of the systemic heart complex. The malformation consisted of a cord- or truncus-like structure at the left cranio-apical ventricle.

The self-adjusting file (SAF) system: An evidence-based update.

Science.gov (United States)

Metzger, Zvi

2014-09-01

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics.

The self-adjusting file (SAF) system: An evidence-based update

Science.gov (United States)

Metzger, Zvi

2014-01-01

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics. PMID:25298639

An Evaluation of the Adjusted DeLone and McLean Model of Information Systems Success; the case of financial information system in Ferdowsi University of Mashhad

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Mohammad Lagzian

2012-07-01

Full Text Available Assessing the success of information systems within organizations has been identified as one of the most critical subjects of information system management in both public and private organizations. It is therefore important to measure the success of information systems from the user's perspective. The purpose of the current study was to evaluate the degree of information system success by the adjusted DeLone and McLean’s model in the field financial information system (FIS in an Iranian University. The relationships among the dimensions in an extended systems success measurement framework were tested. Data were collected by questionnaire from end-users of a financial information system at Ferdowsi University of Mashhad. The adjusted DeLone and McLean model was contained five variables (system quality, information quality, system use, user satisfaction, and individual impact. The results revealed that system quality was significant predictor of system use, user satisfaction and individual impact. Information quality was also a significant predictor of user satisfaction and individual impact, but not of system use. System use and user satisfaction were positively related to individual impact. The influence of user satisfaction on system use was insignificant

Outflow occlusion for circulatory arrest in dogs "Outfow occlusion" para parada circulatória em cães

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James N.B.M. de Andrade

2009-02-01

Full Text Available The purpose of this study was to evaluate the possibility of producing circulatory arrest by occlusion of the pulmonary trunk as an alternative to the venous inflow occlusion through the left hemithorax. Eight healthy mongrel dogs were divided in two groups. Group I underwent 4 minutes of outflow occlusion and Group II was submitted to 8 minutes of circulatory arrest. Outflow occlusion was performed through left thoracotomy and pericardiotomy by passing a Rumel tourniquet around the pulmonary trunk. Physical examination, electrocardiography, echocardiography, blood gas analyses, hemodynamic, and oxygen transport variables were obtained before and after the procedure. The dogs from Group I did not have any clinical, electrocardiographic, echocardiographic, or hemo-dynamic abnormalities after anesthetic recover. In the Group II, only one dog survived, which had no clinical, electrocardiographic, or echocardiographic abnormalities. In this last dog, just after releasing the occlusion, it was detected increases in the following parameters: heart rate (HR, systolic, diastolic and mean arterial blood pressure (SAP; DAP; MAP, pulmonary artery pressure (PAP, pulmonary wedge pressure (PWP, central venous pressure (CVP, cardiac output (CO, systolic index (SI, cardiac index (CI, left and right ventricular stroke work (LVSW; RVSW, oxygen delivery index (DO2, oxygen consumption index (VO2, and oxygen extraction (O2 ext. Moreover, the oxygen content of arterial and mixed venous blood (CaO2; CvO2, and the arterial and mixed venous partial pressure of oxygen (PaO2; PvO2 were decreased 5 minutes after circulatory arrest. Outflow occlusion is a feasible surgical procedure for period of 4 minutes of circulatory arrest.O objetivo deste estudo foi avaliar a possibilidade de se produzir uma parada circulatória pela oclusão do tronco pulmonar, como alternativa ao "inflow occlusion", pelo hemitórax esquerdo. Oito cães sem raça definida foram divididos em dois

Chronic Deep Brain Stimulation of the Hypothalamic Nucleus in Wistar Rats Alters Circulatory Levels of Corticosterone and Proinflammatory Cytokines

Science.gov (United States)

Calleja-Castillo, Juan Manuel; De La Cruz-Aguilera, Dora Luz; Manjarrez, Joaquín; Velasco-Velázquez, Marco Antonio; Morales-Espinoza, Gabriel; Moreno-Aguilar, Julia; Hernández, Maria Eugenia; Aguirre-Cruz, Lucinda

2013-01-01

Deep brain stimulation (DBS) is a therapeutic option for several diseases, but its effects on HPA axis activity and systemic inflammation are unknown. This study aimed to detect circulatory variations of corticosterone and cytokines levels in Wistar rats, after 21 days of DBS-at the ventrolateral part of the ventromedial hypothalamic nucleus (VMHvl), unilateral cervical vagotomy (UCVgX), or UCVgX plus DBS. We included the respective control (C) and sham (S) groups (n = 6 rats per group). DBS treated rats had higher levels of TNF-α (120%; P < 0.01) and IFN-γ (305%; P < 0.001) but lower corticosterone concentration (48%; P < 0.001) than C and S. UCVgX animals showed increased corticosterone levels (154%; P < 0.001) versus C and S. UCVgX plus DBS increased IL-1β (402%; P < 0.001), IL-6 (160%; P < 0.001), and corsticosterone (178%; P < 0.001 versus 48%; P < 0.001) compared with the C and S groups. Chronic DBS at VMHvl induced a systemic inflammatory response accompanied by a decrease of HPA axis function. UCVgX rats experienced HPA axis hyperactivity as result of vagus nerve injury; however, DBS was unable to block the HPA axis hyperactivity induced by unilateral cervical vagotomy. Further studies are necessary to explore these findings and their clinical implication. PMID:24235973

Risks of circulatory diseases among Mayak PA workers with radiation doses estimated using the improved Mayak Worker Dosimetry System 2008

Energy Technology Data Exchange (ETDEWEB)

Moseeva, Maria B.; Azizova, Tamara V.; Grigoryeva, Evgenia S. [Southern Urals Biophysics Institute (SUBI), Ozyorsk, Chelyabinsk Region (Russian Federation); Haylock, Richard [Public Health of England, London (United Kingdom)

2014-05-15

The new Mayak Worker Dosimetry System 2008 (MWDS-2008) was published in 2013 and supersedes the Doses-2005 dosimetry system for Mayak Production Association (PA) workers. It provides revised external and internal dose estimates based on the updated occupational history data. Using MWDS-2008, a cohort of 18,856 workers first employed at one of the main Mayak PA plants during 1948-1972 and followed up to 2005 was identified. Incidence and mortality risks from ischemic heart disease (IHD) (International Classification of Diseases (ICD)-9 codes 410-414) and from cerebrovascular diseases (CVD) (ICD-9 codes 430-438) were examined in this cohort and compared with previously published risk estimates in the same cohort based on the Doses-2005 dosimetry system. Significant associations were observed between doses from external gamma-rays and IHD and CVD incidence and also between internal doses from alpha-radiation and IHD mortality and CVD incidence. The estimates of excess relative risk (ERR)/Gy were consistent with those estimates from the previous studies based on Doses-2005 system apart from the relationship between CVD incidence and internal liver dose where the ERR/Gy based on MWDS-2008 was just over three times higher than the corresponding estimate based on Doses-2005 system. Adjustment for smoking status did not show any effect on the estimates of risk from internal alpha-particle exposure. (orig.)

Convexity Adjustments

DEFF Research Database (Denmark)

M. Gaspar, Raquel; Murgoci, Agatha

2010-01-01

A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

[Evaluation of circulatory state using pulse oximeter: 2. PI (perfusion index) x PVI (pleth variability index)].

Science.gov (United States)

Kaneda, Toru; Suzuki, Toshiyasu

2009-07-01

Pulse oximeter expressed by SpO2 is used for monitoring respiratory state during operation and in ICU. Perfusion index (PI) and pleth variability index (PVI) as new indexes are calculated from pulse oximeter (Masimo SET Radical-7, Masimo Corp., USA, 1998) waveforms. And these indices were used as parameters to evaluate the circulatory state. For PI calculation, the pulsatile infrared signal is indexed against the nonpulsatile infrared signal and expressed as a percentage. It might thus be of future value in assessment of perioperative changes in peripheral perfusion. PVI is a measure of a dynamic change in PI that occurs during complete respiratory cycle. It might be thought that PVI, an index automatically derived from the pulse oximeter waveform analysis, had potentially clinical applications for noninvasive hypovolemia detection and fluid responsiveness monitoring.

Role of long-term mechanical circulatory support in patients with advanced heart failure.

Science.gov (United States)

Stokes, M B; Bergin, P; McGiffin, D

2016-05-01

Advanced heart failure represents a small proportion of patients with heart failure that possess high-risk features associated with high hospital readmission rates, significant functional impairment and mortality. Identification of those who have progressed to, or are near a state of advanced heart failure should prompt referral to a service that offers therapies in mechanical circulatory support (MCS) and cardiac transplantation. MCS has grown as a management strategy in the care of these patients, most commonly as a bridge to cardiac transplantation. The predominant utilisation of MCS is implantation of left ventricular assist devices (LVAD), which have evolved significantly in their technology and application over the past 15-20 years. The technology has evolved to such an extent that Destination Therapy is now being utilised as a strategy in management of advanced heart failure in appropriately selected patients. Complication rates have decreased with VAD implantation, but remain a significant consideration in the decision to implant a device, and in the follow up of these patients. © 2016 Royal Australasian College of Physicians.

THE NEED AND KEYS FOR A NEW GENERATION NETWORK ADJUSTMENT SOFTWARE

Directory of Open Access Journals (Sweden)

I. Colomina

2012-07-01

Full Text Available Orientation and calibration of photogrammetric and remote sensing instruments is a fundamental capacity of current mapping systems and a fundamental research topic. Neither digital remote sensing acquisition systems nor direct orientation gear, like INS and GNSS technologies, made block adjustment obsolete. On the contrary, the continuous flow of new primary data acquisition systems has challenged the capacity of the legacy block adjustment systems – in general network adjustment systems – in many aspects: extensibility, genericity, portability, large data sets capacity, metadata support and many others. In this article, we concentrate on the extensibility and genericity challenges that current and future network systems shall face. For this purpose we propose a number of software design strategies with emphasis on rigorous abstract modeling that help in achieving simplicity, genericity and extensibility together with the protection of intellectual proper rights in a flexible manner. We illustrate our suggestions with the general design approach of GENA, the generic extensible network adjustment system of GeoNumerics.

[Automatic adjustment control system for DC glow discharge plasma source].

Science.gov (United States)

Wan, Zhen-zhen; Wang, Yong-qing; Li, Xiao-jia; Wang, Hai-zhou; Shi, Ning

2011-03-01

There are three important parameters in the DC glow discharge process, the discharge current, discharge voltage and argon pressure in discharge source. These parameters influence each other during glow discharge process. This paper presents an automatic control system for DC glow discharge plasma source. This system collects and controls discharge voltage automatically by adjusting discharge source pressure while the discharge current is constant in the glow discharge process. The design concept, circuit principle and control program of this automatic control system are described. The accuracy is improved by this automatic control system with the method of reducing the complex operations and manual control errors. This system enhances the control accuracy of glow discharge voltage, and reduces the time to reach discharge voltage stability. The glow discharge voltage stability test results with automatic control system are provided as well, the accuracy with automatic control system is better than 1% FS which is improved from 4% FS by manual control. Time to reach discharge voltage stability has been shortened to within 30 s by automatic control from more than 90 s by manual control. Standard samples like middle-low alloy steel and tin bronze have been tested by this automatic control system. The concentration analysis precision has been significantly improved. The RSDs of all the test result are better than 3.5%. In middle-low alloy steel standard sample, the RSD range of concentration test result of Ti, Co and Mn elements is reduced from 3.0%-4.3% by manual control to 1.7%-2.4% by automatic control, and that for S and Mo is also reduced from 5.2%-5.9% to 3.3%-3.5%. In tin bronze standard sample, the RSD range of Sn, Zn and Al elements is reduced from 2.6%-4.4% to 1.0%-2.4%, and that for Si, Ni and Fe is reduced from 6.6%-13.9% to 2.6%-3.5%. The test data is also shown in this paper.

Number of Heat Wave Deaths by Diagnosis, Sex, Age Groups, and Area, in Slovenia, 2015 vs. 2003

Science.gov (United States)

Perčič, Simona; Kukec, Andreja; Cegnar, Tanja; Hojs, Ana

2018-01-01

Background: Number of deaths increases during periods of elevated heat. Objectives: To examine whether differences in heat-related deaths between 2003 and 2015 occurred in Slovenia. Materials and Methods: We estimated relative risks for deaths for the observed diagnoses, sex, age, and area, as well as 95% confidence intervals and excess deaths associated with heat waves occurring in 2015 and 2003. For comparison between 2015 and 2003, we calculated relative risks ratio and 95% confidence intervals. Results: Statistically significant in 2015 were the following: age group 75+, all causes of deaths (RR = 1.10, 95% CI 1.00–1.22); all population, circulatory system diseases (RR = 1.14, 95% CI 1.01–1.30) and age group 75+, diseases of circulatory system (RR = 1.17, 95% CI 1.01–1.34). Statistically significant in 2003 were the following: female, age group 5–74, circulatory system diseases (RR = 1.69, 95% CI 1.08–2.62). Discussion: Comparison between 2015 and 2003, all, circulatory system diseases (RRR = 1.25, 95% CI 1.01–1.55); male, circulatory system diseases (RRR = 1.85, 95% CI 1.41–2.43); all, age group 75+ circulatory system diseases (RRR = 1.34, 95% CI 1.07–1.69); male, age group 75+, circulatory system diseases (RRR = 1.52, 95% CI 1.03–2.25) and female, age group 75+, circulatory system diseases (RRR = 1.43, 95% CI 1.08–1.89). Conclusions: Public health efforts are urgent and should address circulatory system causes and old age groups. PMID:29361792

Parameters-adjustable front-end controller in digital nuclear measurement system

International Nuclear Information System (INIS)

Hao Dejian; Zhang Ruanyu; Yan Yangyang; Wang Peng; Tang Changjian

2013-01-01

Background: One digitizer is used to implement a digital nuclear measurement for the acquisition of nuclear information. Purpose: A principle and method of a parameter-adjustable front-end controller is presented for the sake of reducing the quantitative errors while getting the maximum ENOB (effective number of bits) of ADC (analog-to-digital converter) during waveform digitizing, as well as reducing the losing counts. Methods: First of all, the quantitative relationship among the radiation count rate (n), the amplitude of input signal (V in ), the conversion scale of ADC (±V) and the amplification factor (A) was derived. Secondly, the hardware and software of the front-end controller were designed to fulfill matching the output of different detectors, adjusting the amplification linearly through the control of channel switching, and setting of digital potentiometer by CPLD (Complex Programmable Logic Device). Results: (1) Through the measurement of γ-ray of Am-241 under our digital nuclear measurement set-up with CZT detector, it was validated that the amplitude of output signal of detectors of RC feedback type could be amplified linearly with adjustable amplification by the front-end controller. (2) Through the measurement of X-ray spectrum of Fe-5.5 under our digital nuclear measurement set-up with Si-PIN detector, it was validated that the front-end controller was suitable for the switch resetting type detectors, by which high precision measurement under various count rates could be fulfilled. Conclusion: The principle and method of the parameter-adjustable front-end controller presented in this paper is correct and feasible. (authors)

48 CFR 9904.413 - Adjustment and allocation of pension cost.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Adjustment and allocation of pension cost. 9904.413 Section 9904.413 Federal Acquisition Regulations System COST ACCOUNTING... AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.413 Adjustment and allocation of pension...

A self-adjustable four-point probing system using polymeric three dimensional coils and non-toxic liquid metal

Energy Technology Data Exchange (ETDEWEB)

Oyunbaatar, Nomin-Erdene; Choi, Young Soo; Lee, Dong-Weon, E-mail: mems@jnu.ac.kr [MEMS and Nanotechnology Laboratory, School of Mechanical Engineering, Chonnam National University, Gwangju 500757 (Korea, Republic of)

2015-12-15

This paper describes a self-adjustable four-point probe (S4PP) system with a square configuration. The S4PP system consists of 3D polymer coil springs for the independent operation of each tungsten (W) probe, microfluidic channels filled with a nontoxic liquid metal, and a LabView-based control system. The 3D coil springs made by PMMA are fabricated with a 3D printer and are positioned in a small container filled with the non-toxic liquid metal. This unique configuration allows independent self-adjustment of the probe heights for precise measurements of the electrical properties of both flexible and large-step-height microsamples. The feasibility of the fabricated S4PP system is evaluated by measuring the specific resistance of Cr and Au thin films deposited on silicon wafers. The system is then employed to evaluate the electrical properties of a Au thin film deposited onto a flexible and easily breakable silicon diaphragm (spring constant: ∼3.6 × 10{sup −5} N/m). The resistance of the Cr thin films (thickness: 450 nm) with step heights of 60 and 90 μm is also successfully characterized. These experimental results indicate that the proposed S4PP system can be applied to common metals and semiconductors as well as flexible and large-step-height samples.

A self-adjustable four-point probing system using polymeric three dimensional coils and non-toxic liquid metal

International Nuclear Information System (INIS)

Oyunbaatar, Nomin-Erdene; Choi, Young Soo; Lee, Dong-Weon

2015-01-01

This paper describes a self-adjustable four-point probe (S4PP) system with a square configuration. The S4PP system consists of 3D polymer coil springs for the independent operation of each tungsten (W) probe, microfluidic channels filled with a nontoxic liquid metal, and a LabView-based control system. The 3D coil springs made by PMMA are fabricated with a 3D printer and are positioned in a small container filled with the non-toxic liquid metal. This unique configuration allows independent self-adjustment of the probe heights for precise measurements of the electrical properties of both flexible and large-step-height microsamples. The feasibility of the fabricated S4PP system is evaluated by measuring the specific resistance of Cr and Au thin films deposited on silicon wafers. The system is then employed to evaluate the electrical properties of a Au thin film deposited onto a flexible and easily breakable silicon diaphragm (spring constant: ∼3.6 × 10"−"5 N/m). The resistance of the Cr thin films (thickness: 450 nm) with step heights of 60 and 90 μm is also successfully characterized. These experimental results indicate that the proposed S4PP system can be applied to common metals and semiconductors as well as flexible and large-step-height samples.

Intracorporeal Heat Distribution from Fully Implantable Energy Sources for Mechanical Circulatory Support: A Computational Proof-of-Concept Study

Directory of Open Access Journals (Sweden)

Jacopo Biasetti

2017-10-01

Full Text Available Mechanical circulatory support devices, such as total artificial hearts and left ventricular assist devices, rely on external energy sources for their continuous operation. Clinically approved power supplies rely on percutaneous cables connecting an external energy source to the implanted device with the associated risk of infections. One alternative, investigated in the 70s and 80s, employs a fully implanted nuclear power source. The heat generated by the nuclear decay can be converted into electricity to power circulatory support devices. Due to the low conversion efficiencies, substantial levels of waste heat are generated and must be dissipated to avoid tissue damage, heat stroke, and death. The present work computationally evaluates the ability of the blood flow in the descending aorta to remove the locally generated waste heat for subsequent full-body distribution and dissipation, with the specific aim of investigating methods for containment of local peak temperatures within physiologically acceptable limits. To this aim, coupled fluid–solid heat transfer computational models of the blood flow in the human aorta and different heat exchanger architectures are developed. Particle tracking is used to evaluate temperature histories of cells passing through the heat exchanger region. The use of the blood flow in the descending aorta as a heat sink proves to be a viable approach for the removal of waste heat loads. With the basic heat exchanger design, blood thermal boundary layer temperatures exceed 50°C, possibly damaging blood cells and proteins. Improved designs of the heat exchanger, with the addition of fins and heat guides, allow for drastically lower blood temperatures, possibly leading to a more biocompatible implant. The ability to maintain blood temperatures at biologically compatible levels will ultimately allow for the body-wise distribution, and subsequent dissipation, of heat loads with minimum effects on the human physiology.

Intracorporeal Heat Distribution from Fully Implantable Energy Sources for Mechanical Circulatory Support: A Computational Proof-of-Concept Study.

Science.gov (United States)

Biasetti, Jacopo; Pustavoitau, Aliaksei; Spazzini, Pier Giorgio

2017-01-01

Mechanical circulatory support devices, such as total artificial hearts and left ventricular assist devices, rely on external energy sources for their continuous operation. Clinically approved power supplies rely on percutaneous cables connecting an external energy source to the implanted device with the associated risk of infections. One alternative, investigated in the 70s and 80s, employs a fully implanted nuclear power source. The heat generated by the nuclear decay can be converted into electricity to power circulatory support devices. Due to the low conversion efficiencies, substantial levels of waste heat are generated and must be dissipated to avoid tissue damage, heat stroke, and death. The present work computationally evaluates the ability of the blood flow in the descending aorta to remove the locally generated waste heat for subsequent full-body distribution and dissipation, with the specific aim of investigating methods for containment of local peak temperatures within physiologically acceptable limits. To this aim, coupled fluid-solid heat transfer computational models of the blood flow in the human aorta and different heat exchanger architectures are developed. Particle tracking is used to evaluate temperature histories of cells passing through the heat exchanger region. The use of the blood flow in the descending aorta as a heat sink proves to be a viable approach for the removal of waste heat loads. With the basic heat exchanger design, blood thermal boundary layer temperatures exceed 50°C, possibly damaging blood cells and proteins. Improved designs of the heat exchanger, with the addition of fins and heat guides, allow for drastically lower blood temperatures, possibly leading to a more biocompatible implant. The ability to maintain blood temperatures at biologically compatible levels will ultimately allow for the body-wise distribution, and subsequent dissipation, of heat loads with minimum effects on the human physiology.

Time Course of Changes in Extravascular Lung Water Index, Intracranial and Cerebral Perfusion Pressures in Acute Cerebral Circulatory Disorders

Directory of Open Access Journals (Sweden)

Yu. A. Churlyaev

2009-01-01

Full Text Available Objective: to study the time course of changes in extravascular lung water index (ELWI and intracranial and cerebral perfusion pressures (ICP and CPP and to determine their possible relationships in acute cerebral circulatory disorders (ACCD. Subject and methods. ELWI, pulmonary vascular permeability index (PVPI, ICP, CPP, and central hemodynamics were studied by transpulmonary thermodilution and current X-ray studies were conducted in 18 patients on days 1, 3, 5, and 7 of ACCD. Results. Examinations revealed a supratentorial dislocation of the brain in 6 persons; its subtento-rial dislocation was found in 1 case; supra- and subtentorial dislocations were seen in 6. In patients, ELWI and PVPI increased from days 1 and 5, respectively. The high baseline ICP increased over time. CPP remained unchanged. Preserved left ventricular contractility, enhanced myocardial one, a significant direct correlation between ELWI and PVPI, as well as their increase confirmed that the noncardiogenic genesis was responsible for increased ELWI. A direct significant correlation was found between ICP and ELWI, ICP and PVPI. Against this background, acute respiratory distress syndrome developed in 14 patients with pneumonia evolving in its presence in 7 patients. Conclusion. In ACCD, ELWI increases in the first 24 hours of the acute period. One of its causes is, along with others, primary and/or secondary damage to the brainstem structures with elevated ICP and progressive brain dislocation. The determination of ICP, unlike CPP, is crucial in the diagnosis and treatment of primary/secondary brain injuries and in prognosis. Key words: acute cerebral circulatory disorder, extravascular lung fluid, pulmonary vascular permeability, intracranial pressure, cerebral perfusion pressure, acute respiratory distress syndrome.

Fast renal trapping of porcine Luteinizing Hormone (pLH shown by 123I-scintigraphic imaging in rats explains its short circulatory half-life

Directory of Open Access Journals (Sweden)

Locatelli Alain

2003-10-01

Full Text Available Abstract Background Sugar moieties of gonadotropins play no primary role in receptor binding but they strongly affect their circulatory half-life and consequently their in vivo biopotencies. In order to relate more precisely hepatic trapping of these glycoproteic hormones with their circulatory half-life, we undertook a comparative study of the distribution and elimination of porcine LH (pLH and equine CG (eCG which exhibit respectively a short and a long half-life. This was done first by following half-lives of pLH in piglets with hepatic portal circulation shunted or not. It was expected that such a shunt would enhance the short half-life of pLH. Subsequently, scintigraphic imaging of both 123I-pLH and 123I-eCG was performed in intact rats to compare their routes and rates of distribution and elimination. Methods Native pLH or eCG was injected to normal piglets and pLH was tested in liver-shunted anæsthetized piglet. Blood samples were recovered sequentially over one hour time and the hormone concentrations were determined by a specific ELISA method. Scintigraphic imaging of 123I-pLH and 123I-eCG was performed in rats using a OPTI-CGR gamma camera. Results In liver-shunted piglets, the half-life of pLH was found to be as short as in intact piglets (5 min. In the rat, the half-life of pLH was also found to be very short (3–6 min and 123I-pLH was found to accumulate in high quantity in less than 10 min post injection at the level of kidneys but not in the liver. 123I-eCG didn't accumulate in any organ in the rats during the first hour, plasma concentrations of this gonadotropin being still elevated (80% at this time. Conclusion In both the porcine and rat species, the liver is not responsible for the rapid elimination of pLH from the circulation compared to eCG. Our scintigraphic experiments suggest that the very short circulatory half-life of LH is due to rapid renal trapping.

