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Sample records for tidal volume dyspnea

  1. Prehospital tidal volume influences hospital tidal volume: A cohort study.

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    Stoltze, Andrew J; Wong, Terrence S; Harland, Karisa K; Ahmed, Azeemuddin; Fuller, Brian M; Mohr, Nicholas M

    2015-06-01

    The purposes of the study are to describe current practice of ventilation in a modern air medical system and to measure the association of ventilation strategy with subsequent ventilator care and acute respiratory distress syndrome (ARDS). Retrospective observational cohort study of intubated adult patients (n = 235) transported by a university-affiliated air medical transport service to a 711-bed tertiary academic center between July 2011 and May 2013. Low tidal volume ventilation was defined as tidal volumes less than or equal to 8 mL/kg predicted body weight. Multivariable regression was used to measure the association between prehospital tidal volume, hospital ventilation strategy, and ARDS. Most patients (57%) were ventilated solely with bag valve ventilation during transport. Mean tidal volume of mechanically ventilated patients was 8.6 mL/kg predicted body weight (SD, 0.2 mL/kg). Low tidal volume ventilation was used in 13% of patients. Patients receiving low tidal volume ventilation during air medical transport were more likely to receive low tidal volume ventilation in the emergency department (P tidal volume (P = .840). Low tidal volume ventilation was rare during air medical transport. Air transport ventilation strategy influenced subsequent ventilation but was not associated with ARDS. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Inspiratory time and tidal volume during intermittent positive pressure ventilation.

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    Field, D; Milner, A D; Hopkin, I E

    1985-01-01

    We measured the tidal volume achieved during intermittent positive pressure ventilation using various inspiratory times with a minimum of 0.2 seconds. Results indicate that tidal volume shows no reduction with inspiratory times down to 0.4 seconds. An inspiratory time of 0.3 seconds, however, is likely to reduce tidal volume by 8%, and at 0.2 seconds a 22% fall may be anticipated.

  3. High tidal volume ventilation in infant mice.

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    Cannizzaro, Vincenzo; Zosky, Graeme R; Hantos, Zoltán; Turner, Debra J; Sly, Peter D

    2008-06-30

    Infant mice were ventilated with either high tidal volume (V(T)) with zero end-expiratory pressure (HVZ), high V(T) with positive end-expiratory pressure (PEEP) (HVP), or low V(T) with PEEP. Thoracic gas volume (TGV) was determined plethysmographically and low-frequency forced oscillations were used to measure the input impedance of the respiratory system. Inflammatory cells, total protein, and cytokines in bronchoalveolar lavage fluid (BALF) and interleukin-6 (IL-6) in serum were measured as markers of pulmonary and systemic inflammatory response, respectively. Coefficients of tissue damping and tissue elastance increased in all ventilated mice, with the largest rise seen in the HVZ group where TGV rapidly decreased. BALF protein levels increased in the HVP group, whereas serum IL-6 rose in the HVZ group. PEEP keeps the lungs open, but provides high volumes to the entire lungs and induces lung injury. Compared to studies in adult and non-neonatal rodents, infant mice demonstrate a different response to similar ventilation strategies underscoring the need for age-specific animal models.

  4. Fuzzy Control of Tidal volume, Respiration number and Pressure value

    OpenAIRE

    Hasan Guler; Fikret Ata

    2010-01-01

    In this study, control of tidal volume, respiration number and pressure value which are arrived to patient at mechanical ventilator device which is used in intensive care units were performed with fuzzy logic controller. The aim of this system is to reduce workload of aneshesiologist. By calculating tidal volume, respiration number and pressure value, the error Pe(k) between reference pressure value (Pref) and pressure of gas given ill person (Phasta) and error change rate ;#948;Pe(k) were co...

  5. [Evaluation of tidal volume delivered by ventilators during volume-controlled ventilation].

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    Zhou, Juan; Yan, Yong; Cao, Desen

    2014-12-01

    To study the ways which ensure the delivery of enough tidal volume to patients under various conditions close to the demand of the physician. The volume control ventilation model was chosen, and the simulation lung type was active servo lung ASL 5000 or Michigan lung 1601. The air resistance, air compliance and lung type in simulation lungs were set. The tidal volume was obtained from flow analyzer PF 300. At the same tidal volume, the displaying values of tidal volume of E5, Servo i, Evital 4, and Evital XL ventilators with different lung types of patient, compliance of gas piping, leakage, gas types, etc. were evaluated. With the same setting tidal volume of a same ventilator, the tidal volume delivered to patients was different with different lung types of patient, compliance of gas piping, leakage, gas types, etc. Reducing compliance and increasing resistance of the patient lungs caused high peak airway pressure, the tidal volume was lost in gas piping, and the tidal volume be delivered to the patient lungs was decreased. If the ventilator did not compensate to leakage, the tidal volume delivered to the patient lungs was decreased. When the setting gas type of ventilator did not coincide with that applying to the patient, the tidal volume be delivered to the patient lungs might be different with the setting tidal volume of ventilator. To ensure the delivery of enough tidal volume to patients close to the demand of the physician, containable factors such as the compliance of gas piping, leakage, and gas types should be controlled.

  6. Psychogenic dyspnea

    Directory of Open Access Journals (Sweden)

    Tushar R Sahasrabudhe

    2013-01-01

    Full Text Available Dyspnea is a very common presenting complaint of a patient. Though commonly due to an organic disease, dyspnea can be a manifestation of underlying anxiety disorder. Three typical patterns of psychogenic dyspnea, viz. panic attack, psychogenic hyperventilation, and compulsive sighing, have been reviewed in this article. The article also comments on the diagnostic features and treatment of these patterns. The overlap with organic causes of dyspnea such as bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD has also been discussed. For literature review, a Medline and Pubmed search was conducted using appropriate keywords. Articles were also identified from the authors′ own knowledge of the literature as well as reference lists in articles retrieved.

  7. Ultra-protective tidal volume: how low should we go?

    OpenAIRE

    Costa, Eduardo LV; Amato, Marcelo BP

    2013-01-01

    Applying tidal volumes of less than 6 mL/kg might improve lung protection in patients with acute respiratory distress syndrome. In a recent article, Retamal and colleagues showed that such a reduction is feasible with conventional mechanical ventilation and leads to less tidal recruitment and overdistension without causing carbon dioxide retention or auto-positive end-expiratory pressure. However, whether the compensatory increase in the respiratory rate blunts the lung protection remains une...

  8. Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation?

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    Bachiller, Patricia R; McDonough, Joseph M; Feldman, Jeffrey M

    2008-05-01

    During mechanical ventilation of infants and neonates, small changes in tidal volume may lead to hypo- or hyperventilation, barotrauma, or volutrauma. Partly because breathing circuit compliance and fresh gas flow affect tidal volume delivery by traditional anesthesia ventilators in volume-controlled ventilation (VCV) mode, pressure-controlled ventilation (PCV) using a circle breathing system has become a common approach to minimizing the risk of mechanical ventilation for small patients, although delivered tidal volume is not assured during PCV. A new generation of anesthesia machine ventilators addresses the problems of VCV by adjusting for fresh gas flow and for the compliance of the breathing circuit. In this study, we evaluated the accuracy of new anesthesia ventilators to deliver small tidal volumes. Four anesthesia ventilator systems were evaluated to determine the accuracy of volume delivery to the airway during VCV at tidal volume settings of 100, 200, and 500 mL under different conditions of breathing circuit compliance (fully extended and fully contracted circuits) and lung compliance. A mechanical test lung (adult and infant) was used to simulate lung compliances ranging from 0.0025 to 0.03 L/cm H(2)O. Volumes and pressures were measured using a calibrated screen pneumotachograph and custom software. We tested the Smartvent 7900, Avance, and Aisys anesthesia ventilator systems (GE Healthcare, Madison, WI) and the Apollo anesthesia ventilator (Draeger Medical, Telford, PA). The Smartvent 7900 and Avance ventilators use inspiratory flow sensors to control the volume delivered, whereas the Aisys and Apollo ventilators compensate for the compliance of the circuit. We found that the anesthesia ventilators that use compliance compensation (Aisys and Apollo) accurately delivered both large and small tidal volumes to the airway of the test lung under conditions of normal and low lung compliance during VCV (ranging from 95.5% to 106.2% of the set tidal volume

  9. Gender and perception of dyspnea: The role of the variation in the forced expiratory volume in one second

    Directory of Open Access Journals (Sweden)

    Carlos A. Nigro

    2010-08-01

    Full Text Available During bronchoconstriction women perceive more breathlessness than men. The aims of study were 1 to evaluate if quality of dyspnea in bronchoconstriction was different in women and men 2 to assess if gender difference in the perception of dyspnea could be related to the level of bronchoconstriction. 457 subjects (257 women inhaled methacholine to a 20% decrease in FEV1, or 32 mg/ml. Dyspnea was evaluated using the modified Borg scale and a list of expressions of dyspnea. Borg scores were recorded immediately before the challenge test baseline and at the maximum FEV1 decrease. The prevalence of descriptors of dyspnea reported by women and men was similar. Dyspnea was related to the level of FEV1 (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095, females (OR 2.90, 95%CI 1.33-6.33, p 0.0072, younger subjects (OR 0.93, 95%CI 0.89- 0.97, p 0.0013 and body mass index (BMI (OR 1.11, 95%CI 1.01-1.23, p 0.023. As the FEV1 fell less than 20% from baseline, only the ΔFEV1 was significantly associated with dyspnea (ΔFEV1:OR 1.15, 95%CI 1.07- 1.24, p 0.0002. Instead, if the FEV1 fell higher ≥ 20%, the presence of dyspnea was related to the degree of bronchoconstriction (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187, females (OR 3.02, 95%CI 1.36-6.72, p 0.0067, younger subjects (OR 0.92, 95%CI 0.88-0.96, p 0.0007 and BMI (OR 1.12, 95%CI 1.01-1.23, p 0.023. The quality of dyspnea during the bronchoconstriction was similar in women and men; women showed a higher perception of dyspnea than men only when the FEV1 fell more than 20% from baseline.

  10. Comparison of actual tidal volume in neonatal lung model volume control ventilation using three ventilators.

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    Toyama, H; Endo, Y; Ejima, Y; Matsubara, M; Kurosawa, S

    2011-07-01

    In neonates, small changes in tidal volumes (V(T)) may lead to complications. Previous studies have shown a significant difference between ventilator-measured tidal volume and tidal volume delivered (actual V(T)). We evaluated the accuracy of three different ventilators to deliver small V(T) during volume-controlled ventilation. We tested Servo 300, 840 ventilator and Evita 4 Neoflow ventilators with lung models simulating normal and injured neonatal lung compliance models. Gas volume delivered from the ventilator into the test circuit (V(TV)) and actual V(T) to the test lung were measured using Ventrak respiration monitors at set V(T) (30 ml). The gas volume increase of the breathing circuit was then calculated. Tidal volumes of the SV300 and PB840 in both lung models were similar to the set V(T) and the actual tidal volumes in the injured model (20.7 ml and 19.8 ml, respectively) were significantly less than that in the normal model (27.4 ml and 23.4 ml). PB840 with circuit compliance compensation could not improve the actual V(T). V(TV) of the EV4N in the normal and the injured models (37.8 ml and 46.6 ml) were markedly increased compared with set V(T), and actual V(T) were similar to set V(T) in the normal and injured model (30.2 ml and 31.9 ml, respectively). EV4N measuring V(T) close to the lung could match actual V(T) to almost the same value as the set V(T) however the gas volume of the breathing circuit was increased. If an accurate value for the patient's actual V(T) is needed, this V(T) must be measured by a sensor located between the Y-piece and the tracheal tube.

  11. High tidal volume decreases adult respiratory distress syndrome, atelectasis, and ventilator days compared with low tidal volume in pediatric burned patients with inhalation injury.

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    Sousse, Linda E; Herndon, David N; Andersen, Clark R; Ali, Arham; Benjamin, Nicole C; Granchi, Thomas; Suman, Oscar E; Mlcak, Ronald P

    2015-04-01

    Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of this study was to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia, and ARDS in pediatric burned patients with inhalation injury within 1 year post burn injury. From 1986 to 2014, inhalation injury was diagnosed by bronchoscopy in pediatric burned patients (n = 932). Patients were divided into 3 groups: unventilated (n = 241), high tidal volume (HTV, 15 ± 3 mL/kg, n = 190), and low tidal volume (LTV, 9 ± 3 mL/kg, n = 501). High tidal volume was associated with significantly decreased ventilator days (p tidal volume significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared with low tidal volume in pediatric burned patients with inhalation injury. Therefore, the use of HTV may interrupt sequences leading to lung injury in our patient population. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Low Tidal Volume Reduces Lung Inflammation Induced by Liquid Ventilation in Piglets With Severe Lung Injury.

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    Jiang, Lijun; Feng, Huizhen; Chen, Xiaofan; Liang, Kaifeng; Ni, Chengyao

    2017-05-01

    Total liquid ventilation (TLV) is an alternative treatment for severe lung injury. High tidal volume is usually required for TLV to maintain adequate CO 2 clearance. However, high tidal volume may cause alveolar barotrauma. We aim to investigate the effect of low tidal volume on pulmonary inflammation in piglets with lung injury and under TLV. After the establishment of acute lung injury model by infusing lipopolysaccharide, 12 piglets were randomly divided into two groups, TLV with high tidal volume (25 mL/kg) or with low tidal volume (6 mL/kg) for 240 min, respectively. Extracorporeal CO 2 removal was applied in low tidal volume group to improve CO 2 clearance and in high tidal volume group as sham control. Gas exchange and hemodynamic status were monitored every 30 min during TLV. At the end of the study, pulmonary mRNA expression and plasmatic concentration of interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured by collecting lung tissue and blood samples from piglets. Arterial blood pressure, PaO 2 , and PaCO 2 showed no remarkable difference between groups during the observation period. Compared with high tidal volume strategy, low tidal volume resulted in 76% reduction of minute volume and over 80% reduction in peak inspiratory pressure during TLV. In addition, low tidal volume significantly diminished pulmonary mRNA expression and plasmatic level of IL-6 and IL-8. We conclude that during TLV, low tidal volume reduces lung inflammation in piglets with acute lung injury without compromising gas exchange. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  13. Change in tidal volume during cardiopulmonary resuscitation in newborn piglets.

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    Li, Elliott S; Cheung, Po-Yin; O'Reilly, Megan; Schmölzer, Georg M

    2015-11-01

    The purpose of inflations during cardiopulmonary resuscitation (CPR) is to deliver an adequate tidal volume (VT) to facilitate gas exchange. However, no study has examined VT delivery during chest compression (CC) in detail to understand the effect of CC on lung aeration. The aim of the study was to examine VT changes during CC and their effect on lung aeration. Piglets were anaesthetised, instrumented and intubated with zero leak. They were then randomly assigned to CPR using either 3:1 compression:ventilation ratio (C:V) (n=6), continuous CC with asynchronous ventilations (CCaV) (90 CC/min with 30/min asynchronous ventilations) (n=6) or continuous CC superimposed with 30 s sustained inflations (CC+SI) with a CC rate of 120/min (n=5). A respiratory function monitor (NM3, Respironics, Philips, Andover, Massachusetts, USA) was used to continuously measure inspiration tidal volume (VTi) and expirational tidal volume (VTe). ANOVA with Bonferroni post-test were used to compare variables of all three groups. During the inflation in the 3:1 C:V group, the mean (SD) VTi and VTe was 23.5 (5.3) mL/kg and 19.4 (2.7) mL/kg (p=0.16), respectively. During the CC, we observed a significant VT loss in the 3:1 group with VTi and VTe being 4.1 (1.2) mL/kg and 11.1 (3.3) mL/kg (p=0.007), respectively. In the CCaV group, VTe was higher compared with VTi, but this was not significant. In the CC+SI group, a VT gain during each CC with VTi and VTe of 16.3 (3.2) mL/kg and 14 (3) mL/kg (p=0.21), respectively, was observed. VT delivery is improved using CC+SI compared with 3:1 C:V. This improvement in VT delivery may lead to better alveolar oxygen delivery and lung aeration. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. High initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome.

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    Allison, Michael G; Scott, Michael C; Hu, Kami M; Witting, Michael D; Winters, Michael E

    2015-04-01

    Emergency department (ED) patients are at high risk for the acute respiratory distress syndrome (ARDS). Settings only 1 mL/kg above recommended tidal volumes confers harm for these patients. The purpose of this study was to determine whether ED physicians routinely initiate mechanical ventilation with low tidal volumes in patients at risk for ARDS. We retrospectively reviewed the charts of all adult patients who were intubated in an urban, academic ED. The charts were analyzed to identify patients in whom ARDS developed within 48 hours after ED admission. Patients were eligible for inclusion if they had bilateral infiltrates on imaging, had a Pao2/Fio2 ratio less than 300 mm Hg and did not have heart failure contributing to their presentation. The tidal volumes set in the ED were then compared with the recommended tidal volume of 6 mL/kg of predicted body weight. The initial tidal volumes set in the ED were higher than recommended by an average of 80 mL (95% confidence interval, 60-110, P tidal volume ventilation setting. In an academic, tertiary hospital, newly intubated ED patients in whom ARDS developed within 48 hours after intubation were ventilated with tidal volumes that exceeded recommendations by an average of 1.5 mL/kg. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Parameters affecting the tidal volume during expiratory abdominal compression in patients with prolonged tracheostomy mechanical ventilation.

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    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Takahashi, Naoaki

    2015-07-01

    [Purpose] The aim of this study was to clarify physical parameters affecting the tidal volume during expiratory abdominal compression in patients with prolonged tracheostomy mechanical ventilation. [Methods] Eighteen patients with prolonged mechanical ventilation were included in this study. Expiratory abdominal compression was performed on patients lying in a supine position. The abdomen above the navel was vertically compressed in synchronization with expiration and released with inspiration. We measured the tidal volume during expiratory abdominal compression. [Results] The mean tidal volume during expiratory abdominal compression was higher than that at rest (430.6 ± 127.1 mL vs. 344.0 ± 94.3 mL). The tidal volume during expiratory abdominal compression was correlated with weight, days of ventilator support, dynamic compliance and abdominal expansion. Stepwise multiple regression analysis revealed that weight (β = 0.499), dynamic compliance (β = 0.387), and abdominal expansion (β = 0.365) were factors contributing to the tidal volume during expiratory abdominal compression. [Conclusion] Expiratory abdominal compression increased the tidal volume in patients with prolonged tracheostomy mechanical ventilation. The tidal volume during expiratory abdominal compression was influenced by each of the pulmonary conditions and the physical characteristics.

  16. Comparison of Tidal Volumes at the Endotracheal Tube and at the Ventilator.

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    Kim, Paul; Salazar, Adler; Ross, Patrick A; Newth, Christopher J L; Khemani, Robinder G

    2015-11-01

    Lung protective ventilation for children with acute respiratory distress syndrome requires accurate assessment of tidal volume. Although modern ventilators compensate for ventilator tubing compliance, tidal volume measured at the ventilator may not be accurate, particularly in small children. Although ventilator-specific proximal flow sensors that measure tidal volume at the endotracheal tube have been developed, there is little information regarding their accuracy. We sought to test the accuracy of ventilator measured tidal volume with and without proximal flow sensors against a calibrated pneumotachometer in children. Prospective, observational. Tertiary care PICU. Fifty-one endotracheally intubated and mechanically ventilated children younger than 18 years. Tidal volumes were measured at the ventilator, using a ventilator-specific flow sensor, and a calibrated pneumotachometer connected to the SensorMedics 2600A Pediatric Pulmonary Function Cart. In a pressure control mode of ventilation: median tidal volume measured with the pneumotachometer (9.5 mL/kg [interquartile range, 8.2-11.7 mL/kg]) was significantly higher than tidal volume measured either at the ventilator (8.2 mL/kg [7.1-9.6 mL/kg]) or at the proximal flow sensor (8.1 mL/kg [7.2-10.0 mL/kg]) (p tidal volume measured with the pneumotachometer (10.2 mL/kg [8.8-12.4 mL/kg]) was significantly higher than tidal volume measured either at the ventilator (8.0 mL/kg [7.1-9.7 mL/kg]) or at the proximal flow sensor (8.5 mL/kg [7.3-10.4 mL/kg]) (p Tidal volume measured either at the endotracheal tube with a proximal flow sensor or at the ventilator with compensation for tubing compliance are both significantly lower than tidal volume measured with a calibrated pneumotachometer. This underestimation of delivered tidal volume may be particularly important when managing children with acute respiratory distress syndrome.

  17. Failure of Noninvasive Ventilation for De Novo Acute Hypoxemic Respiratory Failure: Role of Tidal Volume.

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    Carteaux, Guillaume; Millán-Guilarte, Teresa; De Prost, Nicolas; Razazi, Keyvan; Abid, Shariq; Thille, Arnaud W; Schortgen, Frédérique; Brochard, Laurent; Brun-Buisson, Christian; Mekontso Dessap, Armand

    2016-02-01

    A low or moderate expired tidal volume can be difficult to achieve during noninvasive ventilation for de novo acute hypoxemic respiratory failure (i.e., not due to exacerbation of chronic lung disease or cardiac failure). We assessed expired tidal volume and its association with noninvasive ventilation outcome. Prospective observational study. Twenty-four bed university medical ICU. Consecutive patients receiving noninvasive ventilation for acute hypoxemic respiratory failure between August 2010 and February 2013. Noninvasive ventilation was uniformly delivered using a simple algorithm targeting the expired tidal volume between 6 and 8 mL/kg of predicted body weight. Expired tidal volume was averaged and respiratory and hemodynamic variables were systematically recorded at each noninvasive ventilation session. Sixty-two patients were enrolled, including 47 meeting criteria for acute respiratory distress syndrome, and 32 failed noninvasive ventilation (51%). Pneumonia (n = 51, 82%) was the main etiology of acute hypoxemic respiratory failure. The median (interquartile range) expired tidal volume averaged over all noninvasive ventilation sessions (mean expired tidal volume) was 9.8 mL/kg predicted body weight (8.1-11.1 mL/kg predicted body weight). The mean expired tidal volume was significantly higher in patients who failed noninvasive ventilation as compared with those who succeeded (10.6 mL/kg predicted body weight [9.6-12.0] vs 8.5 mL/kg predicted body weight [7.6-10.2]; p = 0.001), and expired tidal volume was independently associated with noninvasive ventilation failure in multivariate analysis. This effect was mainly driven by patients with PaO2/FIO2 up to 200 mm Hg. In these patients, the expired tidal volume above 9.5 mL/kg predicted body weight predicted noninvasive ventilation failure with a sensitivity of 82% and a specificity of 87%. A low expired tidal volume is almost impossible to achieve in the majority of patients receiving noninvasive ventilation

  18. Postprandial dyspnea and malnutrition in patients with chronic obstructive pulmonary disease.

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    Gray-Donald, K; Carrey, Z; Martin, J G

    1998-06-01

    To compare ventilatory response, oxygen uptake and sense of dyspnea of underweight versus normal-weight patients with chronic obstructive pulmonary disease (COPD) after a standard meal, in order to investigate whether an increase in dyspnea due to diet-induced thermogenesis might lead to altered eating habits. Weight loss in patients with COPD leads to adverse health effects, but the reasons for this loss are not well understood. Prospective study. A total of 18 patients (14 men, 4 women) aged 46 to 83 with severe, stable COPD. Minute ventilation (VE), tidal volume (VT), frequency of breathing, oxygen uptake (VO2), carbon dioxide excretion (VCO2) and sense of dyspnea (using the Borg scale) were measured 15 minutes before a 2.5-MJ (600-kcal) balanced liquid meal and at four 15-minute intervals after the meal. Increases in VE, VT, VO2 and VCO2 were observed for all subjects. Corrected for body surface area, the maximum postprandial changes in these indicators did not differ between the underweight and the normal-weight subjects with COPD. Work of breathing (measured in 11 subjects) did not differ between the 2 groups, nor did the number of subjects reporting increased dyspnea. Since the increases in VE, VO2, VCO2 and perceived dyspnea did not differ between the normal-weight and underweight patients, this indicates that dyspnea at mealtimes is not likely to lead to decreased food intake.

  19. Lung protection: an intervention for tidal volume reduction in a teaching intensive care unit

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    Briva, Arturo; Gaiero, Cristina

    2016-01-01

    Objective To determine the effect of feedback and education regarding the use of predicted body weight to adjust tidal volume in a lung-protective mechanical ventilation strategy. Methods The study was performed from October 2014 to November 2015 (12 months) in a single university polyvalent intensive care unit. We developed a combined intervention (education and feedback), placing particular attention on the importance of adjusting tidal volumes to predicted body weight bedside. In parallel, predicted body weight was estimated from knee height and included in clinical charts. Results One hundred fifty-nine patients were included. Predicted body weight assessed by knee height instead of visual evaluation revealed that the delivered tidal volume was significantly higher than predicted. After the inclusion of predicted body weight, we observed a sustained reduction in delivered tidal volume from a mean (standard error) of 8.97 ± 0.32 to 7.49 ± 0.19mL/kg (p < 0.002). Furthermore, the protocol adherence was subsequently sustained for 12 months (delivered tidal volume 7.49 ± 0.54 versus 7.62 ± 0.20mL/kg; p = 0.103). Conclusion The lack of a reliable method to estimate the predicted body weight is a significant impairment for the application of a worldwide standard of care during mechanical ventilation. A combined intervention based on education and repeated feedbacks promoted sustained tidal volume education during the study period (12 months). PMID:27925055

  20. Timing of low tidal volume ventilation and intensive care unit mortality in acute respiratory distress syndrome. A prospective cohort study.

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    Needham, Dale M; Yang, Ting; Dinglas, Victor D; Mendez-Tellez, Pedro A; Shanholtz, Carl; Sevransky, Jonathan E; Brower, Roy G; Pronovost, Peter J; Colantuoni, Elizabeth

    2015-01-15

    Reducing tidal volume decreases mortality in acute respiratory distress syndrome (ARDS). However, the effect of the timing of low tidal volume ventilation is not well understood. To evaluate the association of intensive care unit (ICU) mortality with initial tidal volume and with tidal volume change over time. Multivariable, time-varying Cox regression analysis of a multisite, prospective study of 482 patients with ARDS with 11,558 twice-daily tidal volume assessments (evaluated in milliliter per kilogram of predicted body weight [PBW]) and daily assessment of other mortality predictors. An increase of 1 ml/kg PBW in initial tidal volume was associated with a 23% increase in ICU mortality risk (adjusted hazard ratio, 1.23; 95% confidence interval [CI], 1.06-1.44; P = 0.008). Moreover, a 1 ml/kg PBW increase in subsequent tidal volumes compared with the initial tidal volume was associated with a 15% increase in mortality risk (adjusted hazard ratio, 1.15; 95% CI, 1.02-1.29; P = 0.019). Compared with a prototypical patient receiving 8 days with a tidal volume of 6 ml/kg PBW, the absolute increase in ICU mortality (95% CI) of receiving 10 and 8 ml/kg PBW, respectively, across all 8 days was 7.2% (3.0-13.0%) and 2.7% (1.2-4.6%). In scenarios with variation in tidal volume over the 8-day period, mortality was higher when a larger volume was used earlier. Higher tidal volumes shortly after ARDS onset were associated with a greater risk of ICU mortality compared with subsequent tidal volumes. Timely recognition of ARDS and adherence to low tidal volume ventilation is important for reducing mortality. Clinical trial registered with www.clinicaltrials.gov (NCT 00300248).

  1. Physiological mechanisms of dyspnea during exercise with external thoracic restriction: Role of increased neural respiratory drive

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    Mendonca, Cassandra T.; Schaeffer, Michele R.; Riley, Patrick

    2013-01-01

    We tested the hypothesis that neuromechanical uncoupling of the respiratory system forms the mechanistic basis of dyspnea during exercise in the setting of “abnormal” restrictive constraints on ventilation (VE). To this end, we examined the effect of chest wall strapping (CWS) sufficient to mimic a “mild” restrictive lung deficit on the interrelationships between VE, breathing pattern, dynamic operating lung volumes, esophageal electrode-balloon catheter-derived measures of the diaphragm electromyogram (EMGdi) and the transdiaphragmatic pressure time product (PTPdi), and sensory intensity and unpleasantness ratings of dyspnea during exercise. Twenty healthy men aged 25.7 ± 1.1 years (means ± SE) completed symptom-limited incremental cycle exercise tests under two randomized conditions: unrestricted control and CWS to reduce vital capacity (VC) by 21.6 ± 0.5%. Compared with control, exercise with CWS was associated with 1) an exaggerated EMGdi and PTPdi response; 2) no change in the relationship between EMGdi and each of tidal volume (expressed as a percentage of VC), inspiratory reserve volume, and PTPdi, thus indicating relative preservation of neuromechanical coupling; 3) increased sensory intensity and unpleasantness ratings of dyspnea; and 4) no change in the relationship between increasing EMGdi and each of the intensity and unpleasantness of dyspnea. In conclusion, the increased intensity and unpleasantness of dyspnea during exercise with CWS could not be readily explained by increased neuromechanical uncoupling but likely reflected the awareness of increased neural respiratory drive (EMGdi) needed to achieve any given VE during exercise in the setting of “abnormal” restrictive constraints on tidal volume expansion. PMID:24356524

  2. Effects of different tidal volumes in pulmonary and extrapulmonary lung injury with or without intraabdominal hypertension.

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    Santos, Cíntia L; Moraes, Lillian; Santos, Raquel S; Oliveira, Mariana G; Silva, Johnatas D; Maron-Gutierrez, Tatiana; Ornellas, Débora S; Morales, Marcelo M; Capelozzi, Vera L; Jamel, Nelson; Pelosi, Paolo; Rocco, Patricia R M; Garcia, Cristiane S N B

    2012-03-01

    We hypothesized that: (1) intraabdominal hypertension increases pulmonary inflammatory and fibrogenic responses in acute lung injury (ALI); (2) in the presence of intraabdominal hypertension, higher tidal volume reduces lung damage in extrapulmonary ALI, but not in pulmonary ALI. Wistar rats were randomly allocated to receive Escherichia coli lipopolysaccharide intratracheally (pulmonary ALI) or intraperitoneally (extrapulmonary ALI). After 24 h, animals were randomized into subgroups without or with intraabdominal hypertension (15 mmHg) and ventilated with positive end expiratory pressure = 5 cmH(2)O and tidal volume of 6 or 10 ml/kg during 1 h. Lung and chest wall mechanics, arterial blood gases, lung and distal organ histology, and interleukin (IL)-1β, IL-6, caspase-3 and type III procollagen (PCIII) mRNA expressions in lung tissue were analyzed. With intraabdominal hypertension, (1) chest-wall static elastance increased, and PCIII, IL-1β, IL-6, and caspase-3 expressions were more pronounced than in animals with normal intraabdominal pressure in both ALI groups; (2) in extrapulmonary ALI, higher tidal volume was associated with decreased atelectasis, and lower IL-6 and caspase-3 expressions; (3) in pulmonary ALI, higher tidal volume led to higher IL-6 expression; and (4) in pulmonary ALI, liver, kidney, and villi cell apoptosis was increased, but not affected by tidal volume. Intraabdominal hypertension increased inflammation and fibrogenesis in the lung independent of ALI etiology. In extrapulmonary ALI associated with intraabdominal hypertension, higher tidal volume improved lung morphometry with lower inflammation in lung tissue. Conversely, in pulmonary ALI associated with intraabdominal hypertension, higher tidal volume increased IL-6 expression.

  3. Generation of tidal volume via gentle chest pressure in children over one year old.

    Science.gov (United States)

    Tsui, Ban C H; Horne, Sara; Tsui, Jenkin; Corry, Gareth N

    2015-07-01

    In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is a well-established technique to maintain oxygenation of tissues and organs until medical equipment and staff are available. During CPR, chest compressions help circulate blood and have been shown in animal models to be a means of short-term oxygenation. In this study, we tested whether gentle chest pressure can generate meaningful tidal volume in paediatric subjects. This prospective cohort pilot study recruited children under the age of 17 years and undergoing any surgery requiring general anaesthetic and endotracheal intubation. After induction of general anaesthesia, tidal volumes were obtained before and after intubation by applying a downward force on the chest which was not greater than the patient's weight. Mean tidal volumes were compared for unprotected versus protected airway and for type of surgery. Mean tidal volume generated with an unprotected and protected airway was 2.7 (1.7) and 2.9 (2.3) mL/kg, respectively. Mean tidal volume generated with mechanical ventilation was 13.6 (4.9) mL/kg. No statistical significance was found when comparing tidal volumes generated with an unprotected or protected airway (p = 0.20), type of surgery (tonsillectomy and/or adenoidectomy versus other surgery) (unprotected, p = 0.09; protected, p = 0.37), and when age difference between groups was taken into account (p = 0.34). Using gentle chest pressure, we were able to generate over 20% of the tidal volume achieved with mechanical ventilation. Our results suggest that gentle chest pressure may be a means to support temporary airflow in children. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Monitoring tidal volumes in preterm infants at birth: mask versus endotracheal ventilation.

    Science.gov (United States)

    van Vonderen, Jeroen J; Hooper, Stuart B; Krabbe, Vera B; Siew, Melissa L; Te Pas, Arjan B

    2015-01-01

    Upper airway distention during mask ventilation could reduce gas volumes entering the lung compared with ventilation via an endotracheal tube. Therefore, respiratory tract volumes were measured in lambs and tidal volumes were compared in preterm infants before and after intubation. In seven preterm lambs, volumes of the airways (oropharynx, trachea, lungs) were assessed. In 10 preterm infants, delta pressures, tidal volumes and leak were measured during ventilation 2 min before (mask ventilation) and 2 min after intubation (endotracheal ventilation). Inflations coinciding with breaths were excluded. Amount of upper airway distention in lambs and differences in inspiratory and expiratory tidal volume before and after intubation. In lambs, the combined trachea and oropharynx contributed to 14 (12-21) % (median (IQR), whereas the oropharynx contributed to 9 (7-10) % of the total tidal volume measured at the mouth. In preterm infants, inspiratory (11.1 (7.9-22.6) mL/kg vs 5.8 (3.9-9.6) mL/kg (p=0.01)) and expiratory (8.3 (6.8-15.4) mL/kg vs 4.9 (3.9-9.6) mL/kg (p=0.02)) tidal volumes were significantly larger during mask ventilation compared with endotracheal ventilation. Leak was 18.7 (3.3-28.7) % before versus 0 (0-2.3) % after intubation (p0.05). During mask ventilation, expiratory tidal volume increased from 10.0 (5.4-15.6) mL/kg to 11.3 (7.6-17.0) mL/kg (p=0.01), but remained unchanged during endotracheal ventilation. During neonatal mask ventilation, distention of the upper respiratory tract contributes to the tidal volumes measured and should be taken into account when targeting tidal volumes during mask ventilation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Delivery of tidal volume from four anaesthesia ventilators during volume-controlled ventilation: a bench study.

    Science.gov (United States)

    Wallon, G; Bonnet, A; Guérin, C

    2013-06-01

    Tidal volume (V(T)) must be accurately delivered by anaesthesia ventilators in the volume-controlled ventilation mode in order for lung protective ventilation to be effective. However, the impact of fresh gas flow (FGF) and lung mechanics on delivery of V(T) by the newest anaesthesia ventilators has not been reported. We measured delivered V(T) (V(TI)) from four anaesthesia ventilators (Aisys™, Flow-i™, Primus™, and Zeus™) on a pneumatic test lung set with three combinations of lung compliance (C, ml cm H2O(-1)) and resistance (R, cm H2O litre(-1) s(-2)): C60R5, C30R5, C60R20. For each CR, three FGF rates (0.5, 3, 10 litre min(-1)) were investigated at three set V(T)s (300, 500, 800 ml) and two values of PEEP (0 and 10 cm H2O). The volume error = [(V(TI) - V(Tset))/V(Tset)] ×100 was computed in body temperature and pressure-saturated conditions and compared using analysis of variance. For each CR and each set V(T), the absolute value of the volume error significantly declined from Aisys™ to Flow-i™, Zeus™, and Primus™. For C60R5, these values were 12.5% for Aisys™, 5% for Flow-i™ and Zeus™, and 0% for Primus™. With an increase in FGF, absolute values of the volume error increased only for Aisys™ and Zeus™. However, in C30R5, the volume error was minimal at mid-FGF for Aisys™. The results were similar at PEEP 10 cm H2O. Under experimental conditions, the volume error differed significantly between the four new anaesthesia ventilators tested and was influenced by FGF, although this effect may not be clinically relevant.

  6. Measurement of tidal volume using respiratory ultrasonic plethysmography in anaesthetized, mechanically ventilated horses.

    Science.gov (United States)

    Russold, Elena; Ambrisko, Tamas D; Schramel, Johannes P; Auer, Ulrike; Van Den Hoven, Rene; Moens, Yves P

    2013-01-01

    To compare tidal volume estimations obtained from Respiratory Ultrasonic Plethysmography (RUP) with simultaneous spirometric measurements in anaesthetized, mechanically ventilated horses. Prospective randomized experimental study. Five experimental horses. Five horses were anaesthetized twice (1 week apart) in random order in lateral and in dorsal recumbency. Nine ventilation modes (treatments) were scheduled in random order (each lasting 4 minutes) applying combinations of different tidal volumes (8, 10, 12 mL kg(-1)) and positive end-expiratory pressures (PEEP) (0, 10, 20 cm H(2)O). Baseline ventilation mode (tidal volume=15 mL kg(-1), PEEP=0 cm H(2)O) was applied for 4 minutes between all treatments. Spirometry and RUP data were downloaded to personal computers. Linear regression analyses (RUP versus spirometric tidal volume) were performed using different subsets of data. Additonally RUP was calibrated against spirometry using a regression equation for all RUP signal values (thoracic, abdominal and combined) with all data collectively and also by an individually determined best regression equation (highest R(2)) for each experiment (horse versus recumbency) separately. Agreement between methods was assessed with Bland-Altman analyses. The highest correlation of RUP and spirometric tidal volume (R(2)=0.81) was found with the combined RUP signal in horses in lateral recumbency and ventilated without PEEP. The bias ±2 SD was 0±2.66 L when RUP was calibrated for collective data, but decreased to 0±0.87 L when RUP was calibrated with individual data. A possible use of RUP for tidal volume measurement during IPPV needs individual calibration to obtain limits of agreement within ±20%. © 2012 The Authors. Veterinary Anaesthesia and Analgesia. © 2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

  7. Tidal volume in acute respiratory distress syndrome: how best to select it.

    Science.gov (United States)

    Umbrello, Michele; Marino, Antonella; Chiumello, Davide

    2017-07-01

    Mechanical ventilation is the type of organ support most widely provided in the intensive care unit. However, this form of support does not constitute a cure for acute respiratory distress syndrome (ARDS), as it mainly works by buying time for the lungs to heal while contributing to the maintenance of vital gas exchange. Moreover, it can further damage the lung, leading to the development of a particular form of lung injury named ventilator-induced lung injury (VILI). Experimental evidence accumulated over the last 30 years highlighted the factors associated with an injurious form of mechanical ventilation. The present paper illustrates the physiological effects of delivering a tidal volume to the lungs of patients with ARDS, and suggests an approach to tidal volume selection. The relationship between tidal volume and the development of VILI, the so called volotrauma, will be reviewed. The still actual suggestion of a lung-protective ventilatory strategy based on the use of low tidal volumes scaled to the predicted body weight (PBW) will be presented, together with newer strategies such as the use of airway driving pressure as a surrogate for the amount of ventilatable lung tissue or the concept of strain, i.e., the ratio between the tidal volume delivered relative to the resting condition, that is the functional residual capacity (FRC). An ultra-low tidal volume strategy with the use of extracorporeal carbon dioxide removal (ECCO 2 R) will be presented and discussed. Eventually, the role of other ventilator-related parameters in the generation of VILI will be considered (namely, plateau pressure, airway driving pressure, respiratory rate (RR), inspiratory flow), and the promising unifying framework of mechanical power will be presented.

  8. The impact of large tidal volume ventilation on the absorption of inhaled insulin in rabbits

    DEFF Research Database (Denmark)

    Petersen, Astrid Heide; Laursen, Torben; Ahrén, Bo

    2007-01-01

    Previous studies have shown that ventilation patterns affect absorption of inhaled compounds. Thus, the aim of this study was to investigate the effect of large tidal volume ventilation (LTVV) on the absorption of inhaled insulin in rabbits. Mechanically ventilated rabbits were given human insulin...

  9. Adaptive support ventilation: A translational study evaluating the size of delivered tidal volumes

    NARCIS (Netherlands)

    Veelo, Denise P.; Dongelmans, Dave A.; Binnekade, Jan M.; Paulus, Frederique; Schultz, Marcus J.

    2010-01-01

    Purpose: Adaptive support ventilation (ASV) is a microprocessor-controlled, closed-loop mode of mechanical ventilation that adapts respiratory rates and tidal volumes (V(T)s) based on the Otis least work of breathing formula. We studied calculated V(T)s in a computer simulation model, and V(T)s

  10. Intraoperative ventilation: incidence and risk factors for receiving large tidal volumes during general anesthesia

    Directory of Open Access Journals (Sweden)

    Fernandez-Bustamante Ana

    2011-11-01

    Full Text Available Abstract Background There is a growing concern of the potential injurious role of ventilatory over-distention in patients without lung injury. No formal guidelines exist for intraoperative ventilation settings, but the use of tidal volumes (VT under 10 mL/kg predicted body weight (PBW has been recommended in healthy patients. We explored the incidence and risk factors for receiving large tidal volumes (VT > 10 mL/kg PBW. Methods We performed a cross-sectional analysis of our prospectively collected perioperative electronic database for current intraoperative ventilation practices and risk factors for receiving large tidal volumes (VT > 10 mL/kg PBW. We included all adults undergoing prolonged (≥ 4 h elective abdominal surgery and collected demographic, preoperative (comorbidities, intraoperative (i.e. ventilatory settings, fluid administration and postoperative (outcomes information. We compared patients receiving exhaled tidal volumes > 10 mL/kg PBW with those that received 8-10 or Results Ventilatory settings were non-uniform in the 429 adults included in the analysis. 17.5% of all patients received VT > 10 mL/kg PBW. 34.0% of all obese patients (body mass index, BMI, ≥ 30, 51% of all patients with a height T > 10 mL/kg PBW. Conclusions Ventilation with VT > 10 mL/kg PBW is still common, although poor correlation with PBW suggests it may be unintentional. BMI ≥ 30, female gender and height

  11. Low tidal volume ventilation ameliorates left ventricular dysfunction in mechanically ventilated rats following LPS-induced lung injury.

    Science.gov (United States)

    Cherpanath, Thomas G V; Smeding, Lonneke; Hirsch, Alexander; Lagrand, Wim K; Schultz, Marcus J; Groeneveld, A B Johan

    2015-10-07

    High tidal volume ventilation has shown to cause ventilator-induced lung injury (VILI), possibly contributing to concomitant extrapulmonary organ dysfunction. The present study examined whether left ventricular (LV) function is dependent on tidal volume size and whether this effect is augmented during lipopolysaccharide(LPS)-induced lung injury. Twenty male Wistar rats were sedated, paralyzed and then randomized in four groups receiving mechanical ventilation with tidal volumes of 6 ml/kg or 19 ml/kg with or without intrapulmonary administration of LPS. A conductance catheter was placed in the left ventricle to generate pressure-volume loops, which were also obtained within a few seconds of vena cava occlusion to obtain relatively load-independent LV systolic and diastolic function parameters. The end-systolic elastance / effective arterial elastance (Ees/Ea) ratio was used as the primary parameter of LV systolic function with the end-diastolic elastance (Eed) as primary LV diastolic function. Ees/Ea decreased over time in rats receiving LPS (p = 0.045) and high tidal volume ventilation (p = 0.007), with a lower Ees/Ea in the rats with high tidal volume ventilation plus LPS compared to the other groups (p tidal volume ventilation without LPS (p = 0.223). A significant interaction (p tidal ventilation and LPS for Ees/Ea and Eed, and all rats receiving high tidal volume ventilation plus LPS died before the end of the experiment. Low tidal volume ventilation ameliorated LV systolic and diastolic dysfunction while preventing death following LPS-induced lung injury in mechanically ventilated rats. Our data advocates the use of low tidal volumes, not only to avoid VILI, but to avert ventilator-induced myocardial dysfunction as well.

  12. Determining volume sensitive waters in Beaufort County, SC tidal creeks

    Science.gov (United States)

    Andrew Tweel; Denise Sanger; Anne Blair; John Leffler

    2016-01-01

    Non-point source pollution from stormwater runoff associated with large-scale land use changes threatens the integrity of ecologically and economically valuable estuarine ecosystems. Beaufort County, SC implemented volume-based stormwater regulations on the rationale that if volume discharge is controlled, contaminant loading will also be controlled.

  13. Are tidal volume measurements in neonatal pressure-controlled ventilation accurate?

    Science.gov (United States)

    Chow, Lily C; Vanderhal, Andre; Raber, Jorge; Sola, Augusto

    2002-09-01

    Bedside pulmonary mechanics monitors (PMM) have become useful in ventilatory management in neonates. These monitors are used more frequently due to recent improvements in data-processing capabilities. PMM devices are often part of the ventilator or are separate units. The accuracy and reliability of these systems have not been carefully evaluated. We compared a single ventilatory parameter, tidal volume (V(t)), as measured by several systems. We looked at two freestanding PMMs: the Ventrak Respiratory Monitoring System (Novametrix, Wallingford, CT) and the Bicore CP-100 Neonatal Pulmonary Monitor (Allied Health Care Products, Riverside, CA), and three ventilators with built-in PMM: the VIP Bird Ventilator (Bird Products Corp., Palm Springs, CA), Siemens Servo 300A (Siemens-Elema AB, Solna, Sweden), and Drager Babylog 8000 (Drager, Inc., Chantilly, VA). A calibrated syringe (Hans Rudolph, Inc., Kansas City, MO) was used to deliver tidal volumes of 4, 10, and 20 mL to each ventilator system coupled with a freestanding PMM. After achieving steady state, six consecutive V(t) readings were taken simultaneously from the freestanding PMM and each ventilator. In a second portion of the bench study, we used pressure-control ventilation and measured exhaled tidal volume (V(te)) while ventilating a Bear Test Lung with the same three ventilators. We adjusted peak inspiratory pressure (PIP) under controlled conditions to achieve the three different targeted tidal volumes on the paired freestanding PMM. Again, six V(te) measurements were recorded for each tidal volume. Means and standard deviations were calculated.The percentage difference in measurement of V(t) delivered by calibrated syringe varied greatly, with the greatest discrepancy seen in the smallest tidal volumes, by up to 28%. In pressure control mode, V(te) as measured by the Siemens was significantly overestimated by 20-95%, with the biggest discrepancy at the smallest V(te), particularly when paired with the Bicore

  14. High volume tidal or current flow harnessing system

    Energy Technology Data Exchange (ETDEWEB)

    Gorlov, A.M.

    1984-08-07

    Apparatus permitting the utilization of large volumes of water in the harnessing and extracting of a portion of the power generated by the rise and fall of ocean tides, ocean currents, or flowing rivers includes the provision of a dam, and a specialized single cavity chamber of limited size as compared with the water head enclosed by the dam, and an extremely high volume gating system in which all or nearly all of the water between the high and low levels on either side of the dam is cyclically gated through the single chamber from one side of the dam to the other so as to alternately provide positive air pressure and a partial vacuum within the single chamber. In one embodiment, the specialized chamber has a barrier at the bottom which divides the bottom of the chamber in half, large ports at the bottom of the chamber to permit inflow and outflow of high volumes of water, and ganged structures having a higher total area than that of corresponding ports, in which the structures form sluice gates to selectively seal off and open different sets of ports. In another embodiment, a single chamber is used without a barrier. In this embodiment, vertical sluice gates are used which may be activated automatically by pressures acting on the sluice gates as a result of ingested and expelled water.

  15. Effects of inhalational anaesthesia with low tidal volume ventilation on end-tidal sevoflurane and carbon dioxide concentrations: prospective randomized study.

    Science.gov (United States)

    de la Matta-Martín, M; López-Herrera, D; Luis-Navarro, J C; López-Romero, J L

    2014-02-01

    We investigated how ventilation with low tidal volumes affects the pharmacokinetics of sevoflurane uptake during the first minutes of inhaled anaesthesia. Forty-eight patients scheduled for lung resection were randomly assigned to three groups. Patients in group 1, 2 and 3 received 3% sevoflurane for 3 min via face mask and controlled ventilation with a tidal volume of 2.2, 8 and 12 ml kg(-1), respectively (Phase 1). After tracheal intubation (Phase 2), 3% sevoflurane was supplied for 2 min using a tidal volume of 8 ml kg(-1) (Phase 3). End-tidal sevoflurane concentrations were significantly higher in group 1 at the end of phase 1 and lower at the end of phase 2 than in the other groups as follows: median of 2.5%, 2.2% and 2.3% in phase 1 for groups 1, 2 and 3, respectively (Ptidal carbon dioxide values in group 1 were significantly lower at the end of phase 1 and higher at the end of phase 2 than in the other groups as follows: median of 16.5, 31 and 29.5 mm Hg in phase 1 for groups 1, 2 and 3, respectively (Ptidal volume approximating the airway dead space volume, end-tidal sevoflurane and end-tidal carbon dioxide may not correctly reflect the concentration of these gases in the alveoli, leading to misinterpretation of expired gas data. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  16. Quantitative prediction of respiratory tidal volume based on the external torso volume change: a potential volumetric surrogate

    International Nuclear Information System (INIS)

    Li Guang; Arora, Naveen C; Xie Huchen; Ning, Holly; Citrin, Deborah; Kaushal, Aradhana; Zach, Leor; Camphausen, Kevin; Miller, Robert W; Lu Wei; Low, Daniel

    2009-01-01

    An external respiratory surrogate that not only highly correlates with but also quantitatively predicts internal tidal volume should be useful in guiding four-dimensional computed tomography (4DCT), as well as 4D radiation therapy (4DRT). A volumetric surrogate should have advantages over external fiducial point(s) for monitoring respiration-induced motion of the torso, which deforms in synchronization with a patient-specific breathing pattern. This study establishes a linear relationship between the external torso volume change (TVC) and lung air volume change (AVC) by validating a proposed volume conservation hypothesis (TVC = AVC) throughout the respiratory cycle using 4DCT and spirometry. Fourteen patients' torso 4DCT images and corresponding spirometric tidal volumes were acquired to examine this hypothesis. The 4DCT images were acquired using dual surrogates in cine mode and amplitude-based binning in 12 respiratory stages, minimizing residual motion artifacts. Torso and lung volumes were calculated using threshold-based segmentation algorithms and volume changes were calculated relative to the full-exhalation stage. The TVC and AVC, as functions of respiratory stages, were compared, showing a high correlation (r = 0.992 ± 0.005, p 2 = 0.980) without phase shift. The AVC was also compared to the spirometric tidal volumes, showing a similar linearity (slope = 1.030 ± 0.092, R 2 = 0.947). In contrast, the thoracic and abdominal heights measured from 4DCT showed relatively low correlation (0.28 ± 0.44 and 0.82 ± 0.30, respectively) and location-dependent phase shifts. This novel approach establishes the foundation for developing an external volumetric respiratory surrogate.

  17. Quantitative prediction of respiratory tidal volume based on the external torso volume change: a potential volumetric surrogate

    Energy Technology Data Exchange (ETDEWEB)

    Li Guang; Arora, Naveen C; Xie Huchen; Ning, Holly; Citrin, Deborah; Kaushal, Aradhana; Zach, Leor; Camphausen, Kevin; Miller, Robert W [Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892 (United States); Lu Wei; Low, Daniel [Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110 (United States)], E-mail: ligeorge@mail.nih.gov

    2009-04-07

    An external respiratory surrogate that not only highly correlates with but also quantitatively predicts internal tidal volume should be useful in guiding four-dimensional computed tomography (4DCT), as well as 4D radiation therapy (4DRT). A volumetric surrogate should have advantages over external fiducial point(s) for monitoring respiration-induced motion of the torso, which deforms in synchronization with a patient-specific breathing pattern. This study establishes a linear relationship between the external torso volume change (TVC) and lung air volume change (AVC) by validating a proposed volume conservation hypothesis (TVC = AVC) throughout the respiratory cycle using 4DCT and spirometry. Fourteen patients' torso 4DCT images and corresponding spirometric tidal volumes were acquired to examine this hypothesis. The 4DCT images were acquired using dual surrogates in cine mode and amplitude-based binning in 12 respiratory stages, minimizing residual motion artifacts. Torso and lung volumes were calculated using threshold-based segmentation algorithms and volume changes were calculated relative to the full-exhalation stage. The TVC and AVC, as functions of respiratory stages, were compared, showing a high correlation (r = 0.992 {+-} 0.005, p < 0.0001) as well as a linear relationship (slope = 1.027 {+-} 0.061, R{sup 2} = 0.980) without phase shift. The AVC was also compared to the spirometric tidal volumes, showing a similar linearity (slope = 1.030 {+-} 0.092, R{sup 2} = 0.947). In contrast, the thoracic and abdominal heights measured from 4DCT showed relatively low correlation (0.28 {+-} 0.44 and 0.82 {+-} 0.30, respectively) and location-dependent phase shifts. This novel approach establishes the foundation for developing an external volumetric respiratory surrogate.

  18. Is pulmonary resistance constant, within the range of tidal volume ventilation, in patients with ARDS?

    Science.gov (United States)

    Mols, G; Kessler, V; Benzing, A; Lichtwarck-Aschoff, M; Geiger, K; Guttmann, J

    2001-02-01

    When managing patients with acute respiratory distress syndrome (ARDS), respiratory system compliance is usually considered first and changes in resistance, although recognized, are neglected. Resistance can change considerably between minimum and maximum lung volume, but is generally assumed to be constant in the tidal volume range (V(T)). We measured resistance during tidal ventilation in 16 patients with ARDS or acute lung injury by the slice method and multiple linear regression analysis. Resistance was constant within V(T) in only six of 16 patients. In the remaining patients, resistance decreased, increased or showed complex changes. We conclude that resistance within V(T) varies considerably from patient to patient and that constant resistance within V(T) is not always likely.