Parent emotion socialization and pre-adolescent's social and emotional adjustment: Moderating effects of autonomic nervous system reactivity.

Science.gov (United States)

McQuade, Julia D; Breaux, Rosanna P

2017-12-01

This study examined whether measures of children's autonomic nervous system (ANS) reactivity to social stress moderated the effect of parent emotion socialization on children's social and emotional adjustment. Sixty-one children (9-13 years) completed a peer rejection task while their respiratory sinus arrhythmia reactivity (RSA-R) and skin conductance level reactivity (SCL-R) were assessed. Parents' report of supportive and non-supportive reactions to their child's negative emotions served as measures of emotion socialization. Measures of children's social and emotional adjustment included: teacher-rated peer rejection, aggression, and prosocial behavior and parent-rated aggressive/dysregulated behavior and emotion regulation skills. Measures of children's ANS reactivity moderated the effect of parent emotion socialization on children's adjustment. Supportive responses were more protective for children evidencing RSA augmentation whereas non-supportive responses were more detrimental for children evidencing low SCL-R. Thus children's ANS reactivity during social stress may represent a biological vulnerability that influences sensitivity to parent emotion socialization. Copyright © 2017 Elsevier B.V. All rights reserved.

Life-threatening systemic toxicity and airway compromise from a common European adder bite to the tongue

DEFF Research Database (Denmark)

Hoegberg, L C G; Jessen, C L; Lambertsen, K

2009-01-01

, pharyngeal and facial oedema compromised the airway, leading to respiratory failure, concomitant with circulatory failure related to hypoxaemia and systemic toxic effects. Acute tracheotomy secured the airway, and two doses of antivenom successfully treated the systemic, toxic effects. The reaction...

Speed of adjustment: Evidence from Borsa Istanbul

Directory of Open Access Journals (Sweden)

Emrah Arioglu

2014-06-01

Full Text Available In this study, we investigate the speed of adjustment for leverage ratios of firms listed on Borsa Istanbul, in order to investigate the prediction of the trade-off theory, regarding capital structure rebalancing. For this purpose, we estimate the speed of adjustment by using Generalized Method of Moments system estimation technique. The results of this estimation suggest the speed of adjustment as approximately 29%. This significant speed of adjustment is consistent with the prediction of trade-off theory, which suggests that firms follow target capital structures and when the firms' leverage ratios deviate from these targets; they make financial decisions with the goal of closing the gap between the previous year's leverage and target leverage of the current period.

5 CFR 534.504 - Annual adjustment in pay.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Annual adjustment in pay. 534.504 Section 534.504 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.504 Annual adjustment...

Opportunity to reduce the exhaust gases with engine adjust

International Nuclear Information System (INIS)

Dimitrovski, Mile; Mucevski, Kiril

2002-01-01

According to statistics in the Republic of Macedonia, the number of old vehicles is about 90%. These are vehicles produced between 1975 and 1990 with classical systems for forming and burning the fuel mixture. The most of them do not have system for processing exhaust gases (catalytic converter) and are serious air pollutants of carbon monoxide (CO). In this article we try to make an attempt to reduce exhaust gases in some kinds of these vehicles with adjusting to the system for burning fuel mixture and with adjusting to the system for forming fuel mixture (carburetor). At the same time the changes on the rotate bending moment and engine power are followed. It is noticed that with a proper adjustment the emission of exhaust gases can be reduced without a serious depreciation of the rotate bending moment and the engine power. (Author)

48 CFR 52.215-15 - Pension adjustments and asset reversions.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Pension adjustments and... Clauses 52.215-15 Pension adjustments and asset reversions. As prescribed in 15.408(g), insert the following clause: Pension Adjustments and Asset Reversions (OCT 2010) (a) The Contractor shall promptly...

42 CFR 412.525 - Adjustments to the Federal prospective payment.

Science.gov (United States)

2010-10-01

... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.525 Adjustments to the Federal prospective payment. (a... its estimated costs for a patient exceed the adjusted LTC-MS-DRG payment plus a fixed-loss amount. For...

Control of Cell Fate in the Circulatory and Ventilatory Systems

CERN Document Server

Thiriet, Marc

2012-01-01

The volumes in this authoritative series present a multidisciplinary approach to modeling and simulation of flows in the cardiovascular and ventilatory systems, especially multiscale modeling and coupled simulations. The cardiovascular and respiratory systems are tightly coupled, as their primary function is to supply oxygen to and remove carbon dioxide from the body's cells. Because physiological conduits have deformable and reactive walls, macroscopic flow behavior and prediction must be coupled to nano- and microscopic events in a corrector scheme of regulated mechanisms. Therefore, investigation of flows of blood and air in physiological conduits requires an understanding of the biology, chemistry, and physics of these systems together with the mathematical tools to describe their functioning. Volumes 1 and 2 are devoted to cell organization and fate, as well as activities that are autoregulated and/or controlled by the cell environment. Volume 1 examined cellular features that allow adaptation to env...

Usefulness of extracorporeal membrane oxygenation using double roller pumps in a low body weight newborn: A novel strategy for mechanical circulatory support in an infant

Directory of Open Access Journals (Sweden)

Keisuke Nakanishi

2016-01-01

Full Text Available Extracorporeal membrane oxygenation (ECMO with a centrifugal pump requires a certain flow rate; therefore, its application for low body weight infants is frequently accompanied by oxygenator membrane malfunction and/or inadequate perfusion. To prevent low-flow associated complications, we report a case in which a novel system of dual roller pumps was used. A baby girl with a body mass index 0.25 m 2 , who experienced difficulty weaning from cardiopulmonary bypass after a Norwood-like operation, required an ECMO. Concerns for the tube lifespan reduction due to roller pump friction led to the use of a double roller pump circulation. The termination of ECMO during tube exchange is not needed, because circulation is maintained by another roller pump. The novel strategy of ECMO with double roller pumps will allow low perfusion rate to provide adequate circulatory support for low body weight patients.

HIV quality report cards: impact of case-mix adjustment and statistical methods.

Science.gov (United States)

Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

2014-10-15

There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis.

Science.gov (United States)

Ganapathi, Asvin M; Hanna, Jennifer M; Schechter, Matthew A; Englum, Brian R; Castleberry, Anthony W; Gaca, Jeffrey G; Hughes, G Chad

2014-12-01

The choice of cerebral perfusion strategy for aortic arch surgery has been debated, and the superiority of antegrade (ACP) or retrograde (RCP) cerebral perfusion has not been shown. We examined the early and late outcomes for ACP versus RCP in proximal (hemi-) arch replacement using deep hypothermic circulatory arrest (DHCA). A retrospective analysis of a prospectively maintained database was performed for all patients undergoing elective and nonelective hemiarch replacement at a single referral institution from June 2005 to February 2013. Total arch cases were excluded to limit the analysis to shorter DHCA times and a more uniform patient population for whom clinical equipoise regarding ACP versus RCP exists. A total of 440 procedures were identified, with 360 (82%) using ACP and 80 (18%) using RCP. The endpoints included 30-day/in-hospital and late outcomes. A propensity score with 1:1 matching of 40 pre- and intraoperative variables was used to adjust for differences between the 2 groups. All 80 RCP patients were propensity matched to a cohort of 80 similar ACP patients. The pre- and intraoperative characteristics were not significantly different between the 2 groups after matching. No differences were found in 30-day/in-hospital mortality or morbidity outcomes. The only significant difference between the 2 groups was a shorter mean operative time in the RCP cohort (P = .01). No significant differences were noted in late survival (P = .90). In proximal arch operations using DHCA, equivalent early and late outcomes can be achieved with RCP and ACP, although the mean operative time is significantly less with RCP, likely owing to avoidance of axillary cannulation. Questions remain regarding comparative outcomes with straight DHCA and lesser degrees of hypothermia. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Hypothermic oxygenated machine perfusion reduces bile duct reperfusion injury after transplantation of donation after circulatory death livers

Science.gov (United States)

van Rijn, Rianne; van Leeuwen, Otto B.; Matton, Alix P. M.; Burlage, Laura C.; Wiersema‐Buist, Janneke; van den Heuvel, Marius C.; de Kleine, Ruben H. J.; de Boer, Marieke T.; Gouw, Annette S. H.

2018-01-01

Dual hypothermic oxygenated machine perfusion (DHOPE) of the liver has been advocated as a method to reduce ischemia/reperfusion injury (IRI). This study aimed to determine whether DHOPE reduces IRI of the bile ducts in donation after circulatory death (DCD) liver transplantation. In a recently performed phase 1 trial, 10 DCD livers were preserved with DHOPE after static cold storage (SCS; http://www.trialregister.nl NTR4493). Bile duct biopsies were obtained at the end of SCS (before DHOPE; baseline) and after graft reperfusion in the recipient. Histological severity of biliary injury was graded according to an established semiquantitative grading system. Twenty liver transplantations using DCD livers not preserved with DHOPE served as controls. Baseline characteristics and the degree of bile duct injury at baseline (end of SCS) were similar between both groups. In controls, the degree of stroma necrosis (P = 0.002) and injury of the deep peribiliary glands (PBG; P = 0.02) increased after reperfusion compared with baseline. In contrast, in DHOPE‐preserved livers, the degree of bile duct injury did not increase after reperfusion. Moreover, there was less injury of deep PBG (P = 0.04) after reperfusion in the DHOPE group compared with controls. In conclusion, this study suggests that DHOPE reduces IRI of bile ducts after DCD liver transplantation. Liver Transplantation 24 655–664 2018 AASLD. PMID:29369470

THE PROBLEM OF ENERGY EFFICIENCY OF THE GEOTHERMAL CIRCULATION SYSTEM IN DIFFERENT MODES OF REINJECTION OF THE COOLANT

Directory of Open Access Journals (Sweden)

D. K. Djavatov

2017-01-01

Full Text Available Aim. Advanced technologies are crucial for widespread use of geothermal energy to ensure its competitiveness with conventional forms of energy. To date, the basis for the development of geothermal energy is the technology of extracting the heat transfer fluids from the subsoil. There are the following ways to extract the coolant: freeflow; pumping and circular methods. Of greatest interest is the technology to harness the geothermal energy based on geothermal circulatory system (GCS. There is the problem of the right choice of technological parameters for geothermal systems to ensure their effective functioning.Methods. We consider the development of geothermal energy technology based on geothermal circulatory system, as this technology solves the dumping of the waste water containing environmentally harmful substances. In addition to the environmental issues, this technology makes it possible to intensify the process of production and the degree of extraction of thermal resources, which significantly increases the potential for geothermal heat resources in terms of the fuel and energy balance.Findings. Were carried out optimization calculations for Ternairsky deposits of thermal waters. In the calculations, was taken into account the temperature dependence of important characteristics, such as the density and heat capacity of the coolant.Conclusions. There is the critical temperature of the coolant injected, depending on the flow rate and the diameter of the well, ensuring the effective functioning of the geothermal circulatory systems. 

Adjustable, short focal length permanent-magnet quadrupole based electron beam final focus system

Directory of Open Access Journals (Sweden)

J. K. Lim

2005-07-01

Full Text Available Advanced high-brightness beam applications such as inverse-Compton scattering (ICS depend on achieving of ultrasmall spot sizes in high current beams. Modern injectors and compressors enable the production of high-brightness beams having needed short bunch lengths and small emittances. Along with these beam properties comes the need to produce tighter foci, using stronger, shorter focal length optics. An approach to creating such strong focusing systems using high-field, small-bore permanent-magnet quadrupoles (PMQs is reported here. A final-focus system employing three PMQs, each composed of 16 neodymium iron boride sectors in a Halbach geometry has been installed in the PLEIADES ICS experiment. The field gradient in these PMQs is 560   T/m, the highest ever reported in a magnetic optics system. As the magnets are of a fixed field strength, the focusing system is tuned by adjusting the position of the three magnets along the beam line axis, in analogy to familiar camera optics. This paper discusses the details of the focusing system, simulation, design, fabrication, and experimental procedure in creating ultrasmall beams at PLEIADES.

Eight months of clinical experience with the Self-Adjusting File system.

Science.gov (United States)

Solomonov, Michael

2011-06-01

The Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel) has been recently introduced for the simultaneous instrumentation and irrigation of root canals. The SAF is claimed to adapt itself three dimensionally to the root canal, including its cross-section. It is operated with a continuous flow of sodium hypochlorite that is delivered into the root canal through the hollow file and claimed to be activated by sonic agitation of the irrigant. Our aim was to present for the first time clinical cases prepared with the SAF system and to describe a clinical classification of canals, according to their difficulty, with recommendations for endodontic treatment sequences for each category. This report is based on the experience of a single endodontist, who used the system to treat more than 50 consecutive primary endodontic cases over the prior 8 months. A clinical classification was developed which enabled the operator to select a treatment protocol for easy and optimal glide path preparation to be effectively used with the SAF file in the various root canals encountered in the clinical environment. Clinical classification of canal difficulty makes root canal treatment sequences with the SAF simple and predictable. Many types of cases can be treated with the SAF system although a novice user is advised to advance slowly along the learning curve from simpler to more complicated canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Regional perfusion by extracorporeal membrane oxygenation of abdominal organs from donors after circulatory death: a systematic review.

Science.gov (United States)

Shapey, Iestyn M; Muiesan, Paolo

2013-12-01

Organs from donors after circulatory death (DCDs) are particularly susceptible to the effects of warm ischemia injury. Regional perfusion (RP) by extracorporeal membrane oxygenation (ECMO) is increasingly being advocated as a useful remedy to the effects of ischemia/reperfusion injury, and it has been reported to enable the transplantation of organs from donors previously deemed unsuitable. The MEDLINE, Embase, and Cochrane databases were searched, and articles published between 1997 and 2013 were obtained. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two hundred ten articles were identified, and 11 were eligible for inclusion. Four hundred eighty-two kidneys and 79 livers were transplanted from regional perfusion-supported donor after circulatory death (RP-DCD) sources. One-year graft survival was lower with uncontrolled RP-DCD liver transplantation, whereas 1-year patient survival was similar. Primary nonfunction and ischemic cholangiopathy were significantly more frequent with RP-DCDs versus donors after brain death (DBDs), but there was no difference in postoperative mortality between the 2 groups. The 1-year patient and graft survival rates for RP-DCD kidney transplantation were better than the rates with standard DCDs and were comparable to, if not better than, the rates with DBDs. At experienced centers, delayed graft function (DGF) for kidney transplantation from RP-DCDs was much less frequent in comparison with all other donor types. In conclusion, RP aids the recovery of DCD organs from ischemic injury and enables transplantation with acceptable survival. RP may help to increase the donor pool, but its benefits must still be balanced with the recognition of significantly higher rates of complications in liver transplantation. In kidney transplantation, significant reductions in DGF can be obtained with RP, and there are potentially important implications for long

A study of cerebral circulation, metabolism and MRI findings in patients with chronic cerebral circulatory insufficiency

International Nuclear Information System (INIS)

Kondo, Susumu

1995-01-01

Chronic cerebral circulatory insufficiency (CCCI) is a recently proposed clinical entity characterized by symptoms such as dizziness, a feeling of heavy-headedness or vague numbness without any neurological signs or organic vascular lesions on CT. In order to elucidate its pathogenesis, ultrasonic quantitative blood flow measurement system, positron emission tomography (PET) and MRI were employed to study three groups of subjects: 60 subjects with CCCI (group A), 44 subjects with risk factors for cerebrovascular disease but without neurological abnormalities (group B), and 40 normal healthy volunteers (group C). The results are summarized as follows: Mean common carotid blood flow decreased with age in all groups. Common carotid blood flow was lowest in group A and second lowest in group B in every decade of patient age. PET study revealed that CBF and CMRO 2 in all regions examined were significantly lower in group A than in group C. The incidence of MR signal abnormalities in the white matter increased with age. Group A had the highest incidence, and group C had the lowest. Reduction in mean common carotid blood flow and cerebral blood flow was associated with increasing incidence and severity of MR signal abnormalities. These findings indicate that CCCI is a pathologic condition closely related to diffuse cerebral low perfusion resulting from cerebral arteriosclerosis. The symptoms seen in this condition, which are apt to be taken lightly, may warn of impending ischemic stroke. (author)

48 CFR 216.203 - Fixed-price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustment. 216.203 Section 216.203 Federal Acquisition Regulations System DEFENSE... CONTRACTS Fixed-Price Contracts 216.203 Fixed-price contracts with economic price adjustment. ...

Mechanism of laser micro-adjustment

International Nuclear Information System (INIS)

Shen Hong

2008-01-01

Miniaturization is a requirement in engineering to produce competitive products in the field of optical and electronic industries. Laser micro-adjustment is a new and promising technology for sheet metal actuator systems. Efforts have been made to understand the mechanisms of metal plate forming using a laser heating source. Three mechanisms have been proposed for describing the laser forming processes in different scenarios, namely the temperature gradient mechanism (TGM), buckling mechanism and upsetting mechanism (UM). However, none of these mechanisms can fully describe the deformation mechanisms involved in laser micro-adjustment. Based on the thermal and elastoplastic analyses, a coupled TGM and UM are presented in this paper to illustrate the thermal mechanical behaviours of two-bridge actuators when applying a laser forming process. To validate the proposed coupling mechanism, numerical simulations are carried out and the corresponding results demonstrate the mechanism proposed. The mechanism of the micro-laser adjustment could be taken as a supplement to the laser forming process.

Quantitative Circulatory Physiology: an integrative mathematical model of human physiology for medical education.

Science.gov (United States)

Abram, Sean R; Hodnett, Benjamin L; Summers, Richard L; Coleman, Thomas G; Hester, Robert L

2007-06-01

We have developed Quantitative Circulatory Physiology (QCP), a mathematical model of integrative human physiology containing over 4,000 variables of biological interactions. This model provides a teaching environment that mimics clinical problems encountered in the practice of medicine. The model structure is based on documented physiological responses within peer-reviewed literature and serves as a dynamic compendium of physiological knowledge. The model is solved using a desktop, Windows-based program, allowing students to calculate time-dependent solutions and interactively alter over 750 parameters that modify physiological function. The model can be used to understand proposed mechanisms of physiological function and the interactions among physiological variables that may not be otherwise intuitively evident. In addition to open-ended or unstructured simulations, we have developed 30 physiological simulations, including heart failure, anemia, diabetes, and hemorrhage. Additional stimulations include 29 patients in which students are challenged to diagnose the pathophysiology based on their understanding of integrative physiology. In summary, QCP allows students to examine, integrate, and understand a host of physiological factors without causing harm to patients. This model is available as a free download for Windows computers at http://physiology.umc.edu/themodelingworkshop.

Mechanical circulatory assist device development at the Texas Heart Institute: a personal perspective.

Science.gov (United States)

Frazier, O H

2014-01-01

In December 2013, we performed our 1000th ventricular assist device implantation at the Texas Heart Institute. In my professional career, I have been fortunate to see the development of numerous mechanical circulatory support devices for the treatment of patients with advanced heart failure. In fact, most of the cardiac pumps in wide use today were developed in the Texas Heart Institute research laboratories in cooperation with the National Heart, Lung and Blood Institute or device innovators and manufacturers and implanted clinically at our partner St. Luke's Episcopal Hospital. My early involvement in this field was guided by my mentors, Dr Michael E. DeBakey and, especially, Dr Denton A. Cooley. Also, many of the advances are directly attributable to my ongoing clinical experience. What I learned daily in my surgical practice allowed me to bring insights to the development of this technology that a laboratory researcher alone might not have had. Young academic surgeons interested in this field might be well served to be active not only in laboratory research but also in clinical practice. Copyright © 2014 Elsevier Inc. All rights reserved.

Interagency registry for mechanically assisted circulatory support report on the total artificial heart.

Science.gov (United States)

Arabía, Francisco A; Cantor, Ryan S; Koehl, Devin A; Kasirajan, Vigneshwar; Gregoric, Igor; Moriguchi, Jaime D; Esmailian, Fardad; Ramzy, Danny; Chung, Joshua S; Czer, Lawrence S; Kobashigawa, Jon A; Smith, Richard G; Kirklin, James K

2018-04-26

We sought to better understand the patient population who receive a temporary total artificial heart (TAH) as bridge to transplant or as bridge to decision by evaluating data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database. We examined data related to survival, adverse events, and competing outcomes from patients who received TAHs between June 2006 and April 2017 and used hazard function analysis to explore risk factors for mortality. Data from 450 patients (87% men; mean age, 50 years) were available in the INTERMACS database. The 2 most common diagnoses were dilated cardiomyopathy (50%) and ischemic cardiomyopathy (20%). Risk factors for right heart failure were present in 82% of patients. Most patients were INTERMACS Profile 1 (43%) or 2 (37%) at implantation. There were 266 patients who eventually underwent transplantation, and 162 died. Overall 3-, 6-, and 12-month actuarial survival rates were 73%, 62%, and 53%, respectively. Risk factors for death included older age (p = 0.001), need for pre-implantation dialysis (p = 0.006), higher creatinine (p = 0.008) and lower albumin (p Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

An Evaluation of the Adjusted DeLone and McLean Model of Information Systems Success; the case of financial information system in Ferdowsi University of Mashhad

OpenAIRE

Mohammad Lagzian; Shamsoddin Nazemi; Fatemeh Dadmand

2012-01-01

Assessing the success of information systems within organizations has been identified as one of the most critical subjects of information system management in both public and private organizations. It is therefore important to measure the success of information systems from the user's perspective. The purpose of the current study was to evaluate the degree of information system success by the adjusted DeLone and McLean’s model in the field financial information system (FIS) in an Iranian Univ...

48 CFR 3016.203 - Fixed price contracts with economic price adjustments.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Fixed price contracts with economic price adjustments. 3016.203 Section 3016.203 Federal Acquisition Regulations System DEPARTMENT OF... TYPES OF CONTRACTS Fixed-Price Contracts 3016.203 Fixed price contracts with economic price adjustments. ...

Effects of adjusting cropping systems on utilization efficiency of climatic resources in Northeast China under future climate scenarios

Science.gov (United States)

Guo, Jianping; Zhao, Junfang; Xu, Yanhong; Chu, Zheng; Mu, Jia; Zhao, Qian

Quantitatively evaluating the effects of adjusting cropping systems on the utilization efficiency of climatic resources under climate change is an important task for assessing food security in China. To understand these effects, we used daily climate variables obtained from the regional climate model RegCM3 from 1981 to 2100 under the A1B scenario and crop observations from 53 agro-meteorological experimental stations from 1981 to 2010 in Northeast China. Three one-grade zones of cropping systems were divided by heat, water, topography and crop-type, including the semi-arid areas of the northeast and northwest (III), the one crop area of warm-cool plants in semi-humid plain or hilly regions of the northeast (IV), and the two crop area in irrigated farmland in the Huanghuaihai Plain (VI). An agro-ecological zone model was used to calculate climatic potential productivities. The effects of adjusting cropping systems on climate resource utilization in Northeast China under the A1B scenario were assessed. The results indicated that from 1981 to 2100 in the III, IV and VI areas, the planting boundaries of different cropping systems in Northeast China obviously shifted toward the north and the east based on comprehensively considering the heat and precipitation resources. However, due to high temperature stress, the climatic potential productivity of spring maize was reduced in the future. Therefore, adjusting the cropping system is an effective way to improve the climatic potential productivity and climate resource utilization. Replacing the one crop in one year model (spring maize) by the two crops in one year model (winter wheat and summer maize) significantly increased the total climatic potential productivity and average utilization efficiencies. During the periods of 2011-2040, 2041-2070 and 2071-2100, the average total climatic potential productivities of winter wheat and summer maize increased by 9.36%, 11.88% and 12.13% compared to that of spring maize

Adjustable Parameter-Based Distributed Fault Estimation Observer Design for Multiagent Systems With Directed Graphs.