  19. Effects of respiratory rate and tidal volume on gas exchange in total liquid ventilation.

    Science.gov (United States)

    Bull, Joseph L; Tredici, Stefano; Fujioka, Hideki; Komori, Eisaku; Grotberg, James B; Hirschl, Ronald B

    2009-01-01

    Using a rabbit model of total liquid ventilation (TLV), and in a corresponding theoretical model, we compared nine tidal volume-respiratory rate combinations to identify a ventilator strategy to maximize gas exchange, while avoiding choked flow, during TLV. Nine different ventilation strategies were tested in each animal (n = 12): low [LR = 2.5 breath/min (bpm)], medium (MR = 5 bpm), or high (HR = 7.5 bpm) respiratory rates were combined with a low (LV = 10 ml/kg), medium (MV = 15 ml/kg), or high (HV = 20 ml/kg) tidal volumes. Blood gases and partial pressures, perfluorocarbon gas content, and airway pressures were measured for each combination. Choked flow occurred in all high respiratory rate-high volume animals, 71% of high respiratory rate-medium volume (HRMV) animals, and 50% of medium respiratory rate-high volume (MRHV) animals but in no other combinations. Medium respiratory rate-medium volume (MRMV) resulted in the highest gas exchange of the combinations that did not induce choke. The HRMV and MRHV animals that did not choke had similar or higher gas exchange than MRMV. The theory predicted this behavior, along with spatial and temporal variations in alveolar gas partial pressures. Of the combinations that did not induce choked flow, MRMV provided the highest gas exchange. Alveolar gas transport is diffusion dominated and rapid during gas ventilation but is convection dominated and slow during TLV. Consequently, the usual alveolar gas equation is not applicable for TLV.

  20. Assessment of tidal volume and thoracoabdominal motion using volume and flow-oriented incentive spirometers in healthy subjects

    Directory of Open Access Journals (Sweden)

    V.F. Parreira

    2005-07-01

    Full Text Available The objective of the present study was to evaluate incentive spirometers using volume- (Coach and Voldyne and flow-oriented (Triflo II and Respirex devices. Sixteen healthy subjects, 24 ± 4 years, 62 ± 12 kg, were studied. Respiratory variables were obtained by respiratory inductive plethysmography, with subjects in a semi-reclined position (45º. Tidal volume, respiratory frequency, minute ventilation, inspiratory duty cycle, mean inspiratory flow, and thoracoabdominal motion were measured. Statistical analysis was performed with Kolmogorov-Smirnov test, t-test and ANOVA. Comparison between the Coach and Voldyne devices showed that larger values of tidal volume (1035 ± 268 vs 947 ± 268 ml, P = 0.02 and minute ventilation (9.07 ± 3.61 vs 7.49 ± 2.58 l/min, P = 0.01 were reached with Voldyne, whereas no significant differences in respiratory frequency were observed (7.85 ± 1.24 vs 8.57 ± 1.89 bpm. Comparison between flow-oriented devices showed larger values of inspiratory duty cycle and lower mean inspiratory flow with Triflo II (0.35 ± 0.05 vs 0.32 ± 0.05 ml/s, P = 0.00, and 531 ± 137 vs 606 ± 167 ml/s, P = 0.00, respectively. Abdominal motion was larger (P < 0.05 during the use of volume-oriented devices compared to flow-oriented devices (52 ± 11% for Coach and 50 ± 9% for Voldyne; 43 ± 13% for Triflo II and 44 ± 14% for Respirex. We observed that significantly higher tidal volume associated with low respiratory frequency was reached with Voldyne, and that there was a larger abdominal displacement with volume-oriented devices.

  1. Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

    OpenAIRE

    Lipes, Jed; Bojmehrani, Azadeh; Lellouche, Francois

    2012-01-01

    Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung inj...

  2. Tidal volume and mortality in mechanically ventilated children: a systematic review and meta-analysis of observational studies*.

    Science.gov (United States)

    de Jager, Pauline; Burgerhof, Johannes G M; van Heerde, Marc; Albers, Marcel J I J; Markhorst, Dick G; Kneyber, Martin C J

    2014-12-01

    To determine whether tidal volume is associated with mortality in critically ill, mechanically ventilated children. MEDLINE, EMBASE, and CINAHL databases from inception until July 2013 and bibliographies of included studies without language restrictions. Randomized clinical trials and observational studies reporting mortality in mechanically ventilated PICU patients. Two authors independently selected studies and extracted data on study methodology, quality, and patient outcomes. Meta-analyses were performed using the Mantel-Haenszel random-effects model. Heterogeneity was quantified using I. Study quality was assessed using the Newcastle-Ottawa Score for cohort studies. Out of 142 citations, seven studies met the inclusion criteria, and additional two articles were identified from references of the found articles. One was excluded. These eight studies included 1,756 patients. Mortality rates ranged from 13% to 42%. There was no association between tidal volume and mortality when tidal volume was dichotomized at 7, 8, 10, or 12 mL/kg. Comparing patients ventilated with tidal volume less than 7 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg and tidal volume less than 8 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg also showed no association between tidal volume and mortality. Limiting the analysis to patients with acute lung injury/acute respiratory distress syndrome did not change these results. Heterogeneity was observed in all pooled analyses. A relationship between tidal volume and mortality in mechanically ventilated children could not be identified, irrespective of the severity of disease. The significant heterogeneity observed in the pooled analyses necessitates future studies in well-defined patient populations to understand the effects of tidal volume on patient outcome.

  3. Accuracy of near-patient vs. inbuilt spirometry for monitoring tidal volumes in an in-vitro paediatric lung model.

    Science.gov (United States)

    Morgenroth, S; Thomas, J; Cannizzaro, V; Weiss, M; Schmidt, A R

    2018-03-01

    Spirometric monitoring provides precise measurement and delivery of tidal volumes within a narrow range, which is essential for lung-protective strategies that aim to reduce morbidity and mortality in mechanically-ventilated patients. Conventional anaesthesia ventilators include inbuilt spirometry to monitor inspiratory and expiratory tidal volumes. The GE Aisys CS 2 anaesthesia ventilator allows additional near-patient spirometry via a sensor interposed between the proximal end of the tracheal tube and the respiratory tubing. Near-patient and inbuilt spirometry of two different GE Aisys CS 2 anaesthesia ventilators were compared in an in-vitro study. Assessments were made of accuracy and variability in inspiratory and expiratory tidal volume measurements during ventilation of six simulated paediatric lung models using the ASL 5000 test lung. A total of 9240 breaths were recorded and analysed. Differences between inspiratory tidal volumes measured with near-patient and inbuilt spirometry were most significant in the newborn setting (p tidal volume measurements with near-patient spirometry were consistently more accurate than with inbuilt spirometry for all lung models (p tidal volumes decreased with increasing tidal volumes, and was smaller with near-patient than with inbuilt spirometry. The variability in measured tidal volumes was higher during expiration, especially with inbuilt spirometry. In conclusion, the present in-vitro study shows that measurements with near-patient spirometry are more accurate and less variable than with inbuilt spirometry. Differences between measurement methods were most significant in the smallest patients. We therefore recommend near-patient spirometry, especially for neonatal and paediatric patients. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

  4. Respiratory Pattern and Tidal Volumes Differ for Pressure Support and Volume-assured Pressure Support in Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Nicholson, Trevor T; Smith, Sean B; Siddique, Teepu; Sufit, Robert; Ajroud-Driss, Senda; Coleman, John M; Wolfe, Lisa F

    2017-07-01

    Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease resulting in respiratory failure and death. Use of noninvasive ventilation (NIV) improves survival. However, use of volume-assured pressure support (VAPS) has not been extensively studied in ALS. To explore the clinical usefulness of a detailed evaluation of device-recorded NIV data in the management of chronic respiratory failure in ALS, and to determine whether there are differences in efficacy between patients using VAPS or PS. We performed a retrospective chart review of 271 patients with ALS using either PS or VAPS, along with an evaluation of device-recorded data to explore differences in attainment of goal tidal volumes (Vt) and ratio of respiratory rate to tidal volume (f/Vt), in addition to triggering and cycling ability. Two hundred and fifteen patients were using PS, while 56 were using VAPS. There were no significant differences in demographic data, symptoms, pulmonary function, or patient compliance. Compared with VAPS, achieved Vt was significantly lower for PS while f/Vt was significantly higher. Percent spontaneous triggering was relatively preserved in both cohorts, whereas percent spontaneous cycling was considerably decreased in both. Furthermore, there was no association found between spontaneous triggering or cycling, and pulmonary function, indicating the presence of low spontaneous breath cycling or triggering ability is difficult to predict. Examination of device data for exhaled tidal volumes and f/Vt may be of use in evaluating efficacy of NIV in ALS. VAPS provides more reliable goal Vt than does PS, and is associated with decreased f/Vt. Spontaneous cycling is decreased in ALS despite preservation of triggering ability. Although a set backup rate may address decreased triggering, perhaps more importantly, setting a sufficient fixed inspiratory time would address the issue of decreased cycling.

  5. Tidal volume estimation using the blanket fractal dimension of the tracheal sounds acquired by smartphone.

    Science.gov (United States)

    Reljin, Natasa; Reyes, Bersain A; Chon, Ki H

    2015-04-27

    In this paper, we propose the use of blanket fractal dimension (BFD) to estimate the tidal volume from smartphone-acquired tracheal sounds. We collected tracheal sounds with a Samsung Galaxy S4 smartphone, from five (N = 5) healthy volunteers. Each volunteer performed the experiment six times; first to obtain linear and exponential fitting models, and then to fit new data onto the existing models. Thus, the total number of recordings was 30. The estimated volumes were compared to the true values, obtained with a Respitrace system, which was considered as a reference. Since Shannon entropy (SE) is frequently used as a feature in tracheal sound analyses, we estimated the tidal volume from the same sounds by using SE as well. The evaluation of the performed estimation, using BFD and SE methods, was quantified by the normalized root-mean-squared error (NRMSE). The results show that the BFD outperformed the SE (at least twice smaller NRMSE was obtained). The smallest NRMSE error of 15.877% ± 9.246% (mean ± standard deviation) was obtained with the BFD and exponential model. In addition, it was shown that the fitting curves calculated during the first day of experiments could be successfully used for at least the five following days.

  6. Tidal Volume Estimation Using the Blanket Fractal Dimension of the Tracheal Sounds Acquired by Smartphone

    Directory of Open Access Journals (Sweden)

    Natasa Reljin

    2015-04-01

    Full Text Available In this paper, we propose the use of blanket fractal dimension (BFD to estimate the tidal volume from smartphone-acquired tracheal sounds. We collected tracheal sounds with a Samsung Galaxy S4 smartphone, from five (N = 5 healthy volunteers. Each volunteer performed the experiment six times; first to obtain linear and exponential fitting models, and then to fit new data onto the existing models. Thus, the total number of recordings was 30. The estimated volumes were compared to the true values, obtained with a Respitrace system, which was considered as a reference. Since Shannon entropy (SE is frequently used as a feature in tracheal sound analyses, we estimated the tidal volume from the same sounds by using SE as well. The evaluation of the performed estimation, using BFD and SE methods, was quantified by the normalized root-mean-squared error (NRMSE. The results show that the BFD outperformed the SE (at least twice smaller NRMSE was obtained. The smallest NRMSE error of 15.877% ± 9.246% (mean ± standard deviation was obtained with the BFD and exponential model. In addition, it was shown that the fitting curves calculated during the first day of experiments could be successfully used for at least the five following days.

  7. Utilizing Forced Vital Capacity to Predict Low Lung Compliance and Select Intraoperative Tidal Volume During Thoracic Surgery.

    Science.gov (United States)

    Hoftman, Nir; Eikermann, Eric; Shin, John; Buckley, Jack; Navab, Kaveh; Abtin, Fereidoun; Grogan, Tristan; Cannesson, Maxime; Mahajan, Aman

    2017-12-01

    Tidal volume selection during mechanical ventilation utilizes dogmatic formulas that only consider a patient's predicted body weight (PBW). In this study, we investigate whether forced vital capacity (FVC) (1) correlates better to total lung capacity (TLC) than PBW, (2) predicts low pulmonary compliance, and (3) provides an alternative method for tidal volume selection. One hundred thirty thoracic surgery patients had their preoperative TLC calculated via 2 methods: (1) pulmonary function test (PFT; TLCPFT) and (2) computed tomography 3D reconstruction (TLCCT). We compared the correlation between TLC and PBW with the correlation between TLC and FVC to determine which was stronger. Dynamic pulmonary compliance was then calculated from intraoperative ventilator data and logistic regression models constructed to determine which clinical measure best predicted low compliance. Ratios of tidal volume/FVC plotted against peak inspiratory pressure were utilized to construct a new model for tidal volume selection. Calculated tidal volumes generated by this model were then compared with those generated by the standard lung-protective formula Vt = 7 cc/kg. The correlation between FVC and TLC (0.82 for TLCPFT and 0.76 for TLCCT) was stronger than the correlation between PBW and TLC (0.65 for TLCPFT and 0.58 for TLCCT). Patients with very low compliance had significantly smaller lung volumes (forced expiratory volume at 1 second, FVC, TLC) and lower diffusion capacity of the lungs for carbon monoxide when compared with patients with normal compliance. An FVC cutoff of 3470 cc was 100% sensitive and 51% specific for predicting low compliance. The proposed equation Vt = FVC/8 significantly reduced calculated tidal volume by a mean of 22.5% in patients with low pulmonary compliance without affecting the mean tidal volume in patients with normal compliance (mean difference 0.9%). FVC is more strongly correlated to TLC than PBW and a cutoff of about 3.5 L can be utilized to predict

  8. Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Jed Lipes

    2012-01-01

    Full Text Available Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI and acute respiratory distress syndrome (ARDS. Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

  9. Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

    Science.gov (United States)

    Lipes, Jed; Bojmehrani, Azadeh; Lellouche, Francois

    2012-01-01

    Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges. PMID:22536499

  10. Breathing circuit compliance and accuracy of displayed tidal volume during pressure-controlled ventilation of infants: A quality improvement project.

    Science.gov (United States)

    Glenski, Todd A; Diehl, Carrie; Clopton, Rachel G; Friesen, Robert H

    2017-09-01

    Anesthesia machines have evolved to deliver desired tidal volumes more accurately by measuring breathing circuit compliance during a preuse self-test and then incorporating the compliance value when calculating expired tidal volume. The initial compliance value is utilized in tidal volume calculation regardless of whether the actual compliance of the breathing circuit changes during a case, as happens when corrugated circuit tubing is manually expanded after the preuse self-test but before patient use. We noticed that the anesthesia machine preuse self-test was usually performed on nonexpanded pediatric circuit tubing, and then the breathing circuit was subsequently expanded for clinical use. We aimed to demonstrate that performing the preuse self-test in that manner could lead to incorrectly displayed tidal volume on the anesthesia machine monitor. The goal of this quality improvement project was to change the usual practice and improve the accuracy of displayed tidal volume in infants undergoing general anesthesia. There were four stages of the project: (i) gathering baseline data about the performance of the preuse self-test and using infant and adult test lungs to measure discrepancies of displayed tidal volumes when breathing circuit compliance was changed after the initial preuse self-test; (ii) gathering clinical data during pressure-controlled ventilation comparing anesthesia machine displayed tidal volume with actual spirometry tidal volume in patients less than 10 kg before (machine preuse self-test performed while the breathing circuit was nonexpanded) and after an intervention (machine preuse self-test performed after the breathing circuit was fully expanded); (iii) performing department-wide education to help implement practice change; (iv) gathering postintervention data to determine the prevalence of proper machine preuse self-test. At constant pressure-controlled ventilation through fully expanded circuit tubing, displayed tidal volume was 83

  11. Tidal Volume Single Breath Washout of Two Tracer Gases - A Practical and Promising Lung Function Test

    Science.gov (United States)

    Singer, Florian; Stern, Georgette; Thamrin, Cindy; Fuchs, Oliver; Riedel, Thomas; Gustafsson, Per; Frey, Urs; Latzin, Philipp

    2011-01-01

    Background Small airway disease frequently occurs in chronic lung diseases and may cause ventilation inhomogeneity (VI), which can be assessed by washout tests of inert tracer gas. Using two tracer gases with unequal molar mass (MM) and diffusivity increases specificity for VI in different lung zones. Currently washout tests are underutilised due to the time and effort required for measurements. The aim of this study was to develop and validate a simple technique for a new tidal single breath washout test (SBW) of sulfur hexafluoride (SF6) and helium (He) using an ultrasonic flowmeter (USFM). Methods The tracer gas mixture contained 5% SF6 and 26.3% He, had similar total MM as air, and was applied for a single tidal breath in 13 healthy adults. The USFM measured MM, which was then plotted against expired volume. USFM and mass spectrometer signals were compared in six subjects performing three SBW. Repeatability and reproducibility of SBW, i.e., area under the MM curve (AUC), were determined in seven subjects performing three SBW 24 hours apart. Results USFM reliably measured MM during all SBW tests (n = 60). MM from USFM reflected SF6 and He washout patterns measured by mass spectrometer. USFM signals were highly associated with mass spectrometer signals, e.g., for MM, linear regression r-squared was 0.98. Intra-subject coefficient of variation of AUC was 6.8%, and coefficient of repeatability was 11.8%. Conclusion The USFM accurately measured relative changes in SF6 and He washout. SBW tests were repeatable and reproducible in healthy adults. We have developed a fast, reliable, and straightforward USFM based SBW method, which provides valid information on SF6 and He washout patterns during tidal breathing. PMID:21423739

  12. A prototype of volume-controlled tidal liquid ventilator using independent piston pumps.

    Science.gov (United States)

    Robert, Raymond; Micheau, Philippe; Cyr, Stéphane; Lesur, Olivier; Praud, Jean-Paul; Walti, Hervé

    2006-01-01

    Liquid ventilation using perfluorochemicals (PFC) offers clear theoretical advantages over gas ventilation, such as decreased lung damage, recruitment of collapsed lung regions, and lavage of inflammatory debris. We present a total liquid ventilator designed to ventilate patients with completely filled lungs with a tidal volume of PFC liquid. The two independent piston pumps are volume controlled and pressure limited. Measurable pumping errors are corrected by a programmed supervisor module, which modifies the inserted or withdrawn volume. Pump independence also allows easy functional residual capacity modifications during ventilation. The bubble gas exchanger is divided into two sections such that the PFC exiting the lungs is not in contact with the PFC entering the lungs. The heating system is incorporated into the metallic base of the gas exchanger, and a heat-sink-type condenser is placed on top of the exchanger to retrieve PFC vapors. The prototype was tested on 5 healthy term newborn lambs (<5 days old). The results demonstrate the efficiency and safety of the prototype in maintaining adequate gas exchange, normal acido-basis equilibrium, and cardiovascular stability during a short, 2-hour total liquid ventilator. Airway pressure, lung volume, and ventilation scheme were maintained in the targeted range.

  13. Evaluation the effect of breathing filters on end-tidal carbon dioxide during inferior abdominal surgery in infants and changes of tidal volume and respiratory rate needs for preventing of increasing end-tidal carbon dioxide.

    Science.gov (United States)

    Sajedi, Parvin; Abooei, Mohsen; Shafa, Amir; Karbalaei, Mahboobeh; Babaei, Atefeh

    2016-01-01

    The aim of this study was to prevent of increasing end-tidal carbon dioxide (ETCO 2) with changing of vital capacity and respiratory rate when using of birthing filter in infants. In a randomized clinical trial study, ninety-four infant' patients were studied in three groups. Basic values, such as peak inspiratory pressure, tidal volume, minute ventilation, respiratory rate, and partial pressure of ET CO 2 (PETCO 2 ) level had been evaluated after intubation, 10 min after intubation and 10 min after filter insertion. In the first group, patients only observed for changing in ETCO 2 level. In the second and the third groups, respiratory rates and tidal volume had been increased retrospectively, until that ETCO 2 ≤35 mmHg was received. We used ANOVA, Chi-square, and descriptive tests for data analysis. P Tidal volume 10 min after filter insertion was statistically higher in Group 3 (145.0 ± 26.3 ml) versus 129.3 ± 38.9 ml in Group 1 and 118.7 ± 20.8 ml in Group 2 ( P = 0.02). Furthermore, respiratory rate at this time was statistically higher in Group 2 (25.82 ± 0.43) versus Groups 1 and 3 (21.05 ± 0.20 ml and 21.02 ± 0.60 ml, respectively) ( P = 0.001). Minute volume and PETCO 2 level were statistically significant between Group 1 and the other two groups after filter insertion ( P = 0.01 and P = 0.00,1 respectively). With changing the vital capacity and respiratory rate we can control PETCO 2 level ≤35 mmHg during using of birthing filters in infants. We recommend this instrument during anesthesia of infants.

  14. Association Between Use of Lung-Protective Ventilation With Lower Tidal Volumes and Clinical Outcomes Among Patients Without Acute Respiratory Distress Syndrome A Meta-analysis

    NARCIS (Netherlands)

    Serpa Neto, Ary; Cardoso, Sérgio Oliveira; Manetta, José Antônio; Pereira, Victor Galvão Moura; Espósito, Daniel Crepaldi; Pasqualucci, Manoela de Oliveira Prado; Damasceno, Maria Cecília Toledo; Schultz, Marcus J.

    2012-01-01

    Context Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. Objective To determine

  15. Alveolar Tidal recruitment/derecruitment and Overdistension During Four Levels of End-Expiratory Pressure with Protective Tidal Volume During Anesthesia in a Murine Lung-Healthy Model.

    Science.gov (United States)

    Soares, Joao Henrique Neves; Carvalho, Alysson Roncally; Bergamini, Bruno Curty; Gress, Maria Alice Kuster; Jandre, Frederico Caetano; Zin, Walter Araujo; Giannella-Neto, Antonio

    2018-06-01

    We compared respiratory mechanics between the positive end-expiratory pressure of minimal respiratory system elastance (PEEP minErs ) and three levels of PEEP during low-tidal-volume (6 mL/kg) ventilation in rats. Twenty-four rats were anesthetized, paralyzed, and mechanically ventilated. Airway pressure (P aw ), flow (F), and volume (V) were fitted by a linear single compartment model (LSCM) P aw (t) = E rs  × V(t) + R rs  × F(t) + PEEP or a volume- and flow-dependent SCM (VFDSCM) P aw (t) = (E 1  + E 2  × V(t)) × V(t) + (K 1  + K 2  × |F(t)|) × F(t) + PEEP, where E rs and R rs are respiratory system elastance and resistance, respectively; E 1 and E 2 × V are volume-independent and volume-dependent E rs , respectively; and K 1 and K 2  × F are flow-independent and flow-dependent R rs , respectively. Animals were ventilated for 1 h at PEEP 0 cmH 2 O (ZEEP); PEEP minErs ; 2 cmH 2 O above PEEP minErs (PEEP minErs+2 ); or 4 cmH 2 O above PEEP minErs (PEEP minErs+4 ). Alveolar tidal recruitment/derecruitment and overdistension were assessed by the index %E 2  = 100 × [(E 2  × V T )/(E 1  + |E 2 | × V T )], and alveolar stability by the slope of E rs (t). %E 2 varied between 0 and 30% at PEEP minErs in most respiratory cycles. Alveolar Tidal recruitment/derecruitment (%E 2   30) were predominant in the absence of PEEP and in PEEP levels higher than PEEP minErs , respectively. The slope of E rs (t) was different from zero in all groups besides PEEP minErs+4 . PEEP minErs presented the best compromise between alveolar tidal recruitment/derecruitment and overdistension, during 1 h of low-V T mechanical ventilation.

  16. Effects of tidal volume on work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome.

    Science.gov (United States)

    Kallet, Richard H; Campbell, Andre R; Dicker, Rochelle A; Katz, Jeffrey A; Mackersie, Robert C

    2006-01-01

    To assess the effects of step-changes in tidal volume on work of breathing during lung-protective ventilation in patients with acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS). Prospective, nonconsecutive patients with ALI/ARDS. Adult surgical, trauma, and medical intensive care units at a major inner-city, university-affiliated hospital. Ten patients with ALI/ARDS managed clinically with lung-protective ventilation. Five patients were ventilated at a progressively smaller tidal volume in 1 mL/kg steps between 8 and 5 mL/kg; five other patients were ventilated at a progressively larger tidal volume from 5 to 8 mL/kg. The volume mode was used with a flow rate of 75 L/min. Minute ventilation was maintained constant at each tidal volume setting. Afterward, patients were placed on continuous positive airway pressure for 1-2 mins to measure their spontaneous tidal volume. Work of breathing and other variables were measured with a pulmonary mechanics monitor (Bicore CP-100). Work of breathing progressively increased (0.86 +/- 0.32, 1.05 +/- 0.40, 1.22 +/- 0.36, and 1.57 +/- 0.43 J/L) at a tidal volume of 8, 7, 6, and 5 mL/kg, respectively. In nine of ten patients there was a strong negative correlation between work of breathing and the ventilator-to-patient tidal volume difference (R = -.75 to -.998). : The ventilator-delivered tidal volume exerts an independent influence on work of breathing during lung-protective ventilation in patients with ALI/ARDS. Patient work of breathing is inversely related to the difference between the ventilator-delivered tidal volume and patient-generated tidal volume during a brief trial of unassisted breathing.

  17. Effect of a clinical decision support system on adherence to a lower tidal volume mechanical ventilation strategy

    NARCIS (Netherlands)

    Eslami, Saeid; de Keizer, Nicolette F.; Abu-Hanna, Ameen; de Jonge, Evert; Schultz, Marcus J.

    2009-01-01

    PURPOSE: The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume (V(T)) recommendations. MATERIALS AND METHODS: We performed a prospective before-after evaluation study on applied V(T) to examine the impact of a CDSS on

  18. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury

    NARCIS (Netherlands)

    Choi, Goda; Wolthuis, Esther K.; Bresser, Paul; Levi, Marcel; van der Poll, Tom; Dzoljic, Misa; Vroom, Margreeth B.; Schultz, Marcus J.

    2006-01-01

    BACKGROUND: Alveolar fibrin deposition is a hallmark of acute lung injury, resulting from activation of coagulation and inhibition of fibrinolysis. Previous studies have shown that mechanical ventilation with high tidal volumes may aggravate lung injury in patients with sepsis and acute lung injury.

  19. Accuracy of tidal volume delivered by home mechanical ventilation during mouthpiece ventilation

    Science.gov (United States)

    Prigent, Helene; Falaize, Line; Leroux, Karl; Santos, Dante; Vaugier, Isabelle; Orlikowski, David; Lofaso, Frederic

    2016-01-01

    The aim of our study was to evaluate efficacy and reliability of currently available ventilators for mouthpiece ventilation (MPV). Five life-support home ventilators were assessed in a bench test using different settings simulating the specificities of MPV, such as intermittent circuit disconnection and presence of continuous leaks. The intermittent disconnection of the circuit caused relevant swings in the delivered tidal volume (VT), showing a VT overshoot during the disconnection periods and a VT decrease when the interface was reconnected to the test lung. The five ventilators showed substantial differences in the number of respiratory cycles necessary to reach a stable VT in the volume-controlled setting, ranging from 1.3 ± 0.6 to 7.3 ± 1.2 cycles. These differences were less accentuated in the volume-assisted setting (MPV-dedicated mode, when available). Our data show large differences in the capacity of the different ventilators to deal with the rapidly changing respiratory load features that characterize MPV, which can be further accentuated according to the used ventilator setting. The dedicated MPV modes allow improvement in the performance of ventilators only in some defined situations. This has practical consequences for the choice of the ventilator to be used for MPV in a specific patient. PMID:27146811

  20. Tidal volume delivery from ICU ventilators at BTPS conditions: a bench study.

    Science.gov (United States)

    Duchateau, Paul; Guérin, Claude

    2013-04-01

    Even though it is not a common practice, an external filter to the expiratory limb of the breathing circuit may protect the expiratory valve from water saturation in case of nebulization, or from the environment in case of lung infection with multi-drug-resistant micro-organisms or H1N1 influenza. We added an external filter to the expiratory limb and measured tidal volume (VT) from 6 ICU ventilators: 2 with built-in expiratory filter (Avea, Puritan Bennett 840), and 4 without (Engström Carestation, Evita XL, Evita V500, and Servo-i), set in volume controlled mode, at BTPS (body temperature and pressure saturated) condition, with a heated humidifier and a lung model (compliance 16 mL/cm H2O, resistance 20 cm H2O/L/s) placed inside a neonatal incubator. The temperature was targeted at 37°C for both the heated humidifier and the incubator. The setup was run continuously for 24 hours. In the latter 4 ICU ventilators, a Hygrobac or Sterivent S external filter was placed upstream from the expiratory valve for an additional 24-hour period for each. At the end of this period, VT was measured at 4 nominal VT values (300, 400, 500, and 800 mL) with a pneumotachograph. The volume error computed from the ratio of set to measured VT (% set VT) was the primary end point. In these warm and wet conditions, volume error averaged 96 ± 3% for Avea, 100 ± 7% for Puritan Bennett 840, 90 ± 2% for Evita XL, 100 ± 7% for Evita V500, 105 ± 2% for Servo-i, and 108 ± 4% for Engström Carestation (P ventilators for VT delivery, with further significant changes occurring after addition of a filter at the distal expiratory limb.

  1. Very low tidal volume ventilation with associated hypercapnia--effects on lung injury in a model for acute respiratory distress syndrome.

    Directory of Open Access Journals (Sweden)

    Hans Fuchs

    Full Text Available BACKGROUND: Ventilation using low tidal volumes with permission of hypercapnia is recommended to protect the lung in acute respiratory distress syndrome. However, the most lung protective tidal volume in association with hypercapnia is unknown. The aim of this study was to assess the effects of different tidal volumes with associated hypercapnia on lung injury and gas exchange in a model for acute respiratory distress syndrome. METHODOLOGY/PRINCIPAL FINDINGS: In this randomized controlled experiment sixty-four surfactant-depleted rabbits were exposed to 6 hours of mechanical ventilation with the following targets: Group 1: tidal volume = 8-10 ml/kg/PaCO(2 = 40 mm Hg; Group 2: tidal volume = 4-5 ml/kg/PaCO(2 = 80 mm Hg; Group 3: tidal volume = 3-4 ml/kg/PaCO(2 = 120 mm Hg; Group 4: tidal volume = 2-3 ml/kg/PaCO(2 = 160 mm Hg. Decreased wet-dry weight ratios of the lungs, lower histological lung injury scores and higher PaO(2 were found in all low tidal volume/hypercapnia groups (group 2, 3, 4 as compared to the group with conventional tidal volume/normocapnia (group 1. The reduction of the tidal volume below 4-5 ml/kg did not enhance lung protection. However, oxygenation and lung protection were maintained at extremely low tidal volumes in association with very severe hypercapnia and no adverse hemodynamic effects were observed with this strategy. CONCLUSION: Ventilation with low tidal volumes and associated hypercapnia was lung protective. A tidal volume below 4-5 ml/kg/PaCO(2 80 mm Hg with concomitant more severe hypercapnic acidosis did not increase lung protection in this surfactant deficiency model. However, even at extremely low tidal volumes in association with severe hypercapnia lung protection and oxygenation were maintained.

  2. Lung and chest wall impedances in the dog: effects of frequency and tidal volume.

    Science.gov (United States)

    Barnas, G M; Stamenović, D; Lutchen, K R; Mackenzie, C F

    1992-01-01

    Dependences of the mechanical properties of the respiratory system on frequency (f) and tidal volume (VT) in the normal ranges of breathing are not clear. We measured, simultaneously and in vivo, resistance and elastance of the total respiratory system (Rrs and Ers), lungs (RL and EL), and chest wall (Rcw and Ecw) of five healthy anesthetized paralyzed dogs during sinusoidal volume oscillations at the trachea (50-300 ml, 0.2-2 Hz) delivered at a constant mean lung volume. Each dog showed the same f and VT dependences. The Ers and Ecw increased with increasing f to 1 Hz and decreased with increasing VT up to 200 ml. Although EL increased slightly with increasing f, it was independent of VT. The Rcw decreased from 0.2 to 2 Hz at all VT and decreased with increasing VT. Although the RL decreased from 0.2 to 0.6 Hz and was independent of VT, at higher f RL tended to increase with increasing f and VT (i.e., as peak flow increased). Finally, the f and VT dependences of Rrs were similar to those of Rcw below 0.6 Hz but mirrored RL at higher f. These data capture the competing influences of airflow nonlinearities vs. tissue nonlinearities on f and VT dependence of the lung, chest wall, and total respiratory system. More specifically, we conclude that 1) VT dependences in Ers and Rrs below 0.6 Hz are due to nonlinearities in chest wall properties, 2) above 0.6 Hz, the flow dependence of airways resistance dominates RL and Rrs, and 3) lung tissue behavior is linear in the normal range of breathing.

  3. Low Tidal Volume versus Non-Volume-Limited Strategies for Patients with Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Walkey, Allan J; Goligher, Ewan C; Del Sorbo, Lorenzo; Hodgson, Carol L; Adhikari, Neill K J; Wunsch, Hannah; Meade, Maureen O; Uleryk, Elizabeth; Hess, Dean; Talmor, Daniel S; Thompson, B Taylor; Brower, Roy G; Fan, Eddy

    2017-10-01

    Trials investigating use of lower tidal volumes and inspiratory pressures for patients with acute respiratory distress syndrome (ARDS) have shown mixed results. To compare clinical outcomes of mechanical ventilation strategies that limit tidal volumes and inspiratory pressures (LTV) to strategies with tidal volumes of 10 to 15 ml/kg among patients with ARDS. This is a systematic review and meta-analysis of clinical trials investigating LTV mechanical ventilation strategies. We used random effects models to evaluate the effect of LTV on 28-day mortality, organ failure, ventilator-free days, barotrauma, oxygenation, and ventilation. Our primary analysis excluded trials for which the LTV strategy was combined with the additional strategy of higher positive end-expiratory pressure (PEEP), but these trials were included in a stratified sensitivity analysis. We performed metaregression of tidal volume gradient achieved between intervention and control groups on mortality effect estimates. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to determine the quality of evidence. Seven randomized trials involving 1,481 patients met eligibility criteria for this review. Mortality was not significantly lower for patients receiving an LTV strategy (33.6%) as compared with control strategies (40.4%) (relative risk [RR], 0.87; 95% confidence interval [CI], 0.70-1.08; heterogeneity statistic I 2  = 46%), nor did an LTV strategy significantly decrease barotrauma or ventilator-free days when compared with a lower PEEP strategy. Quality of evidence for clinical outcomes was downgraded for imprecision. Metaregression showed a significant inverse association between larger tidal volume gradient between LTV and control groups and log odds ratios for mortality (β, -0.1587; P = 0.0022). Sensitivity analysis including trials that protocolized an LTV/high PEEP cointervention showed lower mortality associated with LTV (nine trials and 1

  4. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury.

    Science.gov (United States)

    Wolthuis, Esther K; Choi, Goda; Dessing, Mark C; Bresser, Paul; Lutter, Rene; Dzoljic, Misa; van der Poll, Tom; Vroom, Margreeth B; Hollmann, Markus; Schultz, Marcus J

    2008-01-01

    Mechanical ventilation with high tidal volumes aggravates lung injury in patients with acute lung injury or acute respiratory distress syndrome. The authors sought to determine the effects of short-term mechanical ventilation on local inflammatory responses in patients without preexisting lung injury. Patients scheduled to undergo an elective surgical procedure (lasting > or = 5 h) were randomly assigned to mechanical ventilation with either higher tidal volumes of 12 ml/kg ideal body weight and no positive end-expiratory pressure (PEEP) or lower tidal volumes of 6 ml/kg and 10 cm H2O PEEP. After induction of anesthesia and 5 h thereafter, bronchoalveolar lavage fluid and/or blood was investigated for polymorphonuclear cell influx, changes in levels of inflammatory markers, and nucleosomes. Mechanical ventilation with lower tidal volumes and PEEP (n = 21) attenuated the increase of pulmonary levels of interleukin (IL)-8, myeloperoxidase, and elastase as seen with higher tidal volumes and no PEEP (n = 19). Only for myeloperoxidase, a difference was found between the two ventilation strategies after 5 h of mechanical ventilation (P volumes and PEEP may limit pulmonary inflammation in mechanically ventilated patients without preexisting lung injury. The specific contribution of both lower tidal volumes and PEEP on the protective effects of the lung should be further investigated.

  5. Influence of tidal volume on ventilation inhomogeneity assessed by electrical impedance tomography during controlled mechanical ventilation

    International Nuclear Information System (INIS)

    Becher, T; Kott, M; Schädler, D; Vogt, B; Meinel, T; Weiler, N; Frerichs, I

    2015-01-01

    The global inhomogeneity (GI) index is a parameter of ventilation inhomogeneity that can be calculated from images of tidal ventilation distribution obtained by electrical impedance tomography (EIT). It has been suggested that the GI index may be useful for individual adjustment of positive end-expiratory pressure (PEEP) and for guidance of ventilator therapy. The aim of the present work was to assess the influence of tidal volume (V_T) on the GI index values. EIT data from 9 patients with acute respiratory distress syndrome ventilated with a low and a high V_T of 5   ±   1 (mean  ±  SD) and 9   ±   1 ml kg"−"1 predicted body weight at a high and a low level of PEEP (PEEP_h_i_g_h, PEEP_l_o_w) were analyzed. PEEP_h_i_g_h and PEEP_l_o_w were set 2 cmH_2O above and 5 cmH_2O below the lower inflection point of a quasi-static pressure volume loop, respectively. The lower inflection point was identified at 8.1   ±   1.4 (mean  ±  SD) cmH_2O, resulting in a PEEP_h_i_g_h of 10.1   ±   1.4 and a PEEP_l_o_w of 3.1   ±   1.4 cmH_2O. At PEEP_h_i_g_h, we found no significant trend in GI index with low V_T when compared to high V_T (0.49   ±   0.15 versus 0.44   ±   0.09, p = 0.13). At PEEP_l_o_w, we found a significantly higher GI index with low V_T compared to high V_T (0.66   ±   0.19 versus 0.59   ±   0.17, p = 0.01). When comparing the PEEP levels, we found a significantly lower GI index at PEEP_h_i_g_h both for high and low V_T. We conclude that high V_T may lead to a lower GI index, especially at low PEEP settings. This should be taken into account when using the GI index for individual adjustment of ventilator settings. (paper)

  6. Employing an Incentive Spirometer to Calibrate Tidal Volumes Estimated from a Smartphone Camera

    Science.gov (United States)

    Reyes, Bersain A.; Reljin, Natasa; Kong, Youngsun; Nam, Yunyoung; Ha, Sangho; Chon, Ki H.

    2016-01-01

    A smartphone-based tidal volume (VT) estimator was recently introduced by our research group, where an Android application provides a chest movement signal whose peak-to-peak amplitude is highly correlated with reference VT measured by a spirometer. We found a Normalized Root Mean Squared Error (NRMSE) of 14.998% ± 5.171% (mean ± SD) when the smartphone measures were calibrated using spirometer data. However, the availability of a spirometer device for calibration is not realistic outside clinical or research environments. In order to be used by the general population on a daily basis, a simple calibration procedure not relying on specialized devices is required. In this study, we propose taking advantage of the linear correlation between smartphone measurements and VT to obtain a calibration model using information computed while the subject breathes through a commercially-available incentive spirometer (IS). Experiments were performed on twelve (N = 12) healthy subjects. In addition to corroborating findings from our previous study using a spirometer for calibration, we found that the calibration procedure using an IS resulted in a fixed bias of −0.051 L and a RMSE of 0.189 ± 0.074 L corresponding to 18.559% ± 6.579% when normalized. Although it has a small underestimation and slightly increased error, the proposed calibration procedure using an IS has the advantages of being simple, fast, and affordable. This study supports the feasibility of developing a portable smartphone-based breathing status monitor that provides information about breathing depth, in addition to the more commonly estimated respiratory rate, on a daily basis. PMID:26999152

  7. Employing an Incentive Spirometer to Calibrate Tidal Volumes Estimated from a Smartphone Camera

    Directory of Open Access Journals (Sweden)

    Bersain A. Reyes

    2016-03-01

    Full Text Available A smartphone-based tidal volume (VT estimator was recently introduced by our research group, where an Android application provides a chest movement signal whose peak-to-peak amplitude is highly correlated with reference VT measured by a spirometer. We found a Normalized Root Mean Squared Error (NRMSE of 14.998% ± 5.171% (mean ± SD when the smartphone measures were calibrated using spirometer data. However, the availability of a spirometer device for calibration is not realistic outside clinical or research environments. In order to be used by the general population on a daily basis, a simple calibration procedure not relying on specialized devices is required. In this study, we propose taking advantage of the linear correlation between smartphone measurements and VT to obtain a calibration model using information computed while the subject breathes through a commercially-available incentive spirometer (IS. Experiments were performed on twelve (N = 12 healthy subjects. In addition to corroborating findings from our previous study using a spirometer for calibration, we found that the calibration procedure using an IS resulted in a fixed bias of −0.051 L and a RMSE of 0.189 ± 0.074 L corresponding to 18.559% ± 6.579% when normalized. Although it has a small underestimation and slightly increased error, the proposed calibration procedure using an IS has the advantages of being simple, fast, and affordable. This study supports the feasibility of developing a portable smartphone-based breathing status monitor that provides information about breathing depth, in addition to the more commonly estimated respiratory rate, on a daily basis.

  8. Accuracy of height estimation and tidal volume setting using anthropometric formulas in an ICU Caucasian population.

    Science.gov (United States)

    L'her, Erwan; Martin-Babau, Jérôme; Lellouche, François

    2016-12-01

    Knowledge of patients' height is essential for daily practice in the intensive care unit. However, actual height measurements are unavailable on a daily routine in the ICU and measured height in the supine position and/or visual estimates may lack consistency. Clinicians do need simple and rapid methods to estimate the patients' height, especially in short height and/or obese patients. The objectives of the study were to evaluate several anthropometric formulas for height estimation on healthy volunteers and to test whether several of these estimates will help tidal volume setting in ICU patients. This was a prospective, observational study in a medical intensive care unit of a university hospital. During the first phase of the study, eight limb measurements were performed on 60 healthy volunteers and 18 height estimation formulas were tested. During the second phase, four height estimates were performed on 60 consecutive ICU patients under mechanical ventilation. In the 60 healthy volunteers, actual height was well correlated with the gold standard, measured height in the erect position. Correlation was low between actual and calculated height, using the hand's length and width, the index, or the foot equations. The Chumlea method and its simplified version, performed in the supine position, provided adequate estimates. In the 60 ICU patients, calculated height using the simplified Chumlea method was well correlated with measured height (r = 0.78; ∂ ventilation, alternative anthropometric methods to obtain patient's height based on lower leg and on forearm measurements could be useful to facilitate the application of protective mechanical ventilation in a Caucasian ICU population. The simplified Chumlea method is easy to achieve in a bed-ridden patient and provides accurate height estimates, with a low bias.

  9. Tracheal tube airleak in clinical practice and impact on tidal volume measurement in ventilated neonates.

    Science.gov (United States)

    Mahmoud, Ramadan A; Proquitté, Hans; Fawzy, Naglaa; Bührer, Christoph; Schmalisch, Gerd

    2011-03-01

    To determine the prevalence, size, and factors affecting tracheal tube (TT) leak in clinical practice and their influence on the displayed tidal volume (Vt) in ventilated newborn infants using uncuffed TTs. Monitoring of Vt is important for implementation of lung-protective ventilation strategies but becomes meaningless in the presence of large TT airleaks. Retrospective clinical study. Neonatal intensive care unit. Patient records of 163 neonates ventilated with Babylog 8000 for ≥ 5 hrs with a median (range) gestation age of 31.1 wks (23.3-41.9 wks) and a median birth weight of 1470 g (410-4475 g) were evaluated. : Ventilatory settings, TT leak, and Vt were recorded every 3 hrs. The lowest, median, and highest TT leaks were noted on the day the first TT leak (>5%) occurred, the day on which TT leak peaked, and the day of extubation. A TT leak of >5% was seen in 122 (75%) infants. Neonates with TT leak, compared with those without TT leak, had a longer duration of mechanical ventilation (p 40% commonly seen on the third day of mechanical ventilation. Regression analysis showed that a TT leak of 40% indicated that the displayed Vt was underestimated by 1.2 mL/kg (about 24% of target Vt). TT leak is highly variable, and TT leak of >40% with clinically relevant Vt errors occurred in nearly half of all ventilated neonates. Preterm infants of low birth weight and with small-diameter TTs ventilated for a long period were at greater risk of TT leak.

  10. Effect of tidal volume on extravascular lung water content during one-lung ventilation for video-assisted thoracoscopic surgery: a randomised, controlled trial.

    Science.gov (United States)

    Qutub, Hatem; El-Tahan, Mohamed R; Mowafi, Hany A; El Ghoneimy, Yasser F; Regal, Mohamed A; Al Saflan, AbdulHadi A

    2014-09-01

    The use of low tidal volume during one-lung ventilation (OLV) has been shown to attenuate the incidence of acute lung injury after thoracic surgery. To test the effect of tidal volume during OLV for video-assisted thoracoscopic surgery on the extravascular lung water content index (EVLWI). A randomised, double-blind, controlled study. Single university hospital. Thirty-nine patients scheduled for elective video-assisted thoracoscopic surgery. Patients were randomly assigned to one of three groups (n = 13 per group) to ventilate the dependent lung with a tidal volume of 4, 6 or 8 ml  kg(-1) predicted body weight with I:E ratio of 1:2.5 and PEEP of 5 cm H2O. The primary outcomes were perioperative changes in EVLWI and EVLWI to intrathoracic blood volume index (ITBVI) ratio. Secondary outcomes included haemodynamics, oxygenation indices, incidences of postoperative acute lung injury, atelectasis, pneumonia, morbidity and 30-day mortality. A tidal volume of 4 compared with 6 and 8 ml  kg(-1) after 45 min of OLV resulted in an EVLWI of 4.1 [95% confidence interval (CI) 3.5 to 4.7] compared with 7.7 (95% CI 6.7 to 8.6) and 8.6 (95% CI 7.5 to 9.7) ml  kg(-1), respectively (P tidal volume of 4 ml kg during OLV was associated with less lung water content than with larger tidal volumes of 6 to 8 ml kg(-1), although no patient developed acute lung injury. Further studies are required to address the usefulness of EVLWI as a marker for the development of postoperative acute lung injury after the use of a low tidal volume during OLV in patients undergoing pulmonary resection. Clinicaltrials.gov identifier: NCT01762709.

  11. Brain Responses during the Anticipation of Dyspnea.

    Science.gov (United States)

    Stoeckel, M Cornelia; Esser, Roland W; Gamer, Matthias; Büchel, Christian; von Leupoldt, Andreas

    2016-01-01

    Dyspnea is common in many cardiorespiratory diseases. Already the anticipation of this aversive symptom elicits fear in many patients resulting in unfavorable health behaviors such as activity avoidance and sedentary lifestyle. This study investigated brain mechanisms underlying these anticipatory processes. We induced dyspnea using resistive-load breathing in healthy subjects during functional magnetic resonance imaging. Blocks of severe and mild dyspnea alternated, each preceded by anticipation periods. Severe dyspnea activated a network of sensorimotor, cerebellar, and limbic areas. The left insular, parietal opercular, and cerebellar cortices showed increased activation already during dyspnea anticipation. Left insular and parietal opercular cortex showed increased connectivity with right insular and anterior cingulate cortex when severe dyspnea was anticipated, while the cerebellum showed increased connectivity with the amygdala. Notably, insular activation during dyspnea perception was positively correlated with midbrain activation during anticipation. Moreover, anticipatory fear was positively correlated with anticipatory activation in right insular and anterior cingulate cortex. The results demonstrate that dyspnea anticipation activates brain areas involved in dyspnea perception. The involvement of emotion-related areas such as insula, anterior cingulate cortex, and amygdala during dyspnea anticipation most likely reflects anticipatory fear and might underlie the development of unfavorable health behaviors in patients suffering from dyspnea.

  12. Effects of tidal volume and methacholine on low-frequency total respiratory impedance in dogs.

    Science.gov (United States)

    Lutchen, K R; Jackson, A C

    1990-05-01

    The frequency dependence of respiratory impedance (Zrs) from 0.125 to 4 Hz (Hantos et al., J. Appl. Physiol. 60: 123-132, 1986) may reflect inhomogeneous parallel time constants or the inherent viscoelastic properties of the respiratory tissues. However, studies on the lung alone or chest wall alone indicate that their impedance features are also dependent on the tidal volumes (VT) of the forced oscillations. The goals of this study were 1) to identify how total Zrs at lower frequencies measured with random noise (RN) compared with that measure with larger VT, 2) to identify how Zrs measured with RN is affected by bronchoconstriction, and 3) to identify the impact of using linear models for analyzing such data. We measured Zrs in six healthy dogs by use of a RN technique from 0.125 to 4 Hz or with a ventilator from 0.125 to 0.75 Hz with VT from 50 to 250 ml. Then methacholine was administered and the RN was repeated. Two linear models were fit to each separate set of data. Both models assume uniform airways leading to viscoelastic tissues. For healthy dogs, the respiratory resistance (Rrs) decreased with frequency, with most of the decrease occurring from 0.125 to 0.375 Hz. Significant VT dependence of Rrs was seen only at these lower frequencies, with Rrs higher as VT decreased. The respiratory compliance (Crs) was dependent on VT in a similar fashion at all frequencies, with Crs decreasing as VT decreased. Both linear models fit the data well at all VT, but the viscoelastic parameters of each model were very sensitive to VT. After methacholine, the minimum Rrs increased as did the total drop with frequency. Nevertheless the same models fit the data well, and both the airways and tissue parameters were altered after methacholine. We conclude that inferences based only on low-frequency Zrs data are problematic because of the effects of VT on such data (and subsequent linear modeling of it) and the apparent inability of such data to differentiate parallel

  13. Aggravation of dyspnea in stage I non-small cell lung cancer patients following stereotactic body radiotherapy

    DEFF Research Database (Denmark)

    Paludan, Merete; Traberg Hansen, Anders; Petersen, Jørgen

    2006-01-01

    the association of dose-volume histogram parameters with changes in dyspnea. The study concerns 28 medically inoperable stage I NSCLC patients that received SBRT at our department between 2000 and 2003. A central dose of 45 Gy/3 fractions was delivered in 5-8 days. WHO toxicity scoring of dyspnea...... consistent temporal variations of dyspnea after SBRT. We identified COPD as the factor showing the closest association with aggravation of dyspnea. The observed aggravation of dyspnea following SBRT reflects habitual exacerbations of COPD rather than treatment-related toxicity. Concern about pulmonary...

  14. Lower tidal volume strategy (?3?ml/kg) combined with extracorporeal CO2 removal versus ?conventional? protective ventilation (6?ml/kg) in severe ARDS

    OpenAIRE

    Bein, Thomas; Weber-Carstens, Steffen; Goldmann, Anton; M?ller, Thomas; Staudinger, Thomas; Brederlau, J?rg; Muellenbach, Ralf; Dembinski, Rolf; Graf, Bernhard M.; Wewalka, Marlene; Philipp, Alois; Wernecke, Klaus-Dieter; Lubnow, Matthias; Slutsky, Arthur S.

    2013-01-01

    Background Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V T) strategy (V T???3?ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS. Methods Seventy-nine patients were enrolled after a ?stabilization period? (24?h with optimized therapy an...

  15. Comparison of changes in tidal volume associated with expiratory rib cage compression and expiratory abdominal compression in patients on prolonged mechanical ventilation.

    Science.gov (United States)

    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Takahashi, Naoaki

    2015-07-01

    [Purpose] This study was designed to compare and clarify the relationship between expiratory rib cage compression and expiratory abdominal compression in patients on prolonged mechanical ventilation, with a focus on tidal volume. [Subjects and Methods] The subjects were 18 patients on prolonged mechanical ventilation, who had undergone tracheostomy. Each patient received expiratory rib cage compression and expiratory abdominal compression; the order of implementation was randomized. Subjects were positioned in a 30° lateral recumbent position, and a 2-kgf compression was applied. For expiratory rib cage compression, the rib cage was compressed unilaterally; for expiratory abdominal compression, the area directly above the navel was compressed. Tidal volume values were the actual measured values divided by body weight. [Results] Tidal volume values were as follows: at rest, 7.2 ± 1.7 mL/kg; during expiratory rib cage compression, 8.3 ± 2.1 mL/kg; during expiratory abdominal compression, 9.1 ± 2.2 mL/kg. There was a significant difference between the tidal volume during expiratory abdominal compression and that at rest. The tidal volume in expiratory rib cage compression was strongly correlated with that in expiratory abdominal compression. [Conclusion] These results indicate that expiratory abdominal compression may be an effective alternative to the manual breathing assist procedure.

  16. Cyclic PaO2 oscillations assessed in the renal microcirculation: correlation with tidal volume in a porcine model of lung lavage.

    Science.gov (United States)

    Thomas, Rainer; Möllmann, Christian; Ziebart, Alexander; Liu, Tanghua; David, Matthias; Hartmann, Erik K

    2017-07-11

    Oscillations of the arterial partial pressure of oxygen induced by varying shunt fractions occur during cyclic alveolar recruitment within the injured lung. Recently, these were proposed as a pathomechanism that may be relevant for remote organ injury following acute respiratory distress syndrome. This study examines the transmission of oxygen oscillations to the renal tissue and their tidal volume dependency. Lung injury was induced by repetitive bronchoalveolar lavage in eight anaesthetized pigs. Cyclic alveolar recruitment was provoked by high tidal volume ventilation. Oscillations of the arterial partial pressure of oxygen were measured in real-time in the macrocirculation by multi-frequency phase fluorimetry and in the renal microcirculation by combined white-light spectrometry and laser-Doppler flowmetry during tidal volume down-titration. Significant respiratory-dependent oxygen oscillations were detected in the macrocirculation and transmitted to the renal microcirculation in a substantial extent. The amplitudes of these oscillations significantly correlate to the applied tidal volume and are minimized during down-titration. In a porcine model oscillations of the arterial partial pressure of oxygen are induced by cyclic alveolar recruitment and transmitted to the renal microcirculation in a tidal volume-dependent fashion. They might play a role in organ crosstalk and remote organ damage following lung injury.

  17. Novel approach to the exploitation of the tidal energy. Volume 1: Summary and discussion

    Science.gov (United States)

    Gorlov, A. M.

    1981-12-01

    The hydropneumatic concept in the approach to harnessing low tidal hydropower is discussed. The energy of water flow is converted into the energy of an air jet by a specialized air chamber which is placed on the ocean floor across a flowing watercourse. Water passes through the chamber where it works as a natural piston compressing air in the upper part of the closure. Compressed air is used as a new working plenum to drive air turbines. The kinetic energy of an air jet provided by the air chamber is sufficient for stable operation of industrial air turbines. It is possible to use light plastic barriers instead of conventional rigid dams (the water sail concept). It is confirmed that the concept can result in a less expensive and more effective tidal power plant project than the conventional hydroturbine approach.

  18. Lung-Protective Ventilation With Low Tidal Volumes and the Occurrence of Pulmonary Complications in Patients Without Acute Respiratory Distress Syndrome: A Systematic Review and Individual Patient Data Analysis.

    Science.gov (United States)

    Neto, Ary Serpa; Simonis, Fabienne D; Barbas, Carmen S V; Biehl, Michelle; Determann, Rogier M; Elmer, Jonathan; Friedman, Gilberto; Gajic, Ognjen; Goldstein, Joshua N; Linko, Rita; Pinheiro de Oliveira, Roselaine; Sundar, Sugantha; Talmor, Daniel; Wolthuis, Esther K; Gama de Abreu, Marcelo; Pelosi, Paolo; Schultz, Marcus J

    2015-10-01

    Protective mechanical ventilation with low tidal volumes is standard of care for patients with acute respiratory distress syndrome. The aim of this individual patient data analysis was to determine the association between tidal volume and the occurrence of pulmonary complications in ICU patients without acute respiratory distress syndrome and the association between occurrence of pulmonary complications and outcome in these patients. Individual patient data analysis. ICU patients not fulfilling the consensus criteria for acute respiratory distress syndrome at the onset of ventilation. Mechanical ventilation with low tidal volume. The primary endpoint was development of a composite of acute respiratory distress syndrome and pneumonia during hospital stay. Based on the tertiles of tidal volume size in the first 2 days of ventilation, patients were assigned to a "low tidal volume group" (tidal volumes ≤ 7 mL/kg predicted body weight), an "intermediate tidal volume group" (> 7 and volume group" (≥ 10 mL/kg predicted body weight). Seven investigations (2,184 patients) were included. Acute respiratory distress syndrome or pneumonia occurred in 23% of patients in the low tidal volume group, in 28% of patients in the intermediate tidal volume group, and in 31% of the patients in the high tidal volume group (adjusted odds ratio [low vs high tidal volume group], 0.72; 95% CI, 0.52-0.98; p = 0.042). Occurrence of pulmonary complications was associated with a lower number of ICU-free and hospital-free days and alive at day 28 (10.0 ± 10.9 vs 13.8 ± 11.6 d; p volumes is associated with a lower risk of development of pulmonary complications in patients without acute respiratory distress syndrome.

  19. [Dyspnea in the terminal stage].

    Science.gov (United States)

    Binsack, T

    2001-10-01

    From all symptoms in palliative medicine those concerning respiration are most excruciating and most difficult to treat. No other symptom is more dependent on psychosocial circumstances and on the atmosphere around the patient. Therefore the relief of respiratory problems is as important as the therapy of pain. A consequent therapy comprises besides drug therapy (adrenocortical steroids, brochodilators, opioids, sedatives and sometimes antibiotics) also physiotherapy and in special cases oncological treatment and radiotherapy. A team present twenty-four hours a day, the training of relatives and friends, the frank dealing with the patient's anxiety of suffocation are the basis of all therapeutic measures. Dyspnea often is the reason for a longer stay in a palliative care unit.

  20. Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Gu, Wan-Jie; Wang, Fei; Liu, Jing-Chen

    2015-02-17

    In anesthetized patients undergoing surgery, the role of lung-protective ventilation with lower tidal volumes is unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of this ventilation strategy on postoperative outcomes. We searched electronic databases from inception through September 2014. We included RCTs that compared protective ventilation with lower tidal volumes and conventional ventilation with higher tidal volumes in anesthetized adults undergoing surgery. We pooled outcomes using a random-effects model. The primary outcome measures were lung injury and pulmonary infection. We included 19 trials (n=1348). Compared with patients in the control group, those who received lung-protective ventilation had a decreased risk of lung injury (risk ratio [RR] 0.36, 95% confidence interval [CI] 0.17 to 0.78; I2=0%) and pulmonary infection (RR 0.46, 95% CI 0.26 to 0.83; I2=8%), and higher levels of arterial partial pressure of carbon dioxide (standardized mean difference 0.47, 95% CI 0.18 to 0.75; I2=65%). No significant differences were observed between the patient groups in atelectasis, mortality, length of hospital stay, length of stay in the intensive care unit or the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen. Anesthetized patients who received ventilation with lower tidal volumes during surgery had a lower risk of lung injury and pulmonary infection than those given conventional ventilation with higher tidal volumes. Implementation of a lung-protective ventilation strategy with lower tidal volumes may lower the incidence of these outcomes. © 2015 Canadian Medical Association or its licensors.

  1. Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support.

    Science.gov (United States)

    Mendler, Marc R; Weber, Claudia; Hassan, Mohammad A; Huang, Li; Mayer, Benjamin; Hummler, Helmut D

    2017-01-01

    There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H2O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H2O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H2O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP. © 2016 S. Karger AG, Basel.

  2. Tidal volume single breath washout of two tracer gases--a practical and promising lung function test.

    Directory of Open Access Journals (Sweden)

    Florian Singer

    Full Text Available BACKGROUND: Small airway disease frequently occurs in chronic lung diseases and may cause ventilation inhomogeneity (VI, which can be assessed by washout tests of inert tracer gas. Using two tracer gases with unequal molar mass (MM and diffusivity increases specificity for VI in different lung zones. Currently washout tests are underutilised due to the time and effort required for measurements. The aim of this study was to develop and validate a simple technique for a new tidal single breath washout test (SBW of sulfur hexafluoride (SF(6 and helium (He using an ultrasonic flowmeter (USFM. METHODS: The tracer gas mixture contained 5% SF(6 and 26.3% He, had similar total MM as air, and was applied for a single tidal breath in 13 healthy adults. The USFM measured MM, which was then plotted against expired volume. USFM and mass spectrometer signals were compared in six subjects performing three SBW. Repeatability and reproducibility of SBW, i.e., area under the MM curve (AUC, were determined in seven subjects performing three SBW 24 hours apart. RESULTS: USFM reliably measured MM during all SBW tests (n = 60. MM from USFM reflected SF(6 and He washout patterns measured by mass spectrometer. USFM signals were highly associated with mass spectrometer signals, e.g., for MM, linear regression r-squared was 0.98. Intra-subject coefficient of variation of AUC was 6.8%, and coefficient of repeatability was 11.8%. CONCLUSION: The USFM accurately measured relative changes in SF(6 and He washout. SBW tests were repeatable and reproducible in healthy adults. We have developed a fast, reliable, and straightforward USFM based SBW method, which provides valid information on SF(6 and He washout patterns during tidal breathing.

  3. Tidal volume single breath washout of two tracer gases--a practical and promising lung function test.

    Science.gov (United States)

    Singer, Florian; Stern, Georgette; Thamrin, Cindy; Fuchs, Oliver; Riedel, Thomas; Gustafsson, Per; Frey, Urs; Latzin, Philipp

    2011-03-10

    Small airway disease frequently occurs in chronic lung diseases and may cause ventilation inhomogeneity (VI), which can be assessed by washout tests of inert tracer gas. Using two tracer gases with unequal molar mass (MM) and diffusivity increases specificity for VI in different lung zones. Currently washout tests are underutilised due to the time and effort required for measurements. The aim of this study was to develop and validate a simple technique for a new tidal single breath washout test (SBW) of sulfur hexafluoride (SF(6)) and helium (He) using an ultrasonic flowmeter (USFM). The tracer gas mixture contained 5% SF(6) and 26.3% He, had similar total MM as air, and was applied for a single tidal breath in 13 healthy adults. The USFM measured MM, which was then plotted against expired volume. USFM and mass spectrometer signals were compared in six subjects performing three SBW. Repeatability and reproducibility of SBW, i.e., area under the MM curve (AUC), were determined in seven subjects performing three SBW 24 hours apart. USFM reliably measured MM during all SBW tests (n = 60). MM from USFM reflected SF(6) and He washout patterns measured by mass spectrometer. USFM signals were highly associated with mass spectrometer signals, e.g., for MM, linear regression r-squared was 0.98. Intra-subject coefficient of variation of AUC was 6.8%, and coefficient of repeatability was 11.8%. The USFM accurately measured relative changes in SF(6) and He washout. SBW tests were repeatable and reproducible in healthy adults. We have developed a fast, reliable, and straightforward USFM based SBW method, which provides valid information on SF(6) and He washout patterns during tidal breathing.

  4. Ventilatory protective strategies during thoracic surgery: effects of alveolar recruitment maneuver and low-tidal volume ventilation on lung density distribution.

    Science.gov (United States)

    Kozian, Alf; Schilling, Thomas; Schütze, Hartmut; Senturk, Mert; Hachenberg, Thomas; Hedenstierna, Göran

    2011-05-01

    The increased tidal volume (V(T)) applied to the ventilated lung during one-lung ventilation (OLV) enhances cyclic alveolar recruitment and mechanical stress. It is unknown whether alveolar recruitment maneuvers (ARMs) and reduced V(T) may influence tidal recruitment and lung density. Therefore, the effects of ARM and OLV with different V(T) on pulmonary gas/tissue distribution are examined. Eight anesthetized piglets were mechanically ventilated (V(T) = 10 ml/kg). A defined ARM was applied to the whole lung (40 cm H(2)O for 10 s). Spiral computed tomographic lung scans were acquired before and after ARM. Thereafter, the lungs were separated with an endobronchial blocker. The pigs were randomized to receive OLV in the dependent lung with a V(T) of either 5 or 10 ml/kg. Computed tomography was repeated during and after OLV. The voxels were categorized by density intervals (i.e., atelectasis, poorly aerated, normally aerated, or overaerated). Tidal recruitment was defined as the addition of gas to collapsed lung regions. The dependent lung contained atelectatic (56 ± 10 ml), poorly aerated (183 ± 10 ml), and normally aerated (187 ± 29 ml) regions before ARM. After ARM, lung volume and aeration increased (426 ± 35 vs. 526 ± 69 ml). Respiratory compliance enhanced, and tidal recruitment decreased (95% vs. 79% of the whole end-expiratory lung volume). OLV with 10 ml/kg further increased aeration (atelectasis, 15 ± 2 ml; poorly aerated, 94 ± 24 ml; normally aerated, 580 ± 98 ml) and tidal recruitment (81% of the dependent lung). OLV with 5 ml/kg did not affect tidal recruitment or lung density distribution. (Data are given as mean ± SD.) The ARM improves aeration and respiratory mechanics. In contrast to OLV with high V(T), OLV with reduced V(T) does not reinforce tidal recruitment, indicating decreased mechanical stress.

  5. Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test.

    Science.gov (United States)

    Jung, Jong Dal; Kim, Sang Hun; Yu, Byung Sik; Kim, Hye Ji

    2014-08-01

    Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP). In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began. Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.

  6. Lung-Protective Ventilation With Low Tidal Volumes and the Occurrence of Pulmonary Complications in Patients Without Acute Respiratory Distress Syndrome: A Systematic Review and Individual Patient Data Analysis

    NARCIS (Netherlands)

    Neto, Ary Serpa; Simonis, Fabienne D.; Barbas, Carmen S. V.; Biehl, Michelle; Determann, Rogier M.; Elmer, Jonathan; Friedman, Gilberto; Gajic, Ognjen; Goldstein, Joshua N.; Linko, Rita; Pinheiro de Oliveira, Roselaine; Sundar, Sugantha; Talmor, Daniel; Wolthuis, Esther K.; Gama de Abreu, Marcelo; Pelosi, Paolo; Schultz, Marcus J.

    2015-01-01

    Protective mechanical ventilation with low tidal volumes is standard of care for patients with acute respiratory distress syndrome. The aim of this individual patient data analysis was to determine the association between tidal volume and the occurrence of pulmonary complications in ICU patients

  7. Increased expression of AQP 1 and AQP 5 in rat lungs ventilated with low tidal volume is time dependent.

    Directory of Open Access Journals (Sweden)

    Gustavo Fabregat

    Full Text Available BACKGROUND AND GOALS: Mechanical ventilation (MV can induce or worsen pulmonary oedema. Aquaporins (AQPs facilitate the selective and rapid bi-directional movement of water. Their role in the development and resolution of pulmonary oedema is controversial. Our objectives are to determine if prolonged MV causes lung oedema and changes in the expression of AQP 1 and AQP 5 in rats. METHODS: 25 male Wistar rats were subjected to MV with a tidal volume of 10 ml/kg, during 2 hours (n = 12 and 4 hours (n = 13. Degree of oedema was compared with a group of non-ventilated rats (n = 5. The expression of AQP 1 and AQP 5 were determined by western immunoblotting, measuring the amount of mRNA (previously amplified by RT-PCR and immunohistochemical staining of AQPs 1 and 5 in lung samples from all groups. RESULTS: Lung oedema and alveolar-capillary membrane permeability did not change during MV. AQP-5 steady state levels in the western blot were increased (p<0.01 at 2 h and 4 h of MV. But in AQP-1 expression these differences were not found. However, the amount of mRNA for AQP-1 was increased at 2 h and 4 h of MV; and for AQP 5 at 4 h of MV. These findings were corroborated by representative immunohistochemical lung samples. CONCLUSION: In lungs from rats ventilated with a low tidal volume the expression of AQP 5 increases gradually with MV duration, but does not cause pulmonary oedema or changes in lung permeability. AQPs may have a protective effect against the oedema induced by MV.

  8. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury

    NARCIS (Netherlands)

    Wolthuis, Esther K.; Choi, Goda; Dessing, Mark C.; Bresser, Paul; Lutter, Rene; Dzoljic, Misa; van der Poll, Tom; Vroom, Margreeth B.; Hollmann, Markus; Schultz, Marcus J.

    2008-01-01

    Background: Mechanical ventilation with high tidal volumes aggravates lung injury in patients with acute lung injury or acute respiratory distress syndrome. The authors sought to determine the effects of short-term mechanical ventilation on local inflammatory responses in patients without

  9. Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: a systematic translational review and meta-analysis

    NARCIS (Netherlands)

    Serpa Neto, Ary; Nagtzaam, Liselotte; Schultz, Marcus J.

    2014-01-01

    There is convincing evidence for benefit from lung-protective mechanical ventilation with lower tidal volumes in patients with the acute respiratory distress syndrome (ARDS). It is uncertain whether this strategy benefits critically ill patients without ARDS as well. This manuscript systematically

  10. Lung-protective ventilation in intensive care unit and operation room : Tidal volume size, level of positive end-expiratory pressure and driving pressure

    NARCIS (Netherlands)

    Serpa Neto, A.

    2017-01-01

    Several investigations have shown independent associations between three ventilator settings – tidal volume size, positive end–expiratory pressure (PEEP) and driving pressure – and outcomes in patients with the acute respiratory distress syndrome (ARDS). There is an increasing notion that similar

  11. Extracorporeal membrane oxygenation (ECMO) as a treatment strategy for severe acute respiratory distress syndrome (ARDS) in the low tidal volume era: A systematic review.

    Science.gov (United States)

    Tillmann, Bourke W; Klingel, Michelle L; Iansavichene, Alla E; Ball, Ian M; Nagpal, A Dave

    2017-10-01

    To evaluate the hospital survival in patients with severe ARDS managed with ECMO and low tidal volume ventilation as compared to patients managed with low tidal volume ventilation alone. Electronic databases were searched for studies of at least 10 adult patients with severe ARDS comparing the use of ECMO with low tidal volume ventilation to mechanical ventilation with a low tidal volume alone. Only studies reporting hospital or ICU survival were included. All identified studies were assessed independently by two reviewers. Of 1782 citations, 27 studies (n=1674) met inclusion criteria. Hospital survival for ECMO patients ranged from 33.3 to 86%, while survival with conventional therapy ranged from 36.3 to 71.2%. Five studies were identified with appropriate control groups allowing comparison, but due to the high degree of variability between studies (I 2 =63%), their results could not be pooled. Two of these studies demonstrated a significant difference, both favouring ECMO over conventional therapy. Given the lack of studies with appropriate control groups, our confidence in a difference in outcome between the two therapies remains weak. Future studies on the use of ECMO for severe ARDS are needed to clarify the role of ECMO in this disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Adaptive Support Ventilation May Deliver Unwanted Respiratory Rate-Tidal Volume Combinations in Patients with Acute Lung Injury Ventilated According to an Open Lung Concept

    NARCIS (Netherlands)

    Dongelmans, Dave A.; Paulus, Frederique; Veelo, Denise P.; Binnekade, Jan M.; Vroom, Margreeth B.; Schultz, Marcus J.

    2011-01-01

    Background: With adaptive support ventilation, respiratory rate and tidal volume (V(T)) are a function of the Otis least work of breathing formula. We hypothesized that adaptive support ventilation in an open lung ventilator strategy would deliver higher V(T)s to patients with acute lung injury.

  13. Intravenous superoxide dismutase as a protective agent to prevent impairment of lung function induced by high tidal volume ventilation.

    Science.gov (United States)

    Wu, Nan-Chun; Liao, Fan-Ting; Cheng, Hao-Min; Sung, Shih-Hsien; Yang, Yu-Chun; Wang, Jiun-Jr

    2017-07-26

    Positive-pressure mechanical ventilation is essential in assisting patients with respiratory failure in the intensive care unit and facilitating oxygenation in the operating room. However, it was also recognized as a primary factor leading to hospital-acquired pulmonary dysfunction, in which pulmonary oxidative stress and lung inflammation had been known to play important roles. Cu/Zn superoxide dismutase (SOD) is an important antioxidant, and possesses anti-inflammatory capacity. In this study, we aimed to study the efficacy of Cu/Zn SOD, administered intravenously during high tidal volume (HTV) ventilation, to prevent impairment of lung function. Thirty-eight male Sprague-Dawley rats were divided into 3 groups: 5 h ventilation with (A) low tidal volume (LTV; 8 mL/kg; n = 10), (B) high tidal volume (HTV; 18 mL/kg; n = 14), or (C) HTV and intravenous treatment of Cu/Zn SOD at a dose of 1000 U/kg/h (HTV + SOD; n = 14). Lung function was evaluated both at baseline and after 5-h ventilation. Lung injury was assessed by histological examination, lung water and protein contents in the bronchoalveolar lavage fluid (BALF). Pulmonary oxidative stress was examined by concentrations of methylguanidine (MG) and malondialdehyde (MDA) in BALF, and antioxidative activity by protein expression of glutathione peroxidase-1 (GPx-1) in the lung. Severity of lung inflammation was evaluated by white blood cell and differential count in BALF, and protein expression of inducible nitric oxide synthase (iNOS), intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), matrix metalloproteinase-9 (MMP-9), and mRNA expression of nuclear factor-κB (NF-κB) in the lung. We also examined protein expression of surfactant protein (SP)-A and D and we measured hourly changes in serum nitric oxide (NO) level. Five hours of LTV ventilation did not induce a major change in lung function, whereas 5 h of HTV ventilation induced apparent combined restrictive and

  14. Moderately high frequency ventilation with a conventional ventilator allows reduction of tidal volume without increasing mean airway pressure.

    Science.gov (United States)

    Cordioli, Ricardo Luiz; Park, Marcelo; Costa, Eduardo Leite Vieira; Gomes, Susimeire; Brochard, Laurent; Amato, Marcelo Britto Passos; Azevedo, Luciano Cesar Pontes

    2014-12-01

    The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (V T) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV). This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary lavage and injurious ventilation. The animals were ventilated with a randomized sequence of respiratory rates: 30, 60, 90, 120, 150, followed by HFOV at 5 Hz. At each step, V T was adjusted to allow partial pressure of arterial carbon dioxide (PaCO2) to stabilize between 57 and 63 mmHg. Data are shown as median [P25th,P75th]. After lung injury, the PaO2/FiO2 (P/F) ratio was 92 [63,118] mmHg, pulmonary shunt 26 [17,31]%, and static compliance 11 [8,14] mL/cmH2O. Positive end-expiratory pressure (PEEP) was 14 [10,17] cmH2O. At 30 breaths/min, V T was higher than 6 (7.5 [6.8,10.2]) mL/kg, but at all higher frequencies, V T could be reduced and PaCO2 maintained, leading to reductions in plateau pressures and driving pressures. For frequencies of 60 to 150/min, V T progressively fell from 5.2 [5.1,5.9] to 3.8 [3.7,4.2] mL/kg (p mechanics, auto-PEEP generation, hemodynamics, or gas exchange. Mean airway pressure was maintained constant and was increased only during HFOV. During protective mechanical ventilation, HFPPV delivered by a conventional ventilator in a severe ARDS swine model safely allows further tidal volume reductions. This strategy also allowed decreasing airway pressures while maintaining stable PaCO2 levels.

  15. Comparison of changes in tidal volume associated with expiratory rib cage compression and expiratory abdominal compression in patients on prolonged mechanical ventilation

    OpenAIRE

    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Takahashi, Naoaki

    2015-01-01

    [Purpose] This study was designed to compare and clarify the relationship between expiratory rib cage compression and expiratory abdominal compression in patients on prolonged mechanical ventilation, with a focus on tidal volume. [Subjects and Methods] The subjects were 18 patients on prolonged mechanical ventilation, who had undergone tracheostomy. Each patient received expiratory rib cage compression and expiratory abdominal compression; the order of implementation was randomized. Subjects ...

  16. Predicting Dyspnea Inducers by Molecular Topology

    Directory of Open Access Journals (Sweden)

    María Gálvez-Llompart

    2013-01-01

    Full Text Available QSAR based on molecular topology (MT is an excellent methodology used in predicting physicochemical and biological properties of compounds. This approach is applied here for the development of a mathematical model capable to recognize drugs showing dyspnea as a side effect. Using linear discriminant analysis, it was found a four-variable regression equations enabling a predictive rate of about 81% and 73% in the training and test sets of compounds, respectively. These results demonstrate that QSAR-MT is an efficient tool to predict the appearance of dyspnea associated with drug consumption.

  17. Interaction between peri-operative blood transfusion, tidal volume, airway pressure and postoperative ARDS: an individual patient data meta-analysis.

    Science.gov (United States)

    Serpa Neto, Ary; Juffermans, Nicole P; Hemmes, Sabrine N T; Barbas, Carmen S V; Beiderlinden, Martin; Biehl, Michelle; Fernandez-Bustamante, Ana; Futier, Emmanuel; Gajic, Ognjen; Jaber, Samir; Kozian, Alf; Licker, Marc; Lin, Wen-Qian; Memtsoudis, Stavros G; Miranda, Dinis Reis; Moine, Pierre; Paparella, Domenico; Ranieri, Marco; Scavonetto, Federica; Schilling, Thomas; Selmo, Gabriele; Severgnini, Paolo; Sprung, Juraj; Sundar, Sugantha; Talmor, Daniel; Treschan, Tanja; Unzueta, Carmen; Weingarten, Toby N; Wolthuis, Esther K; Wrigge, Hermann; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J

    2018-01-01

    Transfusion of blood products and mechanical ventilation with injurious settings are considered risk factors for postoperative lung injury in surgical Patients. A systematic review and individual patient data meta-analysis was done to determine the independent effects of peri-operative transfusion of blood products, intra-operative tidal volume and airway pressure in adult patients undergoing mechanical ventilation for general surgery, as well as their interactions on the occurrence of postoperative acute respiratory distress syndrome (ARDS). Observational studies and randomized trials were identified by a systematic search of MEDLINE, CINAHL, Web of Science, and CENTRAL and screened for inclusion into a meta-analysis. Individual patient data were obtained from the corresponding authors. Patients were stratified according to whether they received transfusion in the peri-operative period [red blood cell concentrates (RBC) and/or fresh frozen plasma (FFP)], tidal volume size [≤7 mL/kg predicted body weight (PBW), 7-10 and >10 mL/kg PBW] and airway pressure level used during surgery (≤15, 15-20 and >20 cmH 2 O). The primary outcome was development of postoperative ARDS. Seventeen investigations were included (3,659 patients). Postoperative ARDS occurred in 40 (7.2%) patients who received at least one blood product compared to 40 patients (2.5%) who did not [adjusted hazard ratio (HR), 2.32; 95% confidence interval (CI), 1.25-4.33; P=0.008]. Incidence of postoperative ARDS was highest in patients ventilated with tidal volumes of >10 mL/kg PBW and having airway pressures of >20 cmH 2 O receiving both RBC and FFP, and lowest in patients ventilated with tidal volume of ≤7 mL/kg PBW and having airway pressures of ≤15 cmH 2 O with no transfusion. There was a significant interaction between transfusion and airway pressure level (P=0.002) on the risk of postoperative ARDS. Peri-operative transfusion of blood products is associated with an increased risk of

  18. Effect of leak and breathing pattern on the accuracy of tidal volume estimation by commercial home ventilators: a bench study.

    Science.gov (United States)

    Luján, Manel; Sogo, Ana; Pomares, Xavier; Monsó, Eduard; Sales, Bernat; Blanch, Lluís

    2013-05-01

    New home ventilators are able to provide clinicians data of interest through built-in software. Monitoring of tidal volume (VT) is a key point in the assessment of the efficacy of home mechanical ventilation. To assess the reliability of the VT provided by 5 ventilators in a bench test. Five commercial ventilators from 4 different manufacturers were tested in pressure support mode with the help of a breathing simulator under different conditions of mechanical respiratory pattern, inflation pressure, and intentional leakage. Values provided by the built-in software of each ventilator were compared breath to breath with the VT monitored through an external pneumotachograph. Ten breaths for each condition were compared for every tested situation. All tested ventilators underestimated VT (ranges of -21.7 mL to -83.5 mL, which corresponded to -3.6% to -14.7% of the externally measured VT). A direct relationship between leak and underestimation was found in 4 ventilators, with higher underestimations of the VT when the leakage increased, ranging between -2.27% and -5.42% for each 10 L/min increase in the leakage. A ventilator that included an algorithm that computes the pressure loss through the tube as a function of the flow exiting the ventilator had the minimal effect of leaks on the estimation of VT (0.3%). In 3 ventilators the underestimation was also influenced by mechanical pattern (lower underestimation with restrictive, and higher with obstructive). The inclusion of algorithms that calculate the pressure loss as a function of the flow exiting the ventilator in commercial models may increase the reliability of VT estimation.

  19. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis.

    Science.gov (United States)

    Serpa Neto, Ary; Cardoso, Sérgio Oliveira; Manetta, José Antônio; Pereira, Victor Galvão Moura; Espósito, Daniel Crepaldi; Pasqualucci, Manoela de Oliveira Prado; Damasceno, Maria Cecília Toledo; Schultz, Marcus J

    2012-10-24

    Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. To determine whether use of lower tidal volumes is associated with improved outcomes of patients receiving ventilation who do not have ARDS. MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials up to August 2012. Eligible studies evaluated use of lower vs higher tidal volumes in patients without ARDS at onset of mechanical ventilation and reported lung injury development, overall mortality, pulmonary infection, atelectasis, and biochemical alterations. Three reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus. Twenty articles (2822 participants) were included. Meta-analysis using a fixed-effects model showed a decrease in lung injury development (risk ratio [RR], 0.33; 95% CI, 0.23 to 0.47; I2, 0%; number needed to treat [NNT], 11), and mortality (RR, 0.64; 95% CI, 0.46 to 0.89; I2, 0%; NNT, 23) in patients receiving ventilation with lower tidal volumes. The results of lung injury development were similar when stratified by the type of study (randomized vs nonrandomized) and were significant only in randomized trials for pulmonary infection and only in nonrandomized trials for mortality. Meta-analysis using a random-effects model showed, in protective ventilation groups, a lower incidence of pulmonary infection (RR, 0.45; 95% CI, 0.22 to 0.92; I2, 32%; NNT, 26), lower mean (SD) hospital length of stay (6.91 [2.36] vs 8.87 [2.93] days, respectively; standardized mean difference [SMD], 0.51; 95% CI, 0.20 to 0.82; I2, 75%), higher mean (SD) PaCO2 levels (41.05 [3.79] vs 37.90 [4.19] mm Hg, respectively; SMD, -0.51; 95% CI, -0.70 to -0.32; I2, 54%), and lower mean (SD) pH values (7.37 [0.03] vs 7.40 [0

  20. Tidal power: trends and developments

    International Nuclear Information System (INIS)

    1992-01-01

    This volume covers works and studies on tidal power currently being undertaken, both nationally and internationally. The 20 papers included cover the proposed Mersey barrage, the Severn estuary and several papers on the Severn barrage. The Department of Energy's continued variety of generic work on tidal power and various overseas studies carried out by other experts are also detailed, giving the reader an up to date picture of developments in tidal power worldwide. Separate abstracts have been prepared for the individual papers. (author)

  1. Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation.

    Science.gov (United States)

    O'Reilly-Shah, Vikas N; Easton, George S; Jabaley, Craig S; Lynde, Grant C

    2018-05-18

    Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system. Dashboards were emailed to providers four times over the course of the 9-month study. Additionally, the default setting on anaesthesia machines for tidal volume was decreased from 700 mL to 400 mL. Data on surgical cases performed between 1 September 2016 and 31 May 2017 were examined for compliance with LPV. The impact of the interventions was assessed via pairwise logistic regression analysis corrected for multiple comparisons. A total of 14 793 anaesthesia records were analysed. Absolute compliance rates increased from 59.3% to 87.8%preintervention to postintervention. Introduction of attending physician dashboards resulted in a 41% increase in the odds of compliance (OR 1.41, 95% CI 1.17 to 1.69, p=0.002). Subsequently, the addition of advanced practice provider and resident dashboards lead to an additional 93% increase in the odds of compliance (OR 1.93, 95% CI 1.52 to 2.46, p<0.001). Lastly, modifying ventilator defaults led to a 376% increase in the odds of compliance (OR 3.76, 95% CI 3.1 to 4.57, p<0.001). Audit and feedback tools in conjunction with default changes improve provider compliance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise

  2. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers.

    Science.gov (United States)

    Güldner, Andreas; Kiss, Thomas; Serpa Neto, Ary; Hemmes, Sabrine N T; Canet, Jaume; Spieth, Peter M; Rocco, Patricia R M; Schultz, Marcus J; Pelosi, Paolo; Gama de Abreu, Marcelo

    2015-09-01

    Postoperative pulmonary complications are associated with increased morbidity, length of hospital stay, and mortality after major surgery. Intraoperative lung-protective mechanical ventilation has the potential to reduce the incidence of postoperative pulmonary complications. This review discusses the relevant literature on definition and methods to predict the occurrence of postoperative pulmonary complication, the pathophysiology of ventilator-induced lung injury with emphasis on the noninjured lung, and protective ventilation strategies, including the respective roles of tidal volumes, positive end-expiratory pressure, and recruitment maneuvers. The authors propose an algorithm for protective intraoperative mechanical ventilation based on evidence from recent randomized controlled trials.

  3. Botulinum toxin injection in laryngeal dyspnea.

    Science.gov (United States)

    Woisard, Virginie; Liu, Xuelai; Bes, Marie Christine Arné; Simonetta-Moreau, Marion

    2017-02-01

    Data, regarding the use of botulinum toxin (BT-A) in laryngeal dyspnea, are scarce, coming from some cases reports in the literature, including Vocal fold paralysis, laryngeal dystonia, vocal cord dysfunction also called paradoxical motion of the vocal fold (PMVF), and post-neuroleptic laryngeal dyskinesia. There is no consensus regarding the muscles and the doses to inject. The aim of this study is to present a retrospective review of patients treated in our ENT Department by BT-A injection in this indication. This study is a retrospective study describing patients who underwent an injection of botulinum toxin for laryngeal dyspnea in the ENT Department from 2005 to 2015 years. The inclusion criteria were a dyspnea associated with a laryngeal dysfunction, confirmed by flexible fiberoptic nasopharyngolaryngoscopy. Information concerning the causes of the dyspnea, the botulinum toxin BT-A injections procedure, post-injection follow-up, and respiratory outcome were collected for all patients included. In the group of 13 patients included, the main cause identified as principal factor linked with the short breath was: a bilateral VF paralysis (Patel et al., Otolaryngol Head Neck Surg 130:686-689, 7), laryngeal dystonia (Balkissoon and Kenn, Semin Respir Crit Care Med 33:595-605, 2), Anxiety syndrome associated with unilateral vocal fold paralysis or asthma (Marcinow et al., Laryngoscope 124:1425-1430, 3), and an isolated asthma (Zwirner et al., Eur Arch Otorhinolaryngol 254:242-245, 1). Nine out of the thirteen patients were improved by the injections. A BT-A-induced stable benefit for four patients led them to stop the injections in the follow-up. Good outcome was observed in five other patients (main cause: bilateral VP paralysis), allowing a progressive lengthening of the delay between BT-A injections. Four patients did not report a positive risk/benefit ratio after BT-A injections; two of them (with bilateral VF paralysis), because of respiratory side effects and

  4. Impact of Different Tidal Volume Levels at Low Mechanical Power on Ventilator-Induced Lung Injury in Rats

    Directory of Open Access Journals (Sweden)

    Lillian Moraes

    2018-04-01

    Full Text Available Tidal volume (VT has been considered the main determinant of ventilator-induced lung injury (VILI. Recently, experimental studies have suggested that mechanical power transferred from the ventilator to the lungs is the promoter of VILI. We hypothesized that, as long as mechanical power is kept below a safe threshold, high VT should not be injurious. The present study aimed to investigate the impact of different VT levels and respiratory rates (RR on lung function, diffuse alveolar damage (DAD, alveolar ultrastructure, and expression of genes related to inflammation [interleukin (IL-6], alveolar stretch (amphiregulin, epithelial [club cell secretory protein (CC16] and endothelial [intercellular adhesion molecule (ICAM-1] cell injury, and extracellular matrix damage [syndecan-1, decorin, and metalloproteinase (MMP-9] in experimental acute respiratory distress syndrome (ARDS under low-power mechanical ventilation. Twenty-eight Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, 21 animals were randomly assigned to ventilation (2 h with low mechanical power at three different VT levels (n = 7/group: (1 VT = 6 mL/kg and RR adjusted to normocapnia; (2 VT = 13 mL/kg; and 3 VT = 22 mL/kg. In the second and third groups, RR was adjusted to yield low mechanical power comparable to that of the first group. Mechanical power was calculated as [(ΔP,L2/Est,L/2]× RR (ΔP,L = transpulmonary driving pressure, Est,L = static lung elastance. Seven rats were not mechanically ventilated (NV and were used for molecular biology analysis. Mechanical power was comparable among groups, while VT gradually increased. ΔP,L and mechanical energy were higher in VT = 22 mL/kg than VT = 6 mL/kg and VT = 13 mL/kg (p < 0.001 for both. Accordingly, DAD score increased in VT = 22 mL/kg compared to VT = 6 mL/kg and VT = 13 mL/kg [23(18.5–24.75 vs. 16(12–17.75 and 16(13.25–18, p < 0.05, respectively]. VT = 22 mL/kg was associated with higher

  5. Progressive dyspnea due to pulmonary carcinoid tumorlets

    Directory of Open Access Journals (Sweden)

    Anastasios Kallianos

    2017-01-01

    Full Text Available This is a case description of a female patient, 77 years-old, who presented with progressive dyspnea and cough. She had a mild hypoxemia in the arterial blood gases (PaO2 72 mmHg and normal spirometry. The chest computer tomography revealed diffuse “ground glass” opacities, segmental alveolitis, bronchiectasis, fibrotic lesions and numerous micronodules. A thoracoscopy was performed and the obtained biopsy showed carcinoid tumorlets, with positive CK8/18, CD56, TTF-1 and synaptophysin immunohistochemical markers. Pulmonary carcinoid tumorlets are rare, benign lesions and individuals with tumorlets are typically asymptomatic. Our report presents a symptomatic clinical case of carcinoid tumorlet.

  6. Translation and Validation of the Multidimensional Dyspnea-12 Questionnaire.

    Science.gov (United States)

    Amado Diago, Carlos Antonio; Puente Maestu, Luis; Abascal Bolado, Beatriz; Agüero Calvo, Juan; Hernando Hernando, Mercedes; Puente Bats, Irene; Agüero Balbín, Ramón

    2018-02-01

    Dyspnea is a multidimensional symptom, but this multidimensionality is not considered in most dyspnea questionnaires. The Dyspnea-12 takes a multidimensional approach to the assessment of dyspnea, specifically the sensory and the affective response. The objective of this study was to translate into Spanish and validate the Dyspnea-12 questionnaire. The original English version of the Dyspnea-12 questionnaire was translated into Spanish and backtranslated to analyze its equivalence. Comprehension of the text was verified by analyzing the responses of 10 patients. Reliability and validation of the questionnaire were studied in an independent group of COPD patients attending the pulmonology clinics of Hospital Universitario Marqués de Valdecilla, diagnosed and categorized according to GOLD guidelines. The mean age of the group (n=51) was 65 years and mean FEV1 was 50%. All patients understood all questions of the translated version of Dyspnea-12. Internal consistency of the questionnaire was α=0.937 and intraclass correlation coefficient was=.969; P<.001. Statistically significant correlations were found with HADS (anxiety r=.608 and depression r=.615), mMRC dyspnea (r=.592), 6MWT (r=-0.445), FEV1 (r=-0.312), all dimensions of CRQ-SAS (dyspnea r=-0.626; fatigue r=-0.718; emotional function r=-0.663; mastery r=-0.740), CAT (r=0.669), and baseline dyspnea index (r=-0.615). Dyspnea-12 scores were 10.32 points higher in symptomatic GOLD groups (B and D) (P<.001). The Spanish version of Dyspnea-12 is a valid and reliable instrument to study the multidimensional nature of dyspnea. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Dyspnea: when the preliminary imaging is unconvincing

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    Angelica Moretti

    2015-05-01

    Full Text Available A 73-year-old man was admitted to the Emergency Room (ER for dyspnea and cough from several months. In ER were performed blood sampling, chest X-ray, electrocardiogram, echocardiogram and arterial blood gas. A thoracic ultrasound (US revealed in the left side an abundant pleural effusion and a lung consolidation area of about 5 cm without air bronchogram. A thoracentesis showed the presence of hemorrhagic effusion. Chest computed tomography (CT revealed micro-pulmonary embolism, abundant left pleural effusion with atelectasis of the lower ipsilateral lobe. Meanwhile the chest CT revised by the pulmonologist appeared suspicious for the presence of cancer, the cytological examination of pleural fluid revealed the presence of an adenocarcinoma. While the patient was waiting for the bronchoscopy he had a stroke and died in a few days. In conclusion, we believe that thoracic US has to be considered an extension of the physical examination, it is a bedside tool and it represents a valid diagnostic and therapeutic method. Therefore thoracic US, if closely linked to the physician’s activity, can directly affect the decision-making process and management of the patient with dyspnea.

  8. Tidal power

    International Nuclear Information System (INIS)

    Baker, A.C.

    1991-01-01

    This book describes how large tides develop in particular places and how the energy could be extracted by building suitable barrages. The principal features of a barrage and possible methods of operation are described in detail. Although a tidal power barrage would be non-polluting, the resulting changes in the tidal regime would have important environmental effects. These are discussed together with the economics of tidal power. Methods of assessing the likely cost of electricity from any site are set out and applied to possible sites around the world. (author)

  9. Tidal radiation

    International Nuclear Information System (INIS)

    Mashhoon, B.

    1977-01-01

    The general theory of tides is developed within the framework of Einstein's theory of gravitation. It is based on the concept of Fermi frame and the associated notion of tidal frame along an open curve in spacetime. Following the previous work of the author an approximate scheme for the evaluation of tidal gravitational radiation is presented which is valid for weak gravitational fields. The emission of gravitational radiation from a body in the field of a black hole is discussed, and for some cases of astrophysical interest estimates are given for the contributions of radiation due to center-of-mass motion, purely tidal deformation, and the interference between the center of mass and tidal motions

  10. Tidal energy

    International Nuclear Information System (INIS)

    Lochte, H.G.

    1995-01-01

    Together with wave energy, ocean thermal energy, and the often overlooked energy from ocean curents tidal energy belongs to those renewable energy sources that can be subsumed under the generic term of ocean energy. All that these energy sources have in common, however, is that they are found in the ocean. The present article discusses tidal energy with respect to the four principal factors determining the scope of a renewable energy source, namely global, technical, and economic availability and ecological acceptability. (orig.) [de

  11. Low tidal volume mechanical ventilation against no ventilation during cardiopulmonary bypass heart surgery (MECANO): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Nguyen, Lee S; Merzoug, Messaouda; Estagnasie, Philippe; Brusset, Alain; Law Koune, Jean-Dominique; Aubert, Stephane; Waldmann, Thierry; Grinda, Jean-Michel; Gibert, Hadrien; Squara, Pierre

    2017-12-02

    Postoperative pulmonary complications are a leading cause of morbidity and mortality after cardiac surgery. There are no recommendations on mechanical ventilation associated with cardiopulmonary bypass (CPB) during surgery and anesthesiologists perform either no ventilation (noV) at all during CPB or maintain low tidal volume (LTV) ventilation. Indirect evidence points towards better pulmonary outcomes when LTV is performed but no large-scale prospective trial has yet been published in cardiac surgery. The MECANO trial is a single-center, double-blind, randomized, controlled trial comparing two mechanical ventilation strategies, noV and LTV, during cardiac surgery with CPB. In total, 1500 patients are expected to be included, without any restrictions. They will be randomized between noV and LTV on a 1:1 ratio. The noV group will receive no ventilation during CPB. The LTV group will receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive end-expiratory pressure of 5 cmH2O. The primary endpoint will be a composite of all-cause mortality, early respiratory failure defined as a ratio of partial pressure of oxygen/fraction of inspired oxygen ventilation, mechanical ventilation or high-flow oxygen) at 2 days after arrival in the ICU or ventilator-acquired pneumonia defined by the Center of Disease Control. Lung recruitment maneuvers will be performed in the noV and LTV groups at the end of surgery and at arrival in ICU with an insufflation at +30 cmH20 for 5 seconds. Secondary endpoints are those composing the primary endpoint with the addition of pneumothorax, CPB duration, quantity of postoperative bleeding, red blood cell transfusions, revision surgery requirements, length of stay in the ICU and in the hospital and total hospitalization costs. Patients will be followed until hospital discharge. The MECANO trial is the first of its kind to compare in a double-blind design, a no-ventilation to a low-tidal volume strategy for mechanical ventilation during

  12. Intraoperative and postoperative evaluation of low tidal volume combined with low-level positive end-expiratory pressure ventilation in laparoscopic surgery in elderly patients

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    Ye-Qiu Li

    2016-01-01

    Full Text Available Objective: To evaluate intraoperative and postoperative condition of low tidal volume combined with low-level positive end-expiratory pressure ventilation in laparoscopic surgery in elderly patients. Methods: A total of 176 cases of elderly patients (more than 60 years old receiving laparoscopic surgery in our hospital from July 2013 to July 2015 were selected as research subjects and randomly divided into observation group and control group, each group included 88 cases, control group received conventional ventilation strategy, observation group received low tidal volume combined with low-level positive end-expiratory pressure ventilation strategy, and then levels of hemodynamic indexes, respiratory mechanical indexes, serology indexes and cerebral vessel related indexes, etc of two groups were compared. Results: Intraoperative and postoperative heart rate and mean arterial pressure levels of observation group were lower than those of control group, arterial partial pressure of oxygen and oxygenation index levels were higher than those of control group and differences had statistical significance (P<0.05; intraoperative APIP and Pplat values of observation group were lower than those of control group, Cs value was higher than that of control group and differences had statistical significance (P<0.05; intraoperative and postoperative serum IL-8 and TNF-α levels of observation group were lower than those of control group, IL-10 level was higher than that of control group and differences had statistical significance (P<0.05; intraoperative and postoperative PjvO2, SjvO2 and CjvO2 levels of observation group were higher than those of control group, Da-jvO2 level was lower than that of control group and differences had statistical significance (P<0.05. Conclusions: When elderly patients receive laparoscopic surgery, the use of low tidal volume combined with low-level positive end-expiratory pressure ventilation strategy can stabilize hemodynamic

  13. Intrathoracic Caecal Perforation Presenting as Dyspnea

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    Vincent Granier

    2010-01-01

    Full Text Available Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

  14. Correlation of chest computed tomography findings with dyspnea and lung functions in post-tubercular sequelae

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    Ananya Panda

    2016-01-01

    Full Text Available Aims: To study the correlation between dyspnea, radiological findings, and pulmonary function tests (PFTs in patients with sequelae of pulmonary tuberculosis (TB. Materials and Methods: Clinical history, chest computed tomography (CT, and PFT of patients with post-TB sequelae were recorded. Dyspnea was graded according to the Modified Medical Research Council (mMRC scale. CT scans were analyzed for fibrosis, cavitation, bronchiectasis, consolidation, nodules, and aspergilloma. Semi-quantitative analysis was done for these abnormalities. Scores were added to obtain a total morphological score (TMS. The lungs were also divided into three zones and scores added to obtain the total lung score (TLS. Spirometry was done for forced vital capacity (FVC, forced expiratory volume in 1 s (FEV1, and FEV1/FVC. Results: Dyspnea was present in 58/101 patients. A total of 22/58 patients had mMRC Grade 1, and 17/58 patients had Grades 2 and 3 dyspnea each. There was a significant difference in median fibrosis, bronchiectasis, nodules (P < 0.01 scores, TMS, and TLS (P < 0.0001 between dyspnea and nondyspnea groups. Significant correlations were obtained between grades of dyspnea and fibrosis (r = 0.34, P = 0.006, bronchiectasis (r = 0.35, P = 0.004, nodule (r = 0.24, P = 0.016 scores, TMS (r = 0.398, P = 0.000, and TLS (r = 0.35, P = 0.0003. PFTs were impaired in 78/101 (77.2% patients. Restrictive defect was most common in 39.6% followed by mixed in 34.7%. There was a negative but statistically insignificant trend between PFT and fibrosis, bronchiectasis, nodule scores, TMS, and TLS. However, there were significant differences in median fibrosis, cavitation, and bronchiectasis scores in patients with normal, mild to moderate, and severe respiratory defects. No difference was seen in TMS and TLS according to the severity of the respiratory defect. Conclusion: Both fibrosis and bronchiectasis correlated with dyspnea and with PFT. However, this correlation was not

  15. Mechanical ventilation with high tidal volumes attenuates myocardial dysfunction by decreasing cardiac edema in a rat model of LPS-induced peritonitis

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    Smeding Lonneke

    2012-03-01

    Full Text Available Abstract Background Injurious mechanical ventilation (MV may augment organ injury remote from the lungs. During sepsis, myocardial dysfunction is common and increased endothelial activation and permeability can cause myocardial edema, which may, among other factors, hamper myocardial function. We investigated the effects of MV with injuriously high tidal volumes on the myocardium in an animal model of sepsis. Methods Normal rats and intraperitoneal (i.p. lipopolysaccharide (LPS-treated rats were ventilated with low (6 ml/kg and high (19 ml/kg tidal volumes (Vt under general anesthesia. Non-ventilated animals served as controls. Mean arterial pressure (MAP, central venous pressure (CVP, cardiac output (CO and pulmonary plateau pressure (Pplat were measured. Ex vivo myocardial function was measured in isolated Langendorff-perfused hearts. Cardiac expression of endothelial vascular cell adhesion molecule (VCAM-1 and edema were measured to evaluate endothelial inflammation and leakage. Results MAP decreased after LPS-treatment and Vt-dependently, both independent of each other and with interaction. MV Vt-dependently increased CVP and Pplat and decreased CO. LPS-induced peritonitis decreased myocardial function ex vivo but MV attenuated systolic dysfunction Vt-dependently. Cardiac endothelial VCAM-1 expression was increased by LPS treatment independent of MV. Cardiac edema was lowered Vt-dependently by MV, particularly after LPS, and correlated inversely with systolic myocardial function parameters ex vivo. Conclusion MV attenuated LPS-induced systolic myocardial dysfunction in a Vt-dependent manner. This was associated with a reduction in cardiac edema following a lower transmural coronary venous outflow pressure during LPS-induced coronary inflammation.

  16. Combining "open-lung" ventilation and arteriovenous extracorporeal lung assist: influence of different tidal volumes on gas exchange in experimental lung failure.

    Science.gov (United States)

    Muellenbach, Ralf M; Kredel, Markus; Kuestermann, Julian; Klingelhoefer, Michael; Schuster, Frank; Wunder, Christian; Kranke, Peter; Roewer, Norbert; Brederlau, Jörg

    2009-08-01

    Although low-tidal ventilation may reduce mortality in acute respiratory distress syndrome (ARDS), it can also result in severe respiratory acidosis and lung derecruitment. This study tested the hypothesis that combining "open-lung" ventilation and arteriovenous extracorporeal lung assist (av-ECLA) allows for maximal tidal volume (VT) reduction without the development of decompensated respiratory acidosis and impairment of oxygenation. After induction of ARDS in eight female pigs (56.1+/-3.2 kg), lung recruitment was performed and positive end-expiratory pressure was set 3 cmH2O above the lower inflection point of the pressure-volume curve. All animals were ventilated in the pressure-controlled ventilation mode (PCV) with VTs ranging from 0-8 ml/kg. At each VT, gas exchange and hemodynamic measurements were obtained with the av-ECLA circuit clamped and declamped. With each declamping, the gas flow through the membrane lung was set to 10 l of oxygen/min. The respiratory rate was adjusted to maintain normocapnia, but limited to 40/min. After lung recruitment, oxygenation remained significantly improved although VTs were minimized to 0 ml/kg (p<0.05). PaO2 was significantly improved during PCV and av-ECLA compared with PCV alone at VTs <4 ml/kg (p<0.05). With VT <6 ml/kg, severe acidosis could only be avoided if PCV was combined with av-ECLA. Due to sufficient CO2 elimination during av-ECLA, the VTs could be reduced to 0-2 ml/kg without the risk of decompensated respiratory acidosis. It was also shown that the "open-lung" strategy chosen was associated with sustained improvements in oxygenation, even though VTs were minimized.

  17. Intravenous Fentanyl for Dyspnea at the End of Life: Lessons for Future Research in Dyspnea.

    Science.gov (United States)

    Pang, G S; Qu, L M; Tan, Y Y; Yee, A C P

    2016-04-01

    To determine the efficacy of intravenous (IV) Fentanyl in dyspnoeic patients with advanced cancer. Dyspnoeic patients with advanced cancer satisfying the selection criteria received (IV) Fentanyl and were evaluated for response 24 hours post-administration in a prospective observational study. Altogether 36 patients were enrolled into the study. However, data from only 16 patients could be analysed as 20 patients had died or were too sick to self-report scores. Seven out of 16 patients responded to IV Fentanyl although the result was not statistically significant (non-responders versus responders: 56.3% vs 43.8%, p = 0.33). The strongest correlations for variables predictive of responder status were the absence of anxiety and lung metastases. This exploratory study shows that IV Fentanyl can alleviate dyspnea in some patients but is an example of the difficulties conducting dyspnea research. Future studies would benefit from novel developments in the areas of measuring dyspnea in dying patients and statistical analysis of small sample sizes. © The Author(s) 2014.

  18. The Interpretation of Dyspnea in the Patient with Asthma

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    Marc H. Lavietes

    2015-01-01

    Full Text Available Physicians have noted dyspnea in severely ill asthmatic patients to be associated with fright or panic; in more stable patients dyspnea may reflect characteristics including lung function, personality and behavioral traits. This study evaluates the symptom of dyspnea in 32 asthmatic patients twice: first when acutely ill and again after an initial response to therapy. Spirometry was performed, dyspnea quantified (Borg scale, and panic assessed with a specialized measure of acute panic (the acute panic inventory (API in the 32 patients before and again after treatment. After treatment, questionnaires to evaluate somatization and panic disorder were also administered. When acutely ill, both the API and all spirometric measures (PEFR; FEV1; IC correlated with dyspnea. Multiple linear regression showed that measures of the API, the peak expiratory flow rate, and female sex taken together accounted for 41% of dyspnea in acute asthma. After treatment, the API again predicted dyspnea while spirometric data did not. Those subjects who described themselves as having chronic panic disorder reported high grades of dyspnea after treatment also. We conclude that interpretations of the self-report of asthma differ between acutely ill and stable asthmatic patients.

  19. Tides and tidal currents

    NARCIS (Netherlands)

    Roos, A.

    1997-01-01

    Basic phenomena, origin and generation of tides, analysis and prediction of tides, basic equation and types of long waves in one dimension, tidal propagation in one dimension, tidal propagation in two directions, analytical tidal computation, numerical tidal computation.

  20. Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance.

    Science.gov (United States)

    Ferrando, Carlos; Suárez-Sipmann, Fernando; Gutierrez, Andrea; Tusman, Gerardo; Carbonell, Jose; García, Marisa; Piqueras, Laura; Compañ, Desamparados; Flores, Susanie; Soro, Marina; Llombart, Alicia; Belda, Francisco Javier

    2015-01-13

    The stress index (SI), a parameter derived from the shape of the pressure-time curve, can identify injurious mechanical ventilation. We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw). Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n = 11) or to a SI between 0.95 and 1.05 (SI-group, n = 11). Respiratory rate was adjusted to maintain a 'normal' PaCO2 (35 to 65 mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals. PaCO2 was significantly higher in the Pplat-group (82 versus 53 mmHg, P = 0.01), with a resulting lower pH (7.19 versus 7.34, P = 0.01). We observed significant differences in VT (7.3 versus 5.4 mlKg(-1), P = 0.002) and Pplat values (30 versus 35 cmH2O, P = 0.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99, P = 0.42) and end-inspiratory transpulmonary pressure (PTP) (17 versus 18 cmH2O, P = 0.42) were similar in the Pplat- and SI-groups respectively, without differences in overinflated lung areas at end- inspiration in both groups. Cytokines and histopathology showed no differences. Setting tidal volume to a non-injurious stress index in an open lung condition improves

  1. An evaluation of peak inspiratory pressure, tidal volume, and ventilatory frequency during ventilation with a neonatal self-inflating bag resuscitator.

    Science.gov (United States)

    Bassani, Mariana Almada; Filho, Francisco Mezzacappa; de Carvalho Coppo, Maria Regina; Martins Marba, Sérgio Tadeu

    2012-04-01

    Although the self-inflating bag is widely used in the hospital setting, variability of delivered ventilatory parameters is usually high, which might result in both hypoventilation and lung injury. The aims of this study were to assess possible sources of the high variability and to evaluate the adequacy of obtained values in relation to the recommended values for neonatal resuscitation. This was an experimental study in which 172 health professionals (physicians, resident physicians, physiotherapists, nurses, and nursing technicians) who work with neonatal intensive care manually ventilated a test lung (adjusted to simulate the lungs of an intubated term newborn) with a self-inflating bag in 5 different handling techniques, using 10, 5, 4, 3, and 2 fingers. Delivered values of peak inspiratory pressure (PIP), tidal volume (V(T)), and ventilatory frequency (f) were compared, taking into account the different handling modalities and professions by analysis of variance for repeated measures. Chi-square, the Friedman test and the Fisher exact tests were performed to compare the delivered and standard values. PIP and V(T) were significantly affected by the handling technique, with higher values for a greater number of fingers used for ventilation. Profession also influenced V(T) and f significantly: physiotherapists tended to deliver higher volumes and lower rates. Nevertheless, we observed high variability of all studied ventilatory parameters and overall inadequacy of obtained values. Most volunteers delivered excessive pressures and volumes at insufficient ventilatory frequency. Delivered values seem to depend on operators' individual and professional differences, as well as on the number of fingers used to compress the bag. However, from the clinical point of view, it is important to point out the high occurrence of inadequate delivered values, regardless of handling technique and profession.