Science.gov (United States)

Zhang, Ke; Jiang, Bin; Shi, Peng

2017-02-01

In this paper, a novel adjustable parameter (AP)-based distributed fault estimation observer (DFEO) is proposed for multiagent systems (MASs) with the directed communication topology. First, a relative output estimation error is defined based on the communication topology of MASs. Then a DFEO with AP is constructed with the purpose of improving the accuracy of fault estimation. Based on H ∞ and H 2 with pole placement, multiconstrained design is given to calculate the gain of DFEO. Finally, simulation results are presented to illustrate the feasibility and effectiveness of the proposed DFEO design with AP.

Relationships between Digestive, Circulatory, and Urinary Systems in Portuguese Primary Textbooks

Science.gov (United States)

Carvalho, Graça S.; Clèment, Pierre

2007-01-01

In this study, 63 Portuguese primary schoolbooks (1920-2005) were analyzed. The analysis focused on text information (reference to blood absorption and association of the digestive system to other human systems) and on information from images (presence or absence of image "confusion" (when the sequence of the digestive tract is not…

NET SALARY ADJUSTMENT

CERN Multimedia

Finance Division

2001-01-01

On 15 June 2001 the Council approved the correction of the discrepancy identified in the net salary adjustment implemented on 1st January 2001 by retroactively increasing the scale of basic salaries to achieve the 2.8% average net salary adjustment approved in December 2000. We should like to inform you that the corresponding adjustment will be made to your July salary. Full details of the retroactive adjustments will consequently be shown on your pay slip.

42 CFR 412.322 - Indirect medical education adjustment factor.

Science.gov (United States)

2010-10-01

... Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data. CMS.... The indirect teaching adjustment factor equals [e (raised to the power of .2822×the ratio of residents...

A novel adjustable automated system for inducing chronic intermittent hypoxia in mice.

Directory of Open Access Journals (Sweden)

Dora Polšek

Full Text Available Sleep apnea is a chronic, widely underdiagnosed condition characterized by disruption of sleep architecture and intermittent hypoxia due to short cessations of breathing. It is a major independent risk factor for myocardial infarction, congestive heart failure and stroke as well as one of the rare modifiable risk factors for Alzheimer's Dementia. Reliable animal disease models are needed to understand the link between sleep apnea and the various clinically linked disorders.An automated system for inducing hypoxia was developed, in which the major improvement was the possibility to efficiently adjust the length and intensity of hypoxia in two different periods. The chamber used a small volume of gas allowing for fast exchanges of different oxygen levels. The mice were kept in their cages adapted with the system on the cage lid. As a proof of principle, they were exposed to a three week period of intermittent hypoxia for 8 hours a day, with 90 s intervals of 5, 7% and 21% oxygen to validate the model. Treated (n = 8 and control mice (no hypoxia, n = 7 were handled in the same manner and their hippocampal brain regions compared by histology.The chamber provided a fast, reliable and precise intermittent hypoxia, without inducing noticeable side effects to the animals. The validation experiment showed that apoptotic neurons in the hippocampus were more numerous in the mice exposed to intermittent hypoxia than in the control group, in all tested hippocampal regions (cornu ammonis 1 (CA1 P <0.001; cornu ammonis 3 (CA3 P <0.001; and dentate gyrus (DG P = 0.023. In both, control and hypoxic conditions, there was a significantly higher number of apoptotic neurons in the DG compared to the CA1 and CA3 subfields (P <0.001.The new design of a hypoxic chamber provides a fast, adjustable and reliable model of obstructive sleep apnea, which was validated by apoptosis of hippocampal neurons.

The Perils of "Adjustment Disorder" as a Diagnostic Category

Science.gov (United States)

Daniels, John

2009-01-01

"Adjustment disorder" occupies a peculiar position in the diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) straddling the boundary between normal and abnormal psychology. A more human-centered approach in counseling offers a defense of "normal" adjustment as…

Serum Ferritin in Patients With Cirrhosis is Associated With Markers of Liver Insufficiency and Circulatory Dysfunction, but Not of Portal Hypertension.

Science.gov (United States)

Ripoll, Cristina; Keitel, Felix; Hollenbach, Marcus; Greinert, Robin; Zipprich, Alexander

2015-10-01

Iron overload is an increasingly recognized phenomenon in nonhemochromatosis cirrhosis. To evaluate the relationship between iron overload and liver insufficiency and portal hypertension. Cirrhotics with hepatic hemodynamic and ferritin measurement (within 30 d) were included. Exclusion criteria were malignancy (except hepatocellular carcinoma Milan-in), severe chronic obstructive pulmonary disease, acute events in the previous 2 weeks, immunosuppression, transjugular intrahepatic portosystemic shunt or portal vein thrombosis, and end-stage renal disease. Patients were followed-up until death or liver transplant. Univariate and multivariate analysis were used. Fifty-one patients were included (male 61%; median age 57 y; interquartile range, 47 to 66 y); Child-Pugh A 11/B 25/C 15). A positive correlation was observed between ferritin and markers of inflammation (C-reactive protein: r=0.273, P=0.06 and aspartate aminotransferase: r=0.302, P=0.035). No correlation between ferritin and hepatic venous pressure gradient was seen. Negative correlations were observed between ferritin and circulatory dysfunction (mean arterial pressure: r=-0.360, P=0.014 and serum sodium: r=-0.419, P=0.002). In contrast, associations to markers of liver failure such as international normalized ratio (r=0.333, P=0.005), bilirubin (r=0.378, P=0.007), albumin (r=-0.265, P=0.082), model for end-stage liver disease (r=0.293, P=0.041), and Child-Pugh score (r=0.392, P=0.009) were observed. No differences in survival according to ferritin was detected. In patients with cirrhosis, serum ferritin levels are associated with markers of liver insufficiency, inflammation, and circulatory dysfunction but not portal hypertension.

Tissue Functioning and Remodeling in the Circulatory and Ventilatory Systems

CERN Document Server

Thiriet, Marc

2013-01-01

The volumes in this authoritative series present a multidisciplinary approach to modeling and simulation of flows in the cardiovascular and ventilatory systems, especially multiscale modeling and coupled simulations. Volume 5 is devoted to cells, tissues, and organs of the cardiovascular and ventilatory systems with an emphasis on mechanotransduction-based regulation of flow. The blood vessel wall is a living tissue that quickly reacts to loads applied on it by the flowing blood. In any segment of a blood vessel, the endothelial and smooth muscle cells can sense unusual time variations in small-magnitude wall shear stress and large-amplitude wall stretch generated by abnormal hemodynamic stresses. These cells respond with a short-time scale (from seconds to hours) to adapt the vessel caliber. Since such adaptive cell activities can be described using mathematical models, a key objective of this volume is to identify the mesoscopic agents and nanoscopic mediators required to derive adequate mathematical models...

48 CFR 201.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Statutory acquisition-related dollar thresholds-adjustment for inflation. 201.109 Section 201.109 Federal Acquisition...-adjustment for inflation. (d) A matrix showing the most recent escalation adjustments of statutory...

Potential therapeutic agents for circulatory diseases from Bauhinia glauca Benth.subsp. pernervosa. (Da Ye Guan Men).

Science.gov (United States)

Tang, Yingzhan; Ling, Junhong; Zhang, Peng; Zhang, Xiangrong; Zhang, Na; Wang, Wenli; Li, Jiayuan; Li, Ning

2015-08-15

Because of platelets as critical factor in the formation of pathogenic thrombi, anti-platelet activities have been selected as therapeutic target for various circulatory diseases. In order to find potential therapeutic agents, bioassay-directed separation of Bauhinia glauca Benth.subsp. pernervosa. (called Da Ye Guan Men as a traditional Chinese medicine) was performed to get 29 main components (compounds 1-29) from the bioactive part of this herbal. It was the first time to focus on the composition with anti-platelet aggregation activities for this traditional Chinese medicine. The constituents, characterized from the effective extract, were established on the basis of extensive spectral data analysis. Then their anti-platelet aggregation effects were evaluated systematically. On the basis of the chemical profile and biological assay, it was suggested that the flavonoid composition (5 and 18) should be responsible for the anti-platelet aggregation of the herbal because of their significant activities. The primary structure and activity relationship was also discussed briefly. Copyright © 2015. Published by Elsevier Ltd.

Positioning accuracy analysis of adjusting target mechanism of three-dimensional attitude

International Nuclear Information System (INIS)

Ma Li; Wang Kun; Sun Linzhi; Zhou Shasha

2012-01-01

A novel adjusting target mechanism of three-dimensional attitude is presented according to the characteristics of the target transport subsystem in inertial confinement fusion (ICF). The mechanism consists of a tangent mechanism adjusting rotation angle and a set of orthogonal tangent mechanism adjusting two-dimensional deflection angles. The structural parameters of the adjusting target mechanism are analyzed according to principle errors, structure errors and motion errors of following. The analysis results indicate that the system error of the adjusting target mechanism is influenced by the displacement of the linear actuators, the actuator ball radius, the working radius of the tangent mechanism, the angle error of the inclined installation hole, the centralization error of the actuators, the orthogonal error of the two tangent mechanism, and the angle errors of the inclined target rod inclined rotation shaft. The errors of the inclined target rod and inclined rotation shaft are the two greatest impact factors, the spherical contact error is the next. By means of precise assembly and control system compensation, the accuracy of the adjusting target mechanism can be less than 0.1 mrad. (authors)

Visceral vasculature in the family Cordylidae (Reptilia: Squamata)

African Journals Online (AJOL)

1992-11-24

Nov 24, 1992 ... Major circulatory patterns in lizards of the family Cordylidae are poorly known, but may serve as a source of characters for ... circulatory system, a large body of comparative data on circulatory ..... Confirmation of the evolution.

''VaneCAM'' - the third generation of camshaft adjustment systems; ''VaneCAM'' - Nockenwellenversteller der dritten Generation

Energy Technology Data Exchange (ETDEWEB)

Knecht, A. [Hydraulik-Ring GmbH, Nuertingen (Germany). Entwicklung Motorentechnik; Stephan, W. [Hydraulik-Ring GmbH, Nuertingen (Germany); Hannibal, W. [Fachhochschule Suedwestfalen, Iserlohn (Germany). Labor fuer Konstruktion und CAE-Anwendungen

2002-04-01

Continuously variable camphasers are now well established for modern spark-ignition engines in high-volume production. With the latest generation of camshaft adjustment systems using the vane-type actuator principle, it is possible to move rapidly and reliably through a large adjustment angle. The layout of these adjusting systems is very simple. The production costs are low in comparison to the first generation of camphasers using spur/helical gears to vary the valve timing. The new-generation systems are mechatronic, with the function depending on the coordination and tuning of hydraulic actuation and engine electronics. The term 'VaneCAM' is used for the continuously variable systems of this new generation supplied by Hydraulik-Ring in Nuertingen, Germany. (orig.) [German] Stufenlos wirkende Nockenwellenversteller haben sich an modernen Ottomotoren in den letzten Jahren in der Grossserie etabliert. Mit der neuesten Generation von Nockenwellenverstellern, die nach dem Schwenkmotor-Prinzip aufgebaut sind, lassen sich grosse Verdrehwinkel sehr schnell und betriebssicher verstellen. Der Aufbau dieser Versteller ist einfach, und die Herstellkosten sind gering im Vergleich zur ersten Generation von Verstellern. Bei den Systemen der neuen Generation handelt es sich um mechatronische Systeme, deren Funktion von dem Zusammenspiel und der Abstimmung von hydraulischer Ansteuerung und Motorelektronik abhaengt. Mit dem Begriff 'VaneCAM' werden die stufenlos wirkenden Systeme dieser neuen Generation von Hydraulik-Ring aus Nuertingen bezeichnet. (orig.)

Adjustment guidance for cyclotron by real-time display of feasible setting regions

International Nuclear Information System (INIS)

Okamura, Tetsuya; Murakami, Tohru

1990-01-01

A computer aided operation system for start-up of cyclotron is being developed in order to support operators who, through their experiences and intuition, adjust dozens of components to maximize extracted beam current. This paper describes a guidance method using real-time display of feasible setting regions of adjustment parameters. It is a function of the beam adjustment support system. The followings are the key points of this paper. (1) It is proposed that a cyclotron can be modeled as a series of mapping of beam condition. In this model, the adjustment is consider to be a searching process for a mapping which maps the beam condition into the acceptance of cyclotron. (2) The searching process is formulated as a nonlinear minimization problem. In order to solve this problem, a fast search algorithm composed of a line search method (golden section search) and an image processing method (border following) is developed. The solutions are the feasible setting regions. (3) A human interface which displays feasible setting regions and a search history is realized for the beam adjustment support system It enables that the operators and the computers cooperate the operation of beam adjustment. (author)

Structural adjustment and health: A conceptual framework and evidence on pathways.

Science.gov (United States)

Kentikelenis, Alexander E

2017-08-01

Economic reform programs designed by the International Monetary Fund and the World Bank-so-called 'structural adjustment programs'-have formed one of the most influential policy agendas of the past four decades. To gain access to financial support from these organizations, countries-often in economic crisis-have reduced public spending, limited the role of the state, and deregulated economic activity. This article identifies the multiple components of structural adjustment, and presents a conceptual framework linking them to health systems and outcomes. Based on a comprehensive review of the academic literature, the article identifies three main pathways through which structural adjustment affects health: policies directly targeting health systems; policies indirectly impacting health systems; and policies affecting the social determinants of health. The cogency of the framework is illustrated by revisiting Greece's recent experience with structural adjustment, drawing on original IMF reports and secondary literature. Overall, the framework offers a lens through which to analyze the health consequences of structural adjustment across time, space and levels of socioeconomic development, and can be utilized in ex ante health impact assessments of these policies. Copyright © 2017 Elsevier Ltd. All rights reserved.

An Analysis of Missile Systems Cost Growth and Implementation of Acquisition Reform Initiatives Using a Hybrid Adjusted Cost Growth Model

National Research Council Canada - National Science Library

Abate, Christopher

2004-01-01

...) data with a hybrid adjusted cost growth (ACG) model. In addition, an analysis of acquisition reform initiatives during the treatment period was conducted to determine if reform efforts impacted missile system cost growth. A pre-reform...

Evaluation of the incidence of microcracks caused by Mtwo and ProTaper Next rotary file systems versus the self-adjusting file: A scanning electron microscopic study.

Science.gov (United States)

Saha, Suparna Ganguly; Vijaywargiya, Neelam; Saxena, Divya; Saha, Mainak Kanti; Bharadwaj, Anuj; Dubey, Sandeep

2017-01-01

To evaluate the incidence of microcrack formation canal preparation with two rotary nickel-titanium systems Mtwo and ProTaper Next along with the self-adjusting file system. One hundred and twenty mandibular premolar teeth were selected. Standardized access cavities were prepared and the canals were manually prepared up to size 20 after coronal preflaring. The teeth were divided into three experimental groups and one control group ( n = 30). Group 1: The canals were prepared using Mtwo rotary files. Group 2: The canals were prepared with ProTaper Next files. Group 3: The canals were prepared with self-adjusting files. Group 4: The canals were unprepared and used as a control. The roots were sectioned horizontally 3, 6, and 9 mm from the apex and examined under a scanning electron microscope to check for the presence of microcracks. The Pearson's Chi-square test was applied. The highest incidence of microcracks were associated with the ProTaper Next group, 80% ( P = 0.00), followed by the Mtwo group, 70% ( P = 0.000), and the least number of microcracks was noted in the self-adjusting file group, 10% ( P = 0.068). No significant difference was found between the ProTaper Next and Mtwo groups ( P = 0.368) while a significant difference was observed between the ProTaper Next and self-adjusting file groups ( P = 0.000) as well as the Mtwo and self-adjusting file groups ( P = 0.000). All nickel-titanium rotary instrument systems were associated with microcracks. However, the self-adjusting file system had significantly fewer microcracks when compared with the Mtwo and ProTaper Next.

Initial circulatory response to active standing in Parkinson's disease without typical orthostatic hypotension

Directory of Open Access Journals (Sweden)

Guillermo Delgado

2014-03-01

Full Text Available While the circulatory response to orthostatic stress has been already evaluated in Parkinson's disease patients without typical orthostatic hypotension (PD-TOH, there is an initial response to the upright position which is uniquely associated with active standing (AS. We sought to assess this response and to compare it to that seen in young healthy controls (YHC. Method In 10 PD-TOH patients (8 males, 60±7 years, Hoehn and Yahr ≤3 the changes in systolic blood pressure (SBP and heart rate that occur in the first 30 seconds (sec of standing were examined. Both parameters were non-invasively and continuously monitored using the volume-clamp method by Peñáz and the Physiocal criteria by Wesseling. The choice of sample points was prompted by the results of previous studies. These sample points were compared to those of 10 YHC (8 males, 32±8 years. Results The main finding of the present investigation was an increased time between the AS onset and SBP overshoot in PD-TOH group (24±4 vs. 19±3 sec; p<0.05. Conclusion This delay might reflect a prolonged latency in the baroreflex-mediated vascular resistance response, but more studies are needed to confirm this preliminary hypothesis.

Signaling at the cell surface in the circulatory and ventilatory systems

CERN Document Server

Thiriet, Marc

2012-01-01

The volumes in this authoritative series present a multidisciplinary approach to modeling and simulation of flows in the cardiovascular and ventilatory systems, especially multiscale modeling and coupled simulations. The cardiovascular and respiratory systems are tightly coupled, as their primary function is to supply oxygen to and remove carbon dioxide from the body's cells. Because physiological conduits have deformable and reactive walls, macroscopic flow behavior and prediction must be coupled to nano- and microscopic events in a corrector scheme of regulated mechanisms when the vessel lumen caliber varies markedly. Therefore, investigation of flows of blood and air in physiological conduits requires an understanding of the biology, chemistry, and physics of these systems together with the mathematical tools to describe their functioning. Volume 3 is devoted to the set of mediators of the cell surface, especially ion and molecular carriers and catalytic receptors that, once liganded and activated, initiat...

How Do Students Regulate their Learning of Complex Systems with Hypermedia?.

Science.gov (United States)

Azevedo, Roger; Seibert, Diane; Guthrie, John T.; Cromley, Jennifer G.; Wang, Huei-yu; Tron, Myriam

This study examined the role of different goal-setting instructional interventions in facilitating students' shift to more sophisticated mental models of the circulatory system as indicated by both performance and process data. Researchers adopted the information processing model of self-regulated learning of P. Winne and colleagues (1998, 2001)…

The importance of the renin-angiotensin system in normal cardiovascular homeostasis

Science.gov (United States)

Haber, E.

1975-01-01

Studies were carried out on adult mongrel dogs (20 to 30 kilograms) to investigate the importance of the renin-angiotensin system. Results indicate that the renin-angiotensin system plays a major role in the maintenance of circulatory homeostasis when extracellular fluid volume is depleted. It was also found that angiotensin II concentration, in addition to renal perfusion pressure, is a factor in the regulation of renin release.

Public funding for medical research in relation to the burden of disease caused by cardiovascular diseases and neoplasms in Germany.

Science.gov (United States)

Krone, Manuel; Dufner, Vera; Wagner, Martin; Gelbrich, Götz; Ertl, Georg; Heuschmann, Peter U

2018-04-13

Public funding for medical research in Germany is primarily provided by the German Research Foundation (DFG) and the Federal Ministry of Education and Research (BMBF). The aim of this study was to analyze the amount of national public funding for medical research on predominant causes of death in Germany, cardiovascular diseases and neoplasms, in relation to the burden of these diseases in Germany. Three evaluators categorized medical research projects funded by the DFG or BMBF between 2010 and 2012 into the categories "Diseases of the circulatory system" (with subgroups "Ischemic heart diseases", "Heart failure" and "Cerebrovascular diseases") and "Neoplasms". The total amount of public funding by the national agencies was analyzed in relation to the burden of disease for the respective disease condition. Information on national public funding for medical research of 2091 million euros was available; of those, 246.8 million euros (11.8%) were categorized being spent for research on "Neoplasms", 118.4 million euros (5.7%) for research on "Diseases of the circulatory system". This results in 362.08 euros per case of death, 16.58 euros per year of life lost (YLL) and 16.04 euros per disability-adjusted life year (DALY) for "Neoplasms" and in 113.44 euros per case of death, 8.05 euros per YLL and 7.17 euros per DALY for "Diseases of the circulatory system". In Germany, research on cardiovascular diseases receives a lower share of national public funding for medical research compared to oncological research. These results are comparable to other European countries.

5 CFR 9901.333 - Setting and adjusting local market supplements.

Science.gov (United States)

2010-01-01

... factors. The Secretary may determine the effective date of newly set or adjusted targeted local market... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Setting and adjusting local market... DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Pay and Pay Administration Local Market Supplements...

Cooperation in a dynamical adjustment of duopoly game with incomplete information

International Nuclear Information System (INIS)

Ding Zhanwen; Shi Guiping

2009-01-01

In the output competition of Cournot game, the adjustment of output is considered under the circumstances that participants have incomplete information. In this paper, two strategies with output's adjustment are mainly discussed: the tit-for-tat strategy and the tit-for-tat strategy with cooperative intention and their dynamic systems, respectively. The result shows that the tit-for-tat strategy may lead to the cooperation of them, but the stability of adjustment system is sensitive to the parameters; while the tit-for-tat strategy with cooperative intention can make the Pareto Optimality stable within the parameters' certain scope.

Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

Science.gov (United States)

Ellis, Randall P.; Fernandez, Juan Gabriel

2013-01-01

Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

Directory of Open Access Journals (Sweden)

Randall P. Ellis

2013-10-01

Full Text Available Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems.

Enhancing the Relationship Adjustment of South Asian Canadian Couples Using a Systemic-Constructivist Approach to Couple Therapy.

Science.gov (United States)

Ahmad, Saunia; Reid, David W

2016-10-01

The effectiveness of systemic-constructivist couple therapy (SCCT) in improving the relationship adjustment of South Asian Canadian couples in ways that attend to their culture was evaluated. The SCCT interventions engage partners in reflexive processing of both their own and their partner's ways of construing, and the reciprocity between these two. A core change mechanism of SCCT, couple identity ("we-ness"), that connotes the ability for thinking and experiencing relationally, was coded from verbatim transcripts of partners' within-session dialogue. As predicted, South Asian partners' relationship adjustment improved significantly from the first to final session of SCCT, and concurrent increases in each partner's couple identity mediated such improvements. The implications for considering culture and couple identity in couple therapy are discussed. Video Abstract is found in the online version of the article. © 2016 American Association for Marriage and Family Therapy.

Mortality among population with exposure to industrial air pollution containing nickel and other toxic metals.

Science.gov (United States)

Pasanen, Kari; Pukkala, Eero; Turunen, Anu W; Patama, Toni; Jussila, Ilkka; Makkonen, Sari; Salonen, Raimo O; Verkasalo, Pia K

2012-05-01

To assess disease mortality among people with exposure to metal-rich particulate air pollution. We conducted a cohort study on mortality from 1981 to 2005 among 33,573 people living near a nickel/copper smelter in Harjavalta, Finland. Nickel concentration in soil humus was selected as an indicator for long-term exposure. Relative risks--adjusted for age, socioeconomic status, and calendar period--were calculated for three exposure zones. The relative risks for diseases of the circulatory system by increasing exposure were 0.93 (95% confidence interval = 0.79 to 1.09), 1.20 (1.04 to 1.39), and 1.18 (1.00 to 1.39) among men and 1.01 (0.88 to 1.17), 1.20 (1.04 to 1.38), and 1.14 (0.97 to 1.33) among women. Exclusion of smelter workers from the cohort did not materially change the results. Long-term environmental exposure to metal-rich air pollution was associated with increased mortality from circulatory diseases.

A design of calibration single star simulator with adjustable magnitude and optical spectrum output system

Science.gov (United States)

Hu, Guansheng; Zhang, Tao; Zhang, Xuan; Shi, Gentai; Bai, Haojie

2018-03-01

In order to achieve multi-color temperature and multi-magnitude output, magnitude and temperature can real-time adjust, a new type of calibration single star simulator was designed with adjustable magnitude and optical spectrum output in this article. xenon lamp and halogen tungsten lamp were used as light source. The control of spectrum band and temperature of star was realized with different multi-beam narrow band spectrum with light of varying intensity. When light source with different spectral characteristics and color temperature go into the magnitude regulator, the light energy attenuation were under control by adjusting the light luminosity. This method can completely satisfy the requirements of calibration single star simulator with adjustable magnitude and optical spectrum output in order to achieve the adjustable purpose of magnitude and spectrum.

39 CFR 3010.25 - Limitation on unused rate adjustment authority rate adjustments.

Science.gov (United States)

2010-07-01

... only be applied together with inflation-based limitation rate adjustments or when inflation-based... used in lieu of an inflation-based limitation rate adjustment. ... 39 Postal Service 1 2010-07-01 2010-07-01 false Limitation on unused rate adjustment authority...