  2. Comparative evaluation of hemodynamic and respiratory parameters during mechanical ventilation with two tidal volumes calculated by demi-span based height and measured height in normal lungs

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    L Mousavi Seresht

    2014-01-01

    Full Text Available Background : Appropriate determination of tidal volume (VT is important for preventing ventilation induced lung injury. We compared hemodynamic and respiratory parameters in two conditions of receiving VTs calculated by using body weight (BW, which was estimated by measured height (HBW or demi-span based body weight (DBW. Materials and Methods : This controlled-trial was conducted in St. Alzahra Hospital in 2009 on American Society of Anesthesiologists (ASA I and II, 18-65-years-old patients. Standing height and weight were measured and then height was calculated using demi-span method. BW and VT were calculated with acute respiratory distress syndrome-net formula. Patients were randomized and then crossed to receive ventilation with both calculated VTs for 20 min. Hemodynamic and respiratory parameters were analyzed with SPSS version 20.0 using univariate and multivariate analyses. Results : Forty nine patients were studied. Demi-span based body weight and thus VT (DTV were lower than Height based body weight and VT (HTV (P = 0.028, in male patients (P = 0.005. Difference was observed in peak airway pressure (PAP and airway resistance (AR changes with higher PAP and AR at 20 min after receiving HTV compared with DTV. Conclusions : Estimated VT based on measured height is higher than that based on demi-span and this difference exists only in females, and this higher VT results higher airway pressures during mechanical ventilation.

  3. A bench evaluation of fraction of oxygen in air delivery and tidal volume accuracy in home care ventilators available for hospital use

    Science.gov (United States)

    Baboi, Loredana; Subtil, Fabien

    2016-01-01

    Background Turbine-powered ventilators are not only designed for long-term ventilation at home but also for hospital use. It is important to verify their capabilities in delivering fraction of oxygen in air (FIO2) and tidal volume (VT). Methods We assessed the FIO2 accuracy and the VT delivery in four home care ventilators (HCV) on the bench. The four HCV were Astral 150, Elisée 150, Monnal T50 and Trilogy 200 HCV, which were connected to a lung model (ASL 5000). For assessing FIO2 accuracy, lung model was set to mimic an obstructive lung and HCV were set in volume controlled mode (VC). They supplied with air, 3 or 15 L/min oxygen and FIO2 was measured by using a ventilator tester (Citrex H4TM). For the VT accuracy, the lung model was set in a way to mimic three adult configurations (normal, obstructive, or restrictive respiratory disorder) and one pediatric configuration. Each HCV was set in VC. Two VT (300 and 500 mL) in adult lung configuration and one 50 mL VT in pediatric lung configuration, at two positive end expiratory pressures 5 and 10 cmH2O, were tested. VT accuracy was measured as volume error (the relative difference between set and measured VT). Statistical analysis was performed by suing one-factor ANOVA with a Bonferroni correction for multiple tests. Results For Astral 150, Elisée 150, Monnal T50 and Trilogy 200, FIO2 averaged 99.2%, 93.7%, 86.3%, and 62.1%, respectively, at 15 L/min oxygen supplementation rate (P<0.001). Volume error was 0.5%±0%, −38%±0%, −9%±0%, −29%±0% and −36%±0% for pediatric lung condition (P<0.001). In adult lung configurations, Monnal T50 systematically over delivered VT and Trilogy 150 was sensitive to lung configuration when VT was set to 300 mL at either positive end-expiratory pressure (PEEP). Conclusions HCV are different in terms of FIO2 efficiency and VT delivery. PMID:28149559

  4. Quantification of Emphysema with a Three-Dimensional Chest CT Scan: Correlation with the Visual Emphysema Scoring on Chest CT, Pulmonary Function Tests and Dyspnea Severity

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    Park, Hyun Jeong; Hwang, Jung Hwa [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

    2011-09-15

    We wanted to prospectively evaluate the correlation between the quantification of emphysema using 3D CT densitometry with the visual emphysema score, pulmonary function tests (PFT) and the dyspnea score in patients with chronic obstructive pulmonary disease (COPD). Non-enhanced chest CT with 3D reconstruction was performed in 28 men with COPD (age 54-88 years). With histogram analysis, the total lung volume, mean lung density and proportion of low attenuation lung volume below predetermined thresholds were measured. The CT parameters were compared with the visual emphysema score, the PFT and the dyspnea score. A low attenuation lung volume below -950 HU was well correlated with the DLco and FEV{sub 1}/FVC. A Low attenuation lung volume below -950 HU and -930 HU was correlated with visual the emphysema score. A low attenuation lung volume below -950 HU was correlated with the dyspnea score, although the correlations between the other CT parameters and the dyspnea score were not significant. Objective quantification of emphysema using 3D CT densitometry was correlated with the visual emphysema score. A low attenuation lung volume below -950 HU was correlated with the DLco, the FEV{sub 1}/FVC and the dyspnea score.

  5. Quantification of Emphysema with a Three-Dimensional Chest CT Scan: Correlation with the Visual Emphysema Scoring on Chest CT, Pulmonary Function Tests and Dyspnea Severity

    International Nuclear Information System (INIS)

    Park, Hyun Jeong; Hwang, Jung Hwa

    2011-01-01

    We wanted to prospectively evaluate the correlation between the quantification of emphysema using 3D CT densitometry with the visual emphysema score, pulmonary function tests (PFT) and the dyspnea score in patients with chronic obstructive pulmonary disease (COPD). Non-enhanced chest CT with 3D reconstruction was performed in 28 men with COPD (age 54-88 years). With histogram analysis, the total lung volume, mean lung density and proportion of low attenuation lung volume below predetermined thresholds were measured. The CT parameters were compared with the visual emphysema score, the PFT and the dyspnea score. A low attenuation lung volume below -950 HU was well correlated with the DLco and FEV 1 /FVC. A Low attenuation lung volume below -950 HU and -930 HU was correlated with visual the emphysema score. A low attenuation lung volume below -950 HU was correlated with the dyspnea score, although the correlations between the other CT parameters and the dyspnea score were not significant. Objective quantification of emphysema using 3D CT densitometry was correlated with the visual emphysema score. A low attenuation lung volume below -950 HU was correlated with the DLco, the FEV 1 /FVC and the dyspnea score.

  6. Dyspnea assessment and adverse events during sputum induction in COPD

    Directory of Open Access Journals (Sweden)

    Moschandreas Joanna

    2006-06-01

    Full Text Available Abstract Background The inhalation of normal or hypertonic saline during sputum induction (SI may act as an indirect bronchoconstrictive stimulus leading to dyspnea and lung function deterioration. Our aim was to assess dyspnea and adverse events in COPD patients who undergo SI following a safety protocol. Methods Sputum was induced by normal and hypertonic (4.5% saline solution in 65 patients with COPD of varying severity. In order to minimize saline-induced bronchoconstriction a protocol based on the European Respiratory Society sputum induction Task group report was followed. Dyspnea change was scored using the Borg scale and lung function was assessed by spirometry and oximetry. Results Borg score changes [median(IQR 1.5(0–2] were observed during SI in 40 subjects; 16 patients required temporary discontinuation of the procedure due to dyspnea-general discomfort and 2 did not complete the session due to dyspnea-wheezing. The change in Borg dyspnea score was significantly correlated with oxygen saturation and heart rate changes and with discontinuation of the procedure due to undesired symptoms. 19 subjects presented an hyperresponsive reaction (decline>20% from baseline FEV1. No significant correlation between Borg changes and FEV1decline was found. Patients with advanced COPD presented significantly greater Borg and oxygen saturation changes than patients with less severe disease (p = 0.02 and p = 0.001, respectively. Baseline FEV1, oxygen saturation and 6MWT demonstrated significant diagnostic values in distinguishing subjects who develop an adverse physiologic reaction during the procedure. Conclusion COPD patients undergoing SI following a safety protocol do not experience major adverse events. Dyspnea and oxygen desaturation is more likely to occur in patients with disease in advanced stages, leading to short discontinuation or less frequently to termination of the procedure. Baseline FEV1, oxygen saturation and 6MWT may have a

  7. Hemodynamic determinants of dyspnea improvement in acute decompensated heart failure.

    Science.gov (United States)

    Solomonica, Amir; Burger, Andrew J; Aronson, Doron

    2013-01-01

    Dyspnea relief constitutes a major treatment goal and a key measure of treatment efficacy in decompensated heart failure. However, there are no data with regard to the relationship between hemodynamic measurements during treatment and dyspnea improvement. We studied 233 patients assigned to right heart catheterization in the Vasodilation in the Management of Acute Congestive Heart Failure trial. Dyspnea (assessed using a 7-point Likert scale) and hemodynamic parameters were measured simultaneously at 15 and 30 minutes and 1, 2, 3, 6, and 24 hours. Dyspnea relief was defined as moderate or marked improvement. There was a time-dependent association between the reductions in pulmonary capillary wedge pressure (PCWP; 25.4, 24.6, 24.0, 23.5, 23.4, 21.5, and 19.9 mm Hg) and the percentage of patients achieving dyspnea relief (17.7%, 24.6%, 32.2%, 36.2%, 37.8%, 47.4%, and 66.1%, in the respective time points). Multivariable logistic generalized estimating equations modeling demonstrated that reductions of both PCWP and mean pulmonary artery pressure were independently associated with dyspnea relief. Compared with the highest PCWP quartile, the adjusted odds ratios for dyspnea relief were 0.92 (95% confidence interval [CI], 0.67-1.29), 1.07 (95% CI, 0.75-1.55), and 1.80 (95% CI, 1.22-2.65) in the third, second, and first PCWP quartiles, respectively (P(trend)=0.003). Compared with the highest mean pulmonary artery pressure quartile, the adjusted odds ratios for dyspnea relief were 2.0 (95% CI, 1.41-2.82), 2.23 (95% CI, 1.52-3.27), and 2.98 (95% CI, 1.91-4.66) in the third, second, and first mean pulmonary artery pressure quartiles, respectively (P(trend)<0.0001). A clinically significant improvement in dyspnea is associated with a reduction in both PCWP and mean pulmonary artery pressure.

  8. Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea.

    Science.gov (United States)

    Stokes, Natalie R; Dietz, Brett W; Liang, Jackson J

    2016-01-01

    Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes. In combination with the history and physical, efficient, and focused use of laboratory studies, the various cardiopulmonary biomarkers can be useful in establishing the correct diagnosis and guiding treatment decisions in a timely manner. Use and interpretation of such tests must be guided by the clinical context, as well as an understanding of the current evidence supporting their use. This review discusses current standards and research regarding the use of established and emerging cardiopulmonary laboratory markers in the evaluation of acute dyspnea, focusing on recent evidence assessing the diagnostic and prognostic utility of various tests. These markers include brain natriuretic peptide (BNP) and N-terminal prohormone (NT-proBNP), mid-regional peptides proatrial NP and proadrenomedullin, cardiac troponins, D-dimer, soluble ST2, and galectin 3, and included is a discussion on the use of arterial and venous blood gases.

  9. Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses.

    Science.gov (United States)

    Bourdeaux, Christopher P; Thomas, Matthew Jc; Gould, Timothy H; Malhotra, Gaurav; Jarvstad, Andreas; Jones, Timothy; Gilchrist, Iain D

    2016-05-26

    Low tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. 'Nudges' influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU). University Hospitals Bristol, a tertiary, mixed medical and surgical ICU with 20 beds, admitting over 1300 patients per year. Data were collected from 2144 consecutive patients receiving controlled mechanical ventilation for more than 1 hour between October 2010 and September 2014. Patients on controlled mechanical ventilation for more than 20 hours were included in the final analysis. (1) Default ventilator settings were adjusted to comply with low TVe targets from the initiation of ventilation unless actively changed by a clinician. (2) A large dashboard was deployed displaying TVes in the format mL/kg ideal body weight (IBW) with alerts when TVes were excessive. TVe in mL/kg IBW. TVe was significantly lower in the defaults group. In the dashboard intervention, TVe fell more quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached when compared with controls. This effect improved in each subsequent year for 3 years. This study has demonstrated that adjustment of default ventilator settings and a dashboard with alerts for excessive TVe can significantly influence clinical decision-making. This offers a promising strategy to improve compliance with low TVe ventilation, and suggests that using insights from behavioural science has potential to improve the translation of evidence into practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please

  10. Effects of Dexmedetomidine Infusion on Inflammatory Responses and Injury of Lung Tidal Volume Changes during One-Lung Ventilation in Thoracoscopic Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Chun-Yu Wu

    2018-01-01

    Full Text Available One-lung ventilation in thoracic surgery provokes profound systemic inflammatory responses and injury related to lung tidal volume changes. We hypothesized that the highly selective a2-adrenergic agonist dexmedetomidine attenuates these injurious responses. Sixty patients were randomly assigned to receive dexmedetomidine or saline during thoracoscopic surgery. There is a trend of less postoperative medical complication including that no patients in the dexmedetomidine group developed postoperative medical complications, whereas four patients in the saline group did (0% versus 13.3%, p=0.1124. Plasma inflammatory and injurious biomarkers between the baseline and after resumption of two-lung ventilation were particularly notable. The plasma high-mobility group box 1 level decreased significantly from 51.7 (58.1 to 33.9 (45.0 ng.ml−1 (p<0.05 in the dexmedetomidine group, which was not observed in the saline group. Plasma monocyte chemoattractant protein 1 [151.8 (115.1 to 235.2 (186.9 pg.ml−1, p<0.05] and neutrophil elastase [350.8 (154.5 to 421.9 (106.1 ng.ml−1, p<0.05] increased significantly only in the saline group. In addition, plasma interleukin-6 was higher in the saline group than in the dexmedetomidine group at postoperative day 1 [118.8 (68.8 versus 78.5 (58.8 pg.ml−1, p=0.0271]. We conclude that dexmedetomidine attenuates one-lung ventilation-associated inflammatory and injurious responses by inhibiting alveolar neutrophil recruitment in thoracoscopic surgery.

  11. Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs.

    Science.gov (United States)

    Hong, Caron M; Xu, Da-Zhong; Lu, Qi; Cheng, Yunhui; Pisarenko, Vadim; Doucet, Danielle; Brown, Margaret; Aisner, Seena; Zhang, Chunxiang; Deitch, Edwin A; Delphin, Ellise

    2010-06-01

    Protective mechanical ventilation with low tidal volume (Vt) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury. Female pigs were randomized into 3 groups. Group H-Vt/3 (n = 6) was ventilated with a Vt of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H(2)O, group L-Vt/3 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 3 cm H(2)O, and group L-Vt/10 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 10 cm H(2)O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically. In contrast to groups H-Vt/3 and L-Vt/3, group L-Vt/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High Vt/low PEEP resulted in less histologic lung injury.

  12. Adaptive support ventilation may deliver unwanted respiratory rate-tidal volume combinations in patients with acute lung injury ventilated according to an open lung concept.

    Science.gov (United States)

    Dongelmans, Dave A; Paulus, Frederique; Veelo, Denise P; Binnekade, Jan M; Vroom, Margreeth B; Schultz, Marcus J

    2011-05-01

    With adaptive support ventilation, respiratory rate and tidal volume (V(T)) are a function of the Otis least work of breathing formula. We hypothesized that adaptive support ventilation in an open lung ventilator strategy would deliver higher V(T)s to patients with acute lung injury. Patients with acute lung injury were ventilated according to a local guideline advising the use of lower V(T) (6-8 ml/kg predicted body weight), high concentrations of positive end-expiratory pressure, and recruitment maneuvers. Ventilation parameters were recorded when the ventilator was switched to adaptive support ventilation, and after recruitment maneuvers. If V(T) increased more than 8 ml/kg predicted body weight, airway pressure was limited to correct for the rise of V(T). Ten patients with a mean (±SD) Pao(2)/Fio(2) of 171 ± 86 mmHg were included. After a switch from pressure-controlled ventilation to adaptive support ventilation, respiratory rate declined (from 31 ± 5 to 21 ± 6 breaths/min; difference = 10 breaths/min, 95% CI 3-17 breaths/min, P = 0.008) and V(T) increased (from 6.5 ± 0.8 to 9.0 ± 1.6 ml/kg predicted body weight; difference = 2.5 ml, 95% CI 0.4-4.6 ml/kg predicted body weight, P = 0.02). Pressure limitation corrected for the rise of V(T), but minute ventilation declined, forcing the user to switch back to pressure-controlled ventilation. Adaptive support ventilation, compared with pressure-controlled ventilation in an open lung strategy setting, delivers a lower respiratory rate-higher V(T) combination. Pressure limitation does correct for the rise of V(T), but leads to a decline in minute ventilation.

  13. Neonatal mannequin comparison of the Upright self-inflating bag and snap-fit mask versus standard resuscitators and masks: leak, applied load and tidal volumes.

    Science.gov (United States)

    Rafferty, Anthony Richard; Johnson, Lucy; Davis, Peter G; Dawson, Jennifer Anne; Thio, Marta; Owen, Louise S

    2017-11-30

    Neonatal mask ventilation is a difficult skill to acquire and maintain. Mask leak is common and can lead to ineffective ventilation. The aim of this study was to determine whether newly available neonatal self-inflating bags and masks could reduce mask leak without additional load being applied to the face. Forty operators delivered 1 min episodes of mask ventilation to a mannequin using the Laerdal Upright Resuscitator, a standard Laerdal infant resuscitator (Laerdal Medical) and a T-Piece Resuscitator (Neopuff), using both the Laerdal snap-fit face mask and the standard Laerdal size 0/1 face mask (equivalent sizes). Participants were asked to use pressure sufficient to achieve 'appropriate' chest rise. Leak, applied load, airway pressure and tidal volume were measured continuously. Participants were unaware that load was being recorded. There was no difference in mask leak between resuscitation devices. Leak was significantly lower when the snap-fit mask was used with all resuscitation devices, compared with the standard mask (14% vs 37% leak, Pmask was preferred by 83% of participants. The device-mask combinations had no significant effect on applied load. The Laerdal Upright Resuscitator resulted in similar leak to the other resuscitation devices studied, and did not exert additional load to the face and head. The snap-fit mask significantly reduced overall leak with all resuscitation devices and was the mask preferred by participants. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Efeitos de diferentes volumes correntes e da pressão expiratória final positiva sobre a troca gasosa na fístula broncopleural experimental Effects of different tidal volumes and positive end expiratory pressure on gas exchange in experimental bronchopleural fistula

    Directory of Open Access Journals (Sweden)

    Maria Gabriela Cavicchia Toneloto

    2008-09-01

    melhora e o débito da fístula é reduzido quando comparado ao volume corrente de 10ml/Kg. Um baixo volume resulta em hipercapnia e grave dessaturação. Finalmente, em qualquer volume corrente, PEEP aumenta o débito da fístula e diminui a ventilação alveolar.OBJECTIVES: The present study was designed to identify the effect of positive end expiratory pressure (PEEP and the ideal pulmonary tidal volume to ventilate animals with a surgically produced bronchopleural fistula, aiming to reduce fistula output without affecting gas exchange. METHODS: Hemodynamic and respiratory assessment of gas exchange was obtained in five, healthy, young, mechanically ventilated Large White pigs under volume controlled ventilation with FiO2 of 0.4 and an inspiration:expiration ratio of 1:2, keeping respiratory rate at 22 cpm. A bronchopleural fistula was produced by resection of the lingula. Underwater seal drainage was installed and the thorax was hermetically closed. Gas exchange and fistula output were measured with the animals ventilated sequentially with tidal volumes of 4 ml/kg, 7 ml/kg and 10 ml/Kg alternating zero of positive end expiratory pressure (ZEEP and PEEP of 10 cmH2O, always in the same order. RESULTS: These findings are attributed to reduced alveolar ventilation and ventilation/perfusion abnormalities and were attenuated with larger tidal volumes. PEEP increases air leak, even with low volume (of 2.0 ± 2.8mL to 31 ± 20.7mL; p= 0.006 and decreases alveolar ventilation in all tidal volumes. Alveolar ventilation improved with larger tidal volumes, but increased fistula output (10 mL/kg - 25.8 ± 18.3mL to 80.2 ± 43.9mL; p=0.0010. Low tidal volumes result in hypercapnia (ZEEP - Toneloto MGC, Terzi RGG, Silva WA, Moraes AC, Moreira MM 83.7± 6.9 mmHg and with PEEP 10 - 93 ± 10.1mmHg and severely decreased arterial oxygen saturation, about of 84%. CONCLUSIONS: The tidal volume of 7 ml/Kg with ZEEP was considered the best tidal volume because, despite moderate hypercapnia

  15. Benefits of short inspiratory muscle training on exercise capacity, dyspnea, and inspiratory fraction in COPD patients

    Directory of Open Access Journals (Sweden)

    Barakat Shahin

    2008-10-01

    Full Text Available Barakat Shahin1, Michele Germain2, Alzahouri Kazem3, Guy Annat41Department of Physiology, University of Claude Bernard Lyon I, Lyon, France; 2Chef of the Service of EFR, Hospital of the Croix-Rousse at Lyon, France; 3Department of Medical Informatics, Hospital of St. Julien, Nancy, France; 4Department of Physiology, UFR Médecine Lyon Grange-Blanche Université Claude Bernard Lyon I, INSERM ESPRI ERI 22, Lyon, FranceAbstract: Static lung hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD. Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT. The present study is designed to investigate the benefits of a short outpatient program of IMT on inspiratory muscle performance, exercise capacity, perception of dyspnea, and the inspiratory fraction (IF. Thirty patients (24 males, 6 females with significant COPD (forced expiratory volume in one second [FEV1] = 46.21% ± 6.7% predicted, FEV1 = 33.6% ± 8.04% predicted were recruited for this study and had 3 months of IMT (30 minutes/day for 6 days/week in an outpatient clinic. Following IMT, there was a statistically significant increase in inspiratory muscle performance (an increase of the maximal inspiratory pressure from 59% ± 19.1% to 79% ± 21.85% predicted; p = 0.0342, a decrease in dyspnea (from 5.8 ± 0.78 to 1.9 ± 0.57; p = 0.0001, an increase in the distance walked during the 6 minute walk test, from 245 ± 52.37 m to 302 ± 41.30 m, and finally an increase in the IF (the new prognostic factor in COPD from 27.6 ± 9.7% to 31.4% ± 9.8%. The present study concludes that in patients with significant COPD, IMT results in improvement in performance, exercise capacity, sensation of dyspnea, and moreover an improvement in the IF prognostic factor.Keywords: inspiratory muscle training, dyspnea, inspiratory

  16. Three-minute constant rate step test for detecting exertional dyspnea relief after bronchodilation in COPD

    Directory of Open Access Journals (Sweden)

    Borel B

    2016-11-01

    Full Text Available Benoit Borel,1,2 Courtney A Wilkinson-Maitland,3 Alan Hamilton,4 Jean Bourbeau,5 Hélène Perrault,6 Dennis Jensen,3,5,7 François Maltais2 1Laboratoire HAVAE, Université de Limoges, Limoges, France; 2Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, 3Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, 4Boehringer Ingelheim (Canada Limited, Burlington, ON, 5Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Center, Montreal, QC, 6Faculty of Health Sciences, University of Ottawa, Ottawa, ON, 7Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada Background: The aim of this study was to evaluate the responsiveness of the 3-minute constant rate step test (3-MST to detect the relief of exertional dyspnea (respiratory discomfort after acute bronchodilation in COPD patients. Patients and methods: A total of 40 patients with moderate-to-severe COPD (mean forced expiratory volume in 1 second: 45.7 (±14.7, % predicted performed four 3-MSTs at randomly assigned stepping rates of 14, 16, 20 and 24 steps/min after inhalation of nebulized ipratropium bromide (500 µg/salbutamol (2.5 mg and saline placebo, which were randomized to order. Patients rated their intensity of perceived dyspnea at the end of each 3-MST using Borg 0–10 category ratio scale. Results: A total of 37 (92.5%, 36 (90%, 34 (85% and 27 (67.5% patients completed all 3 minutes of exercise at 14, 16, 20 and 24 steps/min under both treatment conditions, respectively. Compared with placebo, ipratropium bromide/salbutamol significantly decreased dyspnea at the end of the third minute of exercise at 14 steps/min (by 0.6±1.0 Borg 0–10 scale units, P<0.01 and 16 steps/min (by 0.7±1.3 Borg 0–10 scale

  17. Respiratory effects of low versus high tidal volume with or without positive end-expiratory pressure in anesthetized dogs with healthy lungs.

    Science.gov (United States)

    De Monte, Valentina; Bufalari, Antonello; Grasso, Salvatore; Ferrulli, Fabienne; Crovace, Alberto Maria; Lacitignola, Luca; Staffieri, Francesco

    2018-05-01

    OBJECTIVE To evaluate the impact of 2 tidal volumes (T V s) with or without positive end-expiratory pressure (PEEP) on lung mechanics, aeration, and gas exchange in healthy anesthetized dogs. ANIMALS 40 mixed-breed dogs with healthy lungs. PROCEDURES Anesthetized dogs were randomly assigned to 4 groups (n = 10/group) with different ventilatory settings: T V of 8 mL/kg and PEEP of 0 cm H 2 O (low T V group), T V of 8 mL/kg and PEEP of 5 cm H 2 O (low T V plus PEEP group), T V of 15 mL/kg and PEEP of 0 cm H 2 O (high T V group), or T V of 15 mL/kg and PEEP of 5 cm H 2 O (high T V plus PEEP group). Expired CO 2 and respiratory rate were titrated on the basis of a predetermined stepwise protocol. Gas exchange, respiratory mechanics, and pulmonary aeration were evaluated by means of CT 30 minutes after starting mechanical ventilation at the assigned setting. RESULTS Partial pressures of arterial and expired CO 2 were higher in the low T V and low T V plus PEEP groups than in the high T V and high T V plus PEEP groups. Peak and plateau airway pressures were higher in the PEEP group than in the other groups. Static lung compliance was higher in the high T V plus PEEP group than in the low T V group. Relative percentages of atelectatic and poorly aerated lung were lower in the high T V plus PEEP group than in the other groups. Oxygenation was similar among groups. CONCLUSIONS AND CLINICAL RELEVANCE Differences in T V and PEEP application during mechanical ventilation may affect respiratory function in anesthetized dogs with healthy lungs. Ventilation with a T V of 15 mL/kg and PEEP of 5 cm H 2 O significantly improved lung compliance and reduced the amount of atelectatic and poorly aerated lung.

  18. Gender and perception of dyspnea: The role of the variation in the forced expiratory volume in one second Género y percepción de disnea: el rol de la variación del volumen espiratorio forzado en un segundo

    Directory of Open Access Journals (Sweden)

    Carlos A. Nigro

    2010-08-01

    Full Text Available During bronchoconstriction women perceive more breathlessness than men. The aims of study were 1 to evaluate if quality of dyspnea in bronchoconstriction was different in women and men 2 to assess if gender difference in the perception of dyspnea could be related to the level of bronchoconstriction. 457 subjects (257 women inhaled methacholine to a 20% decrease in FEV1, or 32 mg/ml. Dyspnea was evaluated using the modified Borg scale and a list of expressions of dyspnea. Borg scores were recorded immediately before the challenge test baseline and at the maximum FEV1 decrease. The prevalence of descriptors of dyspnea reported by women and men was similar. Dyspnea was related to the level of FEV1 (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095, females (OR 2.90, 95%CI 1.33-6.33, p 0.0072, younger subjects (OR 0.93, 95%CI 0.89- 0.97, p 0.0013 and body mass index (BMI (OR 1.11, 95%CI 1.01-1.23, p 0.023. As the FEV1 fell less than 20% from baseline, only the ΔFEV1 was significantly associated with dyspnea (ΔFEV1:OR 1.15, 95%CI 1.07- 1.24, p 0.0002. Instead, if the FEV1 fell higher ≥ 20%, the presence of dyspnea was related to the degree of bronchoconstriction (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187, females (OR 3.02, 95%CI 1.36-6.72, p 0.0067, younger subjects (OR 0.92, 95%CI 0.88-0.96, p 0.0007 and BMI (OR 1.12, 95%CI 1.01-1.23, p 0.023. The quality of dyspnea during the bronchoconstriction was similar in women and men; women showed a higher perception of dyspnea than men only when the FEV1 fell more than 20% from baseline.Durante la broncoconstricción las mujeres perciben más disnea que los hombres. Los objetivos del estudio fueron evaluar: 1 si la calidad de la disnea durante la broncoconstricción fue diferente en mujeres y hombres, 2 si la diferencia entre sexos en la percepción de disnea podría relacionarse al nivel de broncoconstricción. 457 sujetos (257 mujeres inhalaron metacolina hasta un descenso del FEV1 ≥ 20% o 32 mg/ml. La

  19. Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea

    Directory of Open Access Journals (Sweden)

    Stokes NR

    2016-05-01

    Full Text Available Natalie R Stokes,1 Brett W Dietz,1 Jackson J Liang2 1Perelman School of Medicine, University of Pennsylvania, 2Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USAAbstract: Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes. In combination with the history and physical, efficient, and focused use of laboratory studies, the various cardiopulmonary biomarkers can be useful in establishing the correct diagnosis and guiding treatment decisions in a timely manner. Use and interpretation of such tests must be guided by the clinical context, as well as an understanding of the current evidence supporting their use. This review discusses current standards and research regarding the use of established and emerging cardiopulmonary laboratory markers in the evaluation of acute dyspnea, focusing on recent evidence assessing the diagnostic and prognostic utility of various tests. These markers include brain natriuretic peptide (BNP and N-terminal prohormone (NT-proBNP, mid-regional peptides proatrial NP and proadrenomedullin, cardiac troponins, D-dimer, soluble ST2, and galectin 3, and included is a discussion on the use of arterial and venous blood gases.Keywords: cardiopulmonary, emergency, heart failure, troponin, BNP, galectin 3, MR-proANP, MR-proADM

  20. Development and validation of the Dyspnea Index (DI): a severity index for upper airway-related dyspnea.

    Science.gov (United States)

    Gartner-Schmidt, Jackie L; Shembel, Adrianna C; Zullo, Thomas G; Rosen, Clark A

    2014-11-01

    To (1) develop and validate the Dyspnea Index (DI); (2) quantify severity of symptoms in upper airway dyspnea; and (3) validate the DI as an outcome measure. Survey development and validation. Three hundred sixty-nine participants were recruited for different phases of the study. Two hundred participants with chief complaints of dyspnea were given a 41-item questionnaire addressing common symptoms of dyspnea related to the upper airway. The questions were then reduced based on principal component analysis (PCA) and internal consistency resulting in a 10-item questionnaire. Cognitive interviews were conducted with 15 participants. Test-retest reliability and discriminant validity were measured from 51 participants. The DI was further validated by administering the index to 57 healthy controls (HC). Validation of the DI as a treatment outcome tool occurred with 46 participants' pre- and post-treatment scores. PCA revealed that only a single factor was being measured in both the original 41- and 10-item questionnaires. Additional cognitive interviewing suggested that no modification was needed to the DI. Test-retest reliability was r = 0.83. Discriminant validity was r = 0.62. The Mann-Whitney test demonstrated significant differences between healthy/symptomatic participants. Scores from the HC cohort resulted in a mean of 3.12 (SEM = 0.484; SD = 3.65) for the normative values. The DI is an effective and efficient instrument to quantify patients' symptoms of upper airway dyspnea. It is a statistically robust index, with significant reliability and validity, and can be dependably used as a treatment outcome measure. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  1. [Study of setting of ventilator volume tidal and airway pressure alarm threshold with continuous extra-sternum heart compression in cardiopulmonary resuscitation].

    Science.gov (United States)

    Luo, Jian-yu; Wang, Xiao-yuan; Cai, Tian-bin; Jiang, Wen-fang

    2013-02-01

    To investigate the setting of ventilator volume tidal (VT) and airway pressure alarm threshold during cardiopulmonary resuscitation (CPR) by continuous extra-sternum heart compression. Forty cases with respiration and cardiac arrest in the department of critical care medicine were randomly divided into low VT ventilation group and conventional VT group. Both groups were given the volume control mode. In the low VT ventilation group, VT was set on 6 - 7 ml/kg, and high pressure alarm threshold was adjusted to 60 cm H2O by the conventional 40 cm H2O during CPR. In the conventional VT group, VT and high pressure alarm threshold were set at 8 - 12 ml/kg and 40 cm H2O, respectively. Real-time actual VT, peak inspiratory pressure (PIP), and arterial blood gas test, blood lactic acid at 10 minutes and 30 minutes after CPR were observed. At 10 minutes after CPR, in the low VT ventilation group, arterial blood pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3(-), arterial oxygen saturation (SaO2) and blood lactic acid were better as compared with those in the conventional VT ventilation group (pH: 7.21±0.09 vs. 7.13±0.07, PaO2: 45.35±5.92 mm Hg vs. 40.70±4.70 mm Hg, PaCO2: 57.10±7.59 mm Hg vs. 61.60±5.47 mm Hg, HCO3(-): 18.50±3.50 mmol/L vs. 14.75±2.65 mmol/L, SaO2: 0.796±0.069 vs. 0.699±0.066, blood lactic acid: 7.07±1.60 mmol/L vs. 8.13±1.56 mmol/L, all P<0.05). The success rate of resuscitation in the low VT ventilation group was higher than that of the conventional VT ventilation group (45% vs. 15%, P<0.05), and PIP (cm H2O) of low VT ventilation group was lower than that of the conventional VT group (37.25±7.99 cm H2O vs. 42.70±7.40 cm H2O, P<0.05). In all the patients in both groups barotrauma did not occur. The strategy of low ventilator VT (6 - 7 ml/kg) with appropriate elevation of airway pressure alarm threshold was better than that of conventional ventilation setting, with no increase in

  2. Dyspnea, pulmonary function and exercise capacity in adult Saudi patients with sickle cell disease

    International Nuclear Information System (INIS)

    Alameri, Hatem F.; Alem, A.; Al-Momen, A.; Kardas, W.; Owais, M.; Jehangir, A.

    2008-01-01

    Objective was to examine pulmonary function, dyspnea, and exercise capacity in adult Saudi patients with sickle cell disease (SCD) patients. The patients were recruited from the hematology clinic at King Khalid University Hospital in Riyadh from January to December 2005. The study involved 39 patients with stable SCD 20 women and 19 men, with a mean age of 22.7+/- 7.1 years, hemoglobin level of 95.5+/-14.6g/L and hemoglobin F level of 13.7+/08.6. Patients underwent pulmonary function tests PFT forced expiratory volume in first second [FEV1], forced vital capacity [FVC], and diffusion capacity of carbon monoxide [DLco] data are presented as a percentage of the normal prediction, a 6- minute walk test 6MWT and echocardiography. Dyspnea was assessed using the Borg score. The 6MWT data were compared to body mass index matched healthy controls. Forty-one percent of SCD patients had mild dyspnea at rest and this increased to 61% at the end of the 6MWT. Pulmonary function tests were abnormal in 51%, 36% of patients had a restrictive pattern, 10% had isolated decrease in DLco and 5% had a mixed restrictive-obstrutive pattern. The 6MWD was shorter in SCD patients compared to the controls 368+/-67 versus 407+/-47m, p=0.005. No hematological variables correlated with outcome variables. Chronic pulmonary complications in adult Saudi SCD patients are relatively mild but common. Pulmonary function in these patients differs from that published for African-origin SCD patients. The difference may reflect a different natural history of SCD in the 2 populations. (author)

  3. Severe dyspnea due to a giant antrochoanal polyp

    OpenAIRE

    Coloma-Milano M; Gil-Carcedo-Sañudo E; Gil-Carcedo-García LM.; Martín-Batista S; Madrigal-Revuelta M; Vallejo-Valdezate LA

    2012-01-01

    SummaryIntroduction: The antrochoanal polyp is a prevalent pathology in teenagers and young adults. It usually presents with nasal obstruction.Patient and method: Case report: An 80-year-old male with alcoholic encephalopathy, chronic bronchial disease of unknown etiology and polypoid chronic rhinosinusitis came to the emergency service with severe dyspnea without laryngeal features.Anterior rhinoscopy showed a polypoid mass in left nostril that prevented the visualization with nasal endoscop...

  4. Amygdala response to anticipation of dyspnea is modulated by 5-HTTLPR genotype.

    Science.gov (United States)

    Stoeckel, M Cornelia; Esser, Roland W; Gamer, Matthias; Kalisch, Raffael; Büchel, Christian; von Leupoldt, Andreas

    2015-07-01

    Dyspnea anticipation and perception varies largely between individuals. To investigate whether genetic factors related to negative affect such as the 5-HTTLPR polymorphism impact this variability, we investigated healthy, 5-HTTLPR stratified volunteers using resistive load induced dyspnea together with fMRI. Alternating blocks of severe and mild dyspnea ("perception") were differentially cued ("anticipation") and followed by intensity and unpleasantness ratings. In addition, volunteers indicated their anticipatory fear during the anticipation periods. There were no genotype-based group differences concerning dyspnea intensity and unpleasantness or brain activation during perception of severe vs. mild dyspnea. However, in risk allele carriers, higher anticipatory fear was paralleled by stronger amygdala activation during anticipation of severe vs. mild dyspnea. These results suggest a role of the 5-HTTLPR genotype in fearful dyspnea anticipation. © 2015 Society for Psychophysiological Research.

  5. Analysis of Depression and Anxiety Levels in Patients with Dyspnea

    Directory of Open Access Journals (Sweden)

    Servet Kayhan

    2013-07-01

    Full Text Available Aim: The aim of the study was to assess the frequency of anxiety and depression in a sample of elderly patients with chronic respiratory failure and the relationships between these comorbidities and the severity of dyspnea. Material and Method: Sixty-four consecutive inpatients with asthma and chronic obstructive disease were evaluated in a chest disease hospital. A questionnaire including sociodemographic features was applied to patients and healthy control group. Anxiety was assessed by Spielberg state and trait anxiety scale, and depression by Beck depression inventory. Spirometric tests, respiratory symptoms and severity of dyspnea were evaluated in the study group. Results: The mean age of study group was 67.28±9.13 (range between 50-88 years. Of those 22 (34.4% were females and 42 (65.6% were males. The mean Beck depression inventory scores of the group was 18.42±10.00 (range between 5-47, the mean Spielberg’s state anxiety score was 40.20±8.13 and the mean Spielberg’s trait score was 44.70±7.94 these results were close to control group. Depression with Beck depression inventory scores was diagnosed in 24 (37.5%, absent or mild depression in 40 (62.5%, moderate depression in 13 (20.3% and severe depression in 11 (17.2% patients. There was a relation between age and depression scores (p=0.022. Depression scores, Spielberg’s state and trait inventory scores were found statistically related with each other. Discussion: The results of the present study support that anxiety and depressive disorders are found with a high incidence in patients with respiratory impairments but the severity of dyspnea measures does not affect the scores of depression and anxiety.

  6. [A case of laryngeal papilloma with sudden dyspnea].

    Science.gov (United States)

    Pabiszczak, Maciej; Wierzbicka, Małgorzata; Borucki, Lukasz; Iwanik, Katarzyna

    2005-01-01

    Laryngeal papilloma is one of the most common non-malignant tumors of the larynx. In adult they are included to pre-cancerous diseases. In morphological examination, it is a solid tumor. Often it is possible to cure them during one surgical procedure. The disease is mostly localized on the anterior commissurae region, vocal fold, ventricules, and on the laryngeal surface of the epiglottis. If the malignant transformation is suspected, a large excision with margin has to be performed, completed by a histological evaluation. A case of a huge laryngeal papilloma with dyspnea is presented.

  7. Acute laryngeal dyspnea as first presentation of granulomatosis with polyangiitis.

    Science.gov (United States)

    Pajor, Anna Maria; Kwiatkowska, Sylwia; Kroczyńska-Bednarek, Jadwiga; Piotrowski, Wojciech J

    2015-01-01

    Granulomatosis with polyangiitis (GPA) is a multi-organ disease which mostly affects lungs, kidney, and head and neck region. We report a rare case of acute laryngeal dyspnea and rapidly progressive pulmonary changes as first manifestations of disease. A 53 year-old woman presented with symptoms of two-week dyspnea, which aggravated rapidly in the preceding hours. Laryngological examination revealed subglottic infiltrations and vocal fold oedema which required urgent tracheotomy. During few days she developed gingival ulcerations and pulmonary infiltration with negative serum c-ANCA titers. The histopathological examination of subglottic and gingival biopsies and the clinical picture established the diagnosis of GPA. She was treated with prednisone and cyclophosphamide with recovery; however, during over 3 years of follow-up, pulmonary symptoms relapsed and subglottic stenosis persisted. The difficulties in diagnosis and treatment in this unusual presentation of GPA are outlined with conclusion that in patients with subglottic infiltration, which develops rapidly, even when this is a sole presentation of the disease, and when c-ANCA are negative, GPA should always be considered.

  8. Assessment and monitoring of flow limitation and other parameters from flow/volume loops.

    Science.gov (United States)

    Dueck, R

    2000-01-01

    Flow/volume (F/V) spirometry is routinely used for assessing the type and severity of lung disease. Forced vital capacity (FVC) and timed vital capacity (FEV1) provide the best estimates of airflow obstruction in patients with asthma, chronic obstructive pulmonary disease (COPD) and emphysema. Computerized spirometers are now available for early home recognition of asthma exacerbation in high risk patients with severe persistent disease, and for recognition of either infection or rejection in lung transplant patients. Patients with severe COPD may exhibit expiratory flow limitation (EFL) on tidal volume (VT) expiratory F/V (VTF/V) curves, either with or without applying negative expiratory pressure (NEP). EFL results in dynamic hyperinflation and persistently raised alveolar pressure or intrinsic PEEP (PEEPi). Hyperinflation and raised PEEPi greatly enhance dyspnea with exertion through the added work of the threshold load needed to overcome raised pleural pressure. Esophageal (pleural) pressure monitoring may be added to VTF/V loops for assessing the severity of PEEPi: 1) to optimize assisted ventilation by mask or via endotracheal tube with high inspiratory flow rates to lower I:E ratio, and 2) to assess the efficacy of either pressure support ventilation (PSV) or low level extrinsic PEEP in reducing the threshold load of PEEPi. Intraoperative tidal volume F/V loops can also be used to document the efficacy of emphysema lung volume reduction surgery (LVRS) via disappearance of EFL. Finally, the mechanism of ventilatory constraint can be identified with the use of exercise tidal volume F/V loops referenced to maximum F/V loops and static lung volumes. Patients with severe COPD show inspiratory F/V loops approaching 95% of total lung capacity, and flow limitation over the entire expiratory F/V curve during light levels of exercise. Surprisingly, patients with a history of congestive heart failure may lower lung volume towards residual volume during exercise

  9. A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea

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    Cem Sahin

    2015-01-01

    Full Text Available Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea.

  10. Observational study to analyze patterns of treatment of breakthrough dyspnea in cancer patients in clinical practice.

    Science.gov (United States)

    Cabezón-Gutiérrez, Luis; Delgado-Mingorance, Ignacio; Nabal-Vicuña, María; Jiménez-López, Antonio Javier; Cabezón-Álvarez, Ana; Soler-López, Begoña

    2018-06-12

    Although breakthrough dyspnea is very frequent in cancer patients, there are no precise recommendations for treating it. The main objective of this study was to analyze what treatments are used in clinical practice for the management of breakthrough dyspnea in cancer patients in Spain and the secondary objectives were to describe the characteristics of cancer patients with breakthrough dyspnea and the attributes of the disorder. Cancer patients over 18 years of age, with breakthrough dyspnea and a Karnofsky performance score of ≥30, who were treated at departments of oncology in institutes across Spain were included in this cross-sectional observational study. The characteristics of breakthrough dyspnea, history of treatment, anthropometric variables, Mahler dyspnea index, Borg scale, Edmonton Symptoms Assessment Scale, and patient satisfaction with current breakthrough dyspnea treatment were assessed. The mean age of the 149 included patients was 66 years (95% confidence interval: 64.3 to 67.9), and 53 were females (35.6%). The mean breakthrough dyspnea intensity was 5.85 (95% confidence interval 5.48 to 6.22, Borg scale). A total of 55.1% of the first-choice treatments consisted of opioids, followed by oxygen (17.3%). A total of 119 patients (79.9%) received monotherapy for breakthrough dyspnea. Patients presenting with basal dyspnea received oxygen in a greater proportion of cases (21.1% vs 7.4%; p = 0.07). Patients with predictable dyspnea received a greater proportion of opioids (70.9% vs 44.4%; p = 0.01). Opioids constitute first-line therapy for breakthrough dyspnea in routine clinical practice, though the scientific evidence supporting their use is scarce. Further information derived from controlled clinical trials is needed regarding the comparative efficacy of the different treatments in order to justify their use.

  11. VISCOELASTIC MODELS OF TIDALLY HEATED EXOMOONS

    Energy Technology Data Exchange (ETDEWEB)

    Dobos, Vera [Konkoly Thege Miklos Astronomical Institute, Research Centre of Astronomy and Earth Sciences, Hungarian Academy of Sciences, H-1121 Konkoly Thege Miklós út 15-17, Budapest (Hungary); Turner, Edwin L., E-mail: dobos@konkoly.hu [Department of Astrophysical Sciences, Princeton University, 08544, 4 Ivy Lane, Peyton Hall, Princeton, NJ (United States)

    2015-05-01

    Tidal heating of exomoons may play a key role in their habitability, since the elevated temperature can melt the ice on the body even without significant solar radiation. The possibility of life has been intensely studied on solar system moons such as Europa or Enceladus where the surface ice layer covers a tidally heated water ocean. Tidal forces may be even stronger in extrasolar systems, depending on the properties of the moon and its orbit. To study the tidally heated surface temperature of exomoons, we used a viscoelastic model for the first time. This model is more realistic than the widely used, so-called fixed Q models because it takes into account the temperature dependence of the tidal heat flux and the melting of the inner material. Using this model, we introduced the circumplanetary Tidal Temperate Zone (TTZ), which strongly depends on the orbital period of the moon and less on its radius. We compared the results with the fixed Q model and investigated the statistical volume of the TTZ using both models. We have found that the viscoelastic model predicts 2.8 times more exomoons in the TTZ with orbital periods between 0.1 and 3.5 days than the fixed Q model for plausible distributions of physical and orbital parameters. The viscoelastic model provides more promising results in terms of habitability because the inner melting of the body moderates the surface temperature, acting like a thermostat.

  12. VISCOELASTIC MODELS OF TIDALLY HEATED EXOMOONS

    International Nuclear Information System (INIS)

    Dobos, Vera; Turner, Edwin L.

    2015-01-01

    Tidal heating of exomoons may play a key role in their habitability, since the elevated temperature can melt the ice on the body even without significant solar radiation. The possibility of life has been intensely studied on solar system moons such as Europa or Enceladus where the surface ice layer covers a tidally heated water ocean. Tidal forces may be even stronger in extrasolar systems, depending on the properties of the moon and its orbit. To study the tidally heated surface temperature of exomoons, we used a viscoelastic model for the first time. This model is more realistic than the widely used, so-called fixed Q models because it takes into account the temperature dependence of the tidal heat flux and the melting of the inner material. Using this model, we introduced the circumplanetary Tidal Temperate Zone (TTZ), which strongly depends on the orbital period of the moon and less on its radius. We compared the results with the fixed Q model and investigated the statistical volume of the TTZ using both models. We have found that the viscoelastic model predicts 2.8 times more exomoons in the TTZ with orbital periods between 0.1 and 3.5 days than the fixed Q model for plausible distributions of physical and orbital parameters. The viscoelastic model provides more promising results in terms of habitability because the inner melting of the body moderates the surface temperature, acting like a thermostat

  13. Severe dyspnea in a patient with neurofibromatosis type 1

    Directory of Open Access Journals (Sweden)

    P.B. Poble

    2017-01-01

    Full Text Available Neurofibromatosis type 1 (NF1 is a genetic disease in which pulmonary complications are rare, but severe, especially pulmonary hypertension (PH. The mechanisms underlying the onset of PH in patients with NF1 are unclear and might be multifactorial. In particular, the frequent presence of pulmonary parenchymal lesions makes etiological diagnosis of PH difficult. We describe here the case of a patient with NF1 admitted to our clinic with dyspnea and right heart failure revealing severe pre-capillary PH. Parenchymal lesions were mild and PH was attributed to pulmonary vascular involvement. Clinical and hemodynamic conditions of the patient improved under pulmonary arterial hypertension-specific combination therapy. This case suggests that treatment of PH due to pulmonary vascular involvement in NF1 may be aligned with recommendations for PAH treatment.

  14. Acromegaly presented as a cause of laryngeal dyspnea.

    Science.gov (United States)

    Saussez, S; Mahillon, V; Chantrain, G; Thill, M P; Lequeux, T

    2007-12-01

    Acromegalic patients can develop obstructive sleep apnea syndrome or upper airflow obstruction. The development of dyspnea is unusual and the fixation of both vocal cords is exceptional. We report the case of a patient with bilateral vocal cord paralysis. Fiberoptic laryngoscopy and computed tomography (CT) of the neck showed a supra-glottic stenosis due to a swelling of the soft tissue. A tracheostomy was first performed. Thereafter, micro-laryngoscopy using laser vaporisation of the supra-glottic soft tissue was attempted but failed to remove the tracheostomy canula. Finally, blood tests and cerebral MRI revealed an acromegaly. The patient underwent a trans-sphenoidal resection of the pituitary adenoma. Fifteen months later, fiberoptic laryngoscopy showed bilateral restoration of vocal cord mobility and the tracheostomy canula was successfully removed after 18 months. Vocal cord fixation is probably due to hypopharyngeal and laryngeal soft tissue swelling and can be reversible after successful treatment of the adenoma.

  15. Dyspnea and dysphagia associated to hypopharyngeal fibrolipoma: A case report

    Directory of Open Access Journals (Sweden)

    Marco A. Mendez Saenz, MD

    2017-04-01

    Full Text Available Fibrolipomas are benign lesions conformed by fat and connective tissue, classified as histologic variants of lipomas. They are rarely located in the head and neck and represent less than 0.6% of the benign tumors of the larynx and hypopharynx. Their clinical presentation depends on its location and size. We present the case of a 51-year-old male patient who reported progressive dyspnea, dysphagia and obstructive sleep symptoms with a duration of 3 months, without apparent cause. A pharyngolaryngeal fiberoptic endoscopy showed a smooth, rounded mass in the posterior wall of the hypopharynx, partially obstructing the laryngeal vestibule, creating a valve effect. Complete trans-cervical resection of the lesion was performed after the airway was secured by means of a tracheotomy. The final histopathology report was fibrolipoma. He is currently asymptomatic and without evidence of relapse one year after the procedure.

  16. The effects of tidal range on saltmarsh morphology

    Science.gov (United States)

    Goodwin, Guillaume; Mudd, Simon

    2017-04-01

    Saltmarshes are highly productive coastal ecosystems that act simultaneously as flood barriers, carbon storage, pollutant filters and nurseries. As halophytic plants trap suspended sediment and decay in the settled strata, innervated platforms emerge from the neighbouring tidal flats, forming sub-vertical scarps on their eroding borders and sub-horizontal pioneer zones in areas of seasonal expansion. These evolutions are subject to two contrasting influences: stochastically generated waves erode scarps and scour tidal flats, whereas tidally-generated currents transport sediment to and from the marsh through the channel network. Hence, the relative power of waves and tidal currents strongly influences saltmarsh evolution, and regional variations in tidal range yield marshes of differing morphologies. We analyse several sheltered saltmarshes to determine how their morphology reflects variations in tidal forcing. Using tidal, topographic and spectral data, we implement an algorithm based on the open-source software LSDTopoTools to automatically identify features such as marsh platforms, tidal flats, erosion scarps, pioneer zones and tidal channels on local Digital Elevation Models. Normalised geometric properties are then computed and compared throughout the spectrum of tidal range, highlighting a notable effect on channel networks, platform geometry and wave exposure. We observe that micro-tidal marshes typically display jagged outlines and multiple islands along with wide, shallow channels. As tidal range increases, we note the progressive disappearance of marsh islands and linearization of scarps, both indicative of higher hydrodynamic stress, along with a structuration of channel networks and the increase of levee volume, suggesting higher sediment input on the platform. Future research will lead to observing and modelling the evolution of saltmarshes under various tidal forcing in order to assess their resilience to environmental change.

  17. Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study.

    Science.gov (United States)

    Bein, Thomas; Weber-Carstens, Steffen; Goldmann, Anton; Müller, Thomas; Staudinger, Thomas; Brederlau, Jörg; Muellenbach, Ralf; Dembinski, Rolf; Graf, Bernhard M; Wewalka, Marlene; Philipp, Alois; Wernecke, Klaus-Dieter; Lubnow, Matthias; Slutsky, Arthur S

    2013-05-01

    Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V(T)) strategy (V(T) ≈ 3 ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS. Seventy-nine patients were enrolled after a 'stabilization period' (24 h with optimized therapy and high PEEP). They were randomly assigned to receive a low V(T) ventilation (≈3 ml/kg) combined with extracorporeal CO2 elimination, or to a ARDSNet strategy (≈6 ml/kg) without the extracorporeal device. The primary outcome was the 28-days and 60-days ventilator-free days (VFD). Secondary outcome parameters were respiratory mechanics, gas exchange, analgesic/sedation use, complications and hospital mortality. Ventilation with very low V(T)'s was easy to implement with extracorporeal CO2-removal. VFD's within 60 days were not different between the study group (33.2 ± 20) and the control group (29.2 ± 21, p = 0.469), but in more hypoxemic patients (PaO2/FIO2 ≤150) a post hoc analysis demonstrated significant improved VFD-60 in study patients (40.9 ± 12.8) compared to control (28.2 ± 16.4, p = 0.033). The mortality rate was low (16.5%) and did not differ between groups. The use of very low V(T) combined with extracorporeal CO2 removal has the potential to further reduce VILI compared with a 'normal' lung protective management. Whether this strategy will improve survival in ARDS patients remains to be determined (Clinical trials NCT 00538928).

  18. Relationship between anxiety and dyspnea on exertion in patients with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    de Voogd, J.N.; Sanderman, R.; Postema, K.; van Sonderen, E.; Wempe, J.B.

    2011-01-01

    Dyspnea limits exercise in patients with chronic obstructive pulmonary disease (COPD) and is known to induce anxiety. Little is known whether anxiety contributes to exercise-induced dyspnea, which in turn might influence the outcome of diagnostic tests. The aim of the present study was to examine

  19. A system shift in tidal choking due to the construction of Yangshan Harbour, Shanghai, China

    Science.gov (United States)

    Guo, Wenyun; Wang, Xiao Hua; Ding, Pingxing; Ge, Jianzhong; Song, Dehai

    2018-06-01

    Tidal choking is a geometric feature caused by a narrowed channel. Construction of the Yangshan Harbour, Shanghai, China obstructed three key channels and intensively changed the local geometry and topography. In this study nine numerical experiments based on the Finite-Volume Community Ocean Model are conducted to study the project's influence on tidal characteristics. Results show that stronger tidal choking happened at the East Entrance after project, mainly due to the jet induced water-level drop forced by Bernoulli law and the longer and narrower geometry. The stronger tidal choking forces a faster flow and larger tidal energy flux at the choked channel while reducing the tidal amplitude in the Inner Harbour Area (IHA). The scouring on this channel reduces the choking effect but further enlarges tidal energy flux. Moreover, damming the channels decrease the tidal amplitude at the lee side of tidal propagating direction while increasing the amplitude on the stoss side. The dams also decrease the tidal current on both sides, and meanwhile develop two patches with stronger current aside the dam. The project induced changes in tidal characteristics are complex in space, and perturbations in bathymetry increase this complexity. Yangshan Harbour's construction induces little changes in the total tidal energy density in the IHA, but induces obvious changes in the spatial distribution of tidal energy. Although this study is site-specific, the findings may be applicable to tidal dynamics in land reclamation close to open seas, such as the dramatic reclamation of islands in the South China Sea.

  20. Relationship between Dyspnea Descriptors and Underlying Causes of the Symptom; a Cross-sectional Study.

    Science.gov (United States)

    Sajadi, Seyyed Mohammad Ali; Majidi, Alireza; Abdollahimajd, Fahimeh; Jalali, Fatemeh

    2017-01-01

    History taking and physical examination help clinicians identify the patient's problem and effectively treat it. This study aimed to evaluate the descriptors of dyspnea in patients presenting to emergency department (ED) with asthma, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD). This cross-sectional study was conducted on all patients presenting to ED with chief complaint of dyspnea, during 2 years. The patients were asked to describe their dyspnea by choosing three items from the valid and reliable questionnaire or articulating their sensation. The relationship between dyspnea descriptors and underlying cause of symptom was evaluated using SPSS version 16. 312 patients with the mean age of 60.96±17.01 years were evaluated (53.2% male). Most of the patients were > 65 years old (48.7%) and had basic level of education (76.9%). "My breath doesn't go out all the way" with 83.1%, "My chest feels tight " with 45.8%, and "I feel that my airway is obstructed" with 40.7%, were the most frequent dyspnea descriptors in asthma patients. "My breathing requires work" with 46.3%, "I feel that I am suffocating" with 31.5%, and "My breath doesn't go out all the way" with 29.6%, were the most frequent dyspnea descriptors in COPD patients. "My breathing is heavy" with 74.4%, "A hunger for more air" with 24.4%, and "I cannot get enough air" with 23.2%, were the most frequent dyspnea descriptors in CHF patients. Except for "My breath does not go in all the way", there was significant correlation between studied dyspnea descriptors and underlying disease (p = 0.001 for all analyses). It seems that dyspnea descriptors along with other findings from history and physical examination could be helpful in differentiating the causes of the symptom in patients presenting to ED suffering from dyspnea.

  1. Tidal alignment of galaxies

    Energy Technology Data Exchange (ETDEWEB)

    Blazek, Jonathan; Vlah, Zvonimir; Seljak, Uroš

    2015-08-01

    We develop an analytic model for galaxy intrinsic alignments (IA) based on the theory of tidal alignment. We calculate all relevant nonlinear corrections at one-loop order, including effects from nonlinear density evolution, galaxy biasing, and source density weighting. Contributions from density weighting are found to be particularly important and lead to bias dependence of the IA amplitude, even on large scales. This effect may be responsible for much of the luminosity dependence in IA observations. The increase in IA amplitude for more highly biased galaxies reflects their locations in regions with large tidal fields. We also consider the impact of smoothing the tidal field on halo scales. We compare the performance of this consistent nonlinear model in describing the observed alignment of luminous red galaxies with the linear model as well as the frequently used "nonlinear alignment model," finding a significant improvement on small and intermediate scales. We also show that the cross-correlation between density and IA (the "GI" term) can be effectively separated into source alignment and source clustering, and we accurately model the observed alignment down to the one-halo regime using the tidal field from the fully nonlinear halo-matter cross correlation. Inside the one-halo regime, the average alignment of galaxies with density tracers no longer follows the tidal alignment prediction, likely reflecting nonlinear processes that must be considered when modeling IA on these scales. Finally, we discuss tidal alignment in the context of cosmic shear measurements.

  2. Dyspnea in a nonagenarian: The usual suspects, an unexpected culprit.

    Science.gov (United States)

    Madeira, Sérgio; Raposo, Luís; David, Raquel; Marques, Alexandre; Andrade Gomes, José; Cardim, Nuno; Anjos, Rui

    2015-09-01

    Platypnea-orthodeoxia syndrome (POS) is an uncommon syndrome characterized by dyspnea and hypoxemia triggered by orthostatism and relieved by recumbency. It is often associated with an interatrial shunt through a patent foramen ovale (PFO). We report the case of a 92-year-old woman initially admitted in the setting of a traumatic femoral neck fracture (successfully treated with hip replacement surgery) in whom a reversible decline in transcutaneous oxygen saturation from 98% (in the supine position) to 84% (in the upright position) was noted early post-operatively. Thoracic multislice computed tomography excluded pulmonary embolism and severe parenchymal lung disease. The diagnosis of POS was confirmed by tilt-table contrast transesophageal echocardiography, which demonstrated a dynamic and position-dependent right-to-left shunt (torrential when semi-upright and minimal in the supine position) through a PFO. The patient underwent percutaneous closure of the PFO with an Amplatzer device, which led to prompt symptom relief and full functional recovery. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. [Characteristics of tidal breathing pulmonary function in children with tracheobronchomalacia].

    Science.gov (United States)

    Li, Lan; Chen, Qaing; Zhang, Fan; Zhu, Shuang-Gui; Hu, Ci-Lang; Wu, Ai-Min

    2017-12-01

    To investigate the characteristics of tidal breathing pulmonary function in children with tracheobronchomalacia (TBM). In this study, 30 children who were diagnosed with TBM using electronic bronchoscopy were enrolled in the observation group; 30 healthy children were recruited in the normal control group. For individuals in each group, the assessment of tidal breath pulmonary function was performed at diagnosis and 3, 6, 9, and 12 months after diagnosis. There were no significant differences in tidal volume, inspiratory time, expiratory time, and inspiratory to expiratory ratio between the two groups (P>0.05). Compared with the control group, the observation group had a significantly higher respiratory rate and significantly lower ratio of time to peak tidal expiratory flow to total expiratory time (TPTEF/TE) and ratio of volume to peak tidal expiratory flow to total expiratory volume (VPTEF/VE). There was a time-dependent increase in TPTEF/TE and VPTEF/VE for TBM children from the time of initial diagnosis to 12 months after diagnosis. Tidal breathing pulmonary function has characteristic changes in children with TBM. Tidal breathing pulmonary function tends to be recovered with increased age in children with TBM.

  4. An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis.

    Science.gov (United States)

    Mularski, Richard A; Reinke, Lynn F; Carrieri-Kohlman, Virginia; Fischer, Mark D; Campbell, Margaret L; Rocker, Graeme; Schneidman, Ann; Jacobs, Susan S; Arnold, Robert; Benditt, Joshua O; Booth, Sara; Byock, Ira; Chan, Garrett K; Curtis, J Randall; Donesky, Doranne; Hansen-Flaschen, John; Heffner, John; Klein, Russell; Limberg, Trina M; Manning, Harold L; Morrison, R Sean; Ries, Andrew L; Schmidt, Gregory A; Selecky, Paul A; Truog, Robert D; Wang, Angela C C; White, Douglas B

    2013-10-01

    In 2009, the American Thoracic Society (ATS) funded an assembly project, Palliative Management of Dyspnea Crisis, to focus on identification, management, and optimal resource utilization for effective palliation of acute episodes of dyspnea. We conducted a comprehensive search of the medical literature and evaluated available evidence from systematic evidence-based reviews (SEBRs) using a modified AMSTAR approach and then summarized the palliative management knowledge base for participants to use in discourse at a 2009 ATS workshop. We used an informal consensus process to develop a working definition of this novel entity and established an Ad Hoc Committee on Palliative Management of Dyspnea Crisis to further develop an official ATS document on the topic. The Ad Hoc Committee members defined dyspnea crisis as "sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers' ability to achieve symptom relief." Dyspnea crisis can occur suddenly and is characteristically without a reversible etiology. The workshop participants focused on dyspnea crisis management for patients in whom the goals of care are focused on palliation and for whom endotracheal intubation and mechanical ventilation are not consistent with articulated preferences. However, approaches to dyspnea crisis may also be appropriate for patients electing life-sustaining treatment. The Ad Hoc Committee developed a Workshop Report concerning assessment of dyspnea crisis; ethical and professional considerations; efficient utilization, communication, and care coordination; clinical management of dyspnea crisis; development of patient education and provider aid products; and enhancing implementation with audit and quality improvement.

  5. Medida da freqüência respiratória e do volume corrente para prever a falha na extubação de recém-nascidos de muito baixo peso em ventilação mecânica Evaluation of respiratory rate and tidal volume to predict extubation failure in mechanically ventilated very low birth weight infants

    Directory of Open Access Journals (Sweden)

    Josy Davidson

    2008-03-01

    Full Text Available OBJETIVO: Verificar se a freqüência respiratória (FR, o volume corrente (VC e a relação FR/VC poderiam prever a falha na extubação em recém-nascidos de muito baixo peso submetidos à ventilação mecânica. MÉTODOS: Estudo prospectivo, observacional, de recém-nascidos com idade gestacional OBJECTIVE: To verify if respiratory rate (RR, tidal volume (TV and respiratory rate and tidal volume ratio (RR/TV could predict extubation failure in very low birth weight infants submitted to mechanical ventilation. METHODS: This prospective observational study enrolled newborn infants with gestational age <37 weeks and birth weight <1,500g, mechanically ventilated from birth during 48 hours to 30 days and thought to be ready for extubation. As soon as the physicians decided for extubation, the neonates received endotracheal continuous positive airway pressure (CPAP for 10 minutes while spontaneous RR, TV and RR/TV were measured using a fixed-orifice pneumotachograph positioned between the endotracheal tube and the ventilator circuit. Thereafter, the neonates were extubated to nasal CPAP. Extubation failure was defined as the need for reintubation within 48 hours. RESULTS: Of the 35 studied infants, 20 (57% were successfully extubated and 15 (43% required reintubation. RR and RR/TV before extubation had a trend to be higher in unsuccessfully extubated infants. TV was similar in both groups. Sensitivity and specificity of these parameters as predictors of extubation failure were 50 and 67% respectively for RR, 40 and 67% for TV and 40 and 73% for RR/TV. CONCLUSIONS: RR, TV and RR/TV showed low sensitivity and specificity to predict extubation failure in mechanically ventilated very low birth weight infants.

  6. [Exercise laryngoscopy: a new method for the differential diagnosis of dyspnea on exertion].

    Science.gov (United States)

    Tervonen, Hanna; Iljukov, Sergei; Niskanen, Minna-Liisa; Vilkman, Erkki; Sovijärvi, Anssi; Aaltonen, Leena-Maija

    2011-01-01

    Exertional dyspnea originating from the laryngeal level can be established with certainty only if the paradoxical vocal cord adduction is observed during dyspnea. We have developed a novel diagnostic method, exercise laryngoscopy, which involves observation of the larynx with a flexible endoscope applied via the nose during a bicycle ergometry test. It has been our aim to improve the differential diagnosis of dyspnea on exertion and thus also reduce unnecessary antiasthmatic medication. Exercise laryngoscopy allows examination in the out-patient clinics because the method is well tolerated.

  7. Belching, regurgitation, chest tightness and dyspnea: not gastroesophageal reflux disease but asthma.

    Science.gov (United States)

    Zhang, Jing-Xi; Zhan, Xian-Bao; Bai, Chong; Li, Qiang

    2015-02-07

    Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, another etiology should be considered. Here, we report a case of a 43-year-old man who presented with belching, regurgitation, chest tightness and dyspnea for 18 mo, which became gradually more severe. Gastroscopic examination suggested superficial gastritis. Twenty-four-hour esophageal pH monitoring showed that the Demeester score was 11.4, in the normal range. High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal (20 mmHg and 22.4 mmHg, respectively), indicating gastroesophageal junction outflow tract obstruction. Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second (FEV1)/forced vital capacity 32%, FEV1 was 1.21 L, occupying 35% predicted value after salbuterol inhalation], and positive bronchial dilation test (∆FEV1 260 mL, ∆FEV1% 27%). Skin prick test showed Dermatophagoides farinae (++), house dust mite (++++), and shrimp protein (++). Fractional exhaled nitric oxide measurement was 76 ppb. All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting β2-agonist. Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment, therefore, physicians, especially the Gastrointestinal physicians, should pay attention to the belching symptoms of asthma.

  8. Tidally Heated Terrestrial Exoplanets

    Science.gov (United States)

    Henning, Wade Garrett

    This work models the surface and internal temperatures for hypothetical terrestrial planets in situations involving extreme tidal heating. The feasibility of such planets is evaluated in terms of the orbital perturbations that may give rise to them, their required proximity to a hoststar, and the potential for the input tidal heating to cause significant partial melting of the mantle. Trapping terrestrial planets into 2:1 resonances with migrating Hot Jupiters is considered as a reasonable way for Earth-like worlds to both maintain high eccentricities and to move to short enough orbital periods (1-20 days) for extreme tidal heating to occur. Secular resonance and secular orbital perturbations may support moderate tidal heating at a low equilibrium eccentricity. At orbital periods below 10-30 days, with eccentricities from 0.01 to 0.1, tidal heat may greatly exceed radiogenic heat production. It is unlikely to exceed insolation, except when orbiting very low luminosity hosts, and thus will have limited surface temperature expression. Observations of such bodies many not be able to detect tidal surface enhancements given a few percent uncertainty in albedo, except on the nightside of spin synchronous airless objects. Otherwise detection may occur via spectral detection of hotspots or high volcanic gas concentrations including sulfur dioxide and hydrogen sulfide. The most extreme cases may be able to produce magma oceans, or magma slush mantles with up to 40-60% melt fractions. Tides may alter the habitable zones for smaller red dwarf stars, but are generally detrimental. Multiple viscoelastic models, including the Maxwell, Voigt-Kelvin, Standard Anelastic Solid, and Burgers rheologies are explored and applied to objects such as Io and the super-Earth planet GJ 876d. The complex valued Love number for the Burgers rheology is derived and found to be a useful improvement when modeling the low temperature behavior of tidal bodies, particularly during low eccentricity

  9. Defining the minimal important difference for the visual analogue scale assessing dyspnea in patients with malignant pleural effusions.

    Directory of Open Access Journals (Sweden)

    Eleanor K Mishra

    Full Text Available The minimal important difference (MID is essential for interpreting the results of randomised controlled trials (RCTs. Despite a number of RCTs in patients with malignant pleural effusions (MPEs which use the visual analogue scale for dyspnea (VASD as an outcome measure, the MID has not been established.Patients with suspected MPE undergoing a pleural procedure recorded their baseline VASD and their post-procedure VASD (24 hours after the pleural drainage, and in parallel assessed their breathlessness on a 7 point Likert scale.The mean decrease in VASD in patients with a MPE reporting a 'small but just worthwhile decrease' in their dyspnea (i.e. equivalent to the MID was 19mm (95% CI 14-24mm. The mean drainage volume required to produce a change in VASD of 19mm was 760ml.The mean MID for the VASD in patients with a MPE undergoing a pleural procedure is 19mm (95% CI 14-24mm. Thus choosing an improvement of 19mm in the VASD would be justifiable in the design and analysis of future MPE studies.

  10. Limiting volume with modern ventilators.

    Science.gov (United States)

    Wing, Thomas J; Haan, Lutana; Ashworth, Lonny J; Anderson, Jeff

    2015-06-01

    The acute respiratory distress syndrome (ARDS) network low tidal-volume study comparing tidal volumes of 12 ml/kg versus 6 ml/kg was published in 2000. The study was stopped early as data revealed a 22% relative reduction in mortality rate when using 6 ml/kg tidal volume. The current generation of critical care ventilators allows the tidal volume to be set during volume-targeted, assist/control (volume A/C); however, some ventilators include options that may prevent the tidal volume from being controlled. The purpose of this bench study was to evaluate the delivered tidal volume, when these options are active, in a spontaneously breathing lung model using an electronic breathing simulator. Four ventilators were evaluated: CareFusion AVEA (AVEA), Dräger Evita® XL (Evita XL), Covidien Puritan Bennett® 840(TM) (PB 840), and Maquet SERVO-i (SERVO-i). Each ventilator was connected to the Hans Rudolph Electronic Breathing Simulator at an amplitude of 0 cm H2O and then 10 cm H2O. All four ventilators were set to deliver volume A/C, tidal volume 400 ml, respiratory rate 20 bpm, positive end-expiratory pressure 5 cm H2O, peak flowrate 60 L/min. The displayed tidal volume was recorded for each ventilator at the above settings with additional options OFF and then ON. The AVEA has two options in volume A/C: demand breaths and V-sync. When activated, these options allow the patient to exceed the set tidal volume. When using the Evita XL, the option AutoFlow can be turned ON or OFF, and when this option is ON, the tidal volume may vary. The PB 840 does not have any additional options that affect volume delivery, and it maintains the set tidal volume regardless of patient effort. The SERVO-i's demand valve allows additional flow if the patient's inspiratory flowrate exceeds the set flowrate, increasing the delivered tidal volume; this option can be turned OFF with the latest software upgrade. Modern ventilators have an increasing number of optional settings. These settings may

  11. Evidence for cognitive–behavioral strategies improving dyspnea and related distress in COPD

    Directory of Open Access Journals (Sweden)

    Norweg A

    2013-09-01

    Full Text Available Anna Norweg,1 Eileen G Collins2,3 1Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago (UIC, Chicago, IL, USA; 2Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago (UIC, Chicago, IL, USA; 3Rehabilitation Research and Development (RR&D, Edward Hines Jr. VA Hospital, Hines, IL, USA Background: Dyspnea is a complex, prevalent, and distressing symptom of chronic obstructive pulmonary disease (COPD associated with decreased quality of life, significant disability, and increased mortality. It is a major reason for referral to pulmonary rehabilitation. Methods: We reviewed 23 COPD studies to examine the evidence for the effectiveness of cognitive–behavioral strategies for relieving dyspnea in COPD. Results: Preliminary evidence from randomized controlled trials exists to support cognitive–behavioral strategies, used with or without exercise, for relieving sensory and affective components of dyspnea in COPD. Small to moderate treatment effects for relieving dyspnea were noted for psychotherapy (effect size [ES] = 0.08–0.25 for intensity; 0.26–0.65 for mastery and distractive auditory stimuli (ES = 0.08–0.33 for intensity; 0.09 to -0.61 for functional burden. Small to large dyspnea improvements resulted from yoga (ES = 0.2–1.21 for intensity; 0.67 for distress; 0.07 for mastery; and −8.37 for functional burden; dyspnea self-management education with exercise (ES = −0.14 to −1.15 for intensity; −0.62 to −0.69 for distress; 1.04 for mastery; 0.14–0.35 for self-efficacy; and slow-breathing exercises (ES = 4390.34 to −0.83 for intensity; -0.61 to -0.80 for distress; and 0.62 for self-efficacy. Cognitive–behavioral interventions may relieve dyspnea in COPD by (1 decreasing sympathetic nerve activity, dynamic hyperinflation, and comorbid anxiety, and (2 promoting arterial oxygen saturation, myelinated vagus nerve activity, a greater

  12. Observational Study on Safety of Prehospital BLS CPAP in Dyspnea.

    Science.gov (United States)

    Sahu, Novneet; Matthews, Patrick; Groner, Kathryn; Papas, Mia A; Megargel, Ross

    2017-12-01

    with appropriate training. Sahu N , Matthews P , Groner K , Papas MA , Megargel R . Observational study on safety of prehospital BLS CPAP in dyspnea. Prehosp Disaster Med. 2017;32(6):610-614.

  13. An Elderly Female with Dyspnea and Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Jon Van Heukelom

    2017-01-01

    Full Text Available History of Present Illness: A 55-year-old female presented via transfer from a referring hospital with 48 hours of abdominal pain, vomiting and dyspnea. She was found to be in severe distress. Her temperature was 37.5° C (99.5° F, heart rate 130 beats per minute, respiratory rate 47 breaths per minute, blood pressure 80/48, and oxygen saturation of 95% on a non-rebreather mask. She had distended neck veins, diminished breath sounds on the left hemi-thorax, and a distended abdomen. A chest x-ray that had been obtained at the referring hospital was immediately reviewed. The decision was made to intubate the patient. Following intubation, a nasogastric tube was placed with marked improvement in her hemodynamics. An abdomen-pelvis CT was obtained which showed a para-esophageal hernia with the majority of the stomach located in the left hemi-thorax and evidence of a bowel obstruction. Significant findings: Radiography shows a dilated, gas-filled structure that fills nearly the entire left hemi-thorax. Lung markings are visible in the uppermost portion of the left hemi-thorax. There is mediastinal shift to the right. In the visualized portion of the abdomen, dilated loops of bowel are also visualized. This constellation of findings is consistent with a tension gastrothorax. Discussion: Tension gastrothorax is a rare complication of blunt trauma, diaphragmatic hernias, and certain surgical procedures.1,2 Clinically, a tension gastrothorax may mimic that of a tension pneumothorax, making it difficult to diagnose.3,4 Stabilizing treatment includes decompressing the stomach by means of a nasogastric (NG tube.2 Placement may be difficult due the intra-thoracic position of the stomach leading to kinking of the tube. The attempt to place an NG tube can lead to hyperventilation and air swallowing, which can aggravate gastric distention.4 Failure to decompress the stomach, however, may lead to patient decompensation and cardiac arrest.5 Definitive treatment

  14. Use of post-exercise laryngoscopy to evaluate exercise induced dyspnea.

    LENUS (Irish Health Repository)

    McNally, P

    2010-10-01

    We present the case of a child with asthma who continued to have marked exercise induced dyspnea despite appropriate treatment, and in the face of adequate control of all other asthma symptoms. Spirometry showed a marked truncation of inspiratory flow, and laryngoscopy performed immediately after exercise showed laryngomalacia with dynamic, partial inspiratory obstruction. Exercise induced laryngomalacia (EIL) is a rare cause of exercise induced dyspnea which is diagnosed by post exercise flexible laryngoscopy and may require supraglottoplasty.

  15. Coastal inlets and tidal basins

    NARCIS (Netherlands)

    De Vriend, H.J.; Dronkers, J.; Stive, M.J.F.; Van Dongeren, A.; Wang, J.H.

    2002-01-01

    lecture note: Tidal inlets and their associated basins (lagoons) are a common feature of lowland coasts all around the world. A significant part ofthe world's coastlines is formed by barrier island coasts, and most other tidal coasts are interrupted by estuaries and lagoon inlets. These tidal

  16. Perception of dyspnea in childhood asthma crisis by the patients and those in charge of them.

    Science.gov (United States)

    Parente, Ana Alice Amaral Ibiapina; March, Maria Fátima Pombo; Evangelista, Lucia Araujo; Cunha, Antonio Ledo

    2011-01-01

    To evaluate the correlation between perception of dyspnea during a mild to moderate asthma attack using the Modified Borg Scale (MBS) and peak expiratory flow rate (PEFR). This was a cross-sectional study conducted with children and adolescents who sought a pediatric emergency service due to an asthma attack. Data were collected from July 2005 to June 2006. Demographic data were recorded. Patients and those in charge of them were requested to grade, individually, the patient's dyspnea using the MBS; afterwards, the peak expiratory flow rate was measured. 181 asthmatic patients were evaluated, with a mean age of 7.2 (± 2.4) years (range, 4-12). The mother sought medical aid in 83.4% of the cases (151/181). Patient symptoms included coughing in 68.5% (124/181), dyspnea in 47.0% (85/181), and wheezing in 12.7% (23/181). Thirty-six percent (65/181) had a mild attack, and 64.1% (116/181) a moderate one. A significant negative correlation was found between the patients' and accompanying adults' perceptions of patient's dyspnea and the PEFR (% predicted; rs = -0.240 and rs = -0.385, respectively). Both the patients and those looking after them had a poor perception of the severity of the patient's dyspnea. This emphasizes the need to monitor objective measures such as the PEFR and to develop better ways of evaluating dyspnea.

  17. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma.

    Science.gov (United States)

    Weinberger, Miles; Abu-Hasan, Mutasim

    2007-10-01

    Although asthma is the most common cause of cough, wheeze, and dyspnea in children and adults, asthma is often attributed inappropriately to symptoms from other causes. Cough that is misdiagnosed as asthma can occur with pertussis, cystic fibrosis, primary ciliary dyskinesia, airway abnormalities such as tracheomalacia and bronchomalacia, chronic purulent or suppurative bronchitis in young children, and habit-cough syndrome. The respiratory sounds that occur with the upper airway obstruction caused by the various manifestations of the vocal cord dysfunction syndrome or the less common exercise-induced laryngomalacia are often mischaracterized as wheezing and attributed to asthma. The perception of dyspnea is a prominent symptom of hyperventilation attacks. This can occur in those with or without asthma, and patients with asthma may not readily distinguish the perceived dyspnea of a hyperventilation attack from the acute airway obstruction of asthma. Dyspnea on exertion, in the absence of other symptoms of asthma or an unequivocal response to albuterol, is most likely a result of other causes. Most common is the dyspnea associated with normal exercise limitation, but causes of dyspnea on exertion can include other physiologic abnormalities including exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, and exercise-induced supraventricular tachycardia. A careful history, attention to the nature of the respiratory sounds that are present, spirometry, exercise testing, and blood-gas measurement provide useful data to sort out the various causes and avoid inappropriate treatment of these pseudo-asthma clinical manifestations.

  18. Continuous subcutaneous infusion of compound oxycodone for the relief of dyspnea in patients with terminally ill cancer: a retrospective study.

    Science.gov (United States)

    Kawabata, Masahiro; Kaneishi, Keisuke

    2013-05-01

    Pain and dyspnea are the most prevalent and distressing symptoms in patients with terminally ill cancer. Evidences have accumulated for the effects of morphine on dyspnea, whereas little is known about the effects of oxycodone on dyspnea. We investigated the effectiveness of oxycodone for dyspnea in patients with terminally ill cancer. The injectable form of compound oxycodone (iOC) containing hydrocotarnine was administered continuously via subcutaneous route. We administered iOC to 136 patients. The effect on dyspnea was less conspicuous than pain, yet iOC was effective for dyspnea with varying degrees. None of the adverse effects observed were serious. These results suggest that continuous subcutaneous administration of oxycodone could be one of the reasonable alternatives in the management of dyspnea in patients with terminally ill cancer.

  19. Tidal residual current and its role in the mean flow on the Changjiang Bank

    Science.gov (United States)

    Xuan, Jiliang; Yang, Zhaoqing; Huang, Daji; Wang, Taiping; Zhou, Feng

    2016-02-01

    The tidal residual current may play an important role in the mean flow in the Changjiang Bank region, in addition to other residual currents, such as the Taiwan Warm Current, the Yellow Sea Coastal Current, and the Yellow Sea Warm Current. In this paper, a detailed structure of the tidal residual current, in particular the meso-scale eddies, in the Changjiang Bank region is observed from model simulations, and its role in the mean flow is quantified using the well-validated Finite Volume Coastal Ocean Model. The tidal residual current in the Changjiang Bank region consists of two components: an anticyclonic regional-scale tidal residual circulation around the edge of the Changjiang Bank and some cyclonic meso-scale tidal residual eddies across the Changjiang Bank. The meso-scale tidal residual eddies occur across the Changjiang Bank and contribute to the regional-scale tidal residual circulation offshore at the northwest boundary and on the northeast edge of the Changjiang Bank, southeastward along the 50 m isobath. Tidal rectification is the major mechanism causing the tidal residual current to flow along the isobaths. Both components of the tidal residual current have significant effects on the mean flow. A comparison between the tidal residual current and the mean flow indicates that the contribution of the tidal residual current to the mean flow is greater than 50%.

  20. Tidal residual current and its role in the mean flow on the Changjiang Bank

    Energy Technology Data Exchange (ETDEWEB)

    Xuan, Jiliang; Yang, Zhaoqing; Huang, Daji; Wang, Taiping; Zhou, Feng

    2016-02-01

    Tidal residual current may play an important role in the mean flow in the Changjiang Bank region, in addition to other residual currents, such as the Taiwan Warm Current, the Yellow Sea Coastal Current, and the Yellow Sea Warm Current. In this paper, a detailed structure of the tidal residual current, in particular the meso-scale eddies, in the Changjiang Bank region is observed from model simulations, and its role in the mean flow is quantified using the well-validated Finite Volume Coastal Ocean Model). The tidal residual current in the Changjiang Bank region consists of two components: an anticyclonic regional-scale tidal residual circulation around the edge of the Changjiang Bank and some cyclonic meso-scale tidal residual eddies across the Changjiang Bank. The meso-scale tidal residual eddies occur across the Changjiang Bank and contribute to the regional-scale tidal residual circulation offshore at the northwest boundary and at the northeast edge of the Changjiang Bank, southeastward along the 50 m isobath. Tidal rectification is the major mechanism causing the tidal residual current to flow along the isobaths. Both components of the tidal residual current have significant effects on the mean flow. A comparison between the tidal residual current and the mean flow indicates that the contribution of the tidal residual current to the mean flow is greater than 50%.

  1. Effects of fresh gas flow, tidal volume, and charcoal filters on the washout of sevoflurane from the Datex Ohmeda (GE) Aisys, Aestiva/5, and Excel 210 SE Anesthesia Workstations.

    Science.gov (United States)

    Sabouri, A Sassan; Lerman, Jerrold; Heard, Christopher

    2014-10-01

    We investigated the effects of tidal volume (VT), fresh gas flow (FGF), and a charcoal filter in the inspiratory limb on the washout of sevoflurane from the following Datex Ohmeda (GE) Anesthesia Workstations (AWSs): Aisys, Aestiva/5, and Excel 210SE. After equilibrating the AWSs with 2% sevoflurane, the anesthetic was discontinued, and the absorbent anesthesia breathing circuit (ABC), reservoir bag, and test lung were changed. The lung was ventilated with 350 or 200 mL·breath(-1), 15 breaths·min(-1), and a FGF of 10 L·min(-1) while the washout of sevoflurane was performed in triplicate using a calibrated Datex Ohmeda Capnomac Ultima™ and a calibrated MIRAN SapphIRe XL ambient air analyzer until the concentration was ≤ 10 parts per million (ppm). The effects of decreasing the FGF to 5 and 2 L·min(-1) after the initial washout and of a charcoal filter in the ABC were recorded separately. The median washout times with the Aisys AWS (14 min, P Excel 210SE (32 min). The mean (95% confidence interval) washout time with the Aisys increased to 23.5 (21.5 to 25.5) min with VT 200 mL·breath(-1) (P < 0.01). Decreasing the FGF from 10 to 5 and 2 L·min(-1) with the Aisys caused a rebound in sevoflurane concentration to ≥ 50 ppm. Placement of a charcoal filter in the inspiratory limb reduced the sevoflurane concentration to < 2 ppm in the Aisys and Aestiva/5 AWSs within two minutes. The GE AWSs should be purged with large FGFs and VTs ~350 mL·breath(-1) for ~25 min to achieve 10 ppm sevoflurane. The FGF should be maintained to avoid a rebound in anesthetic concentration. Charcoal filters rapidly decrease the anesthetic concentration to < 2 ppm.

  2. Bedside Ultrasonography versus Brain Natriuretic Peptide in Detecting Cardiogenic Causes of Acute Dyspnea

    Directory of Open Access Journals (Sweden)

    Keihan Golshani

    2016-04-01

    Full Text Available Acute dyspnea is a common cause of hospitalization in emergency departments (ED.Distinguishing the cardiac causes of acute dyspnea from pulmonary ones is a major challenge for responsible physicians in EDs. This study compares the characteristics of bedside ultrasonography with serum level of blood natriuretic peptide (BNP in this regard. Methods: This diagnostic accuracy study compares bedside ultrasonography with serum BNP levels in differentiating cardiogenic causes of acute respiratory distress. Echocardiography was considered as the reference test. A checklist including demographic data (age and sex, vital signs, medical history, underlying diseases, serum level of BNP, as well as findings of chest radiography, chest ultrasonography, and echocardiography was filled for all patients with acute onset of dyspnea. Screening characteristics of the two studied methods were calculated and compared using SPSS software, version 20. Results: 48 patients with acute respiratory distress were evaluated (50% female. The mean age of participants was 66.94 ± 16.33 (28-94 years. Based on the results of echocardiography and final diagnosis, the cause of dyspnea was cardiogenic in 20 (41.6% cases. Bedside ultrasonography revealed the cardiogenic cause of acute dyspnea in 18 cases (0 false positive and BNP in 44 cases (24 false positives. The area under the ROC curve for bedside ultrasonography and BNP for differentiating the cardiogenic cause of dyspnea were 86.4 (95% CI: 74.6-98.3 and 66.3 (95% CI: 49.8-89.2, respectively (p = 0.0021. Conclusion: It seems that bedside ultrasonography could be considered as a helpful and accurate method in differentiating cardiogenic causes of acute dyspnea in emergency settings. Nevertheless, more study is needed to make a runaway algorithm to evaluate patients with respiratory distress using bedside ultrasonography, which leads to rapid therapeutic decisions in a short time.

  3. Assessment of dyspnea in terminally III cancer patients. Role of the thoracic surgeon as a palliative care physician

    International Nuclear Information System (INIS)

    Yoshino, Kazuo; Nishiumi, Noboru; Masuda, Ryota; Iwazaki, Masayuki; Saito, Yuki; Tokuda, Yutaka

    2011-01-01

    Many cancer patients suffer from rapidly-progressing dyspnea that is difficult to relieve. The subjects were 26 patients who had dyspnea that was difficult to relieve. The Numeric Rating Scale was used to evaluate their dyspnea. For all patients, the cause of the dyspnea was investigated by CT and x-rays. The principal causes of the dyspnea were pleural effusion that increased daily, complications from pneumonia, massive ascites, multiple metastatic lung tumors and atelectasis, recurrent laryngeal nerve paralysis and narrowing secondary airway compression. Dyspnea was caused by a variety of conditions that overlapped over time, intensifying patients' discomfort. Among 14 patients for whom we recommended treatment with sedation, only 8 of them consented. Among the patients who were treated with sedation, the median interval between the exacerbation of dyspnea and death was 16 days; among non-sedated patients it was 18 days. Palliative care physicians who specialize in the respiratory system can, to some extent, predict the occurrence of rapidly progressive dyspnea in cancer patients. It is important to explain the methods of relieving dyspnea to the patient, the patient's family, and the oncologist early, so that decisions on how to manage dyspnea can be made in advance. (author)

  4. Evaluation of three scales of dyspnea in chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    Chhabra, S K; Gupta, A K; Khuma, M Z

    2009-01-01

    The Modified Medical Research Council (MMRC) scale, baseline dyspnea index (BDI) and the oxygen cost diagram (OCD) are widely used tools for evaluation of limitation of activities due to dyspnea in patients with chronic obstructive pulmonary disease (COPD). There is, however, limited information on how these relate with each other and with multiple parameters of physiological impairment. To study the interrelationships between MMRC, BDI and OCD scales of dyspnea and their correlation with multiple measures of physiological impairment. A retrospective analysis of pooled data of 88 male patients with COPD (GOLD stages 2, 3 and 4) was carried out. Dyspnea was evaluated using the MMRC, BDI and OCD scales. Physiological impairment was assessed by spirometry (FVC % predicted and FEV 1 % predicted), arterial blood gas (ABG) analysis and measurement of the 6-min walk distance (6MWD). The interrelationships between MMRC, BDI and OCD scales were moderately strong. The BDI and OCD scores had strong correlations with ABG abnormalities, weak correlations with spirometric parameters but none with 6MWD. MMRC grades were significantly associated with BDI and OCD scores but did not show clear associations with spirometric parameters, ABG abnormalities and 6MWD. The MMRC grades of dyspnea and the BDI and OCD scales are moderately interrelated. While the BDI and OCD scales have significant associations with parameters of physiological impairment, the MMRC scale does not. (author)

  5. Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management

    Directory of Open Access Journals (Sweden)

    Georgios Psychogios

    2018-04-01

    Full Text Available Diffuse idiopathic skeletal hyperostosis (DISH is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary.In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected. The CT showed anterior osteophytes and ossification of the anterior longitudinal ligament from C2–C7. We performed a panendoscopy in order to explore the upper aerodigestive area. Postoperatively an emergency tracheotomy was needed due to the development of laryngeal edema. The osteophytes were removed in cooperation with the department of orthopaedics. Three months postoperative the patient had no dyspnea or dysphagia, so the tracheotomy could be closed.Cervical hyperostosis is commonly described in elderly patients and usually presenting without symptoms, therefore a surgical treatment is usually not necessary. Nevertheless it can lead to severe morbidity and dyspnea with airway obstruction. Therefore it is essential that cervical hyperostosis is recognized early enough and appropriate treatment is initiated. Flexible endoscopy should be preferred over direct panendoscopy because it could lead to life-threatening edema and a prophylactic tracheostomy should be strongly considered in patients that present with severe dyspnea,

  6. Modeling In-stream Tidal Energy Extraction and Its Potential Environmental Impacts

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Zhaoqing; Wang, Taiping; Copping, Andrea; Geerlofs, Simon H.

    2014-09-30

    In recent years, there has been growing interest in harnessing in-stream tidal energy in response to concerns of increasing energy demand and to mitigate climate change impacts. While many studies have been conducted to assess and map tidal energy resources, efforts for quantifying the associated potential environmental impacts have been limited. This paper presents the development of a tidal turbine module within a three-dimensional unstructured-grid coastal ocean model and its application for assessing the potential environmental impacts associated with tidal energy extraction. The model is used to investigate in-stream tidal energy extraction and associated impacts on estuarine hydrodynamic and biological processes in a tidally dominant estuary. A series of numerical experiments with varying numbers and configurations of turbines installed in an idealized estuary were carried out to assess the changes in the hydrodynamics and biological processes due to tidal energy extraction. Model results indicated that a large number of turbines are required to extract the maximum tidal energy and cause significant reduction of the volume flux. Preliminary model results also indicate that extraction of tidal energy increases vertical mixing and decreases flushing rate in a stratified estuary. The tidal turbine model was applied to simulate tidal energy extraction in Puget Sound, a large fjord-like estuary in the Pacific Northwest coast.

  7. Dissipation of Tidal Energy

    Science.gov (United States)

    2002-01-01

    The moon's gravity imparts tremendous energy to the Earth, raising tides throughout the global oceans. What happens to all this energy? This question has been pondered by scientists for over 200 years, and has consequences ranging from the history of the moon to the mixing of the oceans. Richard Ray at NASA's Goddard Space Flight Center, Greenbelt, Md. and Gary Egbert of the College of Oceanic and Atmospheric Sciences, Oregon State University, Corvallis, Ore. studied six years of altimeter data from the TOPEX/Poseidon satellite to address this question. According to their report in the June 15 issue of Nature, about 1 terawatt, or 25 to 30 percent of the total tidal energy dissipation, occurs in the deep ocean. The remainder occurs in shallow seas, such as on the Patagonian Shelf. 'By measuring sea level with the TOPEX/Poseidon satellite altimeter, our knowledge of the tides in the global ocean has been remarkably improved,' said Richard Ray, a geophysicist at Goddard. The accuracies are now so high that this data can be used to map empirically the tidal energy dissipation. (Red areas, above) The deep-water tidal dissipation occurs generally near rugged bottom topography (seamounts and mid-ocean ridges). 'The observed pattern of deep-ocean dissipation is consistent with topographic scattering of tidal energy into internal motions within the water column, resulting in localized turbulence and mixing', said Gary Egbert an associate professor at OSU. One important implication of this finding concerns the possible energy sources needed to maintain the ocean's large-scale 'conveyor-belt' circulation and to mix upper ocean heat into the abyssal depths. It is thought that 2 terawatts are required for this process. The winds supply about 1 terawatt, and there has been speculation that the tides, by pumping energy into vertical water motions, supply the remainder. However, all current general circulation models of the oceans ignore the tides. 'It is possible that properly

  8. A case of vogt-koyanagi-harada syndrome with persistent dyspnea secondary to laryngeal edema.

    Science.gov (United States)

    Mantopoulos, Dimosthenis; deSilva, Brad W; Cebulla, Colleen M

    2014-01-01

    We report a case of laryngeal edema associated with the Vogt-Koyanagi-Harada (VKH) syndrome. A 32-year-old African-American female presented with a 12-day prodrome, including headache, tinnitus and shortness of breath, which preceded sudden photophobia and bilateral visual loss. Examination and clinical testing were most consistent with VKH, and the patient improved with intravenous methylprednisolone therapy. The patient had persistent dyspnea, which was out of proportion to chest CT findings and which was exacerbated during a recurrence of VKH. Flexible fiberoptic laryngoscopy with stroboscopy revealed diffuse laryngeal edema. Symptoms were alleviated with breathing exercises. Several autoimmune diseases may cause diffuse laryngeal edema. In this case, VKH was associated with the patient's glottic edema and dyspnea. We recommend that laryngeal edema be considered in the differential diagnosis for patients with dyspnea and VKH.

  9. A Case of Vogt-Koyanagi-Harada Syndrome with Persistent Dyspnea Secondary to Laryngeal Edema

    Directory of Open Access Journals (Sweden)

    Dimosthenis Mantopoulos

    2014-11-01

    Full Text Available Purpose: We report a case of laryngeal edema associated with the Vogt-Koyanagi-Harada (VKH syndrome. Patient and Methods: A 32-year-old African-American female presented with a 12-day prodrome, including headache, tinnitus and shortness of breath, which preceded sudden photophobia and bilateral visual loss. Examination and clinical testing were most consistent with VKH, and the patient improved with intravenous methylprednisolone therapy. Results: The patient had persistent dyspnea, which was out of proportion to chest CT findings and which was exacerbated during a recurrence of VKH. Flexible fiberoptic laryngoscopy with stroboscopy revealed diffuse laryngeal edema. Symptoms were alleviated with breathing exercises. Conclusions: Several autoimmune diseases may cause diffuse laryngeal edema. In this case, VKH was associated with the patient's glottic edema and dyspnea. We recommend that laryngeal edema be considered in the differential diagnosis for patients with dyspnea and VKH.

  10. McArdle's Disease Presenting as Unexplained Dyspnea in a Young Woman

    Directory of Open Access Journals (Sweden)

    Nha Voduc

    2004-01-01

    Full Text Available McArdle's disease is a rare, inherited deficiency of myophosphorylase, an enzyme required for the utilization of glycogen. Patients with myophosphorylase deficiency classically present with exercise intolerance, leg pain and muscle fatigue. The case of a young woman with exertional dyspnea and leg cramps is described. Exercise testing confirmed the presence of exercise intolerance and demonstrated an accelerated heart rate response, despite the absence of an anaerobic threshold and a respiratory exchange ratio of less than 1.0. Subsequent ischemic forearm testing and muscle biopsy confirmed the diagnosis of myophosphorylase deficiency. Evaluation of lung mechanics with esophageal pressure measurements demonstrated the presence of respiratory muscle weakness and early fatiguability, suggesting that the patient's dyspnea might have been attributable to an increased respiratory effort. Dyspnea is not a classic symptom associated with myophosphorylase deficiency, although subclinical respiratory muscle impairment may be present. No previous studies have evaluated respiratory muscle function during exercise in patients with myophosphorylase deficiency.

  11. Tidal Venuses: triggering a climate catastrophe via tidal heating.

    Science.gov (United States)

    Barnes, Rory; Mullins, Kristina; Goldblatt, Colin; Meadows, Victoria S; Kasting, James F; Heller, René

    2013-03-01

    Traditionally, stellar radiation has been the only heat source considered capable of determining global climate on long timescales. Here, we show that terrestrial exoplanets orbiting low-mass stars may be tidally heated at high-enough levels to induce a runaway greenhouse for a long-enough duration for all the hydrogen to escape. Without hydrogen, the planet no longer has water and cannot support life. We call these planets "Tidal Venuses" and the phenomenon a "tidal greenhouse." Tidal effects also circularize the orbit, which decreases tidal heating. Hence, some planets may form with large eccentricity, with its accompanying large tidal heating, and lose their water, but eventually settle into nearly circular orbits (i.e., with negligible tidal heating) in the habitable zone (HZ). However, these planets are not habitable, as past tidal heating desiccated them, and hence should not be ranked highly for detailed follow-up observations aimed at detecting biosignatures. We simulated the evolution of hypothetical planetary systems in a quasi-continuous parameter distribution and found that we could constrain the history of the system by statistical arguments. Planets orbiting stars with massesplanet orbiting a 0.3 MSun star at 0.12 AU. We found that it probably did not lose its water via tidal heating, as orbital stability is unlikely for the high eccentricities required for the tidal greenhouse. As the inner edge of the HZ is defined by the onset of a runaway or moist greenhouse powered by radiation, our results represent a fundamental revision to the HZ for noncircular orbits. In the appendices we review (a) the moist and runaway greenhouses, (b) hydrogen escape, (c) stellar mass-radius and mass-luminosity relations, (d) terrestrial planet mass-radius relations, and (e) linear tidal theories.

  12. Ebb-tidal delta morphology in response to a storm surge barrier

    NARCIS (Netherlands)

    Eelkema, M.; Wang, Z.B.; Hibma, A.

    2012-01-01

    The Eastern Scheldt ebb-tidal delta morphology has been adapting for the past 25 years in response to the construction of the Eastern Scheldt storm-surge barrier in 1986. As a result of the barrier, there has been a decrease in tidal amplitudes, volumes, and average flow velocities, and there is

  13. Tidal Energy Research

    Energy Technology Data Exchange (ETDEWEB)

    Stelzenmuller, Nickolas [Univ of Washington; Aliseda, Alberto [Univ of Washington; Palodichuk, Michael [Univ of Washington; Polagye, Brian [Univ of Washington; Thomson, James [Univ of Washington; Chime, Arshiya [Univ of Washington; Malte, Philip [Univ of washington

    2014-03-31

    This technical report contains results on the following topics: 1) Testing and analysis of sub-scale hydro-kinetic turbines in a flume, including the design and fabrication of the instrumented turbines. 2) Field measurements and analysis of the tidal energy resource and at a site in northern Puget Sound, that is being examined for turbine installation. 3) Conceptual design and performance analysis of hydro-kinetic turbines operating at high blockage ratio, for use for power generation and flow control in open channel flows.

  14. Sedimentary structures of tidal flats

    Indian Academy of Sciences (India)

    Sedimentary structures of some coastal tropical tidal flats of the east coast of India, and inner estuarine tidal point bars located at 30 to 50 kilometers inland from the coast, have been extensively studied under varying seasonal conditions. The results reveal that physical features such as flaser bedding, herringbone ...

  15. Right sided arcus aorta as a cause of dyspnea and chronic cough

    Directory of Open Access Journals (Sweden)

    Ozkaya Sevket

    2012-10-01

    Full Text Available Abstract Background Right sided arcus aorta (RSAA is a rare condition that is usually asymptomatic. Patients may present with exertional dyspnea and chronic cough. A recent article suggested that RSAA should be included in the differential diagnosis of asthma, especially in patients with intractable exertional dyspnea. We aimed to present the clinical, radiologic and spirometric features of thirteen patients with RSAA observed in four years at the Rize Education and Research Hospital and Samsun Chest Diseases and Thoracic Surgery Hospital. Methods The characteristics of patients with RSAA, including age, gender, symptoms, radiologic and spirometric findings, were retrospectively evaluated. Results A total of thirteen patients were diagnosed with RSAA. Their ages ranged from 17 to 86 years and the male to female ratio was 11:2. Seven of the patients (54% were symptomatic. The most common symptoms were exertional dyspnea, dysphagia and chronic cough. Five patients had received treatment for asthma with bronchodilators. Spirometry showed intrathoracic tracheal obstruction in five patients. Conclusions The RSAA anomaly occurs more frequently than might be estimated from the number of patients who are detected. Patients with intractable exertional dyspnea and chronic cough should be evaluated for the RSAA anomaly by thoracic CT.

  16. Prevalence of diastolic dysfunction as a possible cause of dyspnea in the elderly

    DEFF Research Database (Denmark)

    Pedersen, Frants; Raymond, Ilan; Mehlsen, Jesper

    2005-01-01

    Symptoms in patients with heart failure and preserved left ventricular ejection fraction may be caused by isolated diastolic dysfunction. The purpose of this study was to assess the prevalence of diastolic dysfunction as a potential cause of dyspnea in a sample of elderly subjects, as well as of ...

  17. Tidal heating in multilayered terrestrial exoplanets

    Energy Technology Data Exchange (ETDEWEB)

    Henning, Wade G.; Hurford, Terry, E-mail: wade.g.henning@nasa.gov [NASA Goddard Space Flight Center, 8800 Greenbelt Road, Greenbelt, MD 20771 (United States)

    2014-07-01

    The internal pattern and overall magnitude of tidal heating for spin-synchronous terrestrial exoplanets from 1 to 2.5 R{sub E} is investigated using a propagator matrix method for a variety of layer structures. Particular attention is paid to ice-silicate hybrid super-Earths, where a significant ice mantle is modeled to rest atop an iron-silicate core, and may or may not contain a liquid water ocean. We find multilayer modeling often increases tidal dissipation relative to a homogeneous model, across multiple orbital periods, due to the ability to include smaller volume low viscosity regions, and the added flexure allowed by liquid layers. Gradations in parameters with depth are explored, such as allowed by the Preliminary Earth Reference Model. For ice-silicate hybrid worlds, dramatically greater dissipation is possible beyond the case of a silicate mantle only, allowing non-negligible tidal activity to extend to greater orbital periods than previously predicted. Surface patterns of tidal heating are found to potentially be useful for distinguishing internal structure. The influence of ice mantle depth and water ocean size and position are shown for a range of forcing frequencies. Rates of orbital circularization are found to be 10-100 times faster than standard predictions for Earth-analog planets when interiors are moderately warmer than the modern Earth, as well as for a diverse range of ice-silicate hybrid super-Earths. Circularization rates are shown to be significantly longer for planets with layers equivalent to an ocean-free modern Earth, as well as for planets with high fractions of either ice or silicate melting.

  18. Tidal Heating in Multilayered Terrestrial Exoplanets

    Science.gov (United States)

    Henning, Wade G.; Hurford, Terry

    2014-01-01

    The internal pattern and overall magnitude of tidal heating for spin-synchronous terrestrial exoplanets from 1 to 2.5 R(sub E) is investigated using a propagator matrix method for a variety of layer structures. Particular attention is paid to ice-silicate hybrid super-Earths, where a significant ice mantle is modeled to rest atop an iron-silicate core, and may or may not contain a liquid water ocean. We find multilayer modeling often increases tidal dissipation relative to a homogeneous model, across multiple orbital periods, due to the ability to include smaller volume low viscosity regions, and the added flexure allowed by liquid layers. Gradations in parameters with depth are explored, such as allowed by the Preliminary Earth Reference Model. For ice-silicate hybrid worlds, dramatically greater dissipation is possible beyond the case of a silicate mantle only, allowing non-negligible tidal activity to extend to greater orbital periods than previously predicted. Surface patterns of tidal heating are found to potentially be useful for distinguishing internal structure. The influence of ice mantle depth and water ocean size and position are shown for a range of forcing frequencies. Rates of orbital circularization are found to be 10-100 times faster than standard predictions for Earth-analog planets when interiors are moderately warmer than the modern Earth, as well as for a diverse range of ice-silicate hybrid super-Earths. Circularization rates are shown to be significantly longer for planets with layers equivalent to an ocean-free modern Earth, as well as for planets with high fractions of either ice or silicate melting.

  19. Tidal heating in multilayered terrestrial exoplanets

    International Nuclear Information System (INIS)

    Henning, Wade G.; Hurford, Terry

    2014-01-01

    The internal pattern and overall magnitude of tidal heating for spin-synchronous terrestrial exoplanets from 1 to 2.5 R E is investigated using a propagator matrix method for a variety of layer structures. Particular attention is paid to ice-silicate hybrid super-Earths, where a significant ice mantle is modeled to rest atop an iron-silicate core, and may or may not contain a liquid water ocean. We find multilayer modeling often increases tidal dissipation relative to a homogeneous model, across multiple orbital periods, due to the ability to include smaller volume low viscosity regions, and the added flexure allowed by liquid layers. Gradations in parameters with depth are explored, such as allowed by the Preliminary Earth Reference Model. For ice-silicate hybrid worlds, dramatically greater dissipation is possible beyond the case of a silicate mantle only, allowing non-negligible tidal activity to extend to greater orbital periods than previously predicted. Surface patterns of tidal heating are found to potentially be useful for distinguishing internal structure. The influence of ice mantle depth and water ocean size and position are shown for a range of forcing frequencies. Rates of orbital circularization are found to be 10-100 times faster than standard predictions for Earth-analog planets when interiors are moderately warmer than the modern Earth, as well as for a diverse range of ice-silicate hybrid super-Earths. Circularization rates are shown to be significantly longer for planets with layers equivalent to an ocean-free modern Earth, as well as for planets with high fractions of either ice or silicate melting.

  20. Comparing dynamic hyperinflation and associated dyspnea induced by metronome-paced tachypnea versus incremental exercise.

    Science.gov (United States)

    Calligaro, Gregory L; Raine, Richard I; Bateman, Mary E; Bateman, Eric D; Cooper, Christopher B

    2014-02-01

    Dynamic hyperinflation (DH) during exercise is associated with both dyspnea and exercise limitation in COPD. Metronome-paced tachypnoea (MPT) is a simple alternative for studying DH. We compared MPT with exercise testing (XT) as methods of provoking DH, and assessed their relationship with dyspnea. We studied 24 patients with moderate COPD (FEV1 59 ± 9% predicted) after inhalation of ipratropium/salbutamol combination or placebo in a double-blind, crossover design. Inspiratory capacity (IC) was measured at baseline and after 30 seconds of MPT with breathing frequencies (fR) of 20, 30 and 40 breaths/min and metronome-defined I:E ratios of 1:1 and 1:2, in random sequence, followed by incremental cycle ergometry with interval determinations of IC. DH was defined as a decline in IC from baseline (∆IC) for both methods. Dyspnea was assessed using a Borg CR-10 scale. ∆IC during MPT was greater with higher fR and I:E ratio of 1:1 versus 1:2, and less when patients were treated with bronchodilator rather than placebo (P = 0.032). DH occurred during 19 (40%) XTs, and during 35 (73%) tests using MPT. Eleven of 18 (61%) non-congruent XTs (where DH occurred on MPT but not XT) terminated before fR of 40 breaths/min was reached. Although greater during XT, the intensity of dyspnea bore no relationship to DH during either MPT and XT. MPT at 40 breaths/min and I:E of 1:1 elicits the greatest ∆IC, and is a more sensitive method for demonstrating DH. The relationship between DH and dyspnea is complex and not determined by DH alone.

  1. Dyspnea descriptors developed in Brazil: application in obese patients and in patients with cardiorespiratory diseases.