System and method of adjusting the equilibrium temperature of an inductively-heated susceptor

Science.gov (United States)

Matsen, Marc R; Negley, Mark A; Geren, William Preston

2015-02-24

A system for inductively heating a workpiece may include an induction coil, at least one susceptor face sheet, and a current controller coupled. The induction coil may be configured to conduct an alternating current and generate a magnetic field in response to the alternating current. The susceptor face sheet may be configured to have a workpiece positioned therewith. The susceptor face sheet may be formed of a ferromagnetic alloy having a Curie temperature and being inductively heatable to an equilibrium temperature approaching the Curie temperature in response to the magnetic field. The current controller may be coupled to the induction coil and may be configured to adjust the alternating current in a manner causing a change in at least one heating parameter of the susceptor face sheet.

Initial and delayed circulatory responses to orthostatic stress in normal humans and in subjects with orthostatic intolerance

NARCIS (Netherlands)

Wieling, W.; Shepherd, J. T.

1992-01-01

Gravitational stresses, which are common daily event for humans, result in a diminution in central blood volume, due to displacement of blood to the lower parts of the body. They demand complex adjustments in the cardiovascular system to offset the decrease in cardiac filling pressure. Such changes

48 CFR 552.216-71 - Economic Price Adjustment-Special Order Program Contracts.

Science.gov (United States)

2010-10-01

... updated index, the Contractor shall have waived its right to an upward price adjustment for the balance of... Contractors shall have waived its right to an upward price adjustment for that option period. Alternatively... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Economic Price Adjustment...

The application of the Ten Group classification system (TGCS in caesarean delivery case mix adjustment. A multicenter prospective study.

Directory of Open Access Journals (Sweden)

Gianpaolo Maso

Full Text Available BACKGROUND: Caesarean delivery (CD rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index, obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively. In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024. CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the

Unified Generic Geometric-Decompositions for Consensus or Flocking Systems of Cooperative Agents and Fast Recalculations of Decomposed Subsystems Under Topology-Adjustments.

Science.gov (United States)

Li, Wei

2016-06-01

This paper considers a unified geometric projection approach for: 1) decomposing a general system of cooperative agents coupled via Laplacian matrices or stochastic matrices and 2) deriving a centroid-subsystem and many shape-subsystems, where each shape-subsystem has the distinct properties (e.g., preservation of formation and stability of the original system, sufficiently simple structures and explicit formation evolution of agents, and decoupling from the centroid-subsystem) which will facilitate subsequent analyses. Particularly, this paper provides an additional merit of the approach: considering adjustments of coupling topologies of agents which frequently occur in system design (e.g., to add or remove an edge, to move an edge to a new place, and to change the weight of an edge), the corresponding new shape-subsystems can be derived by a few simple computations merely from the old shape-subsystems and without referring to the original system, which will provide further convenience for analysis and flexibility of choice. Finally, such fast recalculations of new subsystems under topology adjustments are provided with examples.

Depiction of Trends in Administrative Healthcare Data from Hospital Information System.

Science.gov (United States)

Kalankesh, Leila R; Pourasghar, Faramarz; Jafarabadi, Mohammad Asghari; Khanehdan, Negar

2015-06-01

administrative healthcare data are among main components of hospital information system. Such data can be analyzed and deployed for a variety of purposes. The principal aim of this research was to depict trends of administrative healthcare data from HIS in a general hospital from March 2011 to March 2014. data set used for this research was extracted from the SQL database of the hospital information system in Razi general hospital located in Marand. The data were saved as CSV (Comma Separated Values) in order to facilitate data cleaning and analysis. The variables of data set included patient's age, gender, final diagnosis, final diagnosis code based on ICD-10 classification system, date of hospitalization, date of discharge, LOS(Length of Stay), ward, and survival status of the patient. Data were analyzed and visualized after applying appropriate cleansing and preparing techniques. morbidity showed a constant trend over three years. Pregnancy, childbirth and the puerperium were the leading category of final diagnosis (about 32.8 %). The diseases of the circulatory system were the second class accounting for 13 percent of the hospitalization cases. The diseases of the digestive system had the third rank (10%). Patients aged between 14 and 44 constituted a higher proportion of total cases. Diseases of the circulatory system was the most common class of diseases among elderly patients (age≥65). The highest rate of mortality was observed among patients with final diagnosis of the circulatory system diseases followed by those with diseases of the respiratory system, and neoplasms. Mortality rate for the ICU and the CCU patients were 62% and 33% respectively. The longest average of LOS (7.3 days) was observed among patients hospitalized in the ICU while patients in the Obstetrics and Gynecology ward had the shortest average of LOS (2.4 days). Multiple regression analysis revealed that LOS was correlated with variables of surgery, gender, and type of payment, ward, the

Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port.

Science.gov (United States)

Esquinas, C; Arance, I; Pamplona, J; Moraga, A; Dorado, J F; Angulo, J C

2018-04-08

Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both pATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Central respiratory and circulatory effects of Gymnodinium breve toxin in anaesthetized cats

Science.gov (United States)

Borison, Herbert L.; Ellis, Sydney; McCarthy, Lawrence E.

1980-01-01

1 In cats anaesthetized with pentobarbitone, observations were made on respiration, spontaneous and evoked diaphragmatic electromyograms, blood pressure, heart rate, indirectly-induced contractions of the anterior tibialis muscle and nictitating membrane, and electrical excitability of the inspiratory centre in the medulla oblongata. 2 Gymnodinium breve toxin (GBTX) was administered intravenously, intra-arterially to the brain, and intracerebroventricularly. Physiological effects were recorded while alveolar PCO2 was controlled at a constant level except when changes in gas tension were made in order to measure CO2-ventilatory responsiveness. 3 Adequate doses of GBTX given intravenously by bolus injection elicited a non-tachyphylactic reflex response triad of apnoea, hypotension and bradycardia mediated by the vagus nerves independently of arterial baroreceptor and chemoreceptor innervation. 4 After vagotomy, additional amounts of GBTX (i.v.) resulted in apneustic breathing, hypertension and tachycardia. The cardiovascular effects were abolished by ganglionic blockade with hexamethonium. 5 Smaller doses of GBTX were required intra-arterially and intracerebroventricularly than by the intravenous route of injection to produce respiratory irregularity and cardiovascular hyperactivity. 6 Evoked motor responses, electrical excitability of the medulla oblongata and CO2-ventilatory responsiveness were largely spared even though GBTX caused marked disturbances in respiratory rhythmicity and cardiovascular functions. 7 It is concluded that GBTX acts reflexly on vagally innervated receptors to evoke a Bezold-Jarisch effect but that the toxin further acts centrally to cause irregular breathholding and hypertension with tachycardia, leading ultimately to respiratory and circulatory failure. PMID:7191740

Article mounting and position adjustment stage

Science.gov (United States)

Cutburth, Ronald W.; Silva, Leonard L.

1988-01-01

An improved adjustment and mounting stage of the type used for the detection of laser beams is disclosed. A ring sensor holder has locating pins on a first side thereof which are positioned within a linear keyway in a surrounding housing for permitting reciprocal movement of the ring along the keyway. A rotatable ring gear is positioned within the housing on the other side of the ring from the linear keyway and includes an oval keyway which drives the ring along the linear keyway upon rotation of the gear. Motor-driven single-stage and dual (x, y) stage adjustment systems are disclosed which are of compact construction and include a large laser transmission hole.

Annual Adjustment Factors

Data.gov (United States)

Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

Acylated Ghrelin and Circulatory Oxidative Stress Markers Responses to Acute Resistance and Aerobic Exercise in Postmenopausal Women.

Science.gov (United States)

Carteri, Randhall B; Lopes, André Luis; Schöler, Cinthia M; Correa, Cleiton Silva; Macedo, Rodrigo C; Gross, Júlia Silveira; Kruger, Renata Lopes; Homem de Bittencourt, Paulo I; Reischak-Oliveira, Álvaro

2016-06-01

Since exercise increases the production of reactive oxygen species in different tissues, the objective of this study is to evaluate, compare and correlate the acute effects of aerobic and resistance exercise in circulatory markers of oxidative stress and acylated ghrelin (AG) in postmenopausal women. Ten postmenopausal women completed different protocols: a control session (CON), an aerobic exercise session (AERO); and a single-set (SSR) or 3-set (MSR) resistance exercise protocol. After exercise, both MSR (P = .06) and AERO (P = .02) sessions showed significant increased lipid peroxidation compared with baseline levels. CON and SSR sessions showed no differences after exercise. No differences were found between sessions at any time for total glutathione, glutathione dissulfide or AG concentrations. Exercise significantly increased lipid peroxidation compared with baseline values. As pro oxidant stimuli is necessary to promote chronic adaptations to the antioxidant defenses induced by exercise, our findings are important to consider when evaluating exercise programs prescription variables aiming quality of life in this population.

Convexity Adjustments for ATS Models

DEFF Research Database (Denmark)

Murgoci, Agatha; Gaspar, Raquel M.

. As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...

Case-Mix Adjustment of the Bereaved Family Survey.

Science.gov (United States)

Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

2018-01-01

Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

The Analysis of the Design of the System of Pitch Adjusting for Remote Operated Vehicle

Directory of Open Access Journals (Sweden)

Peng Wu

2014-06-01

Full Text Available ROV (Remotely Operated Vehicle is applied widely currently which is an important tool for detecting in the water, salving on the ocean floor and resources surveying in the ocean. However it is common for ROV that is affected by surging and altering barycenter in the practice, and it is easy for pitching usually, and then ROV is low efficiency. Aiming at the problem, we designed a system of pitch adjusting for ROV including the design of mechanism and motion analysis, and use the AFSM control strategy. The simulation result shows that it has the good tracking feature and robustness.

A system and method for adjusting and presenting stereoscopic content

DEFF Research Database (Denmark)

2013-01-01

on the basis of one or more vision specific parameters (0M, ThetaMuAlphaChi, ThetaMuIotaNu, DeltaTheta) indicating abnormal vision for the user. In this way, presenting stereoscopic content is enabled that is adjusted specifically to the given person. This may e.g. be used for training purposes or for improved...

Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection.

Science.gov (United States)

Tian, Yaohua; Jian, Zhong; Xu, Beibei; Liu, Hui

2017-10-03

Comorbidities have considerable effects on survival outcomes. The primary objective of this retrospective study was to examine the association between age-adjusted Charlson comorbidity index (ACCI) score and postoperative in-hospital mortality in patients with digestive system cancer who have undergone surgical resection of their cancers. Using electronic hospitalization summary reports, we identified 315,464 patients who had undergone surgery for digestive system cancer in top-rank (Grade 3A) hospitals in China between 2013 and 2015. The Cox proportional hazard regression model was applied to evaluate the effect of ACCI score on postoperative mortality, with adjustments for sex, type of resection, anesthesia methods, and caseload of each healthcare institution. The postoperative in-hospital mortality rate in the study cohort was 1.2% (3,631/315,464). ACCI score had a positive graded association with the risk of postoperative in-hospital mortality for all cancer subtypes. The adjusted HRs for postoperative in-hospital mortality scores ≥ 6 for esophagus, stomach, colorectum, pancreas, and liver and gallbladder cancer were 2.05 (95% CI: 1.45-2.92), 2.00 (95% CI: 1.60-2.49), 2.54 (95% CI: 2.02-3.21), 2.58 (95% CI: 1.68-3.97), and 4.57 (95% CI: 3.37-6.20), respectively, compared to scores of 0-1. These findings suggested that a high ACCI score is an independent predictor of postoperative in-hospital mortality in Chinese patients with digestive system cancer who have undergone surgical resection.

Chapter 1. Central nervous system

International Nuclear Information System (INIS)

Planiol, T.; Veyre, A.; Plagne, R.

1975-01-01

The present situation with regard to explorations of the central nervous system by radioactive compounds is reviewed. For the sake of clarity the brain and cerebrospinal fluid examinations are described separately, with emphasis nevertheless on their complementarity. The tracers used in each of these examinations are listed, together with the criteria governing their choice. The different techniques employed are described. Scintigraphy is presented apart from gamma-angio-encephalography since it is not possible with rectilinear scintigraphs to observe the circulatory phase. The results are interpreted by an analysis of normal and pathological aspects of the different stages of the central nervous system [fr

Interface adjustment and exchange coupling in the IrMn/NiFe system

Energy Technology Data Exchange (ETDEWEB)

Spizzo, F.; Tamisari, M.; Chinni, F.; Bonfiglioli, E.; Del Bianco, L., E-mail: lucia.delbianco@unife.it

2017-01-01

The exchange bias effect was investigated, in the 5–300 K temperature range, in samples of IrMn [100 Å]/NiFe [50 Å] (set A) and in samples with inverted layer-stacking sequence (set B), produced at room temperature by DC magnetron sputtering in a static magnetic field of 400 Oe. The samples of each set differ for the nominal thickness (t{sub Cu}) of a Cu spacer, grown at the interface between the antiferromagnetic and ferromagnetic layers, which was varied between 0 and 2 Å. It has been found out that the Cu insertion reduces the values of the exchange field and of the coercivity and can also affect their thermal evolution, depending on the stack configuration. Indeed, the latter also determines a peculiar variation of the exchange bias properties with time, shown and discussed with reference to the samples without Cu of the two sets. The results have been explained considering that, in this system, the exchange coupling mechanism is ruled by the glassy magnetic behavior of the IrMn spins located at the interface with the NiFe layer. Varying the stack configuration and t{sub Cu} results in a modulation of the structural and magnetic features of the interface, which ultimately affects the spins dynamics of the glassy IrMn interfacial component. - Highlights: • Exchange bias effect in IrMn/NiFe samples with interfacial Cu spacer. • A variation of exchange bias with time is observed in as-deposited samples. • Magnetic modification of the interface by varying the stack sequence and Cu thickness. • Interface adjustment affects the dynamics of interfacial IrMn spins. • The exchange bias properties can be tuned by interface adjustment.

Influencing agent group behavior by adjusting cultural trait values.

Science.gov (United States)

Tuli, Gaurav; Hexmoor, Henry

2010-10-01

Social reasoning and norms among individuals that share cultural traits are largely fashioned by those traits. We have explored predominant sociological and cultural traits. We offer a methodology for parametrically adjusting relevant traits. This exploratory study heralds a capability to deliberately tune cultural group traits in order to produce a desired group behavior. To validate our methodology, we implemented a prototypical-agent-based simulated test bed for demonstrating an exemplar from intelligence, surveillance, and reconnaissance scenario. A group of simulated agents traverses a hostile territory while a user adjusts their cultural group trait settings. Group and individual utilities are dynamically observed against parametric values for the selected traits. Uncertainty avoidance index and individualism are the cultural traits we examined in depth. Upon the user's training of the correspondence between cultural values and system utilities, users deliberately produce the desired system utilities by issuing changes to trait. Specific cultural traits are without meaning outside of their context. Efficacy and timely application of traits in a given context do yield desirable results. This paper heralds a path for the control of large systems via parametric cultural adjustments.

A National Survey of Mentoring Practices for Young Investigators in Circulatory and Respiratory Health

Science.gov (United States)

Mottillo, Salvatore; Boyle, Pierre; Jacobi Cadete, Lindsay D.; Rouleau, Jean-Lucien; Eisenberg, Mark J.

2016-01-01

Background. Improving mentorship may help decrease the shortage of young investigators (graduate students, postdoctoral fellows, and new investigators) available to work as independent researchers in cardiovascular and respiratory health. Objectives. To determine (1) the mentoring practices for trainees affiliated with the Canadian Institutes of Health Research (CIHR), Institute of Circulatory and Respiratory Health (ICRH), (2) the positive attributes of mentors, and (3) the recommendations regarding what makes good mentorship. Methods. We conducted a survey and descriptive analysis of young investigators with a CIHR Training and Salary Award from 2010 to 2013 or who submitted an abstract to the ICRH 2014 Young Investigators Forum. Clinicians were compared to nonclinicians. Results. Of 172 participants, 7.0% had no mentor. Only 43.6% had defined goals and 40.7% had defined timelines, while 54.1% had informal forms of mentorship. A significant proportion (33.1%) felt that their current mentorship did not meet their needs. Among clinicians, 22.2% would not have chosen the same mentor again versus 11.4% of nonclinicians. All participants favored mentors who provided guidance on career and work-life balance. Suggestions for improved mentoring included formal mentorship, increased networking, and quality assurance. Conclusion. There is an important need to improve mentoring in cardiovascular and respiratory health. PMID:27445544

A National Survey of Mentoring Practices for Young Investigators in Circulatory and Respiratory Health

Directory of Open Access Journals (Sweden)

Salvatore Mottillo

2016-01-01

Full Text Available Background. Improving mentorship may help decrease the shortage of young investigators (graduate students, postdoctoral fellows, and new investigators available to work as independent researchers in cardiovascular and respiratory health. Objectives. To determine (1 the mentoring practices for trainees affiliated with the Canadian Institutes of Health Research (CIHR, Institute of Circulatory and Respiratory Health (ICRH, (2 the positive attributes of mentors, and (3 the recommendations regarding what makes good mentorship. Methods. We conducted a survey and descriptive analysis of young investigators with a CIHR Training and Salary Award from 2010 to 2013 or who submitted an abstract to the ICRH 2014 Young Investigators Forum. Clinicians were compared to nonclinicians. Results. Of 172 participants, 7.0% had no mentor. Only 43.6% had defined goals and 40.7% had defined timelines, while 54.1% had informal forms of mentorship. A significant proportion (33.1% felt that their current mentorship did not meet their needs. Among clinicians, 22.2% would not have chosen the same mentor again versus 11.4% of nonclinicians. All participants favored mentors who provided guidance on career and work-life balance. Suggestions for improved mentoring included formal mentorship, increased networking, and quality assurance. Conclusion. There is an important need to improve mentoring in cardiovascular and respiratory health.

Use of the adjustable trans-obturator male sling system for the ...

African Journals Online (AJOL)

M.S. El Badry

2016-03-25

Mar 25, 2016 ... procedure for the treatment of male urinary incontinence. It has the advantage of ... However, a lack of postoperative adjustment and the risk of dis- location of the ... of male SUI due to different etiological factors. Subjects and ...

Application of an iterative methodology for cross-section and variance/covariance data adjustment to the analysis of fast spectrum systems accounting for non-linearity

International Nuclear Information System (INIS)

Pelloni, Sandro

2014-01-01

Highlights: • Our data adjustment is based on a Generalized Linear Least-Squares approach. • The computed sensitivity coefficients are converged within an iterative procedure. • The corresponding multistep adjustment thus accounts for non-linearity. • It provides a more accurate simulation of fast-spectrum experiments. - Abstract: The data assimilation benchmark launched by the “Subgroup 33” on “Methods and issues for the combined use of integral experiments and covariance data” of the Working Party on Evaluation Cooperation (WPEC) of the OECD Nuclear Energy Agency Nuclear Science Committee is recalculated by means of a multistep adjustment procedure using the deterministic code system ERANOS in conjunction with a dedicated Generalized Linear Least-Squares approach based on the Bayesian parameter estimation method. Nuclear data in terms of multi-group cross-sections as well as their variances and covariances, are adjusted for 11 nuclides, namely 10 B, 16 O, 23 Na, 56 Fe, 52 Cr, 58 Ni, 235 U, 238 U, 239 Pu, 240 Pu and 241 Pu and 6 nuclear reactions which are elastic and inelastic scattering, lumped (n,2n) and (n,3n), capture, fission and ν ¯ . The adjustment is carried out by making use of experimental data for 19 integral parameters obtained in 7 different fast spectrum systems. In the determination of a posteriori values for these integral parameters including effective multiplication factors, spectral indices and void effects, along with their nuclear data uncertainty, the required adjusted data for these nuclides and reactions are generated in conjunction with pre-computed sensitivity coefficients of the analytical integral parameters to the nuclear data to adjust. The suggested multistep scheme aims at accounting for non-linear effects. Correspondingly, the sensitivity coefficients are recalculated within an iterative procedure on the basis of the a posteriori analytical values and adjusted cross-sections. The adjustment is thus repeated

Evaluating a novel tiered scarcity adjusted water budget and pricing structure using a holistic systems modelling approach.

Science.gov (United States)

Sahin, Oz; Bertone, Edoardo; Beal, Cara; Stewart, Rodney A

2018-06-01

Population growth, coupled with declining water availability and changes in climatic conditions underline the need for sustainable and responsive water management instruments. Supply augmentation and demand management are the two main strategies used by water utilities. Water demand management has long been acknowledged as a least-cost strategy to maintain water security. This can be achieved in a variety of ways, including: i) educating consumers to limit their water use; ii) imposing restrictions/penalties; iii) using smart and/or efficient technologies; and iv) pricing mechanisms. Changing water consumption behaviours through pricing or restrictions is challenging as it introduces more social and political issues into the already complex water resources management process. This paper employs a participatory systems modelling approach for: (1) evaluating various forms of a proposed tiered scarcity adjusted water budget and pricing structure, and (2) comparing scenario outcomes against the traditional restriction policy regime. System dynamics modelling was applied since it can explicitly account for the feedbacks, interdependencies, and non-linear relations that inherently characterise the water tariff (price)-demand-revenue system. A combination of empirical water use data, billing data and customer feedback on future projected water bills facilitated the assessment of the suitability and likelihood of the adoption of scarcity-driven tariff options for a medium-sized city within Queensland, Australia. Results showed that the tiered scarcity adjusted water budget and pricing structure presented was preferable to restrictions since it could maintain water security more equitably with the lowest overall long-run marginal cost. Copyright © 2018 Elsevier Ltd. All rights reserved.

ADJUSTABLE CHIP HOLDER

DEFF Research Database (Denmark)

2009-01-01

An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips...

Energy-Saving Performance of Flap-Adjustment-Based Centrifugal Fan

Directory of Open Access Journals (Sweden)

Genglin Chen

2018-01-01

Full Text Available The current paper mainly focuses on finding a more appropriate way to enhance the fan performance at off-design conditions. The centrifugal fan (CF based on flap-adjustment (FA has been investigated through theoretical, experimental, and finite element methods. To obtain a more predominant performance of CF from the different adjustments, we carried out a comparative analysis on FA and leading-adjustment (LA in aerodynamic performances, which included the adjusted angle of blades, total pressure, efficiency, system-efficiency, adjustment-efficiency, and energy-saving rate. The contribution of this paper is the integrated performance curve of the CF. Finally, the results showed that the effects of FA and LA on economic performance and energy savings of the fan varied with the blade angles. Furthermore, FA was feasible, which is more sensitive than LA. Moreover, the CF with FA offered a more extended flow-range of high economic characteristic in comparison with LA. Finally, when the operation flow-range extends, energy-saving rate of the fan with FA would have improvement.

Autonomic adjusting of activity of cardio-vessel system of girls of the prepubescence period, engaged in dancing aerobic

Directory of Open Access Journals (Sweden)

Romanchuk А.P.

2010-03-01

Full Text Available The vegetative adjusting of activity of the cardio-vessel system of girls is investigational. In an experiment took part girls of 9-12 years old. A type of sport is a dancing aerobics. The indexes of general power of spectrum of variability of cardiac rhythm are presented, systole and diastole arteriotony. Motion of the adaptation re-erecting is appraised under influence of the physical loadings in the conditions of current and operative control. Certain change activity and tone of vegetative influences on the cardio-vessel system. They determine the features of the further adaptation re-erecting in an organism.

Ethical dilemma: offering short-term extracorporeal membrane oxygenation support for terminally ill children who are not candidates for long-term mechanical circulatory support or heart transplantation.

Science.gov (United States)

Shankar, Venkat; Costello, John P; Peer, Syed M; Klugman, Darren; Nath, Dilip S

2014-04-01

The use of extracorporeal membrane oxygenation (ECMO) in terminally ill pediatric patients who are not candidates for long-term mechanical circulatory support or heart transplantation requires careful deliberation. We present the case of a 16-year-old female with a relapse of acute lymphoid leukemia and acute-on-chronic cardiomyopathy who received short-term ECMO therapy. In addition, we highlight several ethical considerations that were crucial to this patient's family-centered care and demonstrate that this therapy can be accomplished in a manner that respects patient autonomy and family wishes.