    Science.gov (United States)

    Teixeira, Christiane Aires; Rodrigues Júnior, Antonio Luiz; Straccia, Luciana Cristina; Vianna, Elcio Dos Santos Oliveira; Silva, Geruza Alves da; Martinez, José Antônio Baddini

    2011-01-01

    To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rápido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiração (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiração clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/inspiração, and falta de ar clusters. Obesity was associated only with the falta de ar cluster. In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.

  2. Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED.

    Science.gov (United States)

    Zanobetti, Maurizio; Scorpiniti, Margherita; Gigli, Chiara; Nazerian, Peiman; Vanni, Simone; Innocenti, Francesca; Stefanone, Valerio T; Savinelli, Caterina; Coppa, Alessandro; Bigiarini, Sofia; Caldi, Francesca; Tassinari, Irene; Conti, Alberto; Grifoni, Stefano; Pini, Riccardo

    2017-06-01

    Acute dyspnea is a common symptom in the ED. The standard approach to dyspnea often relies on radiologic and laboratory results, causing excessive delay before adequate therapy is started. Use of an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis, while maintaining an acceptable safety profile. Consecutive adult patients presenting with dyspnea and admitted after ED evaluation were prospectively enrolled. The gold standard was the final diagnosis assessed by two expert reviewers. Two physicians independently evaluated the patient; a sonographer performed an ultrasound evaluation of the lung, heart, and inferior vena cava, while the treating physician requested traditional tests as needed. Time needed to formulate the ultrasound and the ED diagnoses was recorded and compared. Accuracy and concordance of the ultrasound and the ED diagnoses were calculated. A total of 2,683 patients were enrolled. The average time needed to formulate the ultrasound diagnosis was significantly lower than that required for ED diagnosis (24 ± 10 min vs 186 ± 72 min; P = .025). The ultrasound and the ED diagnoses showed good overall concordance (κ = 0.71). There were no statistically significant differences in the accuracy of PoCUS and the standard ED evaluation for the diagnosis of acute coronary syndrome, pneumonia, pleural effusion, pericardial effusion, pneumothorax, and dyspnea from other causes. PoCUS was significantly more sensitive for the diagnosis of heart failure, whereas a standard ED evaluation performed better in the diagnosis of COPD/asthma and pulmonary embolism. PoCUS represents a feasible and reliable diagnostic approach to the patient with dyspnea, allowing a reduction in time to diagnosis. This protocol could help to stratify patients who should undergo a more detailed evaluation. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  3. Tidal energy in France

    International Nuclear Information System (INIS)

    Lemperiere, F.

    2010-01-01

    The author first discusses the potential theoretical production of tidal energy in the world and more particularly in France, and compares this potential production with that of hydroelectric energy. He discusses the existence of potentially interesting sites in France in terms of sizing and exploitation modes. He describes the main associated works for turbines and sea walls, impacts on the environment, on the economy and on employment. He discusses the production possibilities and their cost, and the issue of energy storage. He indicates sites which could be built before 2025: Saint-Brieuc, Portbail-Coutainville or Granville, Mers or Cayeux, Penly or Saint-Valery en Caux. For each of this site, the author describes the project implantation, gives an gross assessment of the construction cost, and therefore of the kWh cost

  4. Impact of Blunted Perception of Dyspnea on Medical Care Use and Expenditure, and Mortality in Elderly People

    Directory of Open Access Journals (Sweden)

    Satoru eEbihara

    2012-07-01

    Full Text Available Dyspnea is an alarming symptom responsible for millions of patient visits each year. Poor perception of dyspnea might be reasonably attributed to an inappropriately low level of fear and inadequate earlier medical treatment for both patients and physicians, resulting in subsequent intensive care. This study was conducted to evaluate medical care use and cost, and mortality according to the perception of dyspnea in community-dwelling elderly people. We analyzed baseline data from a community-based Comprehensive Geriatric Assessment (CGA in 2002. The perception of dyspnea in 479 Japanese community-dwelling elderly people with normal lung function was measured in August 2002. The sensation of dyspnea during breathing with a linear inspiratory resistance of 10, 20 and 30 cmH2O/L/s was rated using the Borg scale. According to the perception of dyspnea, we divided the elderly into tertiles and compared all hospitalizations, out-patient visits, costs and death through computerized linkage with National Health Insurance (NHI beneficiaries claims history files between August 2002 and March 2008. In-patient hospitalization days and medical care costs significantly increased with the blunted perception of dyspnea, resulting in an increase in total medical-costs with blunted perception of dyspnea. With low perception group as reference, the hazard ratios of all cause mortality were 0.65 (95%CI 0.23-1.89 for intermediate perception group and 0.31(0.10-0.97 for high perception group, indicating the mortality rate also significantly increased with the blunted perception of dyspnea after multivariates adjustment (p=0.04. The blunted perception of dyspnea is related to hospitalization, large medical costs and all-cause mortality in community-dwelling elderly people. These findings provide a rational for preventing serious illness with careful monitoring of objective conditions in the elderly.

  5. Tidal energy site - Tidal energy site mammal/bird survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — A vessel-based line visual transect survey was conducted for birds and marine mammals near the proposed Snohomish County PUD Admiralty Inlet tidal energy site...

  6. Tidal Venuses: Triggering a Climate Catastrophe via Tidal Heating

    Science.gov (United States)

    Mullins, Kristina; Goldblatt, Colin; Meadows, Victoria S.; Kasting, James F.; Heller, René

    2013-01-01

    Abstract Traditionally, stellar radiation has been the only heat source considered capable of determining global climate on long timescales. Here, we show that terrestrial exoplanets orbiting low-mass stars may be tidally heated at high-enough levels to induce a runaway greenhouse for a long-enough duration for all the hydrogen to escape. Without hydrogen, the planet no longer has water and cannot support life. We call these planets “Tidal Venuses” and the phenomenon a “tidal greenhouse.” Tidal effects also circularize the orbit, which decreases tidal heating. Hence, some planets may form with large eccentricity, with its accompanying large tidal heating, and lose their water, but eventually settle into nearly circular orbits (i.e., with negligible tidal heating) in the habitable zone (HZ). However, these planets are not habitable, as past tidal heating desiccated them, and hence should not be ranked highly for detailed follow-up observations aimed at detecting biosignatures. We simulated the evolution of hypothetical planetary systems in a quasi-continuous parameter distribution and found that we could constrain the history of the system by statistical arguments. Planets orbiting stars with massestidal heating. We have applied these concepts to Gl 667C c, a ∼4.5 MEarth planet orbiting a 0.3 MSun star at 0.12 AU. We found that it probably did not lose its water via tidal heating, as orbital stability is unlikely for the high eccentricities required for the tidal greenhouse. As the inner edge of the HZ is defined by the onset of a runaway or moist greenhouse powered by radiation, our results represent a fundamental revision to the HZ for noncircular orbits. In the appendices we review (a) the moist and runaway greenhouses, (b) hydrogen escape, (c) stellar mass-radius and mass-luminosity relations, (d) terrestrial planet mass-radius relations, and (e) linear tidal theories. Key Words: Extrasolar terrestrial planets—Habitability—Habitable zone

  7. Simple artificial training device for respiratory muscle strength and lung volumes in healthy young male and female subjects: A pilot study.

    Science.gov (United States)

    Leelarungrayub, Jirakrit; Pinkaew, Decha; Yankai, Araya; Chautrakoon, Busaba; Kuntain, Rungtiwa

    2017-10-01

    The aim of this study was to evaluate the efficiency of a simple artificial device for respiratory muscle strength training and lung volumes using either combined or non-combined exercise with elastic bands in healthy young participants. Forty healthy young participants (20 male and 20 female) aged 19-24 years old were randomized into two main experiments with four sub-groups; (1) artificial device (n = 10) & standard device (n = 10) training, and (2) artificial device training combined with elastic band (EB) exercise (n = 10) & standard device training combined with EB (n = 10) exercise. Respiratory muscle strength with maximal peak inspiratory pressure (PImax), and lung volumes; tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and vital capacity (VC) were evaluated before and after training once daily for 3 weeks. Moreover, the peak dyspnea score and vital sign parameters were compared between the experimental groups after final training. All parameters had no statistical differences (p > 0.5) between the training devices alone and those combined with EB exercise prior to any experiments. Results from the first experiment showed that training with an artificial device increased all parameters (PImax, VC, IRV, ERV) significantly (p artificial device training combined with EB exercise showed a significant increase in all parameters, except for TV, and they were the same as the increased results in training with the standard device combined with EB exercise. There was no significant difference of data between these groups after the training period. Finally, the results of peak dyspnea score and all vital sign parameters from using the artificial device, with or without EB exercise, showed no statistical difference when compared to use of the standard device. This study proposed that a simple artificial device can be used to train the respiratory muscle with or without elastic band exercise in healthy young subjects

  8. On luminescence bleaching of tidal channel sediments

    DEFF Research Database (Denmark)

    Fruergaard, Mikkel; Pejrup, Morten; Murray, Andrew S.

    2015-01-01

    We investigate the processes responsible for bleaching of the quartz OSL signal from tidal channel sediment. Tidal dynamics are expected to play an important role for complete bleaching of tidal sediments. However, no studies have examined the amount of reworking occurring in tidal channels...... and on tidal flats due to the mixing caused by currents and waves. We apply bed level data to evaluate the amount of vertical sediment reworking in modern tidal channels and at a tidal flat. Cycles of deposition and erosion are measured with a bed level sensor, and the results show that gross sedimentation...... was several times higher than net sedimentation. We propose that tidal channel sediment is bleached either on the tidal flat before it is transported to the tidal channels and incorporated in channel-fill successions or, alternatively, on the shallow intertidal part of the channel banks. Based...

  9. Tidal Creek Sentinel Habitat Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Ecological Research, Assessment and Prediction's Tidal Creeks: Sentinel Habitat Database was developed to support the National Oceanic and Atmospheric...

  10. Relationships between respiratory and airway resistances and activity-related dyspnea in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Plantier L

    2012-03-01

    Full Text Available Bruno Mahut1,2, Aurore Caumont-Prim3,4, Laurent Plantier1,5, Karine Gillet-Juvin1,6, Etienne Callens1, Olivier Sanchez5,6, Brigitte Chevalier-Bidaud3, Plamen Bokov1, Christophe Delclaux1,5,71Assistance Publique – Hôpitaux de Paris (AP-HP, Hôpital Européen Georges Pompidou, Service de Physiologie – Clinique de la Dyspnée, F-75015 Paris, France; 2Cabinet La Berma, 4 avenue de la Providence; F-92160 Antony, France; 3AP-HP, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, F-75015 Paris, France; 4INSERM, Centre d'Investigation Épidémiologique 4, F-75015 Paris, France; 5Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75015 Paris, France; 6AP-HP, Hôpital Européen Georges Pompidou, Service de Pneumologie; F-75015 Paris, France; 7CIC 9201 Plurithématique, Hôpital Européen Georges Pompidou, F-75015 Paris, FranceBackground: The aims of the study were: (1 to compare numerical parameters of specific airway resistance (total, sRawtot, effective, sRaweff and at 0.5 L • s-1, sRaw0.5 and indices obtained from the forced oscillation technique (FOT: resistance extrapolated at 0 Hz [Rrs0 Hz], mean resistance [Rrsmean], and resistance/frequency slope [Rrsslope] and (2 to assess their relationships with dyspnea in chronic obstructive pulmonary disease (COPD.Methods: A specific statistical approach, principal component analysis that also allows graphic representation of all correlations between functional parameters was used. A total of 108 patients (mean ± SD age: 65 ± 9 years, 31 women; GOLD stages: I, 14; II, 47; III, 39 and IV, 8 underwent spirometry, body plethysmography, FOT, and Medical Research Council (MRC scale assessments.Results: Principal component analysis determined that the functional parameters were described by three independent dimensions (airway caliber, lung volumes and their combination, specific resistance and that resistance parameters of the two techniques

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

    Science.gov (United States)

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

    2017-11-01

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

  12. Tidal locking of habitable exoplanets

    Science.gov (United States)

    Barnes, Rory

    2017-12-01

    Potentially habitable planets can orbit close enough to their host star that the differential gravity across their diameters can produce an elongated shape. Frictional forces inside the planet prevent the bulges from aligning perfectly with the host star and result in torques that alter the planet's rotational angular momentum. Eventually the tidal torques fix the rotation rate at a specific frequency, a process called tidal locking. Tidally locked planets on circular orbits will rotate synchronously, but those on eccentric orbits will either librate or rotate super-synchronously. Although these features of tidal theory are well known, a systematic survey of the rotational evolution of potentially habitable exoplanets using classic equilibrium tide theories has not been undertaken. I calculate how habitable planets evolve under two commonly used models and find, for example, that one model predicts that the Earth's rotation rate would have synchronized after 4.5 Gyr if its initial rotation period was 3 days, it had no satellites, and it always maintained the modern Earth's tidal properties. Lower mass stellar hosts will induce stronger tidal effects on potentially habitable planets, and tidal locking is possible for most planets in the habitable zones of GKM dwarf stars. For fast-rotating planets, both models predict eccentricity growth and that circularization can only occur once the rotational frequency is similar to the orbital frequency. The orbits of potentially habitable planets of very late M dwarfs ([InlineEquation not available: see fulltext.]) are very likely to be circularized within 1 Gyr, and hence, those planets will be synchronous rotators. Proxima b is almost assuredly tidally locked, but its orbit may not have circularized yet, so the planet could be rotating super-synchronously today. The evolution of the isolated and potentially habitable Kepler planet candidates is computed and about half could be tidally locked. Finally, projected TESS planets

  13. High-resolution modeling assessment of tidal stream resource in Western Passage of Maine, USA

    Science.gov (United States)

    Yang, Zhaoqing; Wang, Taiping; Feng, Xi; Xue, Huijie; Kilcher, Levi

    2017-04-01

    Although significant efforts have been taken to assess the maximum potential of tidal stream energy at system-wide scale, accurate assessment of tidal stream energy resource at project design scale requires detailed hydrodynamic simulations using high-resolution three-dimensional (3-D) numerical models. Extended model validation against high quality measured data is essential to minimize the uncertainties of the resource assessment. Western Passage in the State of Maine in U.S. has been identified as one of the top ranking sites for tidal stream energy development in U.S. coastal waters, based on a number of criteria including tidal power density, market value and transmission distance. This study presents an on-going modeling effort for simulating the tidal hydrodynamics in Western Passage using the 3-D unstructured-grid Finite Volume Community Ocean Model (FVCOM). The model domain covers a large region including the entire the Bay of Fundy with grid resolution varies from 20 m in the Western Passage to approximately 1000 m along the open boundary near the mouth of Bay of Fundy. Preliminary model validation was conducted using existing NOAA measurements within the model domain. Spatial distributions of tidal power density were calculated and extractable tidal energy was estimated using a tidal turbine module embedded in FVCOM under different tidal farm scenarios. Additional field measurements to characterize resource and support model validation were discussed. This study provides an example of high resolution resource assessment based on the guidance recommended by the International Electrotechnical Commission Technical Specification.

  14. Simple Tidal Prism Models Revisited

    Science.gov (United States)

    Luketina, D.

    1998-01-01

    Simple tidal prism models for well-mixed estuaries have been in use for some time and are discussed in most text books on estuaries. The appeal of this model is its simplicity. However, there are several flaws in the logic behind the model. These flaws are pointed out and a more theoretically correct simple tidal prism model is derived. In doing so, it is made clear which effects can, in theory, be neglected and which can not.

  15. Impact of intertidal area characteristics on estuarine tidal hydrodynamics: A modelling study for the Scheldt Estuary

    Science.gov (United States)

    Stark, J.; Smolders, S.; Meire, P.; Temmerman, S.

    2017-11-01

    Marsh restoration projects are nowadays being implemented as ecosystem-based strategies to reduce flood risks and to restore intertidal habitat along estuaries. Changes in estuarine tidal hydrodynamics are expected along with such intertidal area changes. A validated hydrodynamic model of the Scheldt Estuary is used to gain fundamental insights in the role of intertidal area characteristics on tidal hydrodynamics and tidal asymmetry in particular through several geomorphological scenarios in which intertidal area elevation and location along the estuary is varied. Model results indicate that the location of intertidal areas and their storage volume relative to the local tidal prism determine the intensity and reach along the estuary over which tidal hydrodynamics are affected. Our model results also suggest that intertidal storage areas that are located within the main estuarine channel system, and hence are part of the flow-carrying part of the estuary, may affect tidal hydrodynamics differently than intertidal areas that are side-basins of the main estuarine channel, and hence only contribute little to the flow-carrying cross-section of the estuary. If tidal flats contribute to the channel cross-section and exert frictional effects on the tidal propagation, the elevation of intertidal flats influences the magnitude and direction of tidal asymmetry along estuarine channels. Ebb-dominance is most strongly enhanced if tidal flats are around mean sea level or slightly above. Conversely, flood-dominance is enhanced if the tidal flats are situated low in the tidal frame. For intertidal storage areas at specific locations besides the main channel, flood-dominance in the estuary channel peaks in the vicinity of those areas and generally reduces upstream and downstream compared to a reference scenario. Finally, the model results indicate an along-estuary varying impact on the tidal prism as a result of adding intertidal storage at a specific location. In addition to known

  16. Dyspnea in the ambulance - etiology, mortality, and point-of-care diagnostics

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann

    2016-01-01

    dyspnea in the ambulance requires identification of high-risk groups and early correct treatment. Bringing forward simplified versions of advanced diagnostic modalities known from the hospital as point-of-care diagnostics already in the ambulance may aid the discrimination of underlying conditions causing......, we included all patients dialing the emergency number (1-1-2) due to a medical emergency in three of five Danish regions. For identification of highrisk patients and evaluation of electrocardiogram-based triage, we compared short-term mortality between patients included in the first study based...... that are highly prioritized in emergency medical services – including chest pain and trauma. Whether this increased mortality can be ascribed to an older age and comorbidity among patients suffering dyspnea, or if modifiable risk factors are also present, is unsettled. Improving outcome for patients suffering...

  17. Anterior cervical osteophytes causing dysphagia and dyspnea: an uncommon entity revisited.

    Science.gov (United States)

    Giger, Roland; Dulguerov, Pavel; Payer, Michael

    2006-10-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis (DISH). We present the case of an 83-year-old patient with progressive dysphagia and acute dyspnea, necessitating emergency tracheotomy. Voluminous anterior cervical osteophytes extending from C3 to C7 and narrowing the pharyngoesophageal segment by external compression and bilateral vocal fold immobility were diagnosed radiologically and by fiberoptic laryngoscopy. Surgical removal of all osteophytes led to the resolution of symptoms. Dyspnea with or without dysphagia caused by hypertrophic anterior cervical osteophytes is an uncommon entity. The exhaustive diagnostic workup proposed in the literature could be simplified by using fiberoptic laryngoscopy and dynamic videofluoroscopy. The causes, treatment, and outcome are discussed.

  18. Unexplained dyspnea in a patient of chronic arsenicosis: A diagnostic challenge and learning curve for physicians

    Directory of Open Access Journals (Sweden)

    Amitabha Sengupta

    2015-01-01

    Full Text Available Chronic arsenic exposure causes cutaneous effects like hyperkeratosis, peripheral vascular disease, hypertension, ischemic heart disease, non-cirrhotic portal hypertension, hepatomegaly, peripheral neuropathy, respiratory involvement, bad obstetrical outcome, hematological disturbances, and diabetes mellitus. Here we present a case of a 24-year-old lady, with chronic exposure to arsenic, presenting to us with progressive dyspnea. We found pulmonary arterial hypertension (PAH as a cause of her dyspnea. PAH can occur in arsenicosis, secondary to arsenic-induced chronic obstructive pulmonary disease (COPD, lung fibrosis, and portal hypertension, which we excluded by appropriate investigations in our case. We also excluded a familial or heritable form of PAH. Thus, with the exclusion of all these secondary causes of PAH, as well as a hereditary cause, we came to a conclusion that this PAH might be due to chronic arsenic exposure. To the best of our knowledge, no case of PAH in chronic arsenicosis has been reported to date.

  19. Policy for tidal energy

    Energy Technology Data Exchange (ETDEWEB)

    Shaw, T L

    1977-01-01

    The potential of tidal energy for the United Kingdom should be reassessed, it is argued, and some of its advantages are cited. The technology for its development is available and proven; experience suggests that the capital works will have an indefinite life, with only the turbine blades needing to be replaced occasionally. It is a source of water power, and can be regulated to generate when required, on a flexible basis and only by day if so desired; this compares favorably with the relatively unpredictable nature of the other sources. It can be made to complement directly, and so to improve the performance of the coal and nuclear sources at a scale readily possible from a proportionately small installed capacity. The fuel is free. Present indications unquestionably suggest that it will be timely to reassess this source as part of the present energy review, so that its potential may be realized when needed after 1990. It is especially significant that the environmental effects of the necessary works appear to be comparatively small whereas the industrial and social rewards, so far not financially quantified, could be appreciable. The disadvantages that have been expressed are cited, but the author counters the attack on them. (MCW)

  20. Tidal interaction of galaxies

    International Nuclear Information System (INIS)

    Kozlov, N.N.; Syunyaev, R.A.; Ehneev, T.M.

    1974-01-01

    One of the hypotheses explaining the occurrence of anomalous details in interacting galaxies has been investigated. Pairs of galaxies with 'tails' oppositely directed or neighbouring galaxies with cofferdams 'bridges', as if connecting the galaxies, are called interacting galaxies. The hypothesis connects the origin of cofferdams and 'tails' of interacting galaxies with tidal effects ; the action of power gravitational forces in the intergalactic space. A source of such forces may be neighbouring stellar systems or invisible bodies, for instance, 'dead' quasars after a gravitational collapse. The effect of large masses of matter on the galaxy evolution has been investigated in the Institute of Applied Mathematics of the Academy of Sciences of the USSSR in 1971-1972 by numerical simulation of the process on a digital computer with the subsequent data transmission on a display. Different versions of a massive body flight relative to a galaxy disk are considered. Photographs of a display screen at different moments of time are presented. As a result of mathematical simulation of galaxies gravitational interactions effects are discovered which resemble real structures in photographs of galaxies. It seems to be premature to state that namely these mechanisms cause the formation of 'tails' and cofferdams between galaxies. However, even now it is clear that the gravitational interaction strongly affects the dynamics of the stellar system evolution. Further studies should ascertain a true scale of this effect and its genuine role in galaxy evolution

  1. Perception of urge-to-cough and dyspnea in healthy smokers with decreased cough reflex sensitivity

    OpenAIRE

    Kanezaki, Masashi; Ebihara, Satoru; Nikkuni, Etsuhiro; Gui, Peijun; Suda, Chihiro; Ebihara, Takae; Yamasaki, Miyako; Kohzuki, Masahiro

    2010-01-01

    Background Although cigarette smoking has been implicated as an important risk factor for the development of respiratory symptoms, the perceptional aspects of two symptoms in smokers have not been fully elucidated. Therefore, we simultaneously evaluated the cough reflex sensitivity, the cognition of urge-to-cough and perception of dyspnea in both healthy smokers and non-smokers. Methods Fourteen male healthy never-smokers and 14 age-matched male healthy current-smokers were recruited via publ...

  2. Relationship Among Pulmonary Hypertension, Autoimmunity, Thyroid Hormones and Dyspnea in Patients With Hyperthyroidism.

    Science.gov (United States)

    Zuhur, Sayid Shafi; Baykiz, Derya; Kara, Sonat Pinar; Sahin, Ertan; Kuzu, Idris; Elbuken, Gulsah

    2017-04-01

    Previous studies have reported conflicting results regarding the mechanisms underlying the pathophysiology of pulmonary hypertension (PHT) in patients with hyperthyroidism. Therefore, in this study, we investigated the association between PHT and thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3, fT4 and dyspnea during daily activities in a large population of patients with hyperthyroidism. A total of 129 consecutive patients with hyperthyroidism, 37 with hypothyroidism and 38 euthyroid controls were enrolled in this study. The modified medical research council scale was used for the assessment of dyspnea in daily activities. All the patients and euthyroid controls underwent transthoracic echocardiography for the assessment of PHT. Mild PHT was present in 35%, 36%, 13.5% and 5% of the patients with Graves׳ disease, toxic multinodular goiter, hypothyroidism and euthyroid controls, respectively. Pulmonary vascular resistance (PVR) was higher in hyperthyroid patients with PHT than in those without PHT. Moreover, a significant positive correlation was found between modified medical research council scale and pulmonary artery systolic pressure as well as PVR in patients with hyperthyroidism. No association was found between PHT and serum TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3 and fT4 levels. Mild PHT is present in a significant proportion of patients with hyperthyroidism, regardless of etiology. PVR appears to be the main cause of PHT in patients with hyperthyroidism, and neither autoimmunity nor thyroid hormones are associated with PHT in these patients. Mild dyspnea during daily activities in patients with hyperthyroidism may be related to PHT; however, severe dyspnea requires further evaluation. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  3. Anterior Cervical Osteophytes Causing Dysphagia and Dyspnea: An Uncommon Entity Revisited

    OpenAIRE

    Giger, Roland; Dulguerov, Pavel; Payer, Michael

    2007-01-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis (DISH). We present the case of an 83-year-old patient with progressive dysphagia and acute dyspnea, necessitating emergency tracheotomy. Voluminous anterior cervical osteophytes extending from C3 to C7 and narrowing the pharyngoesophageal segment by external compression and bilateral vocal fold immobility were diagnosed radiologically and by fiberoptic laryngoscop...

  4. Laryngeal schwannoma in an 8-year-old boy with inspiratory dyspnea.

    Science.gov (United States)

    Rognone, Elisa; Rossi, Andrea; Conte, Massimo; Nozza, Paolo; Tarantino, Vincenzo; Fibbi, Antonio; Saetti, Roberto; Cutrone, Cesare; Tortori-Donati, Paolo

    2007-10-01

    Schwannomas of the larynx are rare lesions in the pediatric age group. In this article, we report on the neuroimaging features of a schwannoma arising from the left aryepiglottic fold in an 8-year-old boy with a 6-month history of inspiratory dyspnea. Neuroimaging showed a well-defined, avoid mass originating from the left aryepiglottic fold. The lesion was removed endoscopically. Complete removal of laryngeal schwannomas is curative, and adjuvant treatment is not required.

  5. A Case of Vogt-Koyanagi-Harada Syndrome with Persistent Dyspnea Secondary to Laryngeal Edema

    OpenAIRE

    Dimosthenis Mantopoulos; Brad W. deSilva; Colleen M. Cebulla

    2014-01-01

    Purpose: We report a case of laryngeal edema associated with the Vogt-Koyanagi-Harada (VKH) syndrome. Patient and Methods: A 32-year-old African-American female presented with a 12-day prodrome, including headache, tinnitus and shortness of breath, which preceded sudden photophobia and bilateral visual loss. Examination and clinical testing were most consistent with VKH, and the patient improved with intravenous methylprednisolone therapy. Results: The patient had persistent dyspnea, which wa...

  6. Exercise-induced dyspnea is a problem among the general adolescent population.

    Science.gov (United States)

    Johansson, H; Norlander, K; Hedenström, H; Janson, C; Nordang, L; Nordvall, L; Emtner, M

    2014-06-01

    Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often than the group without EID. No difference was found in the level of physical activity between participants with and without EID. Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. A 68-Year-Old Man With Dyspnea on Exertion and Cough.

    Science.gov (United States)

    Agrawal, Abhinav; Sikachi, Rutuja R; Koenig, Seth; Khanijo, Sameer

    2018-06-01

    A 68-year-old man with a history of chronic lymphocytic leukemia well controlled on ibrutinib, hypertension, obesity, and a remote history of smoking (10 pack-years) presented with increasing dyspnea on exertion and cough. He had previously finished two courses of oral antibiotics for his symptoms without significant improvement. On presentation, he had no fevers or sputum production. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  8. Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Miyazaki, Nagisa; Nishiwaki, Ayuko; Endo, Junki; Ushikoshi, Hiroaki; Ohno, Yasushi; Minatoguchi, Shinya

    2015-12-01

    Combined idiopathic pulmonary fibrosis with pulmonary emphysema (CPFE) is a syndrome with a characteristic presentation of upper lobe emphysema and lower lobe fibrosis. Dyspnea on exertion (DOE) is a major symptom of CPFE. We report a patient with DOE due to CPFE who was successfully treated with acupuncture. Case report. A 72-year-old Japanese man with a 4-year history of DOE was diagnosed with CPFE 2 years previously in another hospital. He received standard Western medicine treatment, which included bronchodilators. However, his DOE did not improve. Consequently, he visited our hospital for acupuncture treatment and received acupuncture treatment once a week for 1 year. After 10 weeks of acupuncture treatment, the results of the 6-minute walk test (6-minute walking distance, 379 m; lowest oxygen saturation, 86%; modified Borg dyspnea scale score: 2 units) were better than those at baseline (352 m, 84%, 4 units, respectively). These values were sustained at both 30 weeks (470 m, 88%, 1 unit) and 60 weeks (473 m, 85%, 2 units). Serum interstitial biomarkers, Krebs von den Lungen and surfactant protein-D, decreased after commencement of acupuncture therapy. A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted.

  9. [Unexpected treatable dyspnea caused by intratracheal granuloma in an amyotrophic lateral sclerosis patient with mechanical ventilation].

    Science.gov (United States)

    Ishida, Shimon; Kimura, Fumiharu; Hosokawa, Takafumi; Satoh, Toshihiko; Furutama, Daisuke; Sugino, Masakazu

    2007-09-01

    Respiratory insufficiency is a problem that develops in nearly all people diagnosed with amyotrophic lateral sclerosis (ALS). A 46-year-old man with ALS, who had been in a bedridden state with tracheal ventilation support, complained of faintness and dyspnea. The airway pressure of the ventilator had increased, and bleeding from the trachea had occurred several times. A fiberoptic bronchoscopy showed granulation located on the anterior wall of the trachea and severe airway obstruction of the tracheostomy tube. Although a long tracheostomy tube had been intubated for the initial management of the tracheal granulation, a tumor on the posterior tracheal wall had relapsed and occluded the tracheal lumen. A self-expandable metallic airway stent was placed into the tracheal stenosis. After stenting, his symptoms of dyspnea and syncope imploved, and the increased airway pressure of the ventilator was normalized. We speculated that the tracheal granuloma had occurred due to a tracheal mucosal injury related to endotracheal suctioning. We should pay attention to complaints of dyspnea in ALS patients with tracheostomy and make a careful consideration to airway care including suction management.

  10. An adult cystic fibrosis patient presenting with persistent dyspnea: case report

    Directory of Open Access Journals (Sweden)

    Farinet Catherine L

    2006-05-01

    Full Text Available Abstract Background Persistent dyspnea is a common finding in the cystic fibrosis patient that typically leads to further work up of an alternative pulmonary etiology. Adult cystic fibrosis patients; however, are growing in numbers and they are living into the ages in which coronary artery disease becomes prevalent. Coronary disease should be included in the consideration of diagnostic possibilities. Case presentation A 52-year-old white male with cystic fibrosis was evaluated for exertional dyspnea associated with vague chest discomfort. Diagnostic testing revealed normal white blood cell, hemoglobin and platelet count, basic metabolic panel, fasting lipid profile, HbA1c, with chest radiograph confirming chronic cystic findings unchanged from prior radiographs and an electrocardiogram that revealed sinus rhythm with left anterior fascicular block. Stress thallium testing demonstrated a reversible anteroseptal perfusion defect with a 55% left ventricular ejection fraction. Heart catheterization found a 99% occlusion of the left anterior descending artery extending into the two diagonal branches, with 100% obstruction of the left anterior descending artery at the trifurcation and 70% lesion affecting the first posterior lateral branch of the circumflex artery. Conclusion This case report represents the first description in the medical literature of a cystic fibrosis patient diagnosed with symptomatic coronary artery disease. Applying a standard clinical practice guide proved useful toward evaluating a differential diagnosis for a cystic fibrosis patient presenting with dyspnea and chest discomfort.

  11. Widespread infilling of tidal channels and navigable waterways in human-modified tidal deltaplain of southwest Bangladesh

    Directory of Open Access Journals (Sweden)

    Carol Wilson

    2017-12-01

    Full Text Available Since the 1960s, ~5000 km2 of tidal deltaplain in southwest Bangladesh has been embanked and converted to densely inhabited, agricultural islands (i.e., polders. This landscape is juxtaposed to the adjacent Sundarbans, a pristine mangrove forest, both well connected by a dense network of tidal channels that effectively convey water and sediment throughout the region. The extensive embanking in poldered areas, however, has greatly reduced the tidal prism (i.e., volume of water transported through local channels. We reveal that >600 km of these major waterways have infilled in recent decades, converting to land through enhanced sedimentation and the direct blocking of waterways by embankments and sluice gates. Nearly all of the observed closures (~98% have occurred along the embanked polder systems, with no comparable changes occurring in channels of the Sundarbans (<2% change. We attribute most of the channel infilling to the local reduction of tidal prism in poldered areas and the associated decline in current velocities. The infilled channels account for ~90 km2 of new land in the last 40–50 years, the rate of which, ~2 km2/yr, offsets the 4 km2/yr that is eroded at the coast, and is equivalent to ~20% of the new land produced naturally at the Ganges-Brahmaputra tidal rivermouth. Most of this new land, called ‘khas’ in Bengali, has been reclaimed for agriculture or aquaculture, contributing to the local economy. However, benefits are tempered by the loss of navigable waterways for commerce, transportation, and fishing, as well as the forced rerouting of tidal waters and sediments necessary to sustain this low-lying landscape against rising sea level. A more sustainable delta will require detailed knowledge of the consequences of these hydrodynamic changes to support more scientifically-grounded management of water, sediment, and tidal energy distribution.

  12. A life-cycle model for wave-dominated tidal inlets along passive margin coasts of North America

    Science.gov (United States)

    Seminack, Christopher T.; McBride, Randolph A.

    2018-03-01

    A regional overview of 107 wave-dominated tidal inlets along the U.S. Atlantic coast, U.S. Gulf of Mexico coast, and Canadian Gulf of St. Lawrence coast yielded a generalized wave-dominated tidal inlet life-cycle model that recognized the rotational nature of tidal inlets. Tidal inlets are influenced by concurrently acting processes transpiring over two timescales: short-term, event-driven processes and long-term, evolutionary processes. Wave-dominated tidal inlets are classified into three rotational categories based on net longshore sediment transport direction and rotation direction along the landward (back-barrier) portion of the inlet channel: downdrift channel rotation, updrift channel rotation, or little-to-no channel rotation. Lateral shifting of the flood-tidal delta depocenter in response to available estuarine accommodation space appears to control inlet channel rotation. Flood-tidal delta deposits fill accommodation space locally within the estuary (i.e., creating bathymetric highs), causing the tidal-inlet channel to rotate. External influences, such as fluvial discharge, pre-existing back-barrier channels, and impeding salt marsh will also influence inlet-channel rotation. Storm events may rejuvenate the tidal inlet by scouring sediment within the flood-tidal delta, increasing local accommodation space. Wave-dominated tidal inlets are generally unstable and tend to open, concurrently migrate laterally and rotate, infill, and close. Channel rotation is a primary reason for wave-dominated tidal inlet closure. During rotation, the inlet channel lengthens and hydraulic efficiency decreases, thus causing tidal prism to decrease. Tidal prism, estuarine accommodation space, and sediment supply to the flood-tidal delta are the primary variables responsible for tidal inlet rotation. Stability of wave-dominated tidal inlets is further explained by: stability (S) = tidal prism (Ω) + estuarine accommodation space (V) - volume of annual sediment supply (Mt

  13. [When the cause of dyspnea is on larynx. Asthma of difficult control, resistant to treatment? Vocal cords dysfunction? or Both?].

    Science.gov (United States)

    Sacre Hazouri, José Antonio

    2006-01-01

    Dyspnea is a symptom whose diagnosis requires the exclusion of other diseases with which it can be confused, such as asthma and a variety of pulmonary and heart diseases. Dyspnea originated in the larynx may occur due to obstruction by a tumor or other affections in situ, interfering the airway, such as: edema by infections or inflammatory processes, a traumatism, an abnormal movement of the larynx structures, such as the inappropriate or absent of the vocal cords or the laryngospasm. Severity of larynx dyspnea may be to mild to acute, risking the life. This paper reviews the normal laryngeal function and the anatomic, obstructive, and functional disorders that can lead to dyspnea. Some suggestions are also made to determine the cause and treat these diseases.

  14. The economics of tidal energy

    International Nuclear Information System (INIS)

    Denny, Eleanor

    2009-01-01

    Concern over global climate change has led policy makers to accept the importance of reducing greenhouse gas emissions. This in turn has led to a large growth in clean renewable generation for electricity production. Much emphasis has been on wind generation as it is among the most advanced forms of renewable generation, however, its variable and relatively unpredictable nature result in increased challenges for electricity system operators. Tidal generation on the other hand is almost perfectly forecastable and as such may be a viable alternative to wind generation. This paper calculates the break-even capital cost for tidal generation on a real electricity system. An electricity market model is used to determine the impact of tidal generation on the operating schedules of the conventional units on the system and on the resulting cycling costs, emissions and fuel savings. It is found that for tidal generation to produce positive net benefits for the case study, the capital costs would have to be less than Euro 510,000 per MW installed which is currently an unrealistically low capital cost. Thus, it is concluded that tidal generation is not a viable option for the case system at the present time.

  15. Remnants of strong tidal interactions

    International Nuclear Information System (INIS)

    Mcglynn, T.A.

    1990-01-01

    This paper examines the properties of stellar systems that have recently undergone a strong tidal shock, i.e., a shock which removes a significant fraction of the particles in the system, and where the shocked system has a much smaller mass than the producer of the tidal field. N-body calculations of King models shocked in a variety of ways are performed, and the consequences of the shocks are investigated. The results confirm the prediction of Jaffe for shocked systems. Several models are also run where the tidal forces on the system are constant, simulating a circular orbit around a primary, and the development of tidal radii under these static conditions appears to be a mild process which does not dramatically affect material that is not stripped. The tidal radii are about twice as large as classical formulas would predict. Remnant density profiles are compared with a sample of elliptical galaxies, and the implications of the results for the development of stellar populations and galaxies are considered. 38 refs

  16. TIDAL LIMITS TO PLANETARY HABITABILITY

    International Nuclear Information System (INIS)

    Barnes, Rory; Jackson, Brian; Greenberg, Richard; Raymond, Sean N.

    2009-01-01

    The habitable zones (HZs) of main-sequence stars have traditionally been defined as the range of orbits that intercept the appropriate amount of stellar flux to permit surface water on a planet. Terrestrial exoplanets discovered to orbit M stars in these zones, which are close-in due to decreased stellar luminosity, may also undergo significant tidal heating. Tidal heating may span a wide range for terrestrial exoplanets and may significantly affect conditions near the surface. For example, if heating rates on an exoplanet are near or greater than that on Io (where tides drive volcanism that resurfaces the planet at least every 1 Myr) and produce similar surface conditions, then the development of life seems unlikely. On the other hand, if the tidal heating rate is less than the minimum to initiate plate tectonics, then CO 2 may not be recycled through subduction, leading to a runaway greenhouse that sterilizes the planet. These two cases represent potential boundaries to habitability and are presented along with the range of the traditional HZ for main-sequence, low-mass stars. We propose a revised HZ that incorporates both stellar insolation and tidal heating. We apply these criteria to GJ 581 d and find that it is in the traditional HZ, but its tidal heating alone may be insufficient for plate tectonics.

  17. Tidal ventilation distribution during pressure-controlled ventilation and pressure support ventilation in post-cardiac surgery patients.

    Science.gov (United States)

    Blankman, P; VAN DER Kreeft, S M; Gommers, D

    2014-09-01

    Inhomogeneous ventilation is an important contributor to ventilator-induced lung injury. Therefore, this study examines homogeneity of lung ventilation by means of electrical impedance tomography (EIT) measurements during pressure-controlled ventilation (PCV) and pressure support ventilation (PSV) using the same ventilation pressures. Twenty mechanically ventilated patients were studied after cardiac surgery. On arrival at the intensive care unit, ventilation distribution was measured with EIT just above the diaphragm for 15 min. After awakening, PCV was switched to PSV and EIT measurements were again recorded. Tidal impedance variation, a measure of tidal volume, increased during PSV compared with PCV, despite using the same ventilation pressures (P = 0.045). The distribution of tidal ventilation to the dependent lung region was more pronounced during PSV compared with PCV, especially during the first half of the inspiration. An even distribution of tidal ventilation between the dependent and non-dependent lung regions was seen during PCV at lower tidal volumes (tidal volumes (≥ 8 ml/kg). In addition, the distribution of tidal ventilation was predominantly distributed to the dependent lung during PSV at low tidal volumes. In post-cardiac surgery patients, PSV showed improved ventilation of the dependent lung region due to the contribution of the diaphragm activity, which is even more pronounced during lower assist levels. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  18. Impact of exercise capacity on dyspnea and health-related quality of life in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Frølich, Anne; Godtfredsen, Nina S

    2012-01-01

    To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD).......To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD)....

  19. The origin of dyspnea and its role in the reduction of exercise endurance in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Mikhail Vasil'evich Sheyanov

    2010-01-01

    Results. Dyspnea during exercise was reported by 54 (52% patients with RA and 9 (9% control patients (p < 0.001. Dyspnea was more frequently detected and more significant in RA patients with other symptoms of respiratory organ lesions (cough, sputum discharge, chest pain on breathing and coughing, anemia, and emotional disorders of the anxious-depressive type. The degree of dyspnea correlated with DAS 28 scores (r = 0.33; p < 0.01. No correlation was found between lung function parameters and blood gas composition. Pulmonary MSCT in RA patients with dyspnea more frequently revealed signs of bronchiolitis and lesion of the lung as its interstitial fibrotic type. Conclusion. Dyspnea is a common symptom and an important factor in reducing EE and QL in patients with RA. Dyspnea in these patients has a multifactorial origin. Of importance in its occurrence are the involvement of the lung and bronchi in the pathological process irrespective of the lung function, as well as RA-associated factors (including anemia, and nosogenic emotional disorders (anxiety and/or depression.

  20. Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnea by plasma pro-B-type natriuretic peptide

    DEFF Research Database (Denmark)

    Mogelvang, R; Goetze, JP; Schnohr, P

    2007-01-01

    OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac d......% to 17%). CONCLUSIONS: In the general population with dyspnea, plasma proBNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction, but are unaffected by pulmonary dysfunction.......OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac...... dyspnea in the emergency department, but their diagnostic significance in evaluating chronic dyspnea in the general population is unknown. METHODS: Within the Copenhagen City Heart Study, a large, community-based population study, dyspnea was evaluated by spirometry, oxygen saturation, echocardiography...

  1. Psycho-Physiological Associates of Dyspnea in Hospitalized Patients with Interstitial Lung Diseases: A Cross-Sectional Study.

    Science.gov (United States)

    Zhou, Yan Hua; Mak, Yim Wah

    2017-10-24

    Dyspnea has been found to be an independent predictor of mortality among patients with respiratory diseases and is often regarded as a difficult symptom to control in patients with interstitial lung diseases (ILDs). Previous studies have found an association of psychological and physiological factors with dyspnea among patients with chronic obstructive airway diseases. However, symptom management of hospitalized patients with ILDs has been hampered by difficulty in priority, since they are often admitted with multiple psycho-physiological needs. This study examined the prevalence of dyspnea and the psycho-physiological factors associated with it among hospitalized Chinese patients with ILDs. We studied 165 hospitalized patients with ILDs recruited consecutively over three months in a public hospital in Guangzhou, China. Dyspnea and common psycho-physiological factors, including cough symptoms, activity capacity, lung function, physical and mental health status, and anxiety and depression symptoms, were measured. By ordered logistic regression, level of dyspnea statistically significantly affected performance in a six-minute walk test and physical functioning in work or other regular daily activities in hospitalized patients with ILDs. Respiratory rehabilitation with an appropriate intensity of exercise training or other strategies for enhancing the physical functioning of this population with moderate and severe levels of dyspnea should be prioritized.

  2. Tidal variations of earth rotation

    Science.gov (United States)

    Yoder, C. F.; Williams, J. G.; Parke, M. E.

    1981-01-01

    The periodic variations of the earths' rotation resulting from the tidal deformation of the earth by the sun and moon were rederived including terms with amplitudes of 0.002 millisec and greater. The series applies to the mantle, crust, and oceans which rotate together for characteristic tidal periods; the scaling parameter is the ratio of the fraction of the Love number producing tidal variations in the moment of inertia of the coupled mantle and oceans (k) to the dimensionless polar moment of inertia of the coupled moments (C). The lunar laser ranging data shows that k/C at monthly and fortnightly frequencies equals 0.99 + or - 0.15 and 0.99 + or - 0.20 as compared to the theoretical value of 0.94 + or - 0.04.

  3. The Origin of Faint Tidal Features around Galaxies in the RESOLVE Survey

    Science.gov (United States)

    Hood, Callie E.; Kannappan, Sheila J.; Stark, David V.; Dell’Antonio, Ian P.; Moffett, Amanda J.; Eckert, Kathleen D.; Norris, Mark A.; Hendel, David

    2018-04-01

    We study tidal features around galaxies in the REsolved Spectroscopy Of a Local VolumE (RESOLVE) survey. Our sample consists of 1048 RESOLVE galaxies that overlap with the DECam Legacy Survey, which reaches an r-band 3σ depth of ∼27.9 mag arcsec‑2 for a 100 arcsec2 feature. Images were masked, smoothed, and inspected for tidal features such as streams, shells, or tails/arms. We find tidal features in 17±2% of our galaxies, setting a lower limit on the true frequency. The frequency of tidal features in the gas-poor (gas-to-stellar mass ratio arms from resonant interactions. Similar to tidal features in gas-poor galaxies, tidal features in gas-rich galaxies imply 1.7× closer nearest neighbors in the same group; however, they are associated with diskier morphologies, higher star formation rates, and higher gas content. In addition to interactions with known neighbors, we suggest that tidal features in gas-rich galaxies may arise from accretion of cosmic gas and/or gas-rich satellites below the survey limit.

  4. Nasal flaring as a clinical sign of respiratory acidosis in patients with dyspnea.

    Science.gov (United States)

    Zorrilla-Riveiro, José Gregorio; Arnau-Bartés, Anna; Rafat-Sellarés, Ramón; García-Pérez, Dolors; Mas-Serra, Arantxa; Fernández-Fernández, Rafael

    2017-04-01

    To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models. The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9-7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13-5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78-14.41) were maintained as factors independently associated with acidosis. Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Nasal flaring as a predictor of mortality in patients with severe dyspnea].

    Science.gov (United States)

    Zorrilla Riveiro, José Gregorio; Arnau Bartés, Anna; García Pérez, Dolors; Rafat Sellarés, Ramón; Mas Serra, Arantxa; Fernández Fernández, Rafael

    2015-02-01

    To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea. Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencies according to the Andorran Medical Triage system. Two observers evaluated the presence of nasal flaring. We recorded demographic and clinical variables, including respiratory effort, vital signs, arterial blood gases, and clinical course (hospital admission and mortality). Bivariable analysis was performed and multivariable logistic regression models were constructed. We enrolled 246 patients with a mean (SD) age of 77 (13) years; 52% were female. Nasal flaring was present in 19.5%. Patients with nasal flaring had triage levels indicating greater severity and they had more severe tachypnea, worse oxygenation, and greater acidosis and hypercapnia. Bivariable analysis detected that the following variables were associated with mortality: age (odds ratio [OR], 1.05; 95% CI, 1.01-1.10), prehospital care from the emergency medical service (OR, 3.97; 95% CI, 1.39-11.39), triage level II (OR, 4.19; 95% CI, 1.63-10.78), signs of respiratory effort such as nasal flaring (OR, 3.79; 95% CI, 1.65-8.69), presence of acidosis (OR, 7.09; 95% CI, 2.97-16.94), and hypercapnia (OR, 2.67; 95% CI, 1,11-6,45). The factors that remained independent predictors of mortality in the multivariable analysis were age, severity (triage level), and nasal flaring. In patients requiring emergency care for dyspnea, nasal flaring is a clinical sign of severity and a predictor of mortality.

  6. The distribution and tapping tidal energy

    Directory of Open Access Journals (Sweden)

    Zygmunt Kowalik

    2004-09-01

    Full Text Available Tidal power along tidal shores has been used for centuries to run small tidal mills. Generating electricity by tapping tidal power proved to be very successful only in the last century through the tidal power plant constructed in 1967 in La Rance, France. This used a large barrier to generate the sea level head necessary for driving turbines. Construction of such plants evolved very slowly because of prohibitive costs and concerns about the environmental impact. Developments in the construction of small, efficient and inexpensive underwater turbines admit the possibility of small scale operations that will use local tidal currents to bring electricity to remote locations. Since the generation of such electricity is concerned with the tidal energy in local water bodies, it is important to understand the site-specific energy balance, i.e., the energy flowing in through open boundaries, and the energy generated and dissipated within the local domain. The question is how to tap the tidal energy while keeping possible changes in the present tidal regimes to a minimum. The older approach of constructing barrages may still be quite useful in some locations. The basics of such tidal power plants constructed in a small bay are analyzed in order to understand the principal parameter for tidal plant evaluation, i.e., the power produced.     The new approach is to place turbines - devices similar to windmills - in the pathway of tidal currents. Theoretically, the amount of power available by such turbines for electricity generation is proportional to the water density and velocity cubed of the tidal flow. The naturally dissipated tidal power due to bottom friction forces is also proportional to the cube of the velocity. Because of this similarity, the exploitation of tidal energy can be directed to reinvesting the naturally dissipated power into tidal power for the generation of electricity. This approach to tidal power exploitation is better tuned

  7. Dyspnea, Tachycardia, and New Onset Seizure as a Presentation of Wilms Tumor: A Case Report

    Directory of Open Access Journals (Sweden)

    Linda Li

    2014-01-01

    Full Text Available Wilms tumor is found in 1 in 10,000 children and most commonly presents in asymptomatic toddlers whose care givers notice a nontender abdominal mass in the right upper quadrant. This case of Wilms tumor presented as a critically ill eleven-year old with significant tachypnea, dyspnea, vague abdominal pain, intermittent emesis, new onset seizure, metabolic acidosis, and hypoxemia. This is the first case in the literature of Wilms Tumor with cavoatrial involvement and seizure and pulmonary embolism resulting in aggressive resuscitation and treatment. Treatment included anticoagulation, chemotherapy, nephrectomy, and surgical resection of thrombi, followed by adjunctive chemotherapy with pulmonary radiation.

  8. Dyspnea with anemia turned out to be a case of hereditary hemorrhagic telangiectasia

    Directory of Open Access Journals (Sweden)

    Amitabha Sengupta

    2013-01-01

    Full Text Available Hereditary hemorrhagic telangiectasia (HHT is a rare autosomal dominant inherited disorder of the vascular system. It can be asymptomatic but when symptomatic most common presentation being epistaxis. It can involve any organs of the body like lungs, skin, liver brain, GI mucosa etc. We are reporting a case of HHT presented to us with dyspnea and severe anemia. He had arteriovenous malformations of different visceral organs and telangiectasia of skin along with presence of similar history in first-degree relatives.

  9. A 26-year-old man with dyspnea and chest pain

    Directory of Open Access Journals (Sweden)

    Saurabh Mittal

    2017-01-01

    Full Text Available A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.

  10. Turning the tide : tidal power in the UK

    OpenAIRE

    Sustainable Development Commission

    2007-01-01

    Contents: Turning the tide : tidal power in the UK -- Executive summary -- Tidal power in the UK : research report 1 : UK tidal resource assessment -- Tidal power in the UK : research report 2 : tidal technologies overview -- Tidal power in the UK : research report 3 : Severn barrage proposals -- Tidal power in the UK : research report 4 : Severn non-barrage options -- Tidal power in the UK : research report 5 : UK case studies. Summarised in the Welsh language version of the executive ...

  11. Facies architecture of heterolithic tidal deposits : The Holocene Holland Tidal Basin

    NARCIS (Netherlands)

    Donselaar, M.E.; Geel, C.R.

    2007-01-01

    The size, shape and spatial position of lithofacies types (or facies architecture) in a tidal estuarine basin are complex and therefore difficult to model. The tidal currents in the basin concentrate sand-sized sediment in a branching pattern of tidal channels and fringing tidal flats. Away from the

  12. Tidal flow separation at protruding beach nourishments

    NARCIS (Netherlands)

    Radermacher, M.; de Schipper, M.A.; Swinkels, Cilia M.; MacMahan, Jamie; Reniers, A.J.H.M.

    2016-01-01

    In recent years, the application of large-scale beach nourishments has been discussed, with the Sand Motor in the Netherlands as the first real-world example. Such protruding beach nourishments have an impact on tidal currents, potentially leading to tidal flow separation and the generation of tidal

  13. Tidal energy - a technology review

    International Nuclear Information System (INIS)

    Price, R.

    1991-01-01

    The tides are caused by gravitational attraction of the sun and the moon acting upon the world's oceans. This creates a clean renewable form of energy which can in principle be tapped for the benefit of mankind. This paper reviews the status of tidal energy, including the magnitude of the resource, the technology which is available for its extraction, the economics, possible environmental effects and non-technical barriers to its implementation. Although the total energy flux of the tides is large, at about 2 TW, in practice only a very small fraction of this total potential can be utilised in the foreseeable future. This is because the energy is spread diffusely over a wide area, requiring large and expensive plant for its collection, and is often available remote from centres of consumption. The best mechanism for exploiting tidal energy is to employ estuarine barrages at suitable sites with high tidal ranges. The technology is relatively mature and components are commercially available now. Also, many of the best sites for implementation have been identified. However, the pace and extent of commercial exploitation of tidal energy is likely to be significantly influenced, both by the treatment of environmental costs of competing fossil fuels, and by the availability of construction capital at modest real interest rates. The largest projects could require the involvement of national governments if they are to succeed. (author) 8 figs., 2 tabs., 19 refs

  14. Properties of active tidal bedforms

    DEFF Research Database (Denmark)

    Winter, Christian; Lefebvre, Alice; Becker, Marius

    2016-01-01

    Bedforms of various shapes and sizes are ubiquitous in tidal channels, inlets and estuaries. They constitute a form roughness which has a large scale effect on the hydrodynamics and sediment transport of coastal environments. It has been shown that this form roughness can be expressed in terms...

  15. Analyse of the prevalence rate and risk factors of pulmonary embolism in the patients with dyspnea

    International Nuclear Information System (INIS)

    Cao Yanxia; Su Jian; Wang Bingsheng; Wu Songhong; Dai Ruiting; Cao Caixia

    2005-01-01

    Objective: To analyse the prevalence rate and risk factors of pulmonary embolism (PE) in patients with dyspnea and to explore the predisposing causes and its early clinical manifestations. Methods: Retrospective analysis was done in 461 patients with dyspnea performed 99 Tc m -macroaggregated albumin (MAA) lung perfusion imaging and 99 Tc m -DTPA ventilation imaging or 99 Tc m -MAA perfusion imaging and chest X-ray examination. Among them, 48 cases without apparent disease were considered as control group, whereas the remaining patients with other underlying illnesses as patients group. PEMS statistics software package was used for estimation of prevalence rate, χ 2 test and PE risk factor analysis. Results: There were 251 PE patients among 461 patients, the prevalence rate [ (π)=95% confidence interval (CI) ] was: lower extremity thrombosis and varicosity (80.79-95.47 ), post cesarean section (55.64-87.12), lower extremity bone surgery or fracture (52.76-87.27 ), cancer operation (52.19-78.19), atrial fibrillation or heart failure (53.30-74.88), obesity (23.14-50.20), post abdominal surgery (20.23-59.43), diabetes (19.12-63.95), chronic bronchitis (1.80-23.06), normal control group (3.47-22.66). Except chronic bronchitis, PE prevalence rate between patients group and control group had significant difference (P 99 Tc m -MAA and DTPA lung imaging should be done as early as possible. (authors)

  16. A Case of Frequent Arousal Following Nocturnal Dyspnea Caused by Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Dae Wui Yoon

    2013-06-01

    Full Text Available Gastroesophageal reflux disease (GERD is a common disorder that is associated with many esophageal syndromes and complications. Most cases of reflux event occur during the day, but reflux during sleep can cause not only esophageal problems, but also sleep problems, such as arousal and poor sleep quality. We report the case of a 17-year-old man who had been referred to us with frequent arousal following sudden dyspnea. On polysomnography, no respiratory disturbances and periodic limb movements were found during the sleep study, but frequent events of arousal were reported (arousal index: 12.3/h. On a 24-hr esophageal pH monitoring test, his DeMeester score was 176.43 and the total reflux time was 1120.9 min (76.9%, indicating the presence of significant acid reflux. After treatment with a proton-pump inhibitor, the arousals following nocturnal dyspnea and fatigue in the morning disappeared in the patient. GERD should be considered as a cause of spontaneous arousal or awakening not accompanying respiratory disturbances.

  17. Pulmonary rehabilitation improves exercise capacity and dyspnea in air pollution-related respiratory disease.

    Science.gov (United States)

    Miyamoto, Naomi; Senjyu, Hideaki; Tanaka, Takako; Asai, Masaharu; Yanagita, Yorihide; Yano, Yudai; Nishinakagawa, Tsuyoshi; Kotaki, Kenji; Kitagawa, Chika; Rikitomi, Naoto; Kozu, Ryo; Honda, Sumihisa

    2014-01-01

    Air pollution in Japan caused respiratory disease, such as chronic bronchitis and asthma, in many individuals in the 1960s. Although air pollution has decreased, many victims of air pollution-related respiratory disease are limited in their activities of daily living because of respiratory symptoms. The purpose of this study was to evaluate the efficacy of pulmonary rehabilitation in victims of air pollution-related chronic bronchitis or asthma. Subjects were enrolled in a 12-week (2-week inpatient followed by 10-week outpatient) pulmonary rehabilitation program. The program comprised conditioning, strength training, endurance training, and patient education. We assessed the Modified Medical Research Council (MMRC) dyspnea grade, pulmonary function, peripheral muscle force, incremental shuttle walk distance (ISWD), and physical activity at baseline and immediately after the program. Twenty-nine subjects (mean age 74.2 ± 10.1 years, 11 males) completed the program, including 11 subjects with COPD and 18 subjects with asthma. Following rehabilitation, the participants (n = 29) showed significant improvements in MMRC dyspnea grade, vital capacity % predicted, quadriceps force and ISWD (all P pollution-related asthma. In conclusion, we recommend that patients with chronic bronchitis or asthma, resulting from exposure to air pollution, are referred for pulmonary rehabilitation.

  18. Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis.

    Science.gov (United States)

    Samad, Idris; Akst, Lee; Karatayli-Özgürsoy, Selmin; Teets, Kristine; Simpson, Marissa; Sharma, Ashwyn; Best, Simon R A; Hillel, Alexander T

    2016-11-01

    Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, -20.3; 95% CI, -27.9 to -12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, -2.2; 95% CI, -3.4 to -0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, -27.5 cm H2O/L/s; 95% CI, -44.8 to -10.3 cm H2O/L/s) postoperatively. Patients

  19. [Development of an activity of daily living scale for patients with COPD: the Activity of Daily Living Dyspnea scale].

    Science.gov (United States)

    Yoza, Yoshiyasu; Ariyoshi, Koya; Honda, Sumihisa; Taniguchi, Hiroyuki; Senjyu, Hideaki

    2009-10-01

    Patients with COPD often experience restriction in their activities of daily living (ADL) due to dyspnea. This type of restriction is unique to patients with COPD and cannot be adequately evaluated by the generic ADL scales. This study developed an ADL scale (the Activity of Daily Living Dyspnea scale [ADL-D scale]) for patients with COPD and investigated its validity and internal consistency. Patients with stable COPD were recruited and completed a pilot 26-item questionnaire. Patients also performed the Incremental Shuttle Walk Test (ISWT), and completed the St George's Respiratory Questionnaire (SGRQ), and Medical Research Council (MRC) dyspnea grade. There were 83 male participants who completed the pilot questionnaire. Following the pilot, 8 items that were not undertaken by the majority of subjects, and 3 items judged to be of low clinical importance by physical therapists were removed from the pilot questionnaire. The final ADL-D scale contained 15 items. Scores obtained with the ADL-D scale were significantly correlated with the MRC dyspnea grades, distance walked on the ISWT and SGRQ scores. The ADL-D scores were significantly different across the five grades of the MRC dyspnea grade. The ADL-D scale showed high consistency (Chronbach's alpha coefficient of 0.96). The ADL-D scale is a useful scale for assessing impairments in ADL in Japanese male patients with COPD.

  20. Maine Tidal Power Initiative: Environmental Impact Protocols For Tidal Power

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Michael Leroy [Univ. of Maine, Orono, ME; Zydlewski, Gayle Barbin [Univ. of Maine, Orono, ME; Xue, Huijie [Univ. of Maine, Orono, ME; Johnson, Teresa R. [Univ. of Maine, Orono, ME

    2014-02-02

    The Maine Tidal Power Initiative (MTPI), an interdisciplinary group of engineers, biologists, oceanographers, and social scientists, has been conducting research to evaluate tidal energy resources and better understand the potential effects and impacts of marine hydro-kinetic (MHK) development on the environment and local community. Project efforts include: 1) resource assessment, 2) development of initial device design parameters using scale model tests, 3) baseline environmental studies and monitoring, and 4) human and community responses. This work included in-situ measurement of the environmental and social response to the pre-commercial Turbine Generator Unit (TGU®) developed by Ocean Renewable Power Company (ORPC) as well as considering the path forward for smaller community scale projects.

  1. Dynamical modeling of tidal streams

    International Nuclear Information System (INIS)

    Bovy, Jo

    2014-01-01

    I present a new framework for modeling the dynamics of tidal streams. The framework consists of simple models for the initial action-angle distribution of tidal debris, which can be straightforwardly evolved forward in time. Taking advantage of the essentially one-dimensional nature of tidal streams, the transformation to position-velocity coordinates can be linearized and interpolated near a small number of points along the stream, thus allowing for efficient computations of a stream's properties in observable quantities. I illustrate how to calculate the stream's average location (its 'track') in different coordinate systems, how to quickly estimate the dispersion around its track, and how to draw mock stream data. As a generative model, this framework allows one to compute the full probability distribution function and marginalize over or condition it on certain phase-space dimensions as well as convolve it with observational uncertainties. This will be instrumental in proper data analysis of stream data. In addition to providing a computationally efficient practical tool for modeling the dynamics of tidal streams, the action-angle nature of the framework helps elucidate how the observed width of the stream relates to the velocity dispersion or mass of the progenitor, and how the progenitors of 'orphan' streams could be located. The practical usefulness of the proposed framework crucially depends on the ability to calculate action-angle variables for any orbit in any gravitational potential. A novel method for calculating actions, frequencies, and angles in any static potential using a single orbit integration is described in the Appendix.

  2. Evaluation of the Appropriate Washout Period Following Fan Therapy for Dyspnea in Patients With Advanced Cancer: A Pilot Study.

    Science.gov (United States)

    Kako, Jun; Morita, Tatsuya; Yamaguchi, Takuhiro; Sekimoto, Asuko; Kobayashi, Masamitsu; Kinoshita, Hiroya; Ogawa, Asao; Zenda, Sadamoto; Uchitomi, Yosuke; Inoguchi, Hironobu; Matsushima, Eisuke

    2018-02-01

    To clarify the duration required for dyspnea to return to baseline severity after fan therapy, to evaluate whether fan-to-legs therapy or no fan therapy would be a suitable control therapy, and to investigate changes in patients' face surface temperature after fan therapy. In this pilot study, all participants received 3 interventions in the following order: no fan, fan to legs, and fan to face. Participants used a fan for 5 minutes, and they scored their dyspnea at 10-minute intervals for 60 minutes or until the score had returned to its baseline value, whichever occurred first. Nine patients with advanced cancer admitted to a palliative care unit were included; they had dyspnea at rest and rated its severity as at least 3 points on a 0- to 10-point numerical rating scale. Descriptive statistics and the Wilcoxon signed rank test were used to analyze the data. All patients completed the study. Of the 9 participants, 6 experienced a clinical benefit from using a fan to their faces. Of these patients, only 2 participants' (2 of 6) dyspnea scores returned to baseline by the end of the 60-minute assessment period after exposure to fan-to-face therapy. In fan-to-legs and no fan settings, there was no change in the dyspnea scores. There were significant differences between the baseline face surface temperature and that after fan-to-face and fan-to-legs settings. When using a crossover design to investigate the effect of fan therapy on dyspnea, 1 hour is an insufficient washout period.

  3. Prospects for Fundy tidal power

    International Nuclear Information System (INIS)

    Clark, R.H.

    1997-01-01

    The Bay of Fundy in Canada probably possesses the most favourable conditions in the world for the exploitation of tidal energy. The results of the comprehensive investigations carried out during the past quarter-century are reviewed together with operating and environmental aspects of the modest (20 MW) Annapolis Tidal Power Station, commissioned in 1984, the primary purpose of which was to evaluate the operation of a large (7.6 m) diameter Straflo turbine unit under low heads. The results of the operating and maintenance experience for the Annapolis Station are reviewed as well as the results of the environmental/ecological studies that have been on-going in the Annapolis Basin. The tidal power investigations have shown that a 1400 MW development at the mouth of the Cumberland Basin, at the head of the bay of Fundy, is technically and economically feasible and that its output would probably be competitive with fossil-fired plants, particularly if a 'green' accounting technique were applied to such energy sources. The importance of timing, if the exploitation of this non-polluting, renewable and completely predicable source is to be used to meet the future electrical energy needs of the maritime provinces, is discussed. (author)

  4. Numerical calculation of hydrodynamic characteristics of tidal currents for submarine excavation engineering in coastal area

    Directory of Open Access Journals (Sweden)

    Jian-hua Li

    2016-04-01

    Full Text Available In coastal areas with complicated flow movement, deposition and scour readily occur in submarine excavation projects. In this study, a small-scale model, with a high resolution in the vertical direction, was used to simulate the tidal current around a submarine excavation project. The finite volume method was used to solve Navier-Stokes equations and the Reynolds stress transport equation, and the entire process of the tidal current was simulated with unstructured meshes, generated in the irregular shape area, and structured meshes, generated in other water areas. The meshes near the bottom and free surface were densified with a minimum layer thickness of 0.05 m. The volume of fluid method was used to track the free surface, the volume fraction of cells on the upstream boundary was obtained from the volume fraction of adjacent cells, and that on the downstream boundary was determined by the water level process. The numerical results agree with the observed data, and some conclusions can be drawn: after the foundation trench excavation, the flow velocity decreases quite a bit through the foundation trench, with reverse flow occurring on the lee slope in the foundation trench; the swirling flow impedes inflow, leading to the occurrence of dammed water above the foundation trench; the turbulent motion is stronger during ebbing than in other tidal stages, the range with the maximum value of turbulent viscosity, occurring on the south side of the foundation trench at maximum ebbing, is greater than those in other tidal stages in a tidal cycle, and the maximum value of Reynolds shear stress occurs on the south side of the foundation trench at maximum ebbing in a tidal cycle. The numerical calculation method shows a strong performance in simulation of the hydrodynamic characteristics of tidal currents in the foundation trench, providing a basis for submarine engineering construction in coastal areas.

  5. Modeling Interactions between Backbarrier Marshes, Tidal Inlets, Ebb-deltas, and Adjacent Barriers Exposed to Rising Sea Levels

    Science.gov (United States)

    Hanegan, K.; Georgiou, I. Y.; FitzGerald, D.

    2016-02-01

    Along barrier island chains, tidal exchange between the backbarrier and the coastal ocean supports unique saltwater and brackish ecosystems and is responsible for exporting sediment and nutrients to the surrounding coast. Tidal prism, basement controls, and wave and tidal energy dictate the size and number of tidal inlets and the volume of sand sequestered in ebb-tidal deltas. The inlet tidal prism is a function of bay area, tidal range, and secondary controls, including flow inertia, basinal hypsometry, and frictional factors. Sea- level rise (SLR) is threatening coastal environments, causing mainland flooding, changes in sediment supply, and conversion of wetlands and tidal flats to open water. These factors are impacting basinal hypsometry and increasing open water area, resulting in enlarging tidal prisms, increased dimensions of tidal inlets and ebb-tidal deltas, and erosion along adjacent barrier shorelines. Although the effects of SLR on coastal morphology are difficult to study by field observations alone, physics-based numerical models provide a sophisticated means of analyzing coastal processes over decadal time-scales and linking process causation to long term development. Here, we use a numerical model that includes relevant features in the barrier/tidal basin system, linking back-barrier marsh degradation, inlet expansion, and ebb-delta growth to barrier erosion through long-term hydrodynamic and morphology simulations. Sediment exchange and process interactions are investigated using an idealized domain resembling backbarrier basins of mixed energy coasts so that the sensitivity to varying SLR rates, interior marsh loss, sediment supply, and hydrodynamic controls can be more easily analyzed. Model runs explore these processes over geologic time scales, demonstrating the vulnerability of backbarrier systems to projected SLR and marsh loss. Results demonstrate the links between changing basin morphology and shoreface sedimentation patterns that initiate

  6. Greater dyspnea is associated with lower health-related quality of life among European patients with COPD

    Directory of Open Access Journals (Sweden)

    Gruenberger JB

    2017-03-01

    Full Text Available Jean-Bernard Gruenberger,1 Jeffrey Vietri,2 Dorothy L Keininger,1 Donald A Mahler3 1Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Basel-Stadt, Switzerland; 2Health Outcomes Practice, Kantar Health, Horsham, PA, 3Geisel School of Medicine at Dartmouth, Hanover, NH, USA Objective: Dyspnea is a defining symptom in the classification and treatment of chronic obstructive pulmonary disease (COPD. However, the degree of variation in burden among symptomatic COPD patients and the possible correlates of burden remain unclear. This study was conducted to characterize patients in Europe currently being treated for COPD according to the level of dyspnea in terms of sociodemographics, health-related quality of life, work productivity impairment, and health care resource use assessed by patient reports.Methods: Data were derived from the 5-EU 2013 National Health and Wellness Survey (N=62,000. Respondents aged ≥40 years who reported currently using a prescription for COPD were grouped according to their level of dyspnea as per the Global Initiative for Chronic Obstructive Lung Disease guidelines and compared on health status (revised Short Form 36 [SF-36]v2, work impairment (Work Productivity and Activity Impairment questionnaire, and number of health care visits in the past 6 months using generalized linear models with appropriate distributions and link functions.Results: Of the 768 respondents who met the inclusion criteria, 245 (32% were considered to have higher dyspnea (equivalent to modified Medical Research Council score ≥2. Higher dyspnea was associated with decrements ranging from 3.9 to 8.2 points in all eight domains of the SF-36 health profile after adjustment for sociodemographics, general health characteristics, and length of COPD diagnosis; mental component summary scores and Short Form-6D health utility scores were lower by 3.5 and 0.06 points, respectively. Adjusted mean activity impairment (55% vs 37%, P<0.001 and

  7. A 29-Year-Old Man With Nonproductive Cough, Exertional Dyspnea, and Chest Discomfort.

    Science.gov (United States)

    Halpenny, Darragh; Suh, James; Garofano, Suzette; Alpert, Jeffrey

    2015-09-01

    A 29-year-old man presented with a 5-month history of worsening dry cough, exertional dyspnea, chest tightness, and palpitations. He had been treated by his primary care physician with trials of guaifenesin/codeine, azithromycin, albuterol, and omeprazole without improvement. He denied wheezing, fever, sweats, anorexia, joint pain, swelling, or rash. He had no past medical history. He denied a history of tobacco smoking or IV drug use. He kept no pets, worked as a manager in an office environment, and had no history of occupational inhalational exposure. He reported using aerosolized insect spray to eradicate bed bugs in his house shortly before the cough began but did not report any acute symptoms when using the spray.

  8. An uncommon case of dyspnea with unilateral laryngeal paralysis in acromegaly.

    Science.gov (United States)

    Lerat, Justine; Lacoste, Marie; Prechoux, Jean-Marc; Aubry, Karine; Nadalon, Sylvie; Ly, Kim Heang; Bessede, Jean-Pierre

    2016-02-01

    A 61-year-old man with obstructive sleep apnea syndrome and normal BMI complained of dyspnea. Nasofibroscopy revealed a global and major oedema of the glottis and supraglottis and also a paralysis of the left vocal fold. CT-scan pointed out a spontaneous hyperdensity of the left arytenoid cartilage. A tracheostomy was performed. Clinical examination revealed large hands and macroglossy with high IGF1 rate. MRI confirmed a supracentimetric pituitary adenoma. To our knowledge, this is the first description of a case of acute respiratory distress due to unilateral larynx paralysis leading to acromegaly diagnosis. This is due to submucosal hypertrophy and vocal cord immobility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea.

    Science.gov (United States)

    Brea Álvarez, B; Tuñón Gómez, M; Esteban García, L; García Hidalgo, C Y; Ruiz Peralbo, R M

    2016-01-01

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. [Is BNP assay useful for the diagnosis of acute dyspnea in emergencies departments?].

    Science.gov (United States)

    Lakhdhar, Rim; Hamouda, Chokri; Ben Ammar, Lotfi; Majed, Kamel; Moncef, Fekih; Kaabachi, Naziha; Drissa, Habiba; Borsali Falfoul, Nebiha

    2013-01-01

    It would be interesting to the emergency doctor to have at his disposal a helpful diagnostic tool like brain natriuretic peptide (BNP). Such assay is simple, available and reliable. To report our experience on the role of BNP in the etiological diagnosis of acute dyspnea (AD) in emergency room (ER) and to assess the cost-effectiveness ratio of such diagnosis strategy. A prospective study conducted in the ER of Rabta university teaching hospital of Tunis, from March 1st to June 20th 2010, involving 30 consecutive patients presenting to the emergency for AD. All patients underwent echocardiography in their acute phase and benefited from the dosage of BNP during the first 4 hours. The echocardiography parameters were collected by a single operator who was unaware of the results of the BNP dosage. The mean age of patients was 72.8years with a sex ratio of 1.5. AD was of orthopnea type in 9 cases and stage III NYHA dyspnea in the other patients. Clinical and radiological signs of left heart failure were noted in 30% of cases. Ultrasound data have objectified systolic dysfunction in 4 cases, diastolic in 3 cases and systolic plus diastolic in 10 cases. The BNP levels were below 100 pg/ml in 10 cases with pulmonary origin of the AD. A BNP level between 100 and 400 pg/ml was noted in 3 cases. In our study, the clinical probability of AHF prior to performing the test was estimated at 53% and estimated at 100% after the BNP assay. The BNP assay has reduced the length of stay in the emergency department 4 to 5 days and saved nearly 50% of the cost of care per patient. The BNP assay, has allowed us to confirm the AHF all cases. Given the prognostic value and economic benefit of this test we recommend its use in ER of our country.

  11. Calculating residual flows through a multiple-inlet system: the conundrum of the tidal period

    Science.gov (United States)

    Duran-Matute, Matias; Gerkema, Theo

    2015-11-01

    The concept of residual, i.e., tidally-averaged, flows through a multiple inlet system is reappraised. The evaluation of the residual through-flow depends on the time interval over which is integrated, in other words, on how one defines the tidal period. It is demonstrated that this definition is ambiguous and that different definitions (based on, e.g., high waters, slack tides, etc.) yield very different results for the residual, also in terms of their long-term statistical properties (median and standard deviation). A basin-wide applicable method of defining the tidal period, in terms of enclosed water volume, is analyzed. We compare the different methods on the basis of high-resolution model results for the Western Dutch Wadden Sea. The multitude of tidal constituents together with wind variability creates broad distributions for the residuals, with standard deviations much larger than the mean or median residual flows.

  12. TIDAL FRICTION AND TIDAL LAGGING. APPLICABILITY LIMITATIONS OF A POPULAR FORMULA FOR THE TIDAL TORQUE

    International Nuclear Information System (INIS)

    Efroimsky, Michael; Makarov, Valeri V.

    2013-01-01

    Tidal torques play a key role in rotational dynamics of celestial bodies. They govern these bodies' tidal despinning and also participate in the subtle process of entrapment of these bodies into spin-orbit resonances. This makes tidal torques directly relevant to the studies of habitability of planets and their moons. Our work begins with an explanation of how friction and lagging should be built into the theory of bodily tides. Although much of this material can be found in various publications, a short but self-consistent summary on the topic has been lacking in the hitherto literature, and we are filling the gap. After these preparations, we address a popular concise formula for the tidal torque, which is often used in the literature, for planets or stars. We explain why the derivation of this expression, offered in the paper by Goldreich and in the books by Kaula (Equation (4.5.29)) and Murray and Dermott (Equation (4.159)), implicitly sets the time lag to be frequency independent. Accordingly, the ensuing expression for the torque can be applied only to bodies having a very special (and very hypothetical) rheology which makes the time lag frequency independent, i.e., the same for all Fourier modes in the spectrum of tide. This expression for the torque should not be used for bodies of other rheologies. Specifically, the expression cannot be combined with an extra assertion of the geometric lag being constant, because at finite eccentricities the said assumption is incompatible with the constant-time-lag condition.

  13. TIDAL FRICTION AND TIDAL LAGGING. APPLICABILITY LIMITATIONS OF A POPULAR FORMULA FOR THE TIDAL TORQUE

    Energy Technology Data Exchange (ETDEWEB)

    Efroimsky, Michael; Makarov, Valeri V., E-mail: michael.efroimsky@usno.navy.mil, E-mail: vvm@usno.navy.mil [US Naval Observatory, Washington, DC 20392 (United States)

    2013-02-10

    Tidal torques play a key role in rotational dynamics of celestial bodies. They govern these bodies' tidal despinning and also participate in the subtle process of entrapment of these bodies into spin-orbit resonances. This makes tidal torques directly relevant to the studies of habitability of planets and their moons. Our work begins with an explanation of how friction and lagging should be built into the theory of bodily tides. Although much of this material can be found in various publications, a short but self-consistent summary on the topic has been lacking in the hitherto literature, and we are filling the gap. After these preparations, we address a popular concise formula for the tidal torque, which is often used in the literature, for planets or stars. We explain why the derivation of this expression, offered in the paper by Goldreich and in the books by Kaula (Equation (4.5.29)) and Murray and Dermott (Equation (4.159)), implicitly sets the time lag to be frequency independent. Accordingly, the ensuing expression for the torque can be applied only to bodies having a very special (and very hypothetical) rheology which makes the time lag frequency independent, i.e., the same for all Fourier modes in the spectrum of tide. This expression for the torque should not be used for bodies of other rheologies. Specifically, the expression cannot be combined with an extra assertion of the geometric lag being constant, because at finite eccentricities the said assumption is incompatible with the constant-time-lag condition.

  14. TIDAL NOVAE IN COMPACT BINARY WHITE DWARFS

    International Nuclear Information System (INIS)

    Fuller, Jim; Lai Dong

    2012-01-01

    Compact binary white dwarfs (WDs) undergoing orbital decay due to gravitational radiation can experience significant tidal heating prior to merger. In these WDs, the dominant tidal effect involves the excitation of outgoing gravity waves in the inner stellar envelope and the dissipation of these waves in the outer envelope. As the binary orbit decays, the WDs are synchronized from outside in (with the envelope synchronized first, followed by the core). We examine the deposition of tidal heat in the envelope of a carbon-oxygen WD and study how such tidal heating affects the structure and evolution of the WD. We show that significant tidal heating can occur in the star's degenerate hydrogen layer. This layer heats up faster than it cools, triggering runaway nuclear fusion. Such 'tidal novae' may occur in all WD binaries containing a CO WD, at orbital periods between 5 minutes and 20 minutes, and precede the final merger by 10 5 -10 6 years.

  15. Seasonal variability of tidal and non-tidal currents off Beypore, SW coast of India

    Digital Repository Service at National Institute of Oceanography (India)

    DineshKumar, P.K.; Srinivas, K.; AnilKumar, N.

    and summer monsoon seasons of year 2000. Information on tidal signals contained in the currents were extracted using harmonic analysis - Least Squares Method and non-tidal component were analyzed using the Chi sub(o) filter. The study established...

  16. Relationship between spontaneous expiratory flow-volume curve pattern and air-flow obstruction in elderly COPD patients.

    Science.gov (United States)

    Nozoe, Masafumi; Mase, Kyoshi; Murakami, Shigefumi; Okada, Makoto; Ogino, Tomoyuki; Matsushita, Kazuhiro; Takashima, Sachie; Yamamoto, Noriyasu; Fukuda, Yoshihiro; Domen, Kazuhisa

    2013-10-01

    Assessment of the degree of air-flow obstruction is important for determining the treatment strategy in COPD patients. However, in some elderly COPD patients, measuring FVC is impossible because of cognitive dysfunction or severe dyspnea. In such patients a simple test of airways obstruction requiring only a short run of tidal breathing would be useful. We studied whether the spontaneous expiratory flow-volume (SEFV) curve pattern reflects the degree of air-flow obstruction in elderly COPD patients. In 34 elderly subjects (mean ± SD age 80 ± 7 y) with stable COPD (percent-of-predicted FEV(1) 39.0 ± 18.5%), and 12 age-matched healthy subjects, we measured FVC and recorded flow-volume curves during quiet breathing. We studied the SEFV curve patterns (concavity/convexity), spirometry results, breathing patterns, and demographics. The SEFV curve concavity/convexity prediction accuracy was examined by calculating the receiver operating characteristic curves, cutoff values, area under the curve, sensitivity, and specificity. Fourteen subjects with COPD had a concave SEFV curve. All the healthy subjects had convex SEFV curves. The COPD subjects who had concave SEFV curves often had very severe airway obstruction. The percent-of-predicted FEV(1)% (32.4%) was the most powerful SEFV curve concavity predictor (area under the curve 0.92, 95% CI 0.83-1.00), and had the highest sensitivity (0.93) and specificity (0.88). Concavity of the SEFV curve obtained during tidal breathing may be a useful test for determining the presence of very severe obstruction in elderly patients unable to perform a satisfactory FVC maneuver.

  17. Avaliação da relação entre espaço morto e volume corrente como índice preditivo de falha de extubação Evaluation of the dead space to tidal volume ratio as a predictor of extubation failure

    Directory of Open Access Journals (Sweden)

    Albert Bousso

    2006-10-01

    Full Text Available OBJETIVO: O objetivo do estudo foi avaliar a relação entre espaço morto e volume corrente (VD/VT como preditivo de falha na extubação de crianças sob ventilação mecânica. MÉTODOS: Entre setembro de 2001 e janeiro de 2003, realizamos uma coorte, na qual foram incluídas todas as crianças (1 dia-15 anos submetidas a ventilação mecânica na unidade de terapia intensiva pediátrica em que foi possível realizar a extubação e a ventilometria pré-extubação com a medida do índice VD/VT. Considerou-se falha na extubação a necessidade de reinstituição de algum tipo de assistência ventilatória, invasiva ou não, em um período de 48 horas. Para a análise dos pacientes que foram reintubados, definiu-se como sucesso-R a não reintubação. Para as análises estatísticas, utilizou-se um corte do VD/VT de 0,65. RESULTADOS: No período estudado, 250 crianças receberam ventilação mecânica na unidade de terapia intensiva pediátrica. Destas, 86 compuseram a amostra estudada. Vinte e uma crianças (24,4% preencheram o critério de falha de extubação, com 11 (12,8% utilizando suporte não-invasivo e 10 (11,6% reintubadas. A idade média foi de 16,8 (±30,1 meses, e a mediana, de 5,5 meses. A média do índice VD/VT de todos os casos foi de 0,62 (±0,18. As médias do índice VD/VT para os pacientes que tiveram a extubação bem sucedida e para os que falharam foram, respectivamente, 0,62 (±0,17 e 0,65 (±0,21 (p = 0,472. Na regressão logística, o índice VD/VT não apresentou correlação estatisticamente significativa com o sucesso ou não da extubação (p = 0,8458, nem para aqueles que foram reintubados (p = 0,5576. CONCLUSÕES: Em uma população pediátrica submetida a ventilação mecânica, por etiologias variadas, o índice VD/VT não possibilitou predizer qual a população de risco para falha de extubação ou reintubação.OBJECTIVE: The objective of this study was to evaluate the ratio of dead space to tidal volume

  18. Interactions Between Wetlands and Tidal Inlets

    National Research Council Canada - National Science Library

    Sanchez, Alejandro

    2008-01-01

    This Coastal and Hydraulics Engineering Technical Note (CHETN) presents numerical simulations investigating how the loss of wetlands in estuaries modifies tidal processes in inlet navigation channels...

  19. Formation of double galaxies by tidal capture

    International Nuclear Information System (INIS)

    Alladin, S.M.; Potdar, A.; Sastry, K.S.

    1975-01-01

    The conditions under which double galaxies may be formed by tidal capture are considered. Estimates for the increase in the internal energy of colliding galaxies due to tidal effects are used to determine the magnitudes Vsub(cap) and Vsub(dis) of the maximum relative velocities at infinite separation required for tidal capture and tidal disruption respectively. A double galaxy will be formed by tidal capture without tidal disruption of a component if Vsub(cap)>Vsub(i) and Vsub(cap)>Vsub(dis) where Vsub(i) is the initial relative speed of the two galaxies at infinite separation. If the two galaxies are of the same dimension, formulation of double galaxies by tidal capture is possible in a close collision either if the two galaxies do not differ much in mass and density distribution or if the more massive galaxy is less centrally concentrated than the other. If it is assumed as statistics suggest, that the mass of a galaxy is proportional to the square of its radius, it follows that the probability of the formation of double galaxies by tidal capture increases with the increase in mass of the galaxies and tidal distribution does not occur in a single collision for any distance of closest approach of the two galaxies. (Auth.)

  20. Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the emergency department.

    Science.gov (United States)

    Cibinel, Gian Alfonso; Casoli, Giovanna; Elia, Fabrizio; Padoan, Monica; Pivetta, Emanuele; Lupia, Enrico; Goffi, Alberto

    2012-02-01

    Dyspnea is a common symptom in patients admitted to the Emergency Department (ED), and discriminating between cardiogenic and non-cardiogenic dyspnea is often a clinical dilemma. The initial diagnostic work-up may be inaccurate in defining the etiology and the underlying pathophysiology. The aim of this study was to evaluate the diagnostic accuracy and reproducibility of pleural and lung ultrasound (PLUS), performed by emergency physicians at the time of a patient's initial evaluation in the ED, in identifying cardiac causes of acute dyspnea. Between February and July 2007, 56 patients presenting to the ED with acute dyspnea were prospectively enrolled in this study. In all patients, PLUS was performed by emergency physicians with the purpose of identifying the presence of diffuse alveolar-interstitial syndrome (AIS) or pleural effusion. All scans were later reviewed by two other emergency physicians, expert in PLUS and blinded to clinical parameters, who were the ultimate judges of positivity for diffuse AIS and pleural effusion. A random set of 80 recorded scannings were also reviewed by two inexperienced observers to assess inter-observer variability. The entire medical record was independently reviewed by two expert physicians (an emergency medicine physician and a cardiologist) blinded to the ultrasound (US) results, in order to determine whether, for each patient, dyspnea was due to heart failure, or not. Sensitivity, specificity, and positive/negative predictive values were obtained; likelihood ratio (LR) test was used. Cohen's kappa was used to assess inter-observer agreement. The presence of diffuse AIS was highly predictive for cardiogenic dyspnea (sensitivity 93.6%, specificity 84%, positive predictive value 87.9%, negative predictive value 91.3%). On the contrary, US detection of pleural effusion was not helpful in the differential diagnosis (sensitivity 83.9%, specificity 52%, positive predictive value 68.4%, negative predictive value 72.2%). Finally

  1. Habitability from Tidally Induced Tectonics

    Science.gov (United States)

    Valencia, Diana; Tan, Vivian Yun Yan; Zajac, Zachary

    2018-04-01

    The stability of Earth’s climate on geological timescales is enabled by the carbon–silicate cycle that acts as a negative feedback mechanism stabilizing surface temperatures via the intake and outgassing of atmospheric carbon. On Earth, this thermostat is enabled by plate tectonics that sequesters outgassed CO2 back into the mantle via weathering and subduction at convergent margins. Here we propose a separate tectonic mechanism—vertical recycling—that can serve as the vehicle for CO2 outgassing and sequestration over long timescales. The mechanism requires continuous tidal heating, which makes it particularly relevant to planets in the habitable zone of M stars. Dynamical models of this vertical recycling scenario and stability analysis show that temperate climates stable over timescales of billions of years are realized for a variety of initial conditions, even as the M star dims over time. The magnitude of equilibrium surface temperatures depends on the interplay of sea weathering and outgassing, which in turn depends on planetary carbon content, so that planets with lower carbon budgets are favored for temperate conditions. The habitability of planets such as found in the Trappist-1 system may be rooted in tidally driven tectonics.

  2. Tidal mixing in Dahej creek waters

    Digital Repository Service at National Institute of Oceanography (India)

    Swamy, G.N.; Sarma, R.V.

    Mixing characteristics of a tidal inlet near Dahej at the mouth of Narmada River, Gujarat, India are examined in terms of tides, currents and bathymetry. The dilution potential of the Dahej Creek waters during a tidal march for a given rate...

  3. TIDALLY HEATED TERRESTRIAL EXOPLANETS: VISCOELASTIC RESPONSE MODELS

    International Nuclear Information System (INIS)

    Henning, Wade G.; O'Connell, Richard J.; Sasselov, Dimitar D.

    2009-01-01

    Tidal friction in exoplanet systems, driven by orbits that allow for durable nonzero eccentricities at short heliocentric periods, can generate internal heating far in excess of the conditions observed in our own solar system. Secular perturbations or a notional 2:1 resonance between a hot Earth and hot Jupiter can be used as a baseline to consider the thermal evolution of convecting bodies subject to strong viscoelastic tidal heating. We compare results first from simple models using a fixed Quality factor and Love number, and then for three different viscoelastic rheologies: the Maxwell body, the Standard Anelastic Solid (SAS), and the Burgers body. The SAS and Burgers models are shown to alter the potential for extreme tidal heating by introducing the possibility of new equilibria and multiple response peaks. We find that tidal heating tends to exceed radionuclide heating at periods below 10-30 days, and exceed insolation only below 1-2 days. Extreme cases produce enough tidal heat to initiate global-scale partial melting, and an analysis of tidal limiting mechanisms such as advective cooling for earthlike planets is discussed. To explore long-term behaviors, we map equilibria points between convective heat loss and tidal heat input as functions of eccentricity. For the periods and magnitudes discussed, we show that tidal heating, if significant, is generally detrimental to the width of habitable zones.

  4. Sedimentation and response to sea-level rise of a restored marsh with reduced tidal exchange: Comparison with a natural tidal marsh

    Science.gov (United States)

    Vandenbruwaene, W.; Maris, T.; Cahoon, D.R.; Meire, P.; Temmerman, S.

    2011-01-01

    Along coasts and estuaries, formerly embanked land is increasingly restored into tidal marshes in order to re-establish valuable ecosystem services, such as buffering against flooding. Along the Scheldt estuary (Belgium), tidal marshes are restored on embanked land by allowing a controlled reduced tide (CRT) into a constructed basin, through a culvert in the embankment. In this way tidal water levels are significantly lowered (ca. 3 m) so that a CRT marsh can develop on formerly embanked land with a ca. 3 m lower elevation than the natural tidal marshes. In this study we compared the long-term change in elevation (ΔE) within a CRT marsh and adjacent natural tidal marsh. Over a period of 4 years, the observed spatio-temporal variations in ΔE rate were related to variations in inundation depth, and this relationship was not significantly different for the CRT marsh and natural tidal marsh. A model was developed to simulate the ΔE over the next century. (1) Under a scenario without mean high water level (MHWL) rise in the estuary, the model shows that the marsh elevation-ΔE feedback that is typical for a natural tidal marsh (i.e. rising marsh elevation results in decreasing inundation depth and therefore a decreasing increase in elevation) is absent in the basin of the CRT marsh. This is because tidal exchange of water volumes between the estuary and CRT marsh are independent from the CRT marsh elevation but dependent on the culvert dimensions. Thus the volume of water entering the CRT remains constant regardless of the marsh elevation. Consequently the CRT MHWL follows the increase in CRT surface elevation, resulting after 75 years in a 2–2.5 times larger elevation gain in the CRT marsh, and a faster reduction of spatial elevation differences. (2) Under a scenario of constant MHWL rise (historical rate of 1.5 cm a-1), the equilibrium elevation (relative to MHWL) is 0.13 m lower in the CRT marsh and is reached almost 2 times faster. (3) Under a scenario of

  5. Relativistic theory of tidal Love numbers

    International Nuclear Information System (INIS)

    Binnington, Taylor; Poisson, Eric

    2009-01-01

    In Newtonian gravitational theory, a tidal Love number relates the mass multipole moment created by tidal forces on a spherical body to the applied tidal field. The Love number is dimensionless, and it encodes information about the body's internal structure. We present a relativistic theory of Love numbers, which applies to compact bodies with strong internal gravities; the theory extends and completes a recent work by Flanagan and Hinderer, which revealed that the tidal Love number of a neutron star can be measured by Earth-based gravitational-wave detectors. We consider a spherical body deformed by an external tidal field, and provide precise and meaningful definitions for electric-type and magnetic-type Love numbers; and these are computed for polytropic equations of state. The theory applies to black holes as well, and we find that the relativistic Love numbers of a nonrotating black hole are all zero.

  6. Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold motion.

    Science.gov (United States)

    De Guzman, Vanessa; Ballif, Catherine L; Maurer, Rie; Hartnick, Christopher J; Raol, Nikhila

    2014-09-01

    Paradoxical vocal fold motion (PVFM) affects almost 1 million adolescents in the United States. However, to date, no disease-specific objective measure exists to assess symptom severity and response to treatment in adolescents with exercise-induced PVFM. To validate the Dyspnea Index (DI) quality-of-life instrument (previously validated for adults with breathing disorders) in children aged 12 to 18 years with exercise-induced PVFM and to determine the minimum significant DI change corresponding to patient-reported or caregiver-reported improvement or worsening of symptoms. A longitudinal study of 56 patients (age range, 12-18 years) diagnosed as having exercise-induced PVFM and their caregivers from February 1, 2013, to September 30, 2013, in an outpatient pediatric otolaryngology office practice. The DI was administered to patients and caregivers, with items modified to reflect the perspective of caregivers. Appropriate DI change was measured to reflect improvement or worsening of symptoms. Test-retest reliability was accomplished by having a subset of patients and caregivers complete the instrument twice within 2 weeks before therapy. Internal consistency was assessed by calculation of Cronbach α. Discriminant validity and convergent validity were determined by comparing DIs with assessment of global change in symptoms. The patient and caregiver mean (SD) DI changes were -12.9 (9.6) and -14.7 (9.3), respectively (P therapy.

  7. Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial.

    Science.gov (United States)

    Özkan, Behzat; Ünlüer, Erden E; Akyol, Pinar Y; Karagöz, Arif; Bayata, Mehmet S; Akoğlu, Haldun; Oyar, Orhan; Dalli, Ayşe; Topal, Fatih E

    2015-12-01

    We aimed to determine the accuracies of point-of-care ultrasound (PoCUS) and stethoscopes as part of the physical examinations of patients with dyspnea. Three emergency medicine specialists in each of two groups of ultrasound and stethoscope performers underwent didactic and hands-on training on PoCUS and stethoscope usage. All the patients enrolled were randomized to one of two predetermined PoCUS or stethoscope groups. The diagnostic performance of ultrasonography was higher than that of the stethoscope in the diagnoses of heart failure (90 vs. 86%, 1.00 vs. 0.89, and 5.00 vs. 4.92, respectively) and pneumonia (90 vs. 86.7%, 0.75 vs. 0.73, and 16.50 vs. 13.82, respectively). No significant differences were observed in the utility parameters of these modalities in these diagnoses. Although some authors argue that it is time to abandon the 'archaic tools' of past centuries, we believe that it is too early to discontinue the use of the stethoscope.

  8. An unusual cause of severe dyspnea: A laryngeal live leech: Case report.

    Science.gov (United States)

    Anajar, Said; Ansari, Rachid; Hassnaoui, Jawad; Abada, Reda; Roubal, Mohammed; Mahtar, Mohammed

    2017-01-01

    Foreign bodies in the upper airways are one of the most challenging otolaryngology emergencies, leeches present a very rare cause of airway foreign bodies around the world. A 6-year-old girl was referred to our otolaryngology department at a tertiary university hospital with a severe dyspnea and hemoptysis. Nasofibroscopy revealed a dark living leech in the supraglottic area which extends to the glottis. The patient was urgently admitted to the operating room, the leech was grasped and removed with a foreign body forceps with a full length of more than 6cm. All symptoms were relieved post operatively and she was discharged one day later. Leeches should be suspected as an airway foreign body in patients with a recent history of drinking from stream water. Prevention remains the best treatment for such cases based simply on hygiene measures like not drinking stream water directly and filtering drinking water before it is used. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Aerobic exercise training without weight loss reduces dyspnea on exertion in obese women

    Science.gov (United States)

    Bernhardt, Vipa; Stickford, Jonathon L.; Bhammar, Dharini M.; Babb, Tony G.

    2015-01-01

    Dyspnea on exertion (DOE) is a common symptom in obesity. We investigated whether aerobic exercise training without weight loss could reduce DOE. Twenty-two otherwise healthy obese women participated in a 12-week supervised aerobic exercise training program, exercising 30 min/day at 70–80% heart rate reserve, 4 days/week. Subjects were grouped based on their Ratings of Perceived Breathlessness (RPB) during constant load 60W cycling: +DOE (n = 12, RPB ≥ 4, 37 ± 7 years, 34 ± 4kg/m2) and −DOE (n = 10, RPB ≤ 2, 32 ± 6 years, 33 ± 3kg/m2). No significant differences between the groups in body composition, pulmonary function, or cardiorespiratory fitness were observed pre-training. Post-training, peak was improved significantly in both groups (+DOE: 12 ± 7, −DOE: 14 ± 8%). RPB was significantly decreased in the + DOE (4.7 ± 1.0–2.5 ± 1.0) and remained low in the −DOE group (1.2 ± 0.6–1.3 ± 1.0) (interaction p exercise training improved cardiorespiratory fitness and DOE and thus appears to be an effective treatment for DOE in obese women. PMID:26593640

  10. Tidal current and tidal energy changes imposed by a dynamic tidal power system in the Taiwan Strait, China

    Science.gov (United States)

    Dai, Peng; Zhang, Jisheng; Zheng, Jinhai

    2017-12-01

    The Taiwan Strait has recently been proposed as a promising site for dynamic tidal power systems because of its shallow depth and strong tides. Dynamic tidal power is a new concept for extracting tidal potential energy in which a coast-perpendicular dike is used to create water head and generate electricity via turbines inserted in the dike. Before starting such a project, the potential power output and hydrodynamic impacts of the dike must be assessed. In this study, a two-dimensional numerical model based on the Delft3D-FLOW module is established to simulate tides in China. A dike module is developed to account for turbine processes and estimate power output by integrating a special algorithm into the model. The domain decomposition technique is used to divide the computational zone into two subdomains with grid refinement near the dike. The hydrodynamic processes predicted by the model, both with and without the proposed construction, are examined in detail, including tidal currents and tidal energy flux. The predicted time-averaged power yields with various opening ratios are presented. The results show that time-averaged power yield peaks at an 8% opening ratio. For semidiurnal tides, the flow velocity increases in front of the head of the dike and decreases on either side. For diurnal tides, these changes are complicated by the oblique incidence of tidal currents with respect to the dike as well as by bathymetric features. The dike itself blocks the propagation of tidal energy flux.

  11. The influence of waves on the tidal kinetic energy resource at a tidal stream energy site

    International Nuclear Information System (INIS)

    Guillou, Nicolas; Chapalain, Georges; Neill, Simon P.

    2016-01-01

    Highlights: • We model the influence of waves on tidal kinetic energy in the Fromveur Strait. • Numerical results are compared with field data of waves and currents. • The introduction of waves improve predictions of tidal stream power during storm. • Mean spring tidal stream potential is reduced by 12% during extreme wave conditions. • Potential is reduced by 7.8% with waves forces and 5.3% with enhanced friction. - Abstract: Successful deployment of tidal energy converters relies on access to accurate and high resolution numerical assessments of available tidal stream power. However, since suitable tidal stream sites are located in relatively shallow waters of the continental shelf where tidal currents are enhanced, tidal energy converters may experience effects of wind-generated surface-gravity waves. Waves may thus influence tidal currents, and associated kinetic energy, through two non-linear processes: the interaction of wave and current bottom boundary layers, and the generation of wave-induced currents. Here, we develop a three-dimensional tidal circulation model coupled with a phase-averaged wave model to quantify the impact of the waves on the tidal kinetic energy resource of the Fromveur Strait (western Brittany) - a region that has been identified with strong potential for tidal array development. Numerical results are compared with in situ observations of wave parameters (significant wave height, peak period and mean wave direction) and current amplitude and direction 10 m above the seabed (the assumed technology hub height for this region). The introduction of waves is found to improve predictions of tidal stream power at 10 m above the seabed at the measurement site in the Strait, reducing kinetic energy by up to 9% during storm conditions. Synoptic effects of wave radiation stresses and enhanced bottom friction are more specifically identified at the scale of the Strait. Waves contribute to a slight increase in the spatial gradient of

  12. Gender effect on the use of modified borg and visual analog scales in the evaluation of dyspnea in chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    Ilgin, D.; Ozalevli, S.; Karaali, H.K.; Cimrin, A.H.; Ucan, E.S.

    2010-01-01

    To investigate the gender effect on the use of Modified Borg Scale (MBS) and Visual Analog Scale (VAS) for the effort dyspnea evaluation in Chronic Obstructive Pulmonary Disease (COPD) patients. Fifty-two patients with severe COPD were included in this study. Pulmonary function (spirometry), quality of life (Chronic Respiratory Disease Questionnaire-CRDQ), exercise capacity (6-minute walking test), and dyspnea severity (Modified Borg and Visual Analog Scales) were evaluated. The dyspnea severity scores were higher and walking distance was shorter in women (p<0.05). The scores of the both scales were correlated with each other in both genders (p<0.05). In men, the dyspnea scores obtained by MBS and VAS scales were significantly correlated with 6-minute walking distance (p=0.001) and total score of CRDQ (p=0.001). On the other hand, the dyspnea severity score of the women obtained by MBS was correlated with only the total score of CRDQ (p<0.05). The results of our study show that gender has an effect on dyspnea perception obtained by MBS and VAS. We suggest that MBS and VAS should be used for men whereas MBS may be more convenient for women in the evaluation of dyspnea in severe COPD. (author)

  13. Relevance of tidal heating on large TNOs

    Science.gov (United States)

    Saxena, Prabal; Renaud, Joe P.; Henning, Wade G.; Jutzi, Martin; Hurford, Terry

    2018-03-01

    We examine the relevance of tidal heating for large Trans-Neptunian Objects, with a focus on its potential to melt and maintain layers of subsurface liquid water. Depending on their past orbital evolution, tidal heating may be an important part of the heat budget for a number of discovered and hypothetical TNO systems and may enable formation of, and increased access to, subsurface liquid water. Tidal heating induced by the process of despinning is found to be particularly able to compete with heating due to radionuclide decay in a number of different scenarios. In cases where radiogenic heating alone may establish subsurface conditions for liquid water, we focus on the extent by which tidal activity lifts the depth of such conditions closer to the surface. While it is common for strong tidal heating and long lived tides to be mutually exclusive, we find this is not always the case, and highlight when these two traits occur together. We find cases where TNO systems experience tidal heating that is a significant proportion of, or greater than radiogenic heating for periods ranging from100‧s of millions to a billion years. For subsurface oceans that contain a small antifreeze component, tidal heating due to very high initial spin states may enable liquid water to be preserved right up to the present day. Of particular interest is the Eris-Dysnomia system, which in those cases may exhibit extant cryovolcanism.

  14. Atmospheric noise of a breaking tidal bore.

    Science.gov (United States)

    Chanson, Hubert

    2016-01-01

    A tidal bore is a surge of waters propagating upstream in an estuary as the tidal flow turns to rising and the flood tide propagates into a funnel-shaped system. Large tidal bores have a marked breaking roller. The sounds generated by breaking tidal bores were herein investigated in the field (Qiantang River) and in laboratory. The sound pressure record showed two dominant periods, with some similarity with an earlier study [Chanson (2009). J. Acoust. Soc. Am. 125(6), 3561-3568]. The two distinct phases were the incoming tidal bore when the sound amplitude increased with the approaching bore, and the passage of the tidal bore in front of the microphone when loud and powerful noises were heard. The dominant frequency ranged from 57 to 131 Hz in the Qiantang River bore. A comparison between laboratory and prototype tidal bores illustrated both common features and differences. The low pitch sound of the breaking bore had a dominant frequency close to the collective oscillations of bubble clouds, which could be modeled with a bubble cloud model using a transverse dimension of the bore roller. The findings suggest that this model might be over simplistic in the case of a powerful breaking bore, like that of the Qiantang River.

  15. No Snowball on Habitable Tidally Locked Planets

    Science.gov (United States)

    Checlair, Jade; Menou, Kristen; Abbot, Dorian S.

    2017-08-01

    The TRAPPIST-1, Proxima Centauri, and LHS 1140 systems are the most exciting prospects for future follow-up observations of potentially inhabited planets. All of the planets orbit nearby M-stars and are likely tidally locked in 1:1 spin–orbit states, which motivates the consideration of the effects that tidal locking might have on planetary habitability. On Earth, periods of global glaciation (snowballs) may have been essential for habitability and remote signs of life (biosignatures) because they are correlated with increases in the complexity of life and in the atmospheric oxygen concentration. In this paper, we investigate the snowball bifurcation (sudden onset of global glaciation) on tidally locked planets using both an energy balance model and an intermediate-complexity global climate model. We show that tidally locked planets are unlikely to exhibit a snowball bifurcation as a direct result of the spatial pattern of insolation they receive. Instead, they will smoothly transition from partial to complete ice coverage and back. A major implication of this work is that tidally locked planets with an active carbon cycle should not be found in a snowball state. Moreover, this work implies that tidally locked planets near the outer edge of the habitable zone with low CO2 outgassing fluxes will equilibrate with a small unglaciated substellar region rather than cycling between warm and snowball states. More work is needed to determine how the lack of a snowball bifurcation might affect the development of life on a tidally locked planet.

  16. No Snowball on Habitable Tidally Locked Planets

    Energy Technology Data Exchange (ETDEWEB)

    Checlair, Jade; Abbot, Dorian S. [Department of the Geophysical Sciences, University of Chicago, 5734 South Ellis Avenue, Chicago, IL 60637 (United States); Menou, Kristen, E-mail: jadecheclair@uchicago.edu [Centre for Planetary Sciences, Department of Physical and Environmental Sciences, University of Toronto at Scarborough, Toronto, ON M1C 1A4 (Canada)

    2017-08-20

    The TRAPPIST-1, Proxima Centauri, and LHS 1140 systems are the most exciting prospects for future follow-up observations of potentially inhabited planets. All of the planets orbit nearby M-stars and are likely tidally locked in 1:1 spin–orbit states, which motivates the consideration of the effects that tidal locking might have on planetary habitability. On Earth, periods of global glaciation (snowballs) may have been essential for habitability and remote signs of life (biosignatures) because they are correlated with increases in the complexity of life and in the atmospheric oxygen concentration. In this paper, we investigate the snowball bifurcation (sudden onset of global glaciation) on tidally locked planets using both an energy balance model and an intermediate-complexity global climate model. We show that tidally locked planets are unlikely to exhibit a snowball bifurcation as a direct result of the spatial pattern of insolation they receive. Instead, they will smoothly transition from partial to complete ice coverage and back. A major implication of this work is that tidally locked planets with an active carbon cycle should not be found in a snowball state. Moreover, this work implies that tidally locked planets near the outer edge of the habitable zone with low CO{sub 2} outgassing fluxes will equilibrate with a small unglaciated substellar region rather than cycling between warm and snowball states. More work is needed to determine how the lack of a snowball bifurcation might affect the development of life on a tidally locked planet.

  17. No Snowball on Habitable Tidally Locked Planets

    International Nuclear Information System (INIS)

    Checlair, Jade; Abbot, Dorian S.; Menou, Kristen

    2017-01-01

    The TRAPPIST-1, Proxima Centauri, and LHS 1140 systems are the most exciting prospects for future follow-up observations of potentially inhabited planets. All of the planets orbit nearby M-stars and are likely tidally locked in 1:1 spin–orbit states, which motivates the consideration of the effects that tidal locking might have on planetary habitability. On Earth, periods of global glaciation (snowballs) may have been essential for habitability and remote signs of life (biosignatures) because they are correlated with increases in the complexity of life and in the atmospheric oxygen concentration. In this paper, we investigate the snowball bifurcation (sudden onset of global glaciation) on tidally locked planets using both an energy balance model and an intermediate-complexity global climate model. We show that tidally locked planets are unlikely to exhibit a snowball bifurcation as a direct result of the spatial pattern of insolation they receive. Instead, they will smoothly transition from partial to complete ice coverage and back. A major implication of this work is that tidally locked planets with an active carbon cycle should not be found in a snowball state. Moreover, this work implies that tidally locked planets near the outer edge of the habitable zone with low CO 2 outgassing fluxes will equilibrate with a small unglaciated substellar region rather than cycling between warm and snowball states. More work is needed to determine how the lack of a snowball bifurcation might affect the development of life on a tidally locked planet.