Gauge-adjusted rainfall estimates from commercial microwave links

Directory of Open Access Journals (Sweden)

M. Fencl

2017-01-01

experimental layouts of ground truth from rain gauges (RGs with different spatial and temporal resolutions. The results suggest that CMLs adjusted by RGs with a temporal aggregation of up to 1 h (i provide precise high-resolution QPEs (relative error  < 7 %, Nash–Sutcliffe efficiency coefficient  >  0.75 and (ii that the combination of both sensor types clearly outperforms each individual monitoring system. Unfortunately, adjusting CML observations to RGs with longer aggregation intervals of up to 24 h has drawbacks. Although it substantially reduces bias, it unfavourably smoothes out rainfall peaks of high intensities, which is undesirable for stormwater management. A similar, but less severe, effect occurs due to spatial averaging when CMLs are adjusted to remote RGs. Nevertheless, even here, adjusted CMLs perform better than RGs alone. Furthermore, we provide first evidence that the joint use of multiple CMLs together with RGs also reduces bias in their QPEs. In summary, we believe that our adjustment method has great potential to improve the space–time resolution of current urban rainfall monitoring networks. Nevertheless, future work should aim to better understand the reason for the observed systematic error in QPEs from CMLs.

Modeling and Dynamic Simulation of the Adjust and Control System Mechanism for Reactor CAREM-25

International Nuclear Information System (INIS)

Larreteguy, A.E; Mazufri, C.M

2000-01-01

The adjust and control system mechanism, MSAC, is an advanced, and in some senses unique, hydromechanical device.The efforts in modeling this mechanism are aimed to: Get a deep understanding of the physical phenomena involved,Identify the set of parameters relevant to the dynamics of the system,Allow the numerical simulation of the system,Predict the behavior of the mechanism in conditions other than that obtainable within the range of operation of the experimental setup (CEM), and Help in defining the design of the CAPEM (loop for testing the mechanism under high pressure/high temperature conditions).Thanks to the close interaction between the mechanics, the experimenters, and the modelists that compose the MSAC task force, it has been possible to suggest improvements, not only in the design of the mechanism, but also in the design and the operation of the pulse generator (GDP) and the rest of the CEM.This effort has led to a design mature enough so as to be tested in a high-pressure loop

Repatriation Adjustment: Literature Review

Directory of Open Access Journals (Sweden)

Gamze Arman

2009-12-01

Full Text Available Expatriation is a widely studied area of research in work and organizational psychology. After expatriates accomplish their missions in host countries, they return to their countries and this process is called repatriation. Adjustment constitutes a crucial part in repatriation research. In the present literature review, research about repatriation adjustment was reviewed with the aim of defining the whole picture in this phenomenon. Present research was classified on the basis of a theoretical model of repatriation adjustment. Basic frame consisted of antecedents, adjustment, outcomes as main variables and personal characteristics/coping strategies and organizational strategies as moderating variables.

Comparative systemic toxicity of ropivacaine and bupivacaine in nonpregnant and pregnant ewes.

Science.gov (United States)

Santos, A C; Arthur, G R; Wlody, D; De Armas, P; Morishima, H O; Finster, M

1995-03-01

Ropivacaine is a new amide local anesthetic, having therapeutic properties similar to those of bupivacaine but with a wider margin of safety. Bupivacaine is probably the most commonly used drug in obstetric epidural analgesia, even though laboratory studies have suggested that pregnancy increases the cardiotoxicity of bupivacaine but not of other local anesthetics. The current study was designed to reevaluate, in a random and blinded fashion, the systemic toxicity of bupivacaine and ropivacaine in nonpregnant and pregnant sheep. Chronically prepared nonpregnant and pregnant ewes were randomized to receive an intravenous infusion of ropivacaine or bupivacaine at a constant rate of 0.5 mg.kg-1.min-1 until circulatory collapse. The investigators were blinded to the identity of local anesthetic. Heart rate, arterial blood pressure, and cardiac rhythm were monitored throughout the study. Arterial blood samples were obtained before infusion and at the onset of toxic manifestations, which appeared in the following sequence: convulsions, hypotension, apnea, and circulatory collapse. Serum drug concentrations and protein binding were determined. Blood pH and gas tensions were measured. There were no significant differences between non-pregnant and pregnant animals in the doses or serum concentrations of either drug required to elicit toxic manifestations. In nonpregnant animals, similar doses and serum concentrations of ropivacaine and bupivacaine were associated with the onset of convulsions and circulatory collapse. In pregnant ewes, greater doses of ropivacaine as compared to bupivacaine were required to produce convulsions (7.5 +/- 0.5 vs. 5.0 +/- 0.6 mg.kg-1) and circulatory collapse (12.9 +/- 0.8 vs. 8.5 +/- 1.2 mg.kg-1). The corresponding serum concentrations of ropivacaine were similar to those of bupivacaine. Pregnancy did not affect the serum protein binding of either drug. The proportion of animals manifesting a malignant ventricular arrhythmia as the terminal

41 CFR 101-26.607-2 - Adjustments.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Adjustments. 101-26.607-2 Section 101-26.607-2 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM...

Inflation - Adjusted Accounting and Corporate Value Redefinition ...

African Journals Online (AJOL)

This paper, therefore, addresses the twisty advocacy and seeming intricacy of Inflation-Adjusted Accounting Systems (IAAS), with a view to illuminating the translational hurdles. The results abundantly necessitate the expeditious consolidation of a more robust framework to fix impending inhibitors such as lack of awareness, ...

Emission of Biophotons and Adjustable Sounds by the Fascial System: Review and Reflections for Manual Therapy.

Science.gov (United States)

Bordoni, Bruno; Marelli, Fabiola; Morabito, Bruno; Sacconi, Beatrice

2018-01-01

Every body structure is wrapped in connective tissue or fascia, creating a structural continuity that gives form and function to every tissue and organ. The fascial tissue is uniformly distributed throughout the body, enveloping, interacting with and permeating blood vessels, nerves, viscera, meninges, bones and muscles, creating various layers at different depths and forming a tridimensional metabolic and mechanical matrix. This article reviews the literature on the emission of biophotons and adjustable sounds by the fascial system, because these biological changes could be a means of local and systemic cellular communication and become another assessment tool for manual (therapy) practitioners. This is the first article that discusses these topics in a single text, attempting to bring such information into an area of application that is beneficial to osteopaths, chiropractors, and manual therapists.

Increased circulatory levels of lipopolysaccharide (LPS) and zonulin signify novel biomarkers of proinflammation in patients with type 2 diabetes.

Science.gov (United States)

Jayashree, B; Bibin, Y S; Prabhu, D; Shanthirani, C S; Gokulakrishnan, K; Lakshmi, B S; Mohan, V; Balasubramanyam, M

2014-03-01

Emerging data indicate that gut-derived endotoxin (metabolic endotoxemia) may contribute to low-grade systemic inflammation in insulin-resistant states. Specific gut bacteria seem to serve as lipopolysaccharide (LPS) sources and several reports claim a role for increased intestinal permeability in the genesis of metabolic disorders. Therefore, we investigated the serum levels of LPS and zonulin (ZO-1, a marker of gut permeability) along with systemic levels of tumor necrosis factor-α (TNF-α) and Interleukin-6 (IL-6) in patients with type 2 diabetes mellitus (T2DM) compared to control subjects. Study subjects were recruited from the Chennai Urban Rural Epidemiology Study [CURES], Chennai, India. Study group (n = 45 each) comprised of a) subjects with normal glucose tolerance (NGT) and (b) patients with T2DM. LPS, ZO-1, TNF-α, and IL-6 levels were measured by ELISA. Serum levels of LPS [p < 0.05], LPS activity [p < 0.001], ZO-1 [p < 0.001], TNFα [p < 0.001], and IL-6 [p < 0.001] were significantly increased in patients with T2DM compared to control subjects. Pearson correlation analysis revealed that LPS activity was significantly and positively correlated with ZO-1, fasting plasma glucose, 2 h post glucose, HbA1c, serum triglycerides, TNF-α, IL-6, and negatively correlated with HDL cholesterol. Regression analysis showed that increased LPS levels were significantly associated with type 2 diabetes [odds ratio (OR) 13.43, 95 % CI 1.998-18.9; p = 0.003]. In Asian Indians who are considered highly insulin resistant, the circulatory LPS levels, LPS activity, and ZO-1 were significantly increased in patients with type 2 diabetes and showed positive correlation with inflammatory markers and poor glycemic/lipid control.

Adjustment of nursing home quality indicators

Directory of Open Access Journals (Sweden)

Hirdes John P

2010-04-01

Full Text Available Abstract Background This manuscript describes a method for adjustment of nursing home quality indicators (QIs defined using the Center for Medicaid & Medicare Services (CMS nursing home resident assessment system, the Minimum Data Set (MDS. QIs are intended to characterize quality of care delivered in a facility. Threats to the validity of the measurement of presumed quality of care include baseline resident health and functional status, pattern of comorbidities, and facility case mix. The goal of obtaining a valid facility-level estimate of true quality of care should include adjustment for resident- and facility-level sources of variability. Methods We present a practical and efficient method to achieve risk adjustment using restriction and indirect and direct standardization. We present information on validity by comparing QIs estimated with the new algorithm to one currently used by CMS. Results More than half of the new QIs achieved a "Moderate" validation level. Conclusions Given the comprehensive approach and the positive findings to date, research using the new quality indicators is warranted to provide further evidence of their validity and utility and to encourage their use in quality improvement activities.

The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study.

Science.gov (United States)

Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

2016-04-01

When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.

[Evaluation of changes in the central and peripheral circulatory system under the influence of physical training carried out under the standard procedure of improving patients after acute coronary syndrome].

Science.gov (United States)

Kapusta, Joanna; Kapusta, Anna; Kowalski, Jan; Irzmański, Robert

2016-06-01

The observed with age, atherosclerotic changes in vessels and increasing damage to the vascular endothelium, causing an increase in the occurrence of cardiovascular events. An important element in the rehabilitation of patients with coronary artery disease is a physical activity, to complement the pharmacological treatment. The aim of the study was to evaluate the influence of a controlled exercise training on changes in central and peripheral circulatory system in patients after acute coronary syndrome. Group comprising 92 patients were divided into three subgroups. The rehabilitation period ranged from 2 to 4 weeks. In group I and II performed a series of interval training on a bicycle ergometer supplemented by general conditioning exercises; in the group III training individually tailored program, consisting of breathing exercises, relaxation and small muscle groups. In all groups, before and after the training cycle test was performed impedance plethysmography of the chest, echocardiography, exercise test. After completing the program, the parameters plethysmography improved in all groups, with the largest changes were observed in the group treated to the longest training: increase PAmpl (pulse wave amplitude) of 16.7% and PSlope (systolic slope) of 17.6%, while decline in the value of CT (crest time) by 5.7% and PT (propagation time) by 6.3%. In groups, which carried out a controlled exercise training have improved as well: exercise capacity of patients, stroke volume SV, cardiac output CO and global myocardial contractility EF. Moreover, a correlation between the results plethysmography parameters and SV, CO and EF. Controlled physical training, which comes under the standard procedure rehabilitation of patients after acute coronary syndrome, leads to better blood perfusion in vessels of the legs and improve myocardial functional parameters, thereby affecting the growth of physical capacity of patients. © 2016 MEDPRESS.

Finite element fatigue analysis of rectangular clutch spring of automatic slack adjuster

Science.gov (United States)

Xu, Chen-jie; Luo, Zai; Hu, Xiao-feng; Jiang, Wen-song

2015-02-01

The failure of rectangular clutch spring of automatic slack adjuster directly affects the work of automatic slack adjuster. We establish the structural mechanics model of automatic slack adjuster rectangular clutch spring based on its working principle and mechanical structure. In addition, we upload such structural mechanics model to ANSYS Workbench FEA system to predict the fatigue life of rectangular clutch spring. FEA results show that the fatigue life of rectangular clutch spring is 2.0403×105 cycle under the effect of braking loads. In the meantime, fatigue tests of 20 automatic slack adjusters are carried out on the fatigue test bench to verify the conclusion of the structural mechanics model. The experimental results show that the mean fatigue life of rectangular clutch spring is 1.9101×105, which meets the results based on the finite element analysis using ANSYS Workbench FEA system.

Role of Osmotic Adjustment in Plant Productivity

Energy Technology Data Exchange (ETDEWEB)

Gebre, G.M.

2001-01-11

Successful implementation of short rotation woody crops requires that the selected species and clones be productive, drought tolerant, and pest resistant. Since water is one of the major limiting factors in poplar (Populus sp.) growth, there is little debate for the need of drought tolerant clones, except on the wettest of sites (e.g., lower Columbia River delta). Whether drought tolerance is compatible with productivity remains a debatable issue. Among the many mechanisms of drought tolerance, dehydration postponement involves the maintenance of high leaf water potential due to, for example, an adequate root system. This trait is compatible with productivity, but requires available soil moisture. When the plant leaf water potential and soil water content decline, the plant must be able to survive drought through dehydration tolerance mechanisms, such as low osmotic potential or osmotic adjustment. Osmotic adjustment and low osmotic potential are considered compatible with growth and yield because they aid in the maintenance of leaf turgor. However, it has been shown that turgor alone does not regulate cell expansion or stomatal conductance and, therefore, the role of osmotic adjustment is debated. Despite this finding, osmotic adjustment has been correlated with grain yield in agronomic crop species, and gene markers responsible for osmotic adjustment are being investigated to improve drought tolerance in productive progenies. Although osmotic adjustment and low osmotic potentials have been investigated in several forest tree species, few studies have investigated the relationship between osmotic adjustment and growth. Most of these studies have been limited to greenhouse or container-grown plants. Osmotic adjustment and rapid growth have been specifically associated in Populus and black spruce (Picea mariuna (Mill.) B.S.P.) progenies. We tested whether these relationships held under field conditions using several poplar clones. In a study of two hybrid poplar

Drive Beam Quadrupoles for the CLIC Project: a Novel Method of Fiducialisation and a New Micrometric Adjustment System

CERN Document Server

AUTHOR|(SzGeCERN)411678; Duquenne, Mathieu; Sandomierski, Jacek; Sosin, Mateusz; Rude, Vivien

2014-01-01

This paper presents a new method of fiducialisation applied to determine the magnetic axis of the Drive Beam quadrupole of the CLIC project with respect to external alignment fiducials, within a micrometric accuracy and precision. It introduces also a new micrometric adjustment system along 5 Degrees of Freedom, developed for the same Drive Beam quadrupole. The combination of both developments opens very interesting perspectives to get a more simple and accurate alignment of the quadrupoles.

Self-adjustable glasses in the developing world

Directory of Open Access Journals (Sweden)

Murthy Gudlavalleti VS

2014-02-01

-6 to +6 diopters, compliance with international standards, quality and affordability, and the likely impact on health systems. Self-adjustable spectacles show poor agreement with conventional refraction methods for high myopia and are unable to correct astigmatism. A limitation of the fluid-filled adjustable spectacles (AdSpecs, Adaptive Eyecare Ltd, Oxford, UK is that once the spectacles are self-adjusted and the power fixed, they become unalterable, just like conventional spectacles. Therefore, they will need to be changed as refractive power changes over time. Current costs of adjustable spectacles are high in developing countries and therefore not affordable to a large segment of the population. Self-adjustable spectacles have potential for "upscaling" if some of the concerns raised are addressed satisfactorily. Keywords: developing countries, eye disease, refractive error, spectacles

Micro computed tomography evaluation of the Self-adjusting file and ProTaper Universal system on curved mandibular molars.

Science.gov (United States)

Serefoglu, Burcu; Piskin, Beyser

2017-09-26

The aim of this investigation was to compare the cleaning and shaping efficiency of Self-adjusting file and Protaper, and to assess the correlation between root canal curvature and working time in mandibular molars using micro-computed tomography. Twenty extracted mandibular molars instrumented with Protaper and Self-adjusting file and the total working time was measured in mesial canals. The changes in canal volume, surface area and structure model index, transportation, uninstrumented area and the correlation between working-time and the curvature were analyzed. Although no statistically significant difference was observed between two systems in distal canals (p>0.05), a significantly higher amount of removed dentin volume and lower uninstrumented area were provided by Protaper in mesial canals (p<0.0001). A correlation between working-time and the canal-curvature was also observed in mesial canals for both groups (SAFr 2 =0.792, p<0.0004, PTUr 2 =0.9098, p<0.0001).

A Machine Learning Framework for Plan Payment Risk Adjustment.

Science.gov (United States)

Rose, Sherri

2016-12-01

To introduce cross-validation and a nonparametric machine learning framework for plan payment risk adjustment and then assess whether they have the potential to improve risk adjustment. 2011-2012 Truven MarketScan database. We compare the performance of multiple statistical approaches within a broad machine learning framework for estimation of risk adjustment formulas. Total annual expenditure was predicted using age, sex, geography, inpatient diagnoses, and hierarchical condition category variables. The methods included regression, penalized regression, decision trees, neural networks, and an ensemble super learner, all in concert with screening algorithms that reduce the set of variables considered. The performance of these methods was compared based on cross-validated R 2 . Our results indicate that a simplified risk adjustment formula selected via this nonparametric framework maintains much of the efficiency of a traditional larger formula. The ensemble approach also outperformed classical regression and all other algorithms studied. The implementation of cross-validated machine learning techniques provides novel insight into risk adjustment estimation, possibly allowing for a simplified formula, thereby reducing incentives for increased coding intensity as well as the ability of insurers to "game" the system with aggressive diagnostic upcoding. © Health Research and Educational Trust.

Climbing Robot for Ferromagnetic Surfaces with Dynamic Adjustment of the Adhesion System

Directory of Open Access Journals (Sweden)

Manuel F. Silva

2012-01-01

Full Text Available This paper presents a climbing robot with wheeled locomotion and adhesion through permanent magnets, developed with the intention of being used in the inspection of different types of man-made ferromagnetic structures, such as towers for wind turbines, fuel storage tanks, and ship hulls. In this paper are presented the main considerations thought for its project, as well as several constructive aspects, among which are detailed its mechanical and electrical construction, the implemented control architecture, and the human-machine interface developed for the manual and automatic control of the vehicle while in operation. Although it can be manually controlled, the vehicle is designed to have a semiautonomous behavior, allowing a remote inspection process controlled by a technician, this way reducing the risks associated with the human inspection of tall structures and ATEX places. The distinguishing characteristic of this robot is its dynamic adjustment system of the permanent magnets in order to assure the machine adhesion to the surfaces, even when crossing slightly irregular and curved surfaces with a large radius.

Design and test about de tritium system to filling tritium glove box

International Nuclear Information System (INIS)

Lei, Jiarong; Du, Yang; Yang, Yong

2008-01-01

In order to deal tritium permeated from inflating tritium system at the scene of inflating tritium, dealing waste tritium gas system was designed according to demand and action of dealing waste tritium gas from inflating tritium, and the data of character and volume about appliance of catalyst reaction and drying agent was calculated. Through the test at the scene of inflating tritium, it is result that dealing waste tritium gas system's efficiency reaches above 85% average in circulatory system, so that it can be used in practice extensively. (author)

Presence of Cytotoxic Extracellular Histones in Machine Perfusate of Donation After Circulatory Death Kidneys.

Science.gov (United States)

van Smaalen, Tim C; Beurskens, Daniëlle M H; Hoogland, E R Pieter; Winkens, Bjorn; Christiaans, Maarten H L; Reutelingsperger, Chris P; van Heurn, L W Ernest; Nicolaes, Gerry A F

2017-04-01

Extracellular histones are cytotoxic molecules that are related to cell stress and death. They have been shown to play a crucial role in multiple pathophysiologic processes like sepsis, inflammation, vascular dysfunction, and thrombosis. Their role in organ donation and graft function and survival is still unknown. The aim of this study was to assess whether an association exists between the presence of extracellular histones in machine perfusates and deceased donor kidney viability. Machine perfusates of 390 donations after circulatory death kidneys were analyzed for histone concentration, and corresponding graft function and survival were assessed. Extracellular histone concentrations were significantly higher in perfusates of kidneys with posttransplant graft dysfunction (primary nonfunction and delayed graft function) and were an independent risk factor for delayed graft function (odds ratio, 2.152; 95% confidence interval [95% CI], 1.199-3.863) and 1 year graft failure (hazard ratio, 1.386; 95% CI, 1.037-1.853), but not for primary nonfunction (odds ratio, 1.342; 95% CI, 0.900-2.002). One year graft survival was 12% higher in the group with low histone concentrations (P = 0.008) as compared with the group that contained higher histone concentrations. This study warrants future studies to probe for a possible role of cytotoxic extracellular histones in organ viability and suggests that quantitation of extracellular histones might contribute to assessment of posttransplant graft function and survival.

Adjustement of multigroup cross sections using fast reactor integral data

International Nuclear Information System (INIS)

Renke, C.A.C.

1982-01-01

A methodology for the adjustment of multigroup cross section is presented, structured with aiming to compatibility the limitated number of measured values of integral parameters known and disponible, and the great number of cross sections to be adjusted the group of cross section used is that obtained from the Carnaval II calculation system, understanding as formular the sets of calculation methods and data bases. The adjustment is realized, using the INCOAJ computer code, developed in function of one statistical formulation, structural from the bayer considerations, taking in account the measurement processes of cross section and integral parameters defined on statistical bases. (E.G.) [pt

Postural adjustments are modulated by manual task complexity

Directory of Open Access Journals (Sweden)

Luis Augusto Teixeira

2009-09-01

Full Text Available Daily life activities of humans are characterized by dual tasks, in which a manual task is performed concomitantly with a postural task. Based on the assumption that both manual and postural tasks require attentional resources, no consensus exists as to how the central nervous system modulates postural adjustments in dual tasks. The aim of the present study was to analyze the effect of a manual task requiring attentional resources on shoulder and ankle adjustments as a function of the direction and predictability of postural perturbation. The participants (n=6 were evaluated during the performance of a simple and a complex manual task, while the base of support was moved backward or forward. Latency of activation of the tibialis anterior and gastroc-nemius muscles and angular acceleration of the shoulder were analyzed. The results showed that execution of the complex manual task delayed postural adjustment. Moreover, this delay occurred differently depending on the direction of postural perturbation. The delay in postural adjustment occurred proximally in the case of anterior displacement of the platform, and distally in the case of posterior displacement. Postural adjustments were more affected by the attentional task than by the predictability of platform displacement. These results are consistent with the concept of an integrated control between manual actions and the maintenance of static posture.

Mortality Surveillance in the U.S. Army 20052014

Science.gov (United States)

2016-07-01

the circulatory system (such as heart attack and stroke)  The number of deaths due to neoplasms and diseases of the circulatory system significantly... malformations , blood, endocrine, skin, pregnancy, infections, pending, and all other natural conditions. 6.2.5 Suicides From 2005 through 2014, 1,402 deaths...nervous system, respiratory system, digestive system, musculoskeletal system, mental and behavioral disorders, congenital malformations , blood

75 FR 81817 - Adjustments of Certain Rates of Pay

Science.gov (United States)

2010-12-29

... Order 13561 of December 22, 2010 Adjustments of Certain Rates of Pay By the authority vested in me as..., it is hereby ordered as follows: Section 1. Statutory Pay Systems. Pursuant to the Continuing... ``Continuing Appropriations Act''), the rates of basic pay or salaries of the statutory pay systems (as defined...

Enhanced Phase-Shifted Current Control for Harmonic Cancellation in Three-Phase Multiple Adjustable Speed Drive Systems

DEFF Research Database (Denmark)

Yang, Yongheng; Davari, Pooya; Zare, Firuz

2017-01-01

A phase-shifted current control can be employed to mitigate certain harmonics induced by the Diode Rectifiers (DR) and Silicon-Controlled Rectifiers (SCR) as the front-ends of multiple parallel Adjustable Speed Drive (ASD) systems. However, the effectiveness of the phase-shifted control relies...... on the loading condition of each drive unit as well as the number of drives in parallel. In order to enhance the harmonic cancellation by means of the phase-shifted current control, the currents drawn by the rectifiers should be maintained almost at the same level. Thus, this paper firstly analyzes the impact...... of unequal loading among the parallel drives, and a scheme to enhance the performance is introduced to improve the quality of the total grid current, where partial loading operation should be enabled. Simulation and experimental case studies on multidrive systems have demonstrated that the enhanced phase...

Adjustable guide for a testing system for reactor pressure vessels

International Nuclear Information System (INIS)

Seifert, W.

1980-01-01

The device consisting of a guide rail and a manipulator is introduced into the gap between pressure vessel wall and biological shield by means of suspending wire drums and manipulator drums. For adjustment of the device an elbow telescope is used. The guide rail is fixed to the pressure vessel wall by means of electromagnets. The movements of the manipulator with respect to the guide rail are performed with the aid of a motor. (DG) [de

High-frequency Doppler ultrasound transducer for the peripheral circulatory system

Energy Technology Data Exchange (ETDEWEB)

Bae, Youngmin; Yang, Jeongwon; Kang, Uk; Kim, Guanghoon [Korea Electrotechnology Research Institute, Ansan (Korea, Republic of)

2011-12-15

A Doppler ultrasound transducer was designed and implemented to measure the blood flow velocity in tiny vessels near the skin of hands or feet. The geometric parameters of the transducer for defining the observation volume were derived and implemented with an acoustic window made of polystyrene. The observation volume designed in this study was located 6.5 mm from the transducer, which was comparable to the value predicted geometrically. The two-way insertion loss of the transducer was -11.3 dB on ultrasound frequency of 20 MHz, and the 3-dB bandwidth was approximately 2 MHz. In addition, the Doppler shift in the frequency measured by using a Doppler device composed of the transducer and a Doppler signal processing unit was proportional to the flow velocity generated by a homemade flowing system. Finally, we concluded that the transducer could be applied to measure the blood flow velocity in hands or feet.

High-frequency Doppler ultrasound transducer for the peripheral circulatory system

International Nuclear Information System (INIS)

Bae, Youngmin; Yang, Jeongwon; Kang, Uk; Kim, Guanghoon

2011-01-01

A Doppler ultrasound transducer was designed and implemented to measure the blood flow velocity in tiny vessels near the skin of hands or feet. The geometric parameters of the transducer for defining the observation volume were derived and implemented with an acoustic window made of polystyrene. The observation volume designed in this study was located 6.5 mm from the transducer, which was comparable to the value predicted geometrically. The two-way insertion loss of the transducer was -11.3 dB on ultrasound frequency of 20 MHz, and the 3-dB bandwidth was approximately 2 MHz. In addition, the Doppler shift in the frequency measured by using a Doppler device composed of the transducer and a Doppler signal processing unit was proportional to the flow velocity generated by a homemade flowing system. Finally, we concluded that the transducer could be applied to measure the blood flow velocity in hands or feet.

Controlled donation after circulatory death in the Netherlands: more organs, more efforts.

Science.gov (United States)

Leiden, H; Haase-Kromwijk, B; Hoitsma, A; Jansen, N

2016-08-01

The Netherlands was one of the first countries in Europe to stimulate controlled donation after circulatory death (cDCD) at a national level in addition to donation after brain death (DBD). With this program the number of organ transplants increased, but it also proved to have challenges as will be shown in this 15-year review. Data about deceased organ donation in the Netherlands, from 2000 until 2014, were analysed taking into account the whole donation process from donor referral to the number of organs transplanted. Donor referral increased by 58%, from 213 to 336 donors per year, and the number of organs transplanted rose by 42%. Meanwhile the contribution of cDCD donors increased from 14% in 2000 to 54% in 2014 among all referrals. The organs were transplanted from 92-99% of referred DBD donors, but this percentage was significantly lower for cDCD donors and also decreased from 86% in 2000-2002 to 67% in 2012-2014. In 16% of all referred cDCD donors, organs were not recovered because donors did not die within the expected two-hour time limit after withdrawal of life- upporting treatment. Furthermore, cDCD is more often performed at a higher donor age, which is associated with a lower percentage of transplanted organs. Although cDCD resulted in more transplants, the effort in donor recruitment is considerably higher. Important challenges in cDCD that need further attention are the time limit after withdrawal of life-supporting treatment and donor age, as well as the possibilities to stimulate non-renal transplants including the heart by machine preservation.

Interconnection and transportation networks: adjustments and stability; Reseaux d'interconnexion et de transport: reglages et stabilite

Energy Technology Data Exchange (ETDEWEB)

Bornard, P. [Reseau de Transport d' Electricite (RTE), Div. Systeme Electrique, 92 - Paris la Defense (France); Pavard, M. [Electricite de France (EDF), 75 - Paris (France); Testud, G. [Reseau de Transport d' Electricite (RTE), Dept. Exploitation du Systeme Electrique, 92 - Paris la Defense (France)

2005-10-01

Keeping the mastery of the safety of a power transportation system and respecting the contractual commitments with respect to the network users implies the implementation of efficient frequency and voltage adjustment systems. This article presents a synthetic overview of the methods and means implemented to ensure the adjustment of the voltage and frequency and the stability of very-high voltage power transportation networks: 1 - recalls of the general problem; 2 - frequency and active power adjustment: adapting generation to consumption, adapting consumption to generation; 3 - voltage and reactive power adjustment: duality of the voltage-reactive compensation adjustment, compensation of the reactive power, voltage adjustment chain, voltage adjustment of very high voltage networks, collapse of the voltage plan; 4 - alternators stability: static stability, transient stability, numerical simulation methods, stability improvement; 5 - conclusion. (J.S.)

Should adjustment disorder be conceptualized as transitional disorder? In pursuit of adjustment disorders definition.

Science.gov (United States)

Israelashvili, Moshe

2012-12-01

The DSM classification of an adjustment disorder is frequently criticized for not being well differentiated from other disorders. A possible reason for this is the vague definition of the term adjustment in social science literature. Hence, the current paper discusses the definition of adjustment and its implications for understanding maladjustment. Differential definitions of the terms adjustment, adaptation, socialization and coping are outlined, leading to the proposition that each one of them represents a different type of demand that is imposed on an individual who encounters a transitional event. Moreover, the four types of demands might be the possible sources of maladjustment. Helping people in transition requires an identification of the source, or combination of sources, that have led to the adjustment problem first, followed by the implementation of an adequate helping approach.

High circulatory leptin mediated NOX-2-peroxynitrite-miR21 axis activate mesangial cells and promotes renal inflammatory pathology in nonalcoholic fatty liver disease

Directory of Open Access Journals (Sweden)

Firas Alhasson

2018-07-01

Full Text Available High circulatory insulin and leptin followed by underlying inflammation are often ascribed to the ectopic manifestations in non-alcoholic fatty liver disease (NAFLD but the exact molecular pathways remain unclear. We have shown previously that CYP2E1-mediated oxidative stress and circulating leptin in NAFLD is associated with renal disease severity. Extending the studies, we hypothesized that high circulatory leptin in NAFLD causes renal mesangial cell activation and tubular inflammation via a NOX2 dependent pathway that upregulates proinflammatory miR21. High-fat diet (60% kcal was used to induce fatty liver phenotype with parallel insulin and leptin resistance. The kidneys were probed for mesangial cell activation and tubular inflammation that showed accelerated NASH phenotype and oxidative stress in the liver. Results showed that NAFLD kidneys had significant increases in α-SMA, a marker of mesangial cell activation, miR21 levels, tyrosine nitration and renal inflammation while they were significantly decreased in leptin and p47 phox knockout mice. Micro RNA21 knockout mice showed decreased tubular immunotoxicity and proinflammatory mediator release. Mechanistically, use of NOX2 siRNA or apocynin,phenyl boronic acid (FBA, DMPO or miR21 antagomir inhibited leptin primed-miR21-mediated mesangial cell activation in vitro suggesting a direct role of leptin-mediated NOX-2 in miR21-mediated mesangial cell activation. Finally, JAK-STAT inhibitor completely abrogated the mesangial cell activation in leptin-primed cells suggesting that leptin signaling in the mesangial cells depended on the JAK-STAT pathway. Taken together the study reports a novel mechanistic pathway of leptin-mediated renal inflammation that is dependent on NOX-2-miR21 axis in ectopic manifestations underlying NAFLD-induced co-morbidities. Keywords: Leptin, NOX-2, NADPH, Mesangial cells, miR21, Oxidative stress, NAFLD, JAK/STAT, siRNA

Fetal rat metabonome alteration by prenatal caffeine ingestion probably due to the increased circulatory glucocorticoid level and altered peripheral glucose and lipid metabolic pathways

International Nuclear Information System (INIS)

Liu, Yansong; Xu, Dan; Feng, Jianghua; Kou, Hao; Liang, Gai; Yu, Hong; He, Xiaohua; Zhang, Baifang; Chen, Liaobin; Magdalou, Jacques; Wang, Hui

2012-01-01

The aims of this study were to clarify the metabonome alteration in fetal rats after prenatal caffeine ingestion and to explore the underlying mechanism pertaining to the increased fetal circulatory glucocorticoid (GC). Pregnant Wistar rats were daily intragastrically administered with different doses of caffeine (0, 20, 60 and 180 mg/kg) from gestational days (GD) 11 to 20. Metabonome of fetal plasma and amniotic fluid on GD20 were analyzed by 1 H nuclear magnetic resonance-based metabonomics. Gene and protein expressions involved in the GC metabolism, glucose and lipid metabolic pathways in fetal liver and gastrocnemius were measured by real-time RT-PCR and immunohistochemistry. Fetal plasma metabonome were significantly altered by caffeine, which presents as the elevated α- and β‐glucose, reduced multiple lipid contents, varied apolipoprotein contents and increased levels of a number of amino acids. The metabonome of amniotic fluids showed a similar change as that in fetal plasma. Furthermore, the expressions of 11β-hydroxysteroid dehydrogenase 2 (11β-HSD-2) were decreased, while the level of blood GC and the expressions of 11β-HSD-1 and glucocorticoid receptor (GR) were increased in fetal liver and gastrocnemius. Meanwhile, the expressions of insulin-like growth factor 1 (IGF-1), IGF-1 receptor and insulin receptor were decreased, while the expressions of adiponectin receptor 2, leptin receptors and AMP-activated protein kinase α2 were increased after caffeine treatment. Prenatal caffeine ingestion characteristically change the fetal metabonome, which is probably attributed to the alterations of glucose and lipid metabolic pathways induced by increased circulatory GC, activated GC metabolism and enhanced GR expression in peripheral metabolic tissues. -- Highlights: ► Prenatal caffeine ingestion altered the metabonome of IUGR fetal rats. ► Caffeine altered the glucose and lipid metabolic pathways of IUGR fetal rats. ► Prenatal caffeine ingestion

Performance of an Adjustable Strength Permanent Magnet Quadrupole

CERN Document Server

Gottschalk, Stephen C; Kangas, Kenneth; Spencer, Cherrill M; Volk, James T

2005-01-01

An adjustable strength permanent magnet quadrupole suitable for use in Next Linear Collider has been built and tested. The pole length is 42cm, aperture diameter 13mm, peak pole tip strength 1.03Tesla and peak integrated gradient * length (GL) is 68.7 Tesla. This paper describes measurements of strength, magnetic centerline and field quality made using an air bearing rotating coil system. The magnetic centerline stability during -20% strength adjustment proposed for beam based alignment was < 0.2 microns. Strength hysteresis was negligible. Thermal expansion of quadrupole and measurement parts caused a repeatable and easily compensated change in the vertical magnetic centerline. Calibration procedures as well as centerline measurements made over a wider tuning range of 100% to 20% in strength useful for a wide range of applications will be described. The impact of eddy currents in the steel poles on the magnetic field during strength adjustments will be reported.

Could LC-NE-Dependent Adjustment of Neural Gain Drive Functional Brain Network Reorganization?

Directory of Open Access Journals (Sweden)

Carole Guedj

2017-01-01

Full Text Available The locus coeruleus-norepinephrine (LC-NE system is thought to act at synaptic, cellular, microcircuit, and network levels to facilitate cognitive functions through at least two different processes, not mutually exclusive. Accordingly, as a reset signal, the LC-NE system could trigger brain network reorganizations in response to salient information in the environment and/or adjust the neural gain within its target regions to optimize behavioral responses. Here, we provide evidence of the co-occurrence of these two mechanisms at the whole-brain level, in resting-state conditions following a pharmacological stimulation of the LC-NE system. We propose that these two mechanisms are interdependent such that the LC-NE-dependent adjustment of the neural gain inferred from the clustering coefficient could drive functional brain network reorganizations through coherence in the gamma rhythm. Via the temporal dynamic of gamma-range band-limited power, the release of NE could adjust the neural gain, promoting interactions only within the neuronal populations whose amplitude envelopes are correlated, thus making it possible to reorganize neuronal ensembles, functional networks, and ultimately, behavioral responses. Thus, our proposal offers a unified framework integrating the putative influence of the LC-NE system on both local- and long-range adjustments of brain dynamics underlying behavioral flexibility.

[Remuneration distribution - should morbidity-dependent overall remuneration also be distributed after adjustments for morbidity?].

Science.gov (United States)

Walendzik, A; Trottmann, M; Leonhardt, R; Wasem, J

2013-04-01

In the 2009 reform of the German collective remuneration system for outpatient medical care, on the level of overall remuneration, the morbidity risk was transferred to the health funds fulfilling a long-term demand of physicians. Nevertheless not transferring morbidity adjustment to the levels of physician groups and singular practices can lead to budgets not related to patient needs and to incentives for risk selection for individual doctors. The systematics of the distribution of overall remuneration in the German remuneration system for outpatient care are analysed focusing on the aspect of morbidity adjustment. Using diagnostic and pharmaceutical information of about half a million insured subjects, a risk adjustment model able to predict individual expenditures for outpatient care for different provider groups is presented. This model enables to additively split the individual care burden into several parts attributed to different physician groups. Conditions for the use of the model in the distribution of overall remuneration between physician groups are developed. A simulation of the use of diagnoses-based risk adjustment in standard service volumes then highlights the conditions for a successfull installation of standard service volumes representing a higher degree of risk adjustment. The presented estimation model is generally applicable for the distribution of overall remuneration to different physician groups. The simulation of standard service volumes using diagnosis-based risk adjustment does not provide a more accurate prediction of the expenditures on the level of physician practices than the age-related calculation currently used in the German remuneration system for outpatient medical care. Using elements of morbidity-based risk adjustment the current German collective system for outpatient medical care could be transformed towards a higher degree of distributional justice concerning medical care for patients and more appropriate incentives

A congenital malformation of the systemic heart complex in Sepia officinalis L. (Cephalopoda)

Science.gov (United States)

Schipp, R.; von Boletzky, S.; Jakobs, P.; Labourg, P. J.

1998-03-01

In semi-adult Sepia officinalis L. (Cephalopoda) from the Bay of Arcachon (France) a congenital malformation of the systemic heart is described by macro-and microscopical methods. It concerns an atypical doubling of the site of insertion at the cephalic aorta at the apical ventricle. Its comparison with the paired anlagen of the systemic heart complex in normal embryogenesis and the central circulatory system of Nautilus gives rise to interpret it as a form of atavism. The possible causal role of mutagenic antifoulings is discussed.

Explaining prescription drug use and expenditures using the adjusted clinical groups case-mix system in the population of British Columbia, Canada.

Science.gov (United States)

Hanley, Gillian E; Morgan, Steve; Reid, Robert J

2010-05-01

Given that prescription drugs have become a major financial component of health care, there is an increased need to explain variations in the use of and expenditure on medicines. Case-mix systems built from existing administrative datasets may prove very useful for such prediction. We estimated the concurrent and prospective predictive validity of the adjusted clinical groups (ACG) system in pharmaceutical research and compared the ACG system with the Charlson index of comorbidity. We ran a generalized linear models to examine the predictive validity of the ACG system and the Charlson index and report the correlation between the predicted and observed expenditures. We reported mean predictive ratios across medical condition and cost-defined groups. When predicting use of medicines, we used C-statistics to summarize the area under the receiver operating characteristic curve. The 3,908,533 British Columbia residents who were registered for the universal health care plan for 275+ days in the calendar years 2004 and 2005. Outcomes were total pharmaceutical expenditures, use of any medicines, and use of medicines from 4+ different therapeutic categories. The ACG case mix system predicted drug expenditures better than the Charlson index. The mean predictive ratios for the ACG system models were all within 4% of the actual costs when examining medical condition group and the C-stats for the 2 dichotomous outcomes were between 0.82 and 0.89. ACG case-mix adjusters are a valuable predictor of pharmaceutical use and expenditures with much higher predictive power than age, sex, and the Charlson index of comorbidity.

Circulatory and muscle metabolic responses to draught work compared to increasing trotting velocities.

Science.gov (United States)

Gottlieb, M; Essén-Gustavsson, B; Lindholm, A; Persson, S G

1988-11-01

Circulatory and muscle metabolic responses were studied in 10 horses which all performed incremental draught work at a low trotting speed on a treadmill (D-test) and also exercise with gradually increasing velocities (S-test). Exercise was continued until the horses could no longer maintain the weights above the floor or maintain speed trotting without changing gait to a gallop. Muscle biopsies were taken from the gluteus and the semitendinosus muscles before, and immediately after, exercise. The heart rate (HR) increased linearly with both increasing draught resistance and velocity and reached mean values of 212 and 203 beats/min, respectively. Blood lactate levels increased exponentially to mean values of 12.9 and 7.9 mmol/litre in the two tests. Both HR and blood lactate levels were significantly higher at the cessation of work in the D-test compared to the S-test. The relationship between HR and blood lactate response in the S-test was similar to that in the D-test. The red cell volume was determined after a standardised exercise tolerance test and was significantly correlated both to the weightloading and to the velocity, producing a HR of 200 beats/min. The changes seen in muscle glycogen and glucose-6-phosphate were similar in the two tests, whereas significantly higher lactate levels and lower creatine phosphate and adenosine triphosphate levels were seen in the D-test compared to the S-test. It was concluded that high oxidative capacity is of importance both for fast trotting and for draught work.(ABSTRACT TRUNCATED AT 250 WORDS)

Methodological study of the adjustment of multigroup cross sections for fast reactors, by means of integral data

International Nuclear Information System (INIS)

Bastos, H.F.B.N.

1979-01-01

In this work a study of the methodology of the adjustment of multigroup cross sections by means of integral data is presented. A synthesis of the principal methods existent and the mathematical development of the adaptation of one of them are made. A calculational system is built from this reference method, with the basic conditions for the operation of the process of adjustment. In order to test the system developed and analyze several problems related to the adjustment, a series of trial adjustments was made with the value of the U 235 fission cross section from the infinite dilution library used in the calculational system for fast reactors of the Instituto de Engenharia Nuclear. (author)

Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables.

Science.gov (United States)

Colais, Paola; Fantini, Maria P; Fusco, Danilo; Carretta, Elisa; Stivanello, Elisa; Lenzi, Jacopo; Pieri, Giulia; Perucci, Carlo A

2012-06-21

Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson's Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V-X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson's classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). The TGCS classification is useful for inter-hospital comparison of CS section rates, but

Adolescent Mothers' Adjustment to Parenting.

Science.gov (United States)

Samuels, Valerie Jarvis; And Others

1994-01-01

Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

Parental Divorce and Children's Adjustment.

Science.gov (United States)

Lansford, Jennifer E

2009-03-01

This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce. © 2009 Association for Psychological Science.

Endodontic management of C-shaped root canal system of mandibular first molar by using a modified technique of self-adjusting file system.

Science.gov (United States)

Helvacioglu-Yigit, Dilek

2015-01-01

C-shaped canal system is a seldom-found root canal anatomy which displays a challenge in all stages of endodontic treatment. According to the literature, this type of canal morphology is not a common finding in the mandibular first molar teeth. This case report presents endodontic management of a mandibular first molar with a C-shaped canal system. Root canal system was cleaned and shaped by nickel-titanium (NiTi) rotary instruments combined with self-adjusting file (SAF). Obturation was performed using warm, vertical condensation combined with the injection of warm gutta-percha. Follow-up examination 12 months later showed that the tooth was asymptomatic. The radiological findings presented no signs of periapical pathology. The clinician must be aware of the occurence and complexity of C-shaped canals in mandibular first molar teeth to perform a successful root canal treatment. The supplementary use of SAF after application of rotary instruments in C-shaped root canals might be a promising approach in endodontic treatment of this type of canal morphology.

A novel adjustable automated system for inducing chronic intermittent hypoxia in mice.

Science.gov (United States)

Polšek, Dora; Bago, Marcel; Živaljić, Marija; Rosenzweig, Ivana; Lacza, Zsombor; Gajović, Srećko

2017-01-01

Sleep apnea is a chronic, widely underdiagnosed condition characterized by disruption of sleep architecture and intermittent hypoxia due to short cessations of breathing. It is a major independent risk factor for myocardial infarction, congestive heart failure and stroke as well as one of the rare modifiable risk factors for Alzheimer's Dementia. Reliable animal disease models are needed to understand the link between sleep apnea and the various clinically linked disorders. An automated system for inducing hypoxia was developed, in which the major improvement was the possibility to efficiently adjust the length and intensity of hypoxia in two different periods. The chamber used a small volume of gas allowing for fast exchanges of different oxygen levels. The mice were kept in their cages adapted with the system on the cage lid. As a proof of principle, they were exposed to a three week period of intermittent hypoxia for 8 hours a day, with 90 s intervals of 5, 7% and 21% oxygen to validate the model. Treated (n = 8) and control mice (no hypoxia, n = 7) were handled in the same manner and their hippocampal brain regions compared by histology. The chamber provided a fast, reliable and precise intermittent hypoxia, without inducing noticeable side effects to the animals. The validation experiment showed that apoptotic neurons in the hippocampus were more numerous in the mice exposed to intermittent hypoxia than in the control group, in all tested hippocampal regions (cornu ammonis 1 (CA1) P apnea, which was validated by apoptosis of hippocampal neurons.

Pricing the option adjust spread of Brazilian Eurobonds

OpenAIRE

Gonçalves, Franklin de O.

1997-01-01

This paper presents results of a pricing system to compute the option adjusted spread ("DAS") of Eurobonds issued by Brazilian firms. The system computes the "DAS" over US treasury rates taktng imo account the embedded options present on these bonds. These options can be calls ("callable bond"), puts ("putable bond") or combinations ("callable and putable bond"). The pricing model takes into account the evolution of the term structure along time, is compatible with the observab...

78 FR 80451 - Adjustments of Certain Rates of Pay

Science.gov (United States)

2013-12-31

... of Pay By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: Section 1. Statutory Pay Systems. The rates of basic pay or salaries of the statutory pay systems (as defined in 5 U.S.C. 5302(1)), as adjusted under 5 U.S...

Tension pneumomediastnum: A rare cause of acute intraoperative circulatory collapse in the setting of unremarkable TEE findings.

Science.gov (United States)

Weaver, Jonathan B; Kumar, Avinash B

2017-02-01

Case report. Operating room. 25YF, ASA IV E who underwent an emergent decompressive craniectomy for refractory intracranial hypertension secondary to acute intracranial hemorhage. A 25Y caucasian female presented with acute intracranial hemorrhage with intraventricular extension secondary to Moya Moya disease. Post admisison, she underwent an emergent decompressive craniectomy for medically refractory intracranial hypertension. Introperatively (post dural closure and bone flap removal) the patient developed acutely worsening peak and plateau pressures followed by pulseless electrical activity necessitating CPR with epinephrine and Vasopressin before return of circulation before return of circulation. Intraoperative TEE done during return of circulation, was essentially non diagnostic, the patient had normal breath sounds throughout, and non-contributory bronchoscopy findings. EKG, arterial blood pressure, heart rate, resp. rate, introperative tranesophageal echocardiogram (TEE), Pulse oximetry, serial arterial blood gases, introperative bronchoscopy, ventilatory peak pressures. A post operative chest CT revealed extensive pneumomediastinum with subcutaneous emphysema. The focussed introperative echocardiogram showed preserved left ventricular function and no evidence of tamponade physiology. Tension pneumomediastinum was the likely etiologic factor for the acute hemodynamic collapse and should be considered in the differential diagnosis of intraoperative circulatory arrest. Copyright © 2016 Elsevier Inc. All rights reserved.

C-reactive protein, Rheumatoid factor and circulatory immune complex as markers for monitoring treatment of infective endocarditis

International Nuclear Information System (INIS)

Alavi, S.M.; Ahmadi, F.; Nashibi, R.

2010-01-01

Objectives: To evaluate the diagnostic usefulness of serum C-reactive protein (CRP), rheumatoid factor (RF) and circulatory immune complex (CIC) determinations in monitoring the outcome of infective endocarditis (IE). Methodology: In this prospective analytic descriptive study CRP, RF and CIC were measured on admission and 4 weeks after initiation of standard antibiotic regimen in 30 hospitalized patients with IE in an educational hospital between 2006 and 2007 in Ahvaz a city south west Iran . Duke criteria were used for diagnosis of IE. CRP and RF were examined using quantitative neflometry (Binding site kit, UK) and CIC was detected by semi quantitative immune diffusion (Baharafshan SIRD kit, Iran). Data were evaluated using statistical analyses in SPSS (version 12, USA) software for windows. Results: The fall in serum C-reactive protein or RF was significant (P= 0.05). Only two of the 30 patients, who had elevated CRP, RF and CIC week four failed to response and one needed cardiac surgery. Conclusions: The C-reactive protein proved to be a good tool for monitoring the treatment of IE. Also RF proved useful in the assessment of patients with IE, but the value of CIC was negligible. (author)

Methodology of adjustment point in the post treatment of gaseous effluents

International Nuclear Information System (INIS)

Vizuet G, J.; Molina, G.

2005-01-01

The methodology to determine the adjustment points of the monitoring system of gaseous discharges is based on the stipulations of the 10CFR20, which are expressed in terms of limit concentrations for the outstanding radionuclides, and of dose limits for the individuals members of the public. Besides the points of liberation properly said, like they are the chimneys of the reactor buildings and of turbine, the points of adjustment of the monitoring instrumentation that watches in real time the discharge of the Treatment system of output gases, to the HVAC of the waste building; they also undergo to the same methodology, with the approaches previously described. (Author)

Power Law Distributions in the Experiment for Adjustment of the Ion Source of the NBI System

International Nuclear Information System (INIS)

Han Xiaopu; Hu Chundong

2005-01-01

The experiential adjustment process in an experiment on the ion source of the neutral beam injector system for the HT-7 Tokamak is reported in this paper. With regard to the data obtained in the same condition, in arranging the arc current intensities of every shot with a decay rank, the distributions of the arc current intensity correspond to the power laws, and the distribution obtained in the condition with the cryo-pump corresponds to the double Pareto distribution. Using the similar study method, the distributions of the arc duration are close to the power laws too. These power law distributions are formed rather naturally instead of being the results of purposeful seeking

12 CFR 19.240 - Inflation adjustments.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b) The...

In elective arch surgery with circulatory arrest, does the arterial cannulation site really matter? A propensity score analysis of right axillary and innominate artery cannulation.

Science.gov (United States)

Preventza, Ourania; Price, Matt D; Spiliotopoulos, Konstantinos; Amarasekara, Hiruni S; Cornwell, Lorraine D; Omer, Shuab; de la Cruz, Kim I; Zhang, Qianzi; Green, Susan Y; LeMaire, Scott A; Rosengart, Todd K; Coselli, Joseph S

2018-05-01

The preferred arterial cannulation site for elective proximal aortic procedures requiring circulatory arrest varies, and different sites have been tried. We evaluated the relationships between arterial cannulation site and adverse outcomes, including stroke, in patients undergoing elective aortic arch surgery. We reviewed the records of 938 patients who underwent elective hemiarch or total arch surgery with circulatory arrest between 2006 and 2016. Five cannulation sites were used: the right axillary (n = 515; 54.9%), innominate (n = 376; 40.1%), and right common carotid arteries (n = 15; 1.6%), each with a side graft; the ascending aorta (n = 19; 2.0%); and the femoral artery (n = 13; 1.4%). Multivariable logistic regression analysis was used to model the effects of cannulation site on adverse outcomes for the entire cohort and for a subcohort of 891 patients who underwent innominate or axillary artery cannulation. Propensity-matching yielded 564 patients (282 pairs) from the right axillary and innominate artery groups. For the entire cohort, mortality, stroke, and composite adverse outcome (operative death or persistent stroke or renal failure at hospital discharge) rates were 7.0%, 4.1%, and 9.8%. In the multivariable analysis of the axillary/innominate subcohort, cannulation site did not independently predict operative mortality, persistent stroke, or composite adverse event. These results were confirmed with the propensity-matched analysis, where both axillary and innominate artery cannulation provided equivalent composite adverse event rates, operative death rates, and overall stroke rates. During elective arch surgery, right axillary artery cannulation and innominate artery cannulation (both via a side graft) produce excellent results and can be used interchangeably. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

An Introduction to Cost-of-Living Adjustments in Public Retirement Plans: Details Matter

Science.gov (United States)

Jennings, Penelope R.; Jennings, William P.; Phillips, G. Michael

2016-01-01

While financial planning students are expected to be able to understand client retirement plans, subtle differences in cost-of-living adjustments can have major impact on the success of client retirement plans. This teaching note compares the cost-of-living adjustments in the largest government sponsored retirement systems and a hypothetical…

Multi-channel medical imaging system

Science.gov (United States)

Frangioni, John V

2013-12-31

A medical imaging system provides simultaneous rendering of visible light and fluorescent images. The system may employ dyes in a small-molecule form that remain in the subject's blood stream for several minutes, allowing real-time imaging of the subject's circulatory system superimposed upon a conventional, visible light image of the subject. The system may provide an excitation light source to excite the fluorescent substance and a visible light source for general illumination within the same optical guide used to capture images. The system may be configured for use in open surgical procedures by providing an operating area that is closed to ambient light. The systems described herein provide two or more diagnostic imaging channels for capture of multiple, concurrent diagnostic images and may be used where a visible light image may be usefully supplemented by two or more images that are independently marked for functional interest.

Perceived parenting and adolescents’ adjustment

Directory of Open Access Journals (Sweden)

Joana Jaureguizar

2018-05-01

Full Text Available Abstract Adolescence is an important developmental period that is characterised by heightened problems of adjustment. The aim of this study is to analyse adolescents’ adjustment, and to explore the typologies and dimensions of parenting, and thus to determine the relationships between these factors. The sample comprised 1285 adolescent students aged 12 to 16 from the Basque Country (Spain. The students filled out the self-report of the Behavior Assessment System for Children (BASC and the Parental Acceptance-Rejection/Control Questionnaire, (PARQ/Control. Differences by age were found in the adolescents’ school maladjustment and parenting style perception. Moreover, perceptions of little parental warmth were related to higher levels of clinical and school maladjustment, and the lower the parental control, the greater the clinical maladjustment. Finally, the results obtained revealed that the interaction between the mothers’ and fathers’ parenting styles was significant only for clinical maladjustment; those students with neglectful mothers and authoritative fathers presented the highest level of clinical maladjustment, followed by other combinations of neglectful mothers. Furthermore, the students from neglectful and authoritarian families presented the highest levels of school maladjustment, without differences between neglectful and authoritarian or between indulgent and authoritative families.

The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence.

Science.gov (United States)

Romera, Eva M; Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario

2016-01-01

There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy) could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34). The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire , the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment.

The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence

Directory of Open Access Journals (Sweden)

Eva M. Romera

2016-11-01

Full Text Available There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34. The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire, the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment.

A literature-based cost analysis of tissue plasminogen activator for prevention of biliary stricture in donation after circulatory death liver transplantation.

Science.gov (United States)

Jones, J M; Bhutiani, N; Wei, D; Goldstein, L; Jones, C M; Cannon, R M

2018-04-17

This study sought to approximate the cost-effectiveness of tPA utilization for prevention of biliary strictures (PTBS) in donation after circulatory death liver transplantation (DCD-LT). Previously-reported PTBS rates in DCD-LT with and without tPA were used to calculate the number needed to treat (NNT) for prevention of one PTBS. The incremental cost of PTBS was then used to determine the cost effectiveness of tPA for prevention of PTBS. The incidence of PTBS in the setting of tPA administration was 20%, while incidence in patients without tPA use was 43% (p PTBS management, use of tPA in DCD-LT protocols was estimated to save $31,528 per PTBS prevented. Utilization of tPA in DCD-LT protocols represents one possible cost-effective strategy for prevention of PTBS in DCD-LT. Copyright © 2018 Elsevier Inc. All rights reserved.

Birth-Order Complementarity and Marital Adjustment.

Science.gov (United States)

Vos, Cornelia J. Vanderkooy; Hayden, Delbert J.

1985-01-01

Tested the influence of birth-order complementarity on marital adjustment among 327 married women using the Spanier Dyadic Adjustment Scale (1976). Birth-order complementarity was found to be unassociated with marital adjustment. (Author/BL)

The academic adjustment scale : Measuring the adjustment of permanent resident or sojourner students

NARCIS (Netherlands)

Anderson, Joel R.; Guan, Yao; Koc, Yasin

In this paper we developed and validated the Academic Adjustment Scale (AAS) - a new scale for measuring academic adjustment, which was developed with a focus on student sojourners who temporarily relocate to a new culture for the purpose of tertiary education, but also is validated for use with

48 CFR 5416.203 - Fixed-price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustment. 5416.203 Section 5416.203 Federal Acquisition Regulations System DEFENSE LOGISTICS AGENCY, DEPARTMENT OF DEFENSE TYPES OF CONTRACTS Fixed Price Contracts 5416.203 Fixed-price...

Mechanical circulatory support as a bridge to cardiac retransplantation: a single center experience.

Science.gov (United States)

Clerkin, Kevin J; Thomas, Sunu S; Haythe, Jennifer; Schulze, P Christian; Farr, Maryjane; Takayama, Hiroo; Jorde, Ulrich P; Restaino, Susan W; Naka, Yoshifumi; Mancini, Donna M

2015-02-01

Cardiac retransplantation is increasing in frequency. Recent data have shown that retransplantation outcomes are now comparable with primary transplantation. The use of mechanical circulatory support (MCS) as a bridge to retransplantation has similar post-retransplant outcomes to those without MCS, but the success of bridging patients to retransplant with MCS has not been well studied. From January 2000 to February 2014 at Columbia University Medical Center, 84 patients were listed for retransplantation. Of this cohort, 48 patients underwent retransplantation, 15 were bridged with MCS, 24 died, and 6 clinically improved. A retrospective analysis was performed examining waiting list time, survival to retransplantation, and survival after retransplant. The effect of the United Network of Organ Sharing (UNOS) allocation policy change in 2006 on waiting list time and MCS use was also investigated. Of 48 patients who underwent retransplantation, 11 were bridged with MCS. Overall 1-year survival to retransplantation was 81.3%. There was no significant difference in waiting list survival (p = 0.71) in those with and without MCS. Death from cardiac arrest or multiorgan failure with infection was more frequent in the medically managed group (p = 0.002). After the UNOS 2006 allocation policy change, waiting list time (599 ± 936 days in Era 1 vs 526 ± 498 days in Era 2, p = 0.65) and waiting list survival (p = 0.22) between eras were comparable, but there was a trend toward greater use of MCS (p = 0.13). Survival after retransplant was acceptable. The use of MCS as a bridge to cardiac retransplantation is a reasonable strategy. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Medical imaging systems

Science.gov (United States)

Frangioni, John V [Wayland, MA

2012-07-24

A medical imaging system provides simultaneous rendering of visible light and fluorescent images. The system may employ dyes in a small-molecule form that remains in a subject's blood stream for several minutes, allowing real-time imaging of the subject's circulatory system superimposed upon a conventional, visible light image of the subject. The system may also employ dyes or other fluorescent substances associated with antibodies, antibody fragments, or ligands that accumulate within a region of diagnostic significance. In one embodiment, the system provides an excitation light source to excite the fluorescent substance and a visible light source for general illumination within the same optical guide that is used to capture images. In another embodiment, the system is configured for use in open surgical procedures by providing an operating area that is closed to ambient light. More broadly, the systems described herein may be used in imaging applications where a visible light image may be usefully supplemented by an image formed from fluorescent emissions from a fluorescent substance that marks areas of functional interest.

Development of prototype micro wind energy system with adjustable blade pitch for experimentation purposes at laboratory level

International Nuclear Information System (INIS)

Ashraf, M.M.; Iqbal, M.

2014-01-01

In this paper, the design of an efficient, operational and productive model of micro wind energy system has been proposed for experimentation purposes at laboratory level. The proposed model constitutes a proficient Horizontal Axis Wind Turbine (HAWT) model with multi-stage pulley system as a gear box and adjustable blade pitch. The wind turbine is coupled to Axial Flux Permanent Magnet Generator (AFPMG). The power density parameter of fabricated AFPMG has been improved to 35.7%. A wind tunnel is placed in front of wind turbine which behaves as the operational source of wind for proposed model. Multiple case studies: demonstration of different components of wind energy system, effect of variable wind speed, effect of variable blade pitch, effect of variable electrical loading, effect of variable pulley ratio, voltage regulation of AFPMG, runaway speed test of HAWT and peripheral speed test of AFPMG are successfully performed on this model. The results obtained from experiments show that proposed model is well suited for experimentation purposes at laboratory level. (author)

Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism.

Science.gov (United States)

Takach Lapner, Sarah; Julian, Jim A; Linkins, Lori-Ann; Bates, Shannon; Kearon, Clive

2017-10-05

Two new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7 %) and the age-adjusted strategy (99.6 %) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1 % vs, 50.9 %; difference 5.2 %; 95 % CI 3.5 % to 6.8 %). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

Retrofitting adjustable speed drives for large induction motors

International Nuclear Information System (INIS)

Wuestefeld, M.R.; Merriam, C.H.; Porter, N.S.

2004-01-01

Adjustable speed drives (ASDs) are used in many power plants to control process flow by varying the speed of synchronous and induction motors. In applications where the flow requirements vary significantly, ASDs reduce energy and maintenance requirements when compared with drag valves, dampers or other methods to control flow. Until recently, high horsepower ASDs were not available for induction motors. However, advances in power electronics technology have demonstrated the reliability and cost effectiveness of ASDs for large horsepower induction motors. Emphasis on reducing operation and maintenance costs and increasing the capacity factor of nuclear power plants has led some utilities to consider replacing flow control devices in systems powered by large induction motors with ASDs. ASDs provide a high degree of reliability and significant energy savings in situations where full flow operation is not needed for a substantial part of the time. This paper describes the basic adjustable speed drive technologies available for large induction motor applications, ASD operating experience and retrofitting ASDs to replace the existing GE Boiling Water Reactor recirculation flow control system

48 CFR 1416.203 - Fixed-price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustment. 1416.203 Section 1416.203 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Fixed-Price Contracts 1416.203...

48 CFR 16.203 - Fixed-price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustment. 16.203 Section 16.203 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Fixed-Price Contracts 16.203 Fixed-price...

48 CFR 916.203 - Fixed-price contracts with economic price adjustments.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustments. 916.203 Section 916.203 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Fixed-Price Contracts 916.203 Fixed...

48 CFR 1216.203 - Fixed-price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustment. 1216.203 Section 1216.203 Federal Acquisition Regulations System DEPARTMENT OF TRANSPORTATION CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Fixed-Price Contracts 1216.203 Fixed...

48 CFR 416.203 - Fixed-price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustment. 416.203 Section 416.203 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Fixed-Price Contracts 416.203 Fixed...

48 CFR 616.203 - Fixed-Price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Fixed-Price contracts with economic price adjustment. 616.203 Section 616.203 Federal Acquisition Regulations System DEPARTMENT OF STATE CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Fixed-Price Contracts 616.203 Fixed...

48 CFR 1316.203 - Fixed-price contracts with economic price adjustment.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fixed-price contracts with economic price adjustment. 1316.203 Section 1316.203 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Fixed-Price Contracts 1316.203 Fixed...

Development of the next generation code system as an engineering modeling language (6). Development of a cross section adjustment and nuclear design accuracy evaluation solver

International Nuclear Information System (INIS)

Yokoyama, Kenji; Numata, Kazuyuki

2008-01-01

A new cross section adjustment and nuclear design accuracy evaluation solver was developed as a set of modules for MARBLE (multi-purpose advanced reactor physics analysis system based on language of engineering). In order to enhance the system extendibility and flexibility, the object-oriented design and analysis technique was adopted to the development. In the new system, it is easy to add a new design accuracy evaluation method because a new numerical calculation module is independent from other modules. Further, several new functions such as searching and editing calculation data are provided in the new solver. These functions can be easily customised by users because they are designed to work cooperatively with Python scripting language, which is used as a user interface of the MARBLE system. In order to validate the new solver, a test calculation was performed for a realistic calculation case of creating a new unified cross section library. In the test calculation, results calculated by the new solver agreed well with those by the conventional code system. In addition, it is possible to reuse existing input data files prepared for the conventional code system because the new solver utilities support the conventional formats. Because the new solver implements all main functions of the conventional code system, MARBLE can be used as a new calculation code system for cross section adjustment and nuclear design accuracy evaluation

Preparation of Silica Nanoparticles Loaded with Nootropics and Their In Vivo Permeation through Blood-Brain Barrier

Czech Academy of Sciences Publication Activity Database

Jampílek, J.; Záruba, K.; Oravec, Michal; Kuneš, M.; Babula, P.; Ulbrich, P.; Brezaniova, I.; Opatřilová, R.; Tříska, Jan; Suchý, P.

2015-01-01

Roč. 2015, feb (2015), s. 812673 ISSN 2314-6133 R&D Projects: GA MŠk EE2.3.20.0246; GA MŠk(CZ) LM2010007 Institutional support: RVO:67179843 Keywords : microscopic analysis * silica-based nanocarriers * circulatory system * circulatory system Subject RIV: ED - Physiology Impact factor: 2.134, year: 2015 http://www.hindawi.com/journals/bmri/aa/812673/

Fiscal Adjustment in IMF-Supported Adjustment Programmes: The ...

African Journals Online (AJOL)

Fiscal adjustment is an essential element of macro-economic stability and economic growth. Given that economic growth is the most powerful weapon in the fight for higher living standards, poor growth performance in African countries, has been a challenge to economists, policy makers and international development ...

78 FR 21503 - Adjustments of Certain Rates of Pay

Science.gov (United States)

2013-04-11

... Order 13641 of April 5, 2013 Adjustments of Certain Rates of Pay By the authority vested in me as... Consolidated and Further Continuing Appropriations Act, 2013 (Public Law 113-6), which requires certain pay... follows: Section 1. Statutory Pay Systems. Pursuant to the Consolidated and Further Continuing...

Operating Regions of Adjustable-Speed Units with Doubly Fed Machines

Czech Academy of Sciences Publication Activity Database

Schreier, Luděk; Chomát, Miroslav; Bendl, Jiří

2004-01-01

Roč. 49, č. 2 (2004), s. 119-136 ISSN 0001-7043 R&D Projects: GA AV ČR IAA2057102 Keywords : AC machines * adjustable-speed systems * doubly fed machine Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering

A study on the Horizontal Control of a Seat for Heavy Machinery using a Phase Adjusting Technique

Directory of Open Access Journals (Sweden)

Kim Chae-sil.

2016-01-01

Full Text Available This study proposes a dynamic plant model to simulate the performance of a heavy equipment vehicle seat system. The system controls the transmission of vibration using a phase adjustment control method. First, a dynamic model for the flexible heavy equipment seat is proposed using a commercial multi-body dynamic analysis tool, ADAMS. This model is used as a plant model. Then a phase adjustment control mechanism for reducing the vibration and shock transmitted by the seat is applied to the driving dynamics control plant model. Angle control using the phase adjustment control was confirmed. This technique is expected to be the basis for a future commercial system.

Adjustable mounting device for high-volume production of beam-shaping systems for high-power diode lasers

Science.gov (United States)

Haag, Sebastian; Bernhardt, Henning; Rübenach, Olaf; Haverkamp, Tobias; Müller, Tobias; Zontar, Daniel; Brecher, Christian

2015-02-01

In many applications for high-power diode lasers, the production of beam-shaping and homogenizing optical systems experience rising volumes and dynamical market demands. The automation of assembly processes on flexible and reconfigurable machines can contribute to a more responsive and scalable production. The paper presents a flexible mounting device designed for the challenging assembly of side-tab based optical systems. It provides design elements for precisely referencing and fixating two optical elements in a well-defined geometric relation. Side tabs are presented to the machine allowing the application of glue and a rotating mechanism allows the attachment to the optical elements. The device can be adjusted to fit different form factors and it can be used in high-volume assembly machines. The paper shows the utilization of the device for a collimation module consisting of a fast-axis and a slow-axis collimation lens. Results regarding the repeatability and process capability of bonding side tab assemblies as well as estimates from 3D simulation for overall performance indicators achieved such as cycle time and throughput will be discussed.

Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

Science.gov (United States)

Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

2006-08-01

We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

[Susceptibility to strategy of the drug component of the IPHCC+RxGroups classification system in a risk-adjusted morbidity compensation scheme--a conceptional and data-supported analysis].

Science.gov (United States)

Behrend, C; Felder, S; Busse, R

2007-01-01

A report commissioned by the German Ministry of Health recommends to the existing scheme for calculating risk-adjusted transfers to sickness funds supplement with the IPHCC+RxGroups method. The method is based on inpatient diagnoses and prescribed drugs as health status measures deduced from prior use. The present study investigates the sickness fund's expected net return from gaming based on the drug component of the risk adjuster. The study explores three possible strategies using the RxGroups method. For the stimulations, insurees are assigned to additional indications or to higher valued RxGroups within the same indication. Then, costs and financial benefits attributable to the altered drug use are estimated and compared with the status quo. The study uses 2000 and 2001 sample data of more than 370,000 insurees of Germany's company-based sickness funds system (BKK). While upgrading increases overall costs, it can be beneficial for the individual sickness funds. Their net return crucially depends on the number of sickness funds gaming the system: the more participating in the game, the smaller is the average net return. Moreover, not participating often is even worse, which in turn points to a prisoner's dilemma. When extending the risk adjustment scheme in social health insurance, the German legislator should take into account the perverse incentives of risk adjusters such as the described prescription drug model.

Adjustable Speed Drives and Power Quality

DEFF Research Database (Denmark)

Davari, Pooya; Yang, Yongheng; Zare, Firuz

2016-01-01

This paper provides an overview and proposes cost-effective and efficient opportunities in improving power quality in Adjustable Speed Drive (ASD) systems. In particular, an Electronic Inductor (EI) technique has been used in single drives to overcome the existing challenges in conventional...... frontend rectifiers even at partial loading conditions. Moreover, the effectiveness of the EI technique along with a phase-shifted current control in terms of improved grid current quality in multi-drive configurations is addressed. Furthermore, a novel DC-link current modulation scheme for multi...

Learning course adjustments during arm movements with reversed sensitivity derivatives

Directory of Open Access Journals (Sweden)

Tweed Douglas B

2010-11-01

Full Text Available Abstract Background To learn, a motor system needs to know its sensitivity derivatives, which quantify how its neural commands affect motor error. But are these derivatives themselves learned, or are they known solely innately? Here we test a recent theory that the brain's estimates of sensitivity derivatives are revisable based on sensory feedback. In its simplest form, the theory says that each control system has a single, adjustable estimate of its sensitivity derivatives which affects all aspects of its task, e.g. if you learn to reach to mirror-reversed targets then your revised estimate should reverse not only your initial aiming but also your online course adjustments when the target jumps in mid-movement. Methods Human subjects bent a joystick to move a cursor to a target on a computer screen, but the cursor's motion was reversed relative to the joystick's. The target jumped once during each movement. Subjects had up to 4000 trials to practice aiming and responding to target jumps. Results All subjects learned to reverse both initial aiming and course adjustments. Conclusions Our study confirms that sensitivity derivatives can be relearned. It is consistent with the idea of a single, all-purpose estimate of those derivatives; and it suggests that the estimate is a function of context, as one would expect given that the true sensitivity derivatives may vary with the state of the controlled system, the target, and the motor commands.

A linguistic approach to solving of the problem of technological adjustment of combines

Directory of Open Access Journals (Sweden)

Lyudmila V. Borisova

2017-06-01

Full Text Available Introduction: The article deals with a linguistic approach to the technological adjustment of difficult harvesters in field conditions. The short characteristic of subject domain is provided. The place of the task of adjustment of the combine harvester working bodies in harvesting is considered. Various groups of signs of the considered task are allocated: external signs of violation of quality of work, regulated parameters of the machine, and parameters of technical condition. The numerical data characterizing interrelations between external signs and parameters of the machine are provided. Materials and Methods: A combine harvester is the difficult dynamic system functioning under constantly changing external conditions. This fact imposes characteristics on the used methods of technological adjustment. Quantitative and qualitative information is used to control harvesting. Availability of different types of uncertainty in considering semantic spaces of factors of the external environment and parameters of the machine allows offering the method of technological adjustment based on an indistinct logical conclusion for the solution of the task. Results: As the analysis result, the decision making methodology for indistinct environment conditions is adapted for the studied subject domain. The generalized scheme of indistinct management of process is offered to technological adjustment of the machine. Models of the studied semantic spaces are considered. Feasibility of use of deductive and inductive conclusions of decisions for various tasks of preliminary setup and adjustment of technological adjustments is shown. The formal and logical scheme of the decision making process based on indistinct expert knowledge is offered. The scheme includes the main stages of the task solution: fazzifikation, composition and defazzifikation. The question of the quantitative assessment of expert knowledge coordination is considered. The examples of the formulation

Assessment of a continuous blood gas monitoring system in animals during circulatory stress

Directory of Open Access Journals (Sweden)

Renzulli Attilio

2011-01-01

Full Text Available Abstract Background The study was aimed to determine the measurement accuracy of The CDI™ blood parameter monitoring system 500 (Terumo Cardiovascular Systems Corporation, Ann Arbor MI in the real-time continuous measurement of arterial blood gases under different cardiocirculatory stress conditions Methods Inotropic stimulation (Dobutamine 2.5 and 5 μg/kg/min, vasoconstriction (Arginine-vasopressin 4, 8 and 16 IU/h, hemorrhage (-10%, -20%, -35%, and -50% of the theoretical volemia, and volume resuscitation were induced in ten swine (57.4 ± 10.7 Kg.Intermittent blood gas assessments were carried out using a routine gas analyzer at any experimental phase and compared with values obtained at the same time settings during continuous monitoring with CDI™ 500 system. The Bland-Altman analysis was employed. Results Bias and precision for pO2 were - 0.06 kPa and 0.22 kPa, respectively (r2 = 0.96; pCO2 - 0.02 kPa and 0.15 kPa, respectively; pH -0.001 and 0.01 units, respectively ( r2 = 0.96. The analysis showed very good agreement for SO2 (bias 0.04,precision 0.33, r2 = 0.95, Base excess (bias 0.04,precision 0.28, r2 = 0.98, HCO3 (bias 0.05,precision 0.62, r2 = 0.92,hemoglobin (bias 0.02,precision 0.23, r2 = 0.96 and K+ (bias 0.02, precision 0.27, r2 = 0.93. The sensor was reliable throughout the experiment during hemodynamic variations. Conclusions Continuous blood gas analysis with the CDI™ 500 system was reliable and it might represent a new useful tool to accurately and timely monitor gas exchange in critically ill patients. Nonetheless, our findings need to be confirmed by larger studies to prove its reliability in the clinical setting.

Outcomes of pediatric patients supported with continuous-flow ventricular assist devices: A report from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS).

Science.gov (United States)

Rossano, Joseph W; Lorts, Angela; VanderPluym, Christina J; Jeewa, Aamir; Guleserian, Kristine J; Bleiweis, Mark S; Reinhartz, Olaf; Blume, Elizabeth D; Rosenthal, David N; Naftel, David C; Cantor, Ryan S; Kirklin, James K

2016-05-01

Continuous-flow (CF) ventricular assist devices (VADs) have largely replaced pulsatile-flow VADs in adult patients. However, there are few data on CF VADs among pediatric patients. In this study we aimed to describe the overall use, patients' characteristics and outcomes of CF VADs in this population. The Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) is a national registry for U.S. Food and Drug Adminstration (FDA)-approved VADs in patients <19 years of age. Patients undergoing placement of durable CF VADs between September 2012 and June 2015 were included and outcomes were compared with those of adults from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). CF VADs were implanted in 109 patients at 35 hospitals. The median age at implantation was 15 years (2.8 to 18.9 years) and median weight was 62 kg (range 16 to 141 kg). The underlying disease was cardiomyopathy in 89 (82%) patients. The INTERMACS level at time of implant was Level 1 in 20 (19%), Level 2 in 64 (61%) and Levels 3 to 7 in 21 (20%) patients. Most were implanted as LVADs (n = 102, 94%). Median duration of support was 2.3 months (range <1 day to 28 months). Serious adverse event rates were low, including neurologic dysfunction (early event rate 4.1 per 100 patient-months with 2 late events). Competing outcomes analysis at 6 months post-implant indicated 61% transplanted, 31% alive with device in place and 8% death before transplant. These outcomes compared favorably with the 3,894 adults supported with CF VADs as a bridge to transplant. CF VADs are commonly utilized in older children and adolescents, with excellent survival rates. Further study is needed to understand impact of patient and device characteristics on outcomes in pediatric patients. Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Fetal rat metabonome alteration by prenatal caffeine ingestion probably due to the increased circulatory glucocorticoid level and altered peripheral glucose and lipid metabolic pathways

Energy Technology Data Exchange (ETDEWEB)

Liu, Yansong [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan University, Wuhan, 430071 (China); Xu, Dan [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan University, Wuhan, 430071 (China); Research Center of Food and Drug Evaluation, Wuhan University, Wuhan, 430071 (China); Feng, Jianghua, E-mail: jianghua.feng@xmu.edu.cn [Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071 (China); Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 (China); Kou, Hao; Liang, Gai [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan University, Wuhan, 430071 (China); Yu, Hong; He, Xiaohua; Zhang, Baifang; Chen, Liaobin [Research Center of Food and Drug Evaluation, Wuhan University, Wuhan, 430071 (China); Magdalou, Jacques [UMR 7561 CNRS-Nancy Université, Faculté de Médicine, Vandoeuvre-lès-Nancy (France); Wang, Hui, E-mail: wanghui19@whu.edu.cn [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan University, Wuhan, 430071 (China); Research Center of Food and Drug Evaluation, Wuhan University, Wuhan, 430071 (China)

2012-07-15

The aims of this study were to clarify the metabonome alteration in fetal rats after prenatal caffeine ingestion and to explore the underlying mechanism pertaining to the increased fetal circulatory glucocorticoid (GC). Pregnant Wistar rats were daily intragastrically administered with different doses of caffeine (0, 20, 60 and 180 mg/kg) from gestational days (GD) 11 to 20. Metabonome of fetal plasma and amniotic fluid on GD20 were analyzed by {sup 1}H nuclear magnetic resonance-based metabonomics. Gene and protein expressions involved in the GC metabolism, glucose and lipid metabolic pathways in fetal liver and gastrocnemius were measured by real-time RT-PCR and immunohistochemistry. Fetal plasma metabonome were significantly altered by caffeine, which presents as the elevated α- and β‐glucose, reduced multiple lipid contents, varied apolipoprotein contents and increased levels of a number of amino acids. The metabonome of amniotic fluids showed a similar change as that in fetal plasma. Furthermore, the expressions of 11β-hydroxysteroid dehydrogenase 2 (11β-HSD-2) were decreased, while the level of blood GC and the expressions of 11β-HSD-1 and glucocorticoid receptor (GR) were increased in fetal liver and gastrocnemius. Meanwhile, the expressions of insulin-like growth factor 1 (IGF-1), IGF-1 receptor and insulin receptor were decreased, while the expressions of adiponectin receptor 2, leptin receptors and AMP-activated protein kinase α2 were increased after caffeine treatment. Prenatal caffeine ingestion characteristically change the fetal metabonome, which is probably attributed to the alterations of glucose and lipid metabolic pathways induced by increased circulatory GC, activated GC metabolism and enhanced GR expression in peripheral metabolic tissues. -- Highlights: ► Prenatal caffeine ingestion altered the metabonome of IUGR fetal rats. ► Caffeine altered the glucose and lipid metabolic pathways of IUGR fetal rats. ► Prenatal caffeine

‘I–We’ boundary fluctuations in couple adjustment to rectal cancer and life with a permanent colostomy

Science.gov (United States)

McCarthy, Molly; Fergus, Karen; Miller, Debbie

2016-01-01

This study investigates couples’ adjustment to rectal cancer and a colostomy using the ‘Classification System of Couple Adjustment to Cancer’, a framework delineating fluctuations in couples’ sense of ‘I’ and ‘We’ in response to cancer. Nine couples affected by rectal cancer and adjusting to life with a colostomy were interviewed. A theoretical thematic analysis of the transcripts was conducted; nearly all ‘I–We’ shifts of the Classification System of Couple Adjustment to Cancer were observed – often in unique ways in response to rectal cancer–specific challenges – and one new shift was described. The results provide a novel and experientially grounded means of conceptualizing complex dyadic coping processes. PMID:28070388

Carrot juice ingestion attenuates high fructose-induced circulatory pro-inflammatory mediators in weanling Wistar rats.

Science.gov (United States)

Mahesh, Malleswarapu; Bharathi, Munugala; Raja Gopal Reddy, Mooli; Pappu, Pranati; Putcha, Uday Kumar; Vajreswari, Ayyalasomayajula; Jeyakumar, Shanmugam M

2017-03-01

Adipose tissue, an endocrine organ, plays a vital role not only in energy homeostasis, but also in the development and/or progression of various metabolic diseases, such as insulin resistance, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD), via several factors and mechanisms, including inflammation. This study tested, whether carrot juice administration affected the adipose tissue development and its inflammatory status in a high fructose diet-induced rat model. For this purpose, male weanling Wistar rats were divided into four groups and fed either control or high fructose diet of AIN-93G composition with or without carrot juice ingestion for an 8 week period. Administration of carrot juice did not affect the adiposity and cell size of visceral fat depot; retroperitoneal white adipose tissue (RPWAT), which was corroborated with unaltered expression of genes involved in adipogenic and lipogenic pathways. However, it significantly reduced the high fructose diet-induced elevation of plasma free fatty acid (FFA) (P ≤ 0.05), macrophage chemoattractant protein 1 (MCP1) (P ≤ 0.01) and high sensitive C-reactive protein (hsCRP) (P ≤ 0.05) levels. Carrot juice administration attenuated the high fructose diet-induced elevation of levels of circulatory FFA and pro-inflammatory mediators; MCP1 and hsCRP without affecting the adiposity and cell size of visceral fat depot; RPWAT. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Expanding the donor lung pool: how many donations after circulatory death organs are we missing?

Science.gov (United States)

Chancellor, William Zachary; Charles, Eric J; Mehaffey, James Hunter; Hawkins, Robert B; Foster, Carrie A; Sharma, Ashish K; Laubach, Victor E; Kron, Irving L; Tribble, Curtis G

2018-03-01

The number of patients with end-stage pulmonary disease awaiting lung transplantation is at an all-time high, while the supply of available organs remains stagnant. Utilizing donation after circulatory death (DCD) donors may help to address the supply-demand mismatch. The objective of this study is to determine the potential donor pool expansion with increased procurement of DCD organs from patients who die at hospitals. The charts of all patients who died at a single, rural, quaternary-care institution between August 2014 and June 2015 were reviewed for lung transplant candidacy. Inclusion criteria were age 65 y (n = 497, 58%). Those without cancer totaled 778 (90.8%) and 512 (59%) did not have lung pathology. This leaves 85 patients qualifying for DCD lung donation (pediatric n = 10, young n = 75, and old n = 0). Potential donors were significantly more likely to have clear chest X-rays (24.3% versus 10.0%, P < 0.0001) and higher mean PaO2/FiO2 (342.1 versus 197.9, P < 0.0001) compared with ineligible patients. A significant number of DCD lungs are available every year from patients who die within hospitals. We estimate the use of suitable DCD lungs could potentially result in a significant increase in the number of lungs available for transplantation. Copyright © 2017 Elsevier Inc. All rights reserved.

12 CFR 313.55 - Salary adjustments.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay arising...

24 CFR 5.611 - Adjusted income.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Adjusted income. 5.611 Section 5... Serving Persons with Disabilities: Family Income and Family Payment; Occupancy Requirements for Section 8 Project-Based Assistance Family Income § 5.611 Adjusted income. Adjusted income means annual income (as...

Adjustment of rainfall estimates from weather radars using in-situ stormwater drainage sensors

DEFF Research Database (Denmark)

Ahm, Malte

importance as long as the estimated flow and water levels are correct. It makes sense to investigate the possibility of adjusting weather radar data to rainfall-runoff measurements instead of rain gauge measurements in order to obtain better predictions of flow and water levels. This Ph.D. study investigates......-rain gauge adjusted data is applied for urban drainage models, discrepancies between radar-estimated runoff and observed runoff still occur. The aim of urban drainage applications is to estimate flow and water levels in critical points in the system. The “true” rainfall at ground level is, therefore, of less...... how rainfall-runoff measurements can be utilised to adjust weather radars. Two traditional adjustments methods based on rain gauges were used as the basis for developing two radar-runoff adjustment methods. The first method is based on the ZR relationship describing the relation between radar...

Adjusting estimative prediction limits

OpenAIRE

Masao Ueki; Kaoru Fueda

2007-01-01

This note presents a direct adjustment of the estimative prediction limit to reduce the coverage error from a target value to third-order accuracy. The adjustment is asymptotically equivalent to those of Barndorff-Nielsen & Cox (1994, 1996) and Vidoni (1998). It has a simpler form with a plug-in estimator of the coverage probability of the estimative limit at the target value. Copyright 2007, Oxford University Press.

Robotically-adjustable microstereotactic frames for image-guided neurosurgery

Science.gov (United States)

Kratchman, Louis B.; Fitzpatrick, J. Michael

2013-03-01

Stereotactic frames are a standard tool for neurosurgical targeting, but are uncomfortable for patients and obstruct the surgical field. Microstereotactic frames are more comfortable for patients, provide better access to the surgical site, and have grown in popularity as an alternative to traditional stereotactic devices. However, clinically available microstereotactic frames require either lengthy manufacturing delays or expensive image guidance systems. We introduce a robotically-adjusted, disposable microstereotactic frame for deep brain stimulation surgery that eliminates the drawbacks of existing microstereotactic frames. Our frame can be automatically adjusted in the operating room using a preoperative plan in less than five minutes. A validation study on phantoms shows that our approach provides a target positioning error of 0.14 mm, which exceeds the required accuracy for deep brain stimulation surgery.

12 CFR 1780.80 - Inflation adjustments.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Inflation adjustments. 1780.80 Section 1780.80... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within OFHEO's...

Load-Independent Harmonic Mitigation in SCR-Fed Three-Phase Multiple Adjustable Speed Drive Systems with Deliberately Dispatched Firing Angles

DEFF Research Database (Denmark)

Yang, Yongheng; Davari, Pooya; Blaabjerg, Frede

2018-01-01

Adjustable speed drives (ASD) are widely used in industry for energy savings, where low-cost diode rectifiers are still employed as the front-ends, also for simplicity in control and reliability in operation. However, significant harmonics appear at the grid, which should be tackled according...... a harmonic mitigation strategy for multiple ASD systems, where silicon-controlled rectifiers (SCR) with boost converters in the dc-link have been adopted to increase the harmonic-current controllability. More specific, the SCR firing angles are deliberately dispatched among the drive units, which results...

Adaptation to a warming-drying trend through cropping system adjustment over three decades: A case study in the northern agro-pastural ecotone of China

Science.gov (United States)

Zhang, Jingting; An, Pingli; Pan, Zhihua; Hao, Baozhen; Wang, Liwei; Dong, Zhiqiang; Pan, Xuebiao; Xue, Qingwu

2015-06-01

Long-term field monitoring data and historical crop data are useful to assess the impacts of climate change and to manage cropping systems. The objectives of this study are to understand the cropping system response to a warming-drying trend in the northern agro-pastural ecotone (NAE) of China and to document how farmers can adapt to the warming-drying trend by changing cropping system structure and adjusting planting date. The results indicate that a significant warming-drying trend existed in the NAE from 1980 to 2009, and this trend significantly decreased crop (spring wheat, naked oat, and potato) yields. Furthermore, the yield decreased by 16.2%-28.4% with a 1°C increase in maximum temperature and decreased by 6.6%-11.8% with a 10% decrease in precipitation. Considering food security, water use efficiency, and water ecological adaptability in the semi-arid NAE, cropping system structure adjustment (e.g., a shift from wheat to potato as the predominant crop) and planting date adaptation (e.g., a delay in crop planting date) can offset the impact of the warming-drying trend in the NAE. Based on the successful offsetting of the impact of the warming-drying trend in the NAE, we conclude that farmers can reduce the negative effects of climate change and minimize the risk of crop failure by adapting their cropping system structure at the farming level.

Electronic gaming and psychosocial adjustment.

Science.gov (United States)

Przybylski, Andrew K

2014-09-01

The rise of electronic games has driven both concerns and hopes regarding their potential to influence young people. Existing research identifies a series of isolated positive and negative effects, yet no research to date has examined the balance of these potential effects in a representative sample of children and adolescents. The objective of this study was to explore how time spent playing electronic games accounts for significant variation in positive and negative psychosocial adjustment using a representative cohort of children aged 10 to 15 years. A large sample of children and adolescents aged 10 to 15 years completed assessments of psychosocial adjustment and reported typical daily hours spent playing electronic games. Relations between different levels of engagement and indicators of positive and negative psychosocial adjustment were examined, controlling for participant age and gender and weighted for population representativeness. Low levels (3 hours daily) of game engagement was linked to key indicators of psychosocial adjustment. Low engagement was associated with higher life satisfaction and prosocial behavior and lower externalizing and internalizing problems, whereas the opposite was found for high levels of play. No effects were observed for moderate play levels when compared with non-players. The links between different levels of electronic game engagement and psychosocial adjustment were small (Games consistently but not robustly associated with children's adjustment in both positive and negative ways, findings that inform policy-making as well as future avenues for research in the area. Copyright © 2014 by the American Academy of Pediatrics.

Does unemployment cause long-term mortality? Selection and causation after the 1992–96 deep Swedish recession

Science.gov (United States)

Garcy, Anthony M.

2016-01-01

Abstract Background: Mass unemployment in Europe is endemic, especially among the young. Does it cause mortality? Methods: We analyzed long-term effects of unemployment occurring during the deep Swedish recession 1992–96. Mortality from all and selected causes was examined in the 6-year period after the recession among those employed in 1990 (3.4 million). Direct health selection was analyzed as risk of unemployment by prior medical history based on all hospitalizations 1981–91. Unemployment effects on mortality were estimated with and without adjustment for prior social characteristics and for prior medical history. Results: A prior circulatory disease history did not predict unemployment; a history of alcohol-related disease or suicide attempts did, in men and women. Unemployment predicted excess male, but not female, mortality from circulatory disease, both ischemic heart disease and stroke, and from all causes combined, after full adjustment. Adjustment for prior social characteristics reduced estimates considerably; additional adjustment for prior medical history did not. Mortality from external and alcohol-related causes was raised in men and women experiencing unemployment, after adjustment for social characteristics and medical history. For the youngest birth cohorts fully adjusted alcohol mortality HRs were substantial (male HR = 4.44; female HR = 5.73). The effect of unemployment on mortality was not uniform across the population; men, those with a low education, low income, unmarried or in urban employment were more vulnerable. Conclusions: Direct selection by medical history explains a modest fraction of any increased mortality risk following unemployment. Mass unemployment imposes long-term mortality risk on a sizeable segment of the population. PMID:27085193

Underwriters' view of risk - An adjuster's perspective

International Nuclear Information System (INIS)

Smith, M.

1992-01-01

This paper reviews how a risk assessment is performed by an insurance adjuster to determine rates and insurability of a client. It provides a historical perspective on insurance and how information systems are used to monitor past claims to determine future risk. Although this paper does not specifically address the oil and gas industry, it is informative in identifying how insurance rates are determined and risk assessments for various oil and gas operations are performed

7 CFR 1744.64 - Budget adjustment.

Science.gov (United States)

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from another...

US hospital payment adjustments for innovative technology lag behind those in Germany, France, and Japan.

Science.gov (United States)

Hernandez, John; Machacz, Susanne F; Robinson, James C

2015-02-01

Medicare pioneered add-on payments to facilitate the adoption of innovative technologies under its hospital prospective payment system. US policy makers are now experimenting with broader value-based payment initiatives, but these have not been adjusted for innovation. This article examines the structure, processes, and experience with Medicare's hospital new technology add-on payment program since its inception in 2001 and compares it with analogous payment systems in Germany, France, and Japan. Between 2001 and 2015 CMS approved nineteen of fifty-three applications for the new technology add-on payment program. We found that the program resulted in $201.7 million in Medicare payments in fiscal years 2002-13-less than half the level anticipated by Congress and only 34 percent of the amount projected by CMS. The US program approved considerably fewer innovative technologies, compared to analogous technology payment mechanisms in Germany, France and Japan. We conclude that it is important to adjust payments for new medical innovations within prospective and value-based payment systems explicitly as well as implicitly. The most straightforward method to use in adjusting value-based payments is for the insurer to retrospectively adjust spending targets to account for the cost of new technologies. If CMS made such retrospective adjustments, it would not financially penalize hospitals for adopting beneficial innovations. Project HOPE—The People-to-People Health Foundation, Inc.

Salary adjustments

CERN Multimedia

HR Department

2008-01-01

In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

Salary adjustments

CERN Multimedia

HR Department

2008-01-01

In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

Cultural Distance Asymmetry in Expatriate Adjustment

DEFF Research Database (Denmark)

Selmer, Jan; Chiu, Randy K.; Shenkar, Oded

2007-01-01

of the assignment. Design/methodology/approach - Using a two-flow sample of US expatriates in Germany and German expatriates in the USA, we examine and compare the psychological and socio-cultural adjustment of each group of executives. Findings - Controlling for the length of assignment, we find that German...... expatriates in the USA were better adjusted, both socio-culturally and psychologically, than American expatriates in Germany. These results support the asymmetry hypothesis and call into question previous findings attesting to the relationship between CD and expatriate adjustment. Originality......Purpose - The current literature implicitly assumes a symmetric impact of cultural distance (CD) on expatriate adjustment. By using distance as a predictor of adjustment, the literature has rendered the direction of the flow irrelevant: a US expatriate in Germany is presumed to face the same hurdle...

Concurrently adjusting interrelated control parameters to achieve optimal engine performance

Science.gov (United States)

Jiang, Li; Lee, Donghoon; Yilmaz, Hakan; Stefanopoulou, Anna

2015-12-01

Methods and systems for real-time engine control optimization are provided. A value of an engine performance variable is determined, a value of a first operating condition and a value of a second operating condition of a vehicle engine are detected, and initial values for a first engine control parameter and a second engine control parameter are determined based on the detected first operating condition and the detected second operating condition. The initial values for the first engine control parameter and the second engine control parameter are adjusted based on the determined value of the engine performance variable to cause the engine performance variable to approach a target engine performance variable. In order to cause the engine performance variable to approach the target engine performance variable, adjusting the initial value for the first engine control parameter necessitates a corresponding adjustment of the initial value for the second engine control parameter.

A complete generalized adjustment criterion

NARCIS (Netherlands)

Perković, Emilija; Textor, Johannes; Kalisch, Markus; Maathuis, Marloes H.

2015-01-01

Covariate adjustment is a widely used approach to estimate total causal effects from observational data. Several graphical criteria have been developed in recent years to identify valid covariates for adjustment from graphical causal models. These criteria can handle multiple causes, latent

The tension adjuster used at the work line of electron beam radiation cross-linking wire and cable

International Nuclear Information System (INIS)

Zhang Yingfa; Liu Zhenhao; Yin Xuejun

1999-01-01

The tension adjuster is an important equipment in the transport system at the work line of electron beam radiation cross-linking wire and cable to realize the velocity synchronism. There are many kinds of the adjuster. By putting various adjusters together properly, the authors can keep the line work stable and raise the quality of the product. Two kinds of standing adjuster and their mechanism are introduced. Also the corresponding figures and formulas are shown

Signalling chains with probe and adjust learning

Science.gov (United States)

Gosti, Giorgio

2018-04-01

Many models explain the evolution of signalling in repeated stage games on social networks, differently in this study each signalling game evolves a communication strategy to transmit information across the network. Specifically, I formalise signalling chain games as a generalisation of Lewis' signalling games, where a number of players are placed on a chain network and play a signalling game in which they have to propagate information across the network. I show that probe and adjust learning allows the system to develop communication conventions, but it may temporarily perturb the system out of conventions. Through simulations, I evaluate how long the system takes to evolve a signalling convention and the amount of time it stays in it. This discussion presents a mechanism in which simple players can evolve signalling across a social network without necessarily understanding the entire system.

Development and Performance Evaluation of Light Shelves Using Width-Adjustable Reflectors

Directory of Open Access Journals (Sweden)

Heangwoo Lee

2018-01-01

Full Text Available In recent years, there has been an increase in the consumption of energy for lighting purposes, which has led to an increase in the number of studies being conducted on this subject. Most studies have focused on light shelves, which are daylighting systems used for reducing the lighting energy required for the interiors of buildings. However, the existing light shelves cannot actively deal with external environmental factors, which often lead to an infringement of the right to light during the night when the performance of the light shelf deteriorates. Therefore, in this study, we propose a light shelf with a width-adjustable reflector and verify its validity using a testbed. The reflector of the proposed light shelf system is modularized so that the length can be adjusted in stages. The optimum width of the light shelf is calculated in terms of the energy reduction and uniformity ratio improvement, and the obtained optimum width is varied depending on the season. We find that the width-adjustable reflector can save 20% and 21.6% more lighting energy than light shelves with fixed reflector widths of 0.3 m and 0.6 m, respectively.