  18. Dyspnea in a case of shoulder dislocation – to beware of this rare life-threatening symptom

    Directory of Open Access Journals (Sweden)

    Joshi Satyen Praful

    2016-01-01

    Full Text Available Shoulder dislocation is a common injury in orthopedic practice. In an acute presentation, closed reduction of the shoulder joint leads to an uneventful recovery. However, in the developing world neglected shoulder dislocation and treatments from quacks are not uncommon. Improper treatment and neglect can rarely become life threatening. We present one such case, emphasizing the need to investigate the symptom of dyspnea in a patient with history of shoulder dislocation.

  19. Dyspnea and choking as presenting symptoms in primary medulla oblongata germinoma.

    Science.gov (United States)

    Yip, Chi-Man; Tseng, Hui-Hwa; Hsu, Shu-Shong; Liao, Wei-Chuan; Chen, Jun-Yih; Chen, Chih-Hao; Chang, Chia-Yuan

    2014-01-01

    The medulla oblongata is the lower half of the brainstem. It contains the cardiac, respiratory, vomiting, and vasomotor centers and deals with autonomic functions such as breathing, heartbeat, and blood pressure. Primary medulla oblongata germinoma is very rare and less than 20 cases have been reported in the English literature. A 22-year-old female without any particular past medical history presented to us in October 2012 with the chief complaint of dyspnea and frequent choking for 1 month. Neurological examination revealed lower cranial nerve palsies and nystagmus. Her brain computed tomography (CT) and brain magnetic resonance imaging (MRI) demonstrated a mass lesion at the dorsal surface of medulla oblongata with extension into the inferior fourth ventricle and foramen magnum. She underwent bilateral suboccipital craniotomy and C1 laminoplasty with the grossly total resection of the tumor. The histological examination of the tumor proved germinoma. Postoperative adjuvant radiotherapy was arranged. The latest brain MRI and whole spine MRI done 1 year after surgery showed neither residual nor recurrent tumor in the whole axis. She is regularly followed-up at our outpatient department and is doing well except having left vocal cord palsy, which occurred before surgery. Medulloblastoma, ependymoma, glioma, hemangioblastoma, and cavernous angioma are common intraaxial tumors in the medulla oblongata and fourth ventricle. Intracranial germ cell tumors originate from extragonadal seminal cells and have been found in 0.4-3.4% of patients with primary central nervous system (CNS) tumors in Western countries, while the incidence is reported to be 5-8 times greater in Japan and the Far East. Although germinoma of medulla oblongata is rare and difficult to diagnose preoperatively, it should be included in the differential diagnosis of medulla masses with fourth ventricle extension, especially in Asian population.

  20. Laryngeal dyspnea in relation to an interaction between acenocoumarol and topical econazole lotion.

    Science.gov (United States)

    Wey, Pierre-François; Petitjeans, Fabrice; Lions, Christophe; Ould-Ahmed, Mehdi; Escarment, Jacques

    2008-08-01

    Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage. An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours. Transnasal fiberoptic laryngoscopy revealed a significant laryngeal hematoma, as well as a hematoma on the floor of the mouth and in the tonsil area. Laboratory abnormalities included a prothrombin time 120 seconds. The patient had been receiving acenocoumarol 4 mg/d for 10 years for episodes of atrial fibrillation and recurrent deep venous thrombosis. Seventeen days earlier, she had received a prescription for topical econazole lotion 1% to be applied 3 times daily for 1 month to treat a dermatitis affecting 12% of the body surface. The patient was admitted to the intensive care unit for treatment of respiratory failure, where oxygen was delivered by face mask. The coagulation disorders were treated with prothrombin complex concentrate 30 IU/kg IV and vitamin K1 10 mg IV, and values normalized within 36 hours. Surgical evacuation of the laryngeal hematoma was not necessary. After 48 hours, improvement in the patient's respiratory symptoms allowed transfer to the ear, nose, and throat unit, where daily endoscopic examination was performed. Aspirin was substituted for acenocoumarol, and the patient returned home after 10 days without sequelae. Based on a Naranjo score of 7, this episode was probably related to an interaction between acenocoumarol and econazole. This report describes a case of a probable interaction between topical econazole lotion 1% and acenocoumarol that resulted in overanticoagulation and a life-threatening laryngeal

  1. Tidal interactions with Kerr black holes

    International Nuclear Information System (INIS)

    Hiscock, W.A.

    1977-01-01

    The tidal deformation of an extended test body falling with zero angular momentum into a Kerr black hole is calculated. Numerical results for infall along the symmetry axis and in the equatorial plane of the black hole are presented for a range of values of a, the specific angular momentum of the black hole. Estimates of the tidal contribution to the gravitational radiation are also given. The tidal contribution in equatorial infall into a maximally rotating Kerr black hole may be of the same order as the center-of-mass contribution to the gravitational radiation

  2. Tidal influence on subtropical estuarine methane emissions

    Science.gov (United States)

    Sturm, Katrin; Grinham, Alistair; Werner, Ursula; Yuan, Zhiguo

    2014-05-01

    The relatively unstudied subtropical estuaries, particularly in the Southern Hemisphere, represent an important gap in our understanding of global greenhouse gas (GHG) emissions. These systems are likely to form an important component of GHG budgets as they occupy a relatively large surface area, over 38 000 km2 in Australia. Here, we present studies conducted in the Brisbane River estuary, a representative system within the subtropical region of Queensland, Australia. This is a highly modified system typical of 80% of Australia's estuaries. Generally, these systems have undergone channel deepening and straightening for safer shipping access and these modifications have resulted in large increases in tidal reach. The Brisbane River estuary's natural tidal reach was 16 km and this is now 85 km and tidal currents influence double the surface area (9 km2 to 18 km2) in this system. Field studies were undertaken to improve understanding of the driving factors behind methane water-air fluxes. Water-air fluxes in estuaries are usually calculated with the gas exchange coefficient (k) for currents and wind as well as the concentration difference across the water-air interface. Tidal studies in the lower and middle reaches of the estuary were performed to monitor the influence of the tidal stage (a proxy for kcurrent) on methane fluxes. Results for both investigated reaches showed significantly higher methane fluxes during the transition time of tides, the time of greatest tidal currents, than during slack tide periods. At these tidal transition times with highest methane chamber fluxes, lowest methane surface water concentrations were monitored. Modelled fluxes using only wind speed (kwind) were at least one order of magnitude lower than observed from floating chambers, demonstrating that current speed was likely the driving factor of water-air fluxes. An additional study was then conducted sampling the lower, middle and upper reaches during a tidal transition period

  3. The role of voice therapy in the treatment of dyspnea and dysphonia in a patient with a vagal nerve stimulation device.

    Science.gov (United States)

    Gillespie, Amanda I; Helou, Leah B; Ingle, John W; Baldwin, Maria; Rosen, Clark A

    2014-01-01

    Vagal nerve stimulators (VNS) are implanted to treat medically refractory epilepsy and depression. The VNS stimulates the vagus nerve in the left neck. Laryngeal side effects are common and include dysphagia, dysphonia, and dyspnea. The current case study represents a patient with severe dyspnea and dysphonia, persisting even with VNS deactivation. The case demonstrates the use of voice and respiratory retraining therapy for the treatment of VNS-induced dysphonia and dyspnea. It also highlights the importance of a multidisciplinary approach, including laryngology, neurology, and speech-language pathology, in the treatment of these challenging patients. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  4. Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea.

    Science.gov (United States)

    Sforza, Alfonso; Mancusi, Costantino; Carlino, Maria Viviana; Buonauro, Agostino; Barozzi, Marco; Romano, Giuseppe; Serra, Sossio; de Simone, Giovanni

    2017-06-19

    The availability of ultra-miniaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. Information on accuracy of ultrasound with handheld units in immediate differential diagnosis in emergency department (ED) is poor. The aim of this study is to test the usefulness and accuracy of lung ultrasound (LUS) alone or combined with ultrasound of the heart and inferior vena cava (IVC) using a PUD for the differential diagnosis of acute dyspnea (AD). We included 68 patients presenting to the ED of "Maurizio Bufalini" Hospital in Cesena (Italy) for AD. All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The series was divided into patients with dyspnea of cardiac or non-cardiac origin. We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive value and negative predictive value of the three ultrasonic methods and their various combinations for the diagnosis of cardiogenic dyspnea (CD), comparing with the final diagnosis made by an independent emergency physician. LUS alone exhibited a good sensitivity (92.6%) and specificity (80.5%). The highest accuracy (90%) for the diagnosis of CD was obtained with the combination of LUS and one of the other two methods (heart or IVC). The IUE with PUD is a useful extension of the clinical examination, can be readily available at the bedside or in ambulance, requires few minutes and has a reliable diagnostic discriminant ability in the setting of AD.

  5. Exploitation of tidal power in the Bay of Cadiz: ancient tidal mills

    Directory of Open Access Journals (Sweden)

    José J. Alonso del Rosario

    2006-03-01

    Full Text Available Tidal mills were the main industrial activity in the Bay of Cadiz for centuries. They were the last step in the production of salt and flour made by grinding grains. They were installed along the shallow channels, called “caños”, around the Bay, where the frictional and geometrical effects are very strong. The authors have analyzed the propagation of the semidiurnal tidal waves along the Caño de Sancti Petri and the available tidal power in the area. The ancient tidal mills were located where the available tidal potential energy is highest, which ensured productivity for grinding salt and wheat in ancient times. Some considerations about the possibility of installing tidal power plants in the Bay of Cadiz now are given, which show that it could be a real and renewal alternative source of energy for the area.

  6. Downstream hydraulic geometry of a tidally influenced river delta

    NARCIS (Netherlands)

    Sassi, M.G.; Hoitink, A.J.F.; Brye, de B.; Deleersnijder, E.

    2012-01-01

    Channel geometry in tidally influenced river deltas can show a mixed scaling behavior between that of river and tidal channel networks, as the channel forming discharge is both of river and tidal origin. We present a method of analysis to quantify the tidal signature on delta morphology, by

  7. Development of tidal watersheds in the Wadden Sea

    NARCIS (Netherlands)

    Wang, Z.B.; Vroom, J.; van Prooijen, B.C.; Labeur, R.J.; Stive, M.J.F.; Hansen, M.H.P.

    2011-01-01

    The Wadden Sea consists of a series of tidal lagoons which are connected to the North Sea by tidal inlets. Boundaries to each lagoon are the mainland coast, the barrier islands on both sides of the tidal inlet, and the tidal watersheds behind the two barrier islands. Behind each Wadden Island there

  8. October 2015 Phoenix pulmonary journal club: lung volume reduction

    Directory of Open Access Journals (Sweden)

    Mathew M

    2015-11-01

    Full Text Available No abstract available. Article truncated at 150 words. The October 2015 pulmonary journal club focused on the review of older studies evaluating lung volume reduction surgery and how this has transitioned toward the development of non-surgical modes of lung volume reduction. The physiology behind dyspnea in chronic obstructive pulmonary disease (COPD is a complex process. One of the proposed mechanisms has been hyperinflation associated with air trapping. In the mid 1990s studies by Cooper and Peterson (1 offered a promising approach in which lung volume reduction (LVR could improve ventilatory mechanics and improve dyspnea. As the procedure gained more popularity, additional larger scale trials were performed to support its validity. We reviewed 2 studies looking at lung volume reduction. The first was "The Effect of Lung Volume Reduction Surgery In Patients With Severe Emphysema” (2 . This was a smaller, randomized controlled trial (RCT that looked at 2 groups of 24 patients. Once group received LVR while the ...

  9. Tidal Mixing at the Shelf Break

    National Research Council Canada - National Science Library

    Hogg, Nelson; Legg, Sonya

    2005-01-01

    ...; the second a set of simulations of flow over the Hawaiian ridge. The most exciting scientific result is the importance of internal hydraulic jumps in generating tidal mixing at large amplitude, steep topography...

  10. Tidal Mixing at the Shelf Break

    National Research Council Canada - National Science Library

    Hogg, Nelson; Legg, Sonya

    2005-01-01

    The aim of this project was to study mixing forced by tidal flow over sudden changes in topographic slope such as near the shelf-break, using high-resolution nonhydrostatic numerical simulations employing the MIT gem...

  11. Microbial quality of a marine tidal pool

    CSIR Research Space (South Africa)

    Genthe, Bettina

    1995-01-01

    Full Text Available In this study the source of microbial pollution to a tidal pool was investigated. Both adjacent seawater which could contribute to possible faecal pollution and potential direct bather pollution were studied. The microbial quality of the marine...

  12. Tides and tidal harmonics at Umbharat, Gujarat

    Digital Repository Service at National Institute of Oceanography (India)

    Suryanarayana, A.; Swamy, G.N.

    A part of the data on tides recorded at Machiwada near Umbharat, Gulf of Cambay during April 1978 was subjected to harmonic analysis following the Admiralty procedure. The general tidal characteristics and the value of four major harmonic...

  13. Resonant Tidal Disruption in Galactic Nuclei

    OpenAIRE

    Rauch, Kevin P.; Ingalls, Brian

    1997-01-01

    It has recently been shown that the rate of angular momentum relaxation in nearly-Keplerian star clusters is greatly increased by a process termed resonant relaxation (Rauch & Tremaine 1996), who also argued that tidal disruption of stars in galactic nuclei containing massive black holes could be noticeably enhanced by this process. We describe here the results of numerical simulations of resonant tidal disruption which quantitatively test the predictions made by Rauch & Tremaine. The simulat...

  14. On the ambiguity in relativistic tidal deformability

    Science.gov (United States)

    Gralla, Samuel E.

    2018-04-01

    The LIGO collaboration recently reported the first gravitational-wave constraints on the tidal deformability of neutron stars. I discuss an inherent ambiguity in the notion of relativistic tidal deformability that, while too small to affect the present measurement, may become important in the future. I propose a new way to understand the ambiguity and discuss future prospects for reliably linking observed gravitational waveforms to compact object microphysics.

  15. WIYN Open Cluster Study: Tidal Interactions in Solar type Binaries

    OpenAIRE

    Meibom, S.; Mathieu, R. D.

    2003-01-01

    We present an ongoing study on tidal interactions in late-type close binary stars. New results on tidal circularization are combined with existing data to test and constrain theoretical predictions of tidal circularization in the pre-main-sequence (PMS) phase and throughout the main-sequence phase of stellar evolution. Current data suggest that tidal circularization during the PMS phase sets the tidal cutoff period for binary populations younger than ~1 Gyr. Binary populations older than ~1 G...

  16. Half Moon Cove Tidal Project. Feasibility report

    Energy Technology Data Exchange (ETDEWEB)

    1980-11-01

    The proposed Half Moon Cove Tidal Power Project would be located in a small cove in the northern part of Cobscook Bay in the vicinity of Eastport, Maine. The project would be the first tidal electric power generating plant in the United States of America. The basin impounded by the barrier when full will approximate 1.2 square miles. The average tidal range at Eastport is 18.2 feet. The maximum spring tidal range will be 26.2 feet and the neap tidal range 12.8 feet. The project will be of the single pool-type single effect in which generation takes place on the ebb tide only. Utilizing an average mean tidal range of 18.2 feet the mode of operation enables generation for approximately ten and one-half (10-1/2) hours per day or slightly in excess of five (5) hours per tide. The installed capacity will be 12 MW utilizing 2 to 6 MW units. An axial flow, or Bulb type of turbine was selected for this study.

  17. TIDAL INTERACTIONS IN MERGING WHITE DWARF BINARIES

    International Nuclear Information System (INIS)

    Piro, Anthony L.

    2011-01-01

    The recently discovered system J0651 is the tightest known detached white dwarf (WD) binary. Since it has not yet initiated Roche-lobe overflow, it provides a relatively clean environment for testing our understanding of tidal interactions. I investigate the tidal heating of each WD, parameterized in terms of its tidal Q parameter. Assuming that the heating can be radiated efficiently, the current luminosities are consistent with Q 1 ∼ 7 x 10 10 and Q 2 ∼ 2 x 10 7 , for the He and C/O WDs, respectively. Conversely, if the observed luminosities are merely from the cooling of the WDs, these estimated values of Q represent the upper limits. A large Q 1 for the He WD means its spin velocity will be slower than that expected if it was tidally locked, which, since the binary is eclipsing, may be measurable via the Rossiter-McLaughlin effect. After one year, gravitational wave emission shifts the time of eclipses by 5.5 s, but tidal interactions cause the orbit to shrink more rapidly, changing the time by up to an additional 0.3 s after a year. Future eclipse timing measurements may therefore infer the degree of tidal locking.

  18. Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease.

    Science.gov (United States)

    Rocker, Graeme; Young, Joanne; Donahue, Margaret; Farquhar, Morag; Simpson, Catherine

    2012-06-12

    A recent national practice guideline recommends the use of opioids for the treatment of refractory dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD). We conducted two qualitative studies to explore the experiences of patients and family caregivers with opioids for refractory COPD-related dyspnea and the perspectives and attitudes of physicians toward opioids in this context. Patients (n = 8; 5 men, 3 women), their caregivers (n = 12; 5 men, 7 women) and physicians (n = 28, 17 men, 11 women) in Nova Scotia participated in the studies. Semistructured interviews were recorded, transcribed verbatim, coded conceptually and analyzed for emergent themes using interpretive description methodology. Patients reported that opioids provided a sense of calm and relief from severe dyspnea. Family caregivers felt that opioids helped patients to breathe more "normally," observed improvements in patients' symptoms of anxiety and depression, and experienced reductions in their own stress. Patients reported substantial improvements in their quality of life. All patients and family caregivers wanted opioid therapy to continue. Most physicians were reluctant to prescribe opioids for refractory dyspnea, describing a lack of related knowledge and experience, and fears related to the potential adverse effects and legal censure. Discrepancies between the positive experiences of patients and family caregivers with opioids and the reluctance of physicians to prescribe opioids for refractory dyspnea constitute an important gap in care. Bridging this gap will require initiatives to improve the uptake of practice guidelines and to increase confidence in prescribing opioids for dyspnea refractory to conventional treatment.

  19. Plant distributions along salinity and tidal gradients in Oregon tidal marshes

    Science.gov (United States)

    Accurately modeling climate change effects on tidal marshes in the Pacific Northwest requires understanding how plant assemblages and species are presently distributed along gradients of salinity and tidal inundation. We outline on-going field efforts by the EPA and USGS to dete...

  20. Tidal exchange between a freshwater tidal marsh and an impacted estuary: the Scheldt estuary, Belgium

    NARCIS (Netherlands)

    van Damme, S.; Dehairs, F.; Tackx, M.; Beauchard, O.; Struyf, E.; Gribsholt, B.; van Cleemput, O.; Meire, P.

    2009-01-01

    Tidal marsh exchange studies are relatively simple tools to investigate the interaction between tidal marshes and estuaries. They have mostly been confined to only a few elements and to saltwater or brackish systems. This study presents mass-balance results of an integrated one year campaign in a

  1. Geometry of tidal inlet systems : A key factor for the net sediment transport in tidal inlets

    NARCIS (Netherlands)

    Ridderinkhof, W.; de Swart, H. E.; van der Vegt, M.; Alebregtse, N. C.; Hoekstra, P.

    2014-01-01

    The net transport of sediment between the back-barrier basin and the sea is an important process for determining the stability of tidal inlet systems. Earlier studies showed that in a short basin, tidal flats favor peak ebb-currents stronger than peak flood currents, implying export of coarse

  2. Dynamics of tidal and non-tidal currents along the southwest continental shelf of India

    Digital Repository Service at National Institute of Oceanography (India)

    Aruna, C.; Ravichandran, C.; Srinivas, K.; Rasheed, P.A.A.; Lekshmi, S.

    are predominantly mixed, semidiurnal in nature. Motion over any continental shelf is governed by the tide-driven oscillatory flow. In this paper, tidal and non-tidal characteristics of the waters of Southwest continental shelf of India are assessed using...

  3. Positive outcome of average volume-assured pressure support mode of a Respironics V60 Ventilator in acute exacerbation of chronic obstructive pulmonary disease: a case report

    Directory of Open Access Journals (Sweden)

    Okuda Miyuki

    2012-09-01

    Full Text Available Abstract Introduction We were able to treat a patient with acute exacerbation of chronic obstructive pulmonary disease who also suffered from sleep-disordered breathing by using the average volume-assured pressure support mode of a Respironics V60 Ventilator (Philips Respironics: United States. This allows a target tidal volume to be set based on automatic changes in inspiratory positive airway pressure. This removed the need to change the noninvasive positive pressure ventilation settings during the day and during sleep. The Respironics V60 Ventilator, in the average volume-assured pressure support mode, was attached to our patient and improved and stabilized his sleep-related hypoventilation by automatically adjusting force to within an acceptable range. Case presentation Our patient was a 74-year-old Japanese man who was hospitalized for treatment due to worsening of dyspnea and hypoxemia. He was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and full-time biphasic positive airway pressure support ventilation was initiated. Our patient was temporarily provided with portable noninvasive positive pressure ventilation at night-time following an improvement in his condition, but his chronic obstructive pulmonary disease again worsened due to the recurrence of a respiratory infection. During the initial exacerbation, his tidal volume was significantly lower during sleep (378.9 ± 72.9mL than while awake (446.5 ± 63.3mL. A ventilator that allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range was attached in average volume-assured pressure support mode, improving his sleep-related hypoventilation, which is often associated with the use of the Respironics V60 Ventilator. Polysomnography performed while our patient was on noninvasive positive pressure ventilation revealed obstructive sleep apnea syndrome (apnea-hypopnea index = 14, suggesting that his chronic

  4. Tidal streams in the local group and beyond observations and implications

    CERN Document Server

    Carlin, Jeffrey

    2016-01-01

    This volume is written by leading scientists in the field, who review the current state of our knowledge of tidal streams in the Milky Way, the Andromeda galaxy, and in other nearby galaxies.  The cosmological origins of dwarf galaxies and the physical processes by which they are tidally disrupted into streams and incorporated into galaxy halos are discussed. The techniques that have been used to identify tidal streams are presented, and will be useful to researchers who would like to find substructures in the next generation of optical sky surveys, including Pan-STARRS and LSST.  The methods that are currently under development to constrain both large scale distribution of dark matter in the Milky Way and the (small scale) lumpiness of the dark matter distribution are also explained.  The authors also provide motivation for future spectroscopic surveys of Milky Way halo stars, which will aid both in the identification of tidal streams and the constraint of dark matter properties.This volume is aimed at g...

  5. Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnea by plasma pro-B-type natriuretic peptide

    DEFF Research Database (Denmark)

    Mogelvang, R; Goetze, JP; Schnohr, P

    2007-01-01

    OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac...... the expected concentration of plasma proBNP based on age and gender was established for dyspneic subjects: an actual plasma proBNP concentration below half of the expected value ruled out left ventricular systolic and diastolic dysfunction (sensitivity 100%, 95% CI 100% to 100%; specificity 15%, 95% CI 12...

  6. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD.

    Science.gov (United States)

    Rocha, Flávia Roberta; Brüggemann, Ana Karla Vieira; Francisco, Davi de Souza; Medeiros, Caroline Semprebom de; Rosal, Danielle; Paulin, Elaine

    2017-01-01

    To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD. We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea. In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL. In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL. Avaliar a relação da mobilidade diafragmática com a função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária (AFVD) em pacientes com DPOC. Foram avaliados 25 pacientes com diagnóstico de DPOC, classificados de acordo com critérios da Global Initiative for Chronic Obstructive Lung Disease, e 25 indivíduos saudáveis. Todos foram submetidos às seguintes avaliações: mensuração antropométrica, espirometria, força muscular respiratória, mobilidade diafragmática (por radiografia), AFVD e percepção de dispneia. No grupo DPOC, houve correlações da mobilidade diafragmática com variáveis de função pulmonar, força muscular inspiratória e percepção de dispneia. Não houve correlações da mobilidade diafragmática com força muscular expiratória e AFVD. A mobilidade diafragmática parece estar associada tanto com a obstrução das vias aéreas quanto com a hiperinsuflação pulmonar em pacientes com DPOC, assim como com a capacidade ventilatória e percep

  7. Noninvasive measurement of mean alveolar carbon dioxide tension and Bohr's dead space during tidal breathing.

    Science.gov (United States)

    Koulouris, N G; Latsi, P; Dimitroulis, J; Jordanoglou, B; Gaga, M; Jordanoglou, J

    2001-06-01

    The lack of methodology for measuring the alveolar carbon dioxide tension (PA,CO2) has forced investigators to make several assumptions, such as that PA,CO2 is equal to end-tidal (PET,CO2) and arterial CO2 tension (Pa,CO2). The present study measured the mean PA,CO2 and Bohr's dead space ratio (Bohr's dead space/tidal volume (VD,Bohr/VT)) during tidal breathing. The method used is a new, simple and noninvasive technique, based on the analysis of the expired CO2 volume per breath (VCO2) versus the exhaled VT. This curve was analysed in 21 normal, healthy subjects and 35 chronic obstructive pulmonary disease (COPD) patients breathing tidally through a mouthpiece apparatus in the sitting position. It is shown that: 1) PA,CO2 is similar to Pa,CO2 in normal subjects, whilst it is significantly lower than Pa,CO2 in COPD patients; 2) PA,CO2 is significantly higher than PET,CO2 in all subjects, especially in COPD patients; 3) VD,Bohr/VT is increased in COPD patients as compared to normal subjects; and 4) VD,Bohr/VT is lower than the "physiological" dead space ratio (VD,phys/VT) in COPD patients. It is concluded that the expired carbon dioxide versus tidal volume curve is a useful tool for research and clinical work, because it permits the noninvasive and accurate measurement of Bohr's dead space and mean alveolar carbon dioxide tension accurately during spontaneous breathing.

  8. Use of tidal breathing curves for evaluating expiratory airway obstruction in infants.

    Science.gov (United States)

    Hevroni, Avigdor; Goldman, Aliza; Blank-Brachfeld, Miriam; Abu Ahmad, Wiessam; Ben-Dov, Lior; Springer, Chaim

    2018-01-15

    To evaluate tidal breathing (TB) flow-volume and flow-time curves for identification of expiratory airway obstruction in infants. Pulmonary function tests were analyzed retrospectively in 156 infants aged 3-24 months with persistent or recurrent respiratory complaints. Parameters derived from TB curves were compared to maximal expiratory flow at functional residual capacity ([Formula: see text]maxFRC) measured by rapid thoracoabdominal compression technique. Analyzed parameters were: inspiratory time (t I ), expiratory time (t E ), tidal volume, peak tidal expiratory flow (PTEF), time to peak tidal expiratory flow (t PTEF ), expiratory flow when 50% and 25% of tidal volume remains in the lungs (FEF 50 , FEF 25 , respectively), and the ratios t PTEF /t E , t I /t E , FEF 50 /PTEF, and FEF 25 /PTEF. Statistical comparisons between flow indices and TB parameters were performed using mean squared error and Pearson's sample correlation coefficient. The study population was also divided into two groups based on severity of expiratory obstruction (above or below z-score for [Formula: see text]maxFRC of -2) to generate receiver operating characteristic (ROC) curves and calculate discriminatory values between the groups. TB parameters that were best correlated to [Formula: see text]maxFRC were: t PTEF /t E , FEF 50 /PTEF, and FEF 25 /PTEF, with r = 0.61, 0.67, 0.65, respectively (p < 0.0001 for all). ROC curves for FEF 50 /PTEF, FEF 25 /PTEF and t PTEF /t E showed areas under the curve of 0.813, 0.797, and 0.796, respectively. Cutoff value z-scores of -0.35, -0.34, and -0.43 for these three parameters, respectively, showed an 86% negative predictive value for severe airway obstructions. TB curves can assist in ruling out severe expiratory airway obstruction in infants.

  9. Carbon sequestration by Australian tidal marshes

    KAUST Repository

    Macreadie, Peter I.

    2017-03-10

    Australia\\'s tidal marshes have suffered significant losses but their recently recognised importance in CO2 sequestration is creating opportunities for their protection and restoration. We compiled all available data on soil organic carbon (OC) storage in Australia\\'s tidal marshes (323 cores). OC stocks in the surface 1 m averaged 165.41 (SE 6.96) Mg OC ha-1 (range 14-963 Mg OC ha-1). The mean OC accumulation rate was 0.55 ± 0.02 Mg OC ha-1 yr-1. Geomorphology was the most important predictor of OC stocks, with fluvial sites having twice the stock of OC as seaward sites. Australia\\'s 1.4 million hectares of tidal marshes contain an estimated 212 million tonnes of OC in the surface 1 m, with a potential CO2-equivalent value of $USD7.19 billion. Annual sequestration is 0.75 Tg OC yr-1, with a CO2-equivalent value of $USD28.02 million per annum. This study provides the most comprehensive estimates of tidal marsh blue carbon in Australia, and illustrates their importance in climate change mitigation and adaptation, acting as CO2 sinks and buffering the impacts of rising sea level. We outline potential further development of carbon offset schemes to restore the sequestration capacity and other ecosystem services provided by Australia tidal marshes.

  10. Relationship between regional ventilation and aerosol deposition in tidal breathing

    Energy Technology Data Exchange (ETDEWEB)

    Trajan, M.; Logus, J.W.; Enns, E.G.; Man, S.F.

    1984-07-01

    The regional distribution of the deposition of 1.2 micron particles of 99mTc sulfur colloid inhaled by tidal breathing was compared with the distribution of ventilation as measured by a 133Xe washout technique. Twelve subjects were studied, 6 with normal pulmonary function tests, 5 with air-flow limitation, and 1 with unilateral phrenic nerve paralysis. Both xenon and aerosol were inhaled at tidal volume by the subjects while seated upright. A large field gamma camera acquired posterior scans. Thirteen experiments were also done on 7 dogs: 1 with extrathoracic obstruction of the airway to 1 lung, and 12 with bronchoconstriction from the instillation of methacholine chloride into the airways of a lower lobe. Two of these dogs were studied with a gamma camera system, and the others were studied with a Picker multi-probe system. Both in humans and in dogs, an increase in time constant, which indicated a decrease in ventilation, was associated with an increase in peripheral aerosol deposition when normalized for ventilation. It is suggested that the increased residence time is responsible for the increased deposition in regions that received lesser ventilation.

  11. Relationship between regional ventilation and aerosol deposition in tidal breathing

    International Nuclear Information System (INIS)

    Trajan, M.; Logus, J.W.; Enns, E.G.; Man, S.F.

    1984-01-01

    The regional distribution of the deposition of 1.2 micron particles of 99mTc sulfur colloid inhaled by tidal breathing was compared with the distribution of ventilation as measured by a 133Xe washout technique. Twelve subjects were studied, 6 with normal pulmonary function tests, 5 with air-flow limitation, and 1 with unilateral phrenic nerve paralysis. Both xenon and aerosol were inhaled at tidal volume by the subjects while seated upright. A large field gamma camera acquired posterior scans. Thirteen experiments were also done on 7 dogs: 1 with extrathoracic obstruction of the airway to 1 lung, and 12 with bronchoconstriction from the instillation of methacholine chloride into the airways of a lower lobe. Two of these dogs were studied with a gamma camera system, and the others were studied with a Picker multi-probe system. Both in humans and in dogs, an increase in time constant, which indicated a decrease in ventilation, was associated with an increase in peripheral aerosol deposition when normalized for ventilation. It is suggested that the increased residence time is responsible for the increased deposition in regions that received lesser ventilation

  12. Tidal effects in twin-degenerate binaries

    International Nuclear Information System (INIS)

    Campbell, C.G.

    1984-01-01

    The tidal velocity field is calculated for an initially non-rotating low mass white dwarf secondary in a twin-degenerate binary. These motions are used to find the tidal torque on the secondary, to first order in the orbital frequency, and an expression is derived for the synchronization time. For a lobe-filling secondary the synchronization time has a weak dependence on the mass and luminosity of the star, and for the binary G61-29 is found to be of the same order as the estimated lifetime of the system. It is emphasized, however, that tidal excitation of non-radial oscillatory modes in the secondary may significantly shorten the synchronization time. (author)

  13. Tidal analysis of Met rocket wind data

    Science.gov (United States)

    Bedinger, J. F.; Constantinides, E.

    1976-01-01

    A method of analyzing Met Rocket wind data is described. Modern tidal theory and specialized analytical techniques were used to resolve specific tidal modes and prevailing components in observed wind data. A representation of the wind which is continuous in both space and time was formulated. Such a representation allows direct comparison with theory, allows the derivation of other quantities such as temperature and pressure which in turn may be compared with observed values, and allows the formation of a wind model which extends over a broader range of space and time. Significant diurnal tidal modes with wavelengths of 10 and 7 km were present in the data and were resolved by the analytical technique.

  14. The wave and tidal resource of Scotland

    Science.gov (United States)

    Neill, Simon; Vogler, Arne; Lewis, Matt; Goward-Brown, Alice

    2017-04-01

    As the marine renewable energy industry evolves, in parallel with an increase in the quantity of available data and improvements in validated numerical simulations, it is occasionally appropriate to re-assess the wave and tidal resource of a region. This is particularly true for Scotland - a leading nation that the international community monitors for developments in the marine renewable energy industry, and which has witnessed much progress in the sector over the last decade. With 7 leased wave and 17 leased tidal sites, Scotland is well poised to generate significant levels of electricity from its abundant natural marine resources. In this review of Scotland's wave and tidal resource, I present the theoretical and technical resource, and provide an overview of commercial progress. I also discuss issues that affect future development of the marine energy seascape in Scotland, applicable to other regions of the world, including the potential for developing lower energy sites, and grid connectivity.

  15. TIDAL TURBULENCE SPECTRA FROM A COMPLIANT MOORING

    Energy Technology Data Exchange (ETDEWEB)

    Thomson, Jim; Kilcher, Levi; Richmond, Marshall C.; Talbert, Joe; deKlerk, Alex; Polagye, Brian; Guerra, Maricarmen; Cienfuegos, Rodrigo

    2013-06-13

    A compliant mooring to collect high frequency turbulence data at a tidal energy site is evaluated in a series of short demon- stration deployments. The Tidal Turbulence Mooring (TTM) improves upon recent bottom-mounted approaches by suspend- ing Acoustic Doppler Velocimeters (ADVs) at mid-water depths (which are more relevant to tidal turbines). The ADV turbulence data are superior to Acoustic Doppler Current Profiler (ADCP) data, but are subject to motion contamination when suspended on a mooring in strong currents. In this demonstration, passive stabilization is shown to be sufficient for acquiring bulk statistics of the turbulence, without motion correction. With motion cor- rection (post-processing), data quality is further improved; the relative merits of direct and spectral motion correction are dis- cussed.

  16. Ocean energy. Tide and tidal power

    Energy Technology Data Exchange (ETDEWEB)

    Finkl, Charles W. [Coastal Planning and Engineering, Inc., Boca Raton, FL (United States); Charlier, Roger H.

    2009-07-01

    Engineers' dreams and fossil energy replacement schemes can come true. Man has been tapping the energy of the sea to provide power for his industries for centuries. Tidal energy combined with that of waves and marine winds rank among those most successfully put the work. Large scale plants are capital intensive but smaller ones, particularly built in China, have proven profitable. Since the initiation of the St Malo project in France, similar projects have gone into active service where methods have been devised to cut down on costs, new types of turbines developed and cost competitiveness considerably improved. Tidal power has enormous potential. The book reviews recent progress in extracting power from the ocean, surveys the history of tidal power harnessing and updates a prior publication by the author. (orig.)

  17. From Globular Clusters to Tidal Dwarfs: Structure Formation in Tidal Tails

    Science.gov (United States)

    Knierman, K.; Hunsberger, S.; Gallagher, S.; Charlton, J.; Whitmore, B.; Hibbard, J.; Kundu, A.; Zaritsky, D.

    1999-12-01

    Galaxy interactions trigger star formation in tidal debris. How does this star formation depend on the local and global physical conditions? Using WFPC2/HST images, we investigate the range of structure within tidal tails of four classic ``Toomre Sequence'' mergers: NGC 4038/9 (``Antennae''), NGC 7252 (``Atoms for Peace''), NGC 3921, and NGC 3256. These tails contain a variety of stellar associations with sizes from globular clusters up to dwarf Irregulars. We explore whether there is a continuum between the two extremes. Our eight fields sample seven tidal tails at a variety of stages in the evolutionary sequence. Some of these tails are rich in HI while others are HI poor. Large tidal dwarfs are embedded in three of the tails. Using V and I WFPC2 images, we measure luminosities and colors of substructures within the tidal tails. The properties of globular cluster candidates in the tails will be contrasted with those of the hundreds of young clusters in the central regions of these mergers. We address whether globular clusters form and survive in the tidal tails and whether tidal dwarfs are composed of only young stars. By comparing the properties of structures in the tails of the four mergers with different ages, we examine systematic evolution of structure along the evolutionary sequence and as a function of HI content. We acknowledge support from NASA through STScI, and from NSF for an REU supplement for Karen Knierman.

  18. Homogeneous wave turbulence driven by tidal flows

    Science.gov (United States)

    Favier, B.; Le Reun, T.; Barker, A.; Le Bars, M.

    2017-12-01

    When a moon orbits around a planet, the rotation of the induced tidal bulge drives a homogeneous, periodic, large-scale flow. The combination of such an excitation with the rotating motion of the planet has been shown to drive parametric resonance of a pair of inertial waves in a mechanism called the elliptical instability. Geophysical fluid layers can also be stratified: this is the case for instance of the Earth's oceans and, as suggested by several studies, of the upper part of the Earth's liquid Outer Core. We thus investigate the stability of a rotating and stratified layer undergoing tidal distortion in the limit where either rotation or stratification is dominant. We show that the periodic tidal flow drives a parametric subharmonic resonance of inertial (resp. internal) waves in the rotating (resp. stratified) case. The instability saturates into a wave turbulence pervading the whole fluid layer. In such a state, the instability mechanism conveys the tidal energy from the large scale tidal flow to the resonant modes, which then feed a succession of triadic resonances also generating small spatial scales. In the rotating case, we observe a kinetic energy spectrum with a k-2 slope for which the Coriolis force is dominant at all spatial scales. In the stratified case, where the timescale separation is increased between the tidal excitation and the Brunt-Väisälä frequencies, the temporal spectrum decays with a ω-2 power law up to the cut-off frequency beyond which waves do not exist. This result is reminiscent of the Garrett and Munk spectrum measured in the oceans and theoretically described as a manifestation of internal wave turbulence. In addition to revealing an instability driving homogeneous turbulence in geophysical fluid layers, our approach is also an efficient numerical tool to investigate the possibly universal properties of wave turbulence in a geophysical context.

  19. SHORT TERM EFFECT OF ACUPUNCTURE-TENS ON LUNG FUNCTIONS AND DYSPNEA FOR SUBJECTS WITH MODERATE COPD

    Directory of Open Access Journals (Sweden)

    Vinod Babu. K

    2015-10-01

    Full Text Available Background: Acupuncture TENS is used to improve pain instead of invasive acupuncture. Acupuncture shown to improve dyspnoea and lung functions in COPD (Chronic Obstructive Pulmonary Disease patients. The purpose of the study is to determine Short term effectiveness of Acupuncture-TENS in reducing dyspnea and improving lung functions for subjects with moderate COPD. Method: An experimental study design, selected 30 geriatric subjects with COPD randomized 15 subjects into each Study and Control group. Study group received Acu-TENS for 45 minutes for total 5 sessions, while control group received placebo TENS. Outcome measurements such as breathlessness using Modified Borg Scale (MBS, Lung functions using Pulmonary Function Test (PFT was measured before and after intervention. Results: Analysis from pre-intervention to post-intervention within study group found that there is statistically significant change in means of MBS, FEV1, FEV1/FVC ratio and within control group there is a statistically significant change in means of MBS, but there is no statistically significant change in means of FEV1, FVC and FEV1/FVC ratio. When post-intervention means were compared between the groups there is no statistically significant difference in means of MBS and FEV1, FVC and FEV1/FVC ratio. Conclusion: It is concluded that one week of Acu-TENS on EXL1 point found no significant effect on improving dyspnea and lung functions in subjects with moderate COPD in geriatric populations.

  20. Intensive symptom control of opioid-refractory dyspnea in congestive heart failure: Role of milrinone in the palliative care unit.

    Science.gov (United States)

    Silvestre, Julio; Montoya, Maria; Bruera, Eduardo; Elsayem, Ahmed

    2015-12-01

    We describe an exemplary case of congestive heart failure (CHF) symptoms controlled with milrinone. We also analyze the benefits and risks of milrinone administration in an unmonitored setting. We describe the case of a patient with refractory leukemia and end-stage CHF who developed severe dyspnea after discontinuation of milrinone. At that point, despite starting opioids, she had been severely dyspneic and anxious, requiring admission to the palliative care unit (PCU) for symptom control. After negotiation with hospital administrators, milrinone was administered in an unmonitored setting such as the PCU. A multidisciplinary team approach was also provided. Milrinone produced a dramatic improvement in the patient's symptom scores and performance status. The patient was eventually discharged to home hospice on a milrinone infusion with excellent symptom control. This case suggests that milrinone may be of benefit for short-term inpatient administration for dyspnea management, even in unmonitored settings and consequently during hospice in do-not-resuscitate (DNR) patients. This strategy may reduce costs and readmissions to the hospital related to end-stage CHF.

  1. Increased Tidal Dissipation Using Advanced Rheological Models: Implications for Io and Tidally Active Exoplanets

    Science.gov (United States)

    Renaud, Joe P.; Henning, Wade G.

    2018-04-01

    The advanced rheological models of Andrade and Sundberg & Cooper are compared to the traditional Maxwell model to understand how each affects the tidal dissipation of heat within rocky bodies. We find both Andrade and Sundberg–Cooper rheologies can produce at least 10× the tidal heating compared to a traditional Maxwell model for a warm (1400–1600 K) Io-like satellite. Sundberg–Cooper can cause even larger dissipation around a critical temperature and frequency. These models allow cooler planets to stay tidally active in the face of orbital perturbations—a condition we term “tidal resilience.” This has implications for the time evolution of tidally active worlds and the long-term equilibria they fall into. For instance, if Io’s interior is better modeled by the Andrade or Sundberg–Cooper rheologies, the number of possible resonance-forming scenarios that still produce a hot, modern Io is expanded, and these scenarios do not require an early formation of the Laplace resonance. The two primary empirical parameters that define the Andrade anelasticity are examined in several phase spaces to provide guidance on how their uncertainties impact tidal outcomes, as laboratory studies continue to constrain their real values. We provide detailed reference tables on the fully general equations required for others to insert the models of Andrade and Sundberg–Cooper into standard tidal formulae. Lastly, we show that advanced rheologies can greatly impact the heating of short-period exoplanets and exomoons, while the properties of tidal resilience could mean a greater number of tidally active worlds among all extrasolar systems.

  2. Short period tidal variations of earth rotation

    Science.gov (United States)

    Yoder, C. F.; Williams, J. G.; Parke, M. E.; Dickey, J. O.

    1981-01-01

    It is explained that the tidal deformation of the earth's polar moment of inertia by the moon and sun cause periodic variations in rotation. The short period oscillations give rise to a meter-sized, diurnal signature in the lunar laser ranging data obtained at McDonald Observatory. A solution is given for the scale parameter k/C at fortnightly and monthly tidal frequencies. The results are compared with those obtained by other investigators and with a theoretical estimate which includes the effect of oceans and a decoupled fluid core.

  3. CFD for wind and tidal offshore turbines

    CERN Document Server

    Montlaur, Adeline

    2015-01-01

    The book encompasses novel CFD techniques to compute offshore wind and tidal applications. Computational fluid dynamics (CFD) techniques are regarded as the main design tool to explore the new engineering challenges presented by offshore wind and tidal turbines for energy generation. The difficulty and costs of undertaking experimental tests in offshore environments have increased the interest in the field of CFD which is used to design appropriate turbines and blades, understand fluid flow physical phenomena associated with offshore environments, predict power production or characterise offshore environments, amongst other topics.

  4. Tidal forces in Kiselev black hole

    Energy Technology Data Exchange (ETDEWEB)

    Shahzad, M.U. [University of Central Punjab, CAMS, UCP Business School, Lahore (Pakistan); Jawad, Abdul [COMSATS Institute of Information Technology, Department of Mathematics, Lahore (Pakistan)

    2017-06-15

    The aim of this paper is to examine the tidal forces occurring in a Kiselev black hole surrounded by radiation and dust fluids. It is noted that the radial and angular components of the tidal force change the sign between event and Cauchy horizons. We solve the geodesic deviation equation for radially free-falling bodies toward Kiselev black holes. We explain the geodesic deviation vector graphically and point out the location of the event and Cauchy horizons for specific values of the radiation and dust parameters. (orig.)

  5. CLIMATE INSTABILITY ON TIDALLY LOCKED EXOPLANETS

    International Nuclear Information System (INIS)

    Kite, Edwin S.; Manga, Michael; Gaidos, Eric

    2011-01-01

    Feedbacks that can destabilize the climates of synchronously rotating rocky planets may arise on planets with strong day-night surface temperature contrasts. Earth-like habitable planets maintain stable surface liquid water over geologic time. This requires equilibrium between the temperature-dependent rate of greenhouse-gas consumption by weathering, and greenhouse-gas resupply by other processes. Detected small-radius exoplanets, and anticipated M-dwarf habitable-zone rocky planets, are expected to be in synchronous rotation (tidally locked). In this paper, we investigate two hypothetical feedbacks that can destabilize climate on planets in synchronous rotation. (1) If small changes in pressure alter the temperature distribution across a planet's surface such that the weathering rate goes up when the pressure goes down, a runaway positive feedback occurs involving increasing weathering rate near the substellar point, decreasing pressure, and increasing substellar surface temperature. We call this feedback enhanced substellar weathering instability (ESWI). (2) When decreases in pressure increase the fraction of surface area above the melting point (through reduced advective cooling of the substellar point), and the corresponding increase in volume of liquid causes net dissolution of the atmosphere, a further decrease in pressure will occur. This substellar dissolution feedback can also cause a runaway climate shift. We use an idealized energy balance model to map out the conditions under which these instabilities may occur. In this simplified model, the weathering runaway can shrink the habitable zone and cause geologically rapid 10 3 -fold atmospheric pressure shifts within the habitable zone. Mars may have undergone a weathering runaway in the past. Substellar dissolution is usually a negative feedback or weak positive feedback on changes in atmospheric pressure. It can only cause runaway changes for small, deep oceans and highly soluble atmospheric gases. Both

  6. CLIMATE INSTABILITY ON TIDALLY LOCKED EXOPLANETS

    Energy Technology Data Exchange (ETDEWEB)

    Kite, Edwin S.; Manga, Michael [Department of Earth and Planetary Science, University of California at Berkeley, CA 94720 (United States); Gaidos, Eric, E-mail: edwin.kite@gmail.com [Department of Geology and Geophysics, University of Hawaii at Manoa, Honolulu, HI 96822 (United States)

    2011-12-10

    Feedbacks that can destabilize the climates of synchronously rotating rocky planets may arise on planets with strong day-night surface temperature contrasts. Earth-like habitable planets maintain stable surface liquid water over geologic time. This requires equilibrium between the temperature-dependent rate of greenhouse-gas consumption by weathering, and greenhouse-gas resupply by other processes. Detected small-radius exoplanets, and anticipated M-dwarf habitable-zone rocky planets, are expected to be in synchronous rotation (tidally locked). In this paper, we investigate two hypothetical feedbacks that can destabilize climate on planets in synchronous rotation. (1) If small changes in pressure alter the temperature distribution across a planet's surface such that the weathering rate goes up when the pressure goes down, a runaway positive feedback occurs involving increasing weathering rate near the substellar point, decreasing pressure, and increasing substellar surface temperature. We call this feedback enhanced substellar weathering instability (ESWI). (2) When decreases in pressure increase the fraction of surface area above the melting point (through reduced advective cooling of the substellar point), and the corresponding increase in volume of liquid causes net dissolution of the atmosphere, a further decrease in pressure will occur. This substellar dissolution feedback can also cause a runaway climate shift. We use an idealized energy balance model to map out the conditions under which these instabilities may occur. In this simplified model, the weathering runaway can shrink the habitable zone and cause geologically rapid 10{sup 3}-fold atmospheric pressure shifts within the habitable zone. Mars may have undergone a weathering runaway in the past. Substellar dissolution is usually a negative feedback or weak positive feedback on changes in atmospheric pressure. It can only cause runaway changes for small, deep oceans and highly soluble atmospheric

  7. Mapping the Tidal Destruction of the Hercules Dwarf: A Wide-field DECam Imaging Search for RR Lyrae Stars

    Science.gov (United States)

    Garling, Christopher; Willman, Beth; Sand, David J.; Hargis, Jonathan; Crnojević, Denija; Bechtol, Keith; Carlin, Jeffrey L.; Strader, Jay; Zou, Hu; Zhou, Xu; Nie, Jundan; Zhang, Tianmeng; Zhou, Zhimin; Peng, Xiyan

    2018-01-01

    We investigate the hypothesized tidal disruption of the Hercules ultra-faint dwarf galaxy (UFD). Previous tidal disruption studies of the Hercules UFD have been hindered by the high degree of foreground contamination in the direction of the dwarf. We bypass this issue by using RR Lyrae stars, which are standard candles with a very low field-volume density at the distance of Hercules. We use wide-field imaging from the Dark Energy Camera on CTIO to identify candidate RR Lyrae stars, supplemented with observations taken in coordination with the Beijing–Arizona Sky Survey on the Bok Telescope. Combining color, magnitude, and light-curve information, we identify three new RR Lyrae stars associated with Hercules. All three of these new RR Lyrae stars lie outside its published tidal radius. When considered with the nine RR Lyrae stars already known within the tidal radius, these results suggest that a substantial fraction of Hercules’ stellar content has been stripped. With this degree of tidal disruption, Hercules is an interesting case between a visibly disrupted dwarf (such as the Sagittarius dwarf spheroidal galaxy) and one in dynamic equilibrium. The degree of disruption also shows that we must be more careful with the ways we determine object membership when estimating dwarf masses in the future. One of the three discovered RR Lyrae stars sits along the minor axis of Hercules, but over two tidal radii away. This type of debris is consistent with recent models that suggest Hercules’ orbit is aligned with its minor axis.

  8. NOAA Historical Tidal Current Data for the Coastal United States

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Knowledge of the timing and strength of tidal currents is extremely important for safe navigation in coastal waters. Tidal currents are almost always the strongest...

  9. Tidal flow characteristics at Kasheli (Kalwa/ Bassein creek), Bombay

    Digital Repository Service at National Institute of Oceanography (India)

    Swamy, G.N.; Suryanarayana, A.

    Tidal flow characteristics of waters at Kasheli, connected to the sea through Thane and Bassein Creeks in Bombay, Maharashtra, India are investigated based on tide and current observations carried out in 1980-81. The results establish that the tidal...

  10. Spatial tidal asymmetry of Cochin estuary, West Coast, India

    Digital Repository Service at National Institute of Oceanography (India)

    Vinita, J.; Shivaprasad, A.; Manoj, N.T.; Revichandran, C.; Naveenkumar, K.R.; Jineesh, V.K.

    tidal amplitude and currents get attenuated towards upstream through frictional dissipation The results showed that the tidal momentum balance along the main axis of the channel was dominated by pressure gradient and friction The influence of advection...

  11. Lagoon Sediment Dynamics: A Coupled Model to Study a Medium-Term Silting of Tidal Channels

    Directory of Open Access Journals (Sweden)

    Marco Petti

    2018-04-01

    Full Text Available The silting of tidal channels is a natural process that affects several shallow lagoons and makes it difficult to navigate, requiring regular maintenance interventions. This phenomenon is the result of the complex non-linear interaction between tidal currents and wave motion. In this work, the morphodynamic evolution of the Marano and Grado lagoon is investigated by means of a two-dimensional horizontal (2DH morphological-hydrodynamic and a spectral coupled model. An innovative procedure to reproduce the overall bathymetric changes in the medium term and, in particular, the volumes deposited inside channels, is presented. An average year with a sequence of winds and tides acting over that time was reconstructed, carrying out cross correlation techniques and spectral analyses of measured data. The predicted morphological evolution matches the annual dredged volumes in the lagoon critical branches and shows the distribution of erosion and deposition of cohesive sediments according to spatially variable values of critical shear stress.

  12. 2nd Workshop on Tidal Friction and the Earth's Rotation

    CERN Document Server

    Sündermann, Jürgen

    1982-01-01

    In the four years which elapsed between our first workshop on .Tidal Friction and the Earth's Rotation and the second, the proceedings of which are presented here, many of the disciplines involved made ad­ vances which we felt should be exchanged. We were encouraged by the good reception our first report met with. Of course, more insight often means more problems. Therefore, this volume contains new results and revisions of matters which previously appeared settled. We are certainly far from "final answers". For this reason, differing opinions on some issues are to be found in this book. Moreover, we have refrained from making mathematical symbols uniform to avoid the risk of errors and non-compatibility with the earlier work of an author. The two workshops have stimulated collaboration between participants working in various fields. The final versions of the contributions have already profited from these discussions. We are convinced that they will also influence further investigations. This advancement of ...

  13. Tidal propagation off the central west coast of India

    Digital Repository Service at National Institute of Oceanography (India)

    Unnikrishnan, A.S.

    . [Keywords: Tidal propagation, Mumbai high, Global tidal model, Shelf model, Central west coast of India] Introduction In coastal regions, tides play an important role in determining circulation and hydrography. Barotropic tides coming from the open... with increase in the width of the shelf. Materials and Methods Global tidal models Schwiderski5 used a hydrodynamic interpolation technique to determine the amplitude and phase of tidal constituents of global ocean. Since the availability of satellite...

  14. Morphodynamics of the Manyema Tidal Delta at Kunduchi, Tanzania

    African Journals Online (AJOL)

    Keywords: Morphodynamics, Kunduchi, Manyema, shoreline change, tidal creek, tidal delta. Abstract—The prevailing northward longshore drift of beach sand on the northern part of Msasani Bay, north of Dar es Salaam, is interrupted at Kunduchi by the tidal flushing of ... Western Indian Ocean J. Mar. Sci. Vol. 11, No. 2, pp.

  15. Field migration rates of tidal meanders recapitulate fluvial morphodynamics

    Science.gov (United States)

    Finotello, Alvise; Lanzoni, Stefano; Ghinassi, Massimiliano; Marani, Marco; Rinaldo, Andrea; D'Alpaos, Andrea

    2018-02-01

    The majority of tidal channels display marked meandering features. Despite their importance in oil-reservoir formation and tidal landscape morphology, questions remain on whether tidal-meander dynamics could be understood in terms of fluvial processes and theory. Key differences suggest otherwise, like the periodic reversal of landscape-forming tidal flows and the widely accepted empirical notion that tidal meanders are stable landscape features, in stark contrast with their migrating fluvial counterparts. On the contrary, here we show that, once properly normalized, observed migration rates of tidal and fluvial meanders are remarkably similar. Key to normalization is the role of tidal channel width that responds to the strong spatial gradients of landscape-forming flow rates and tidal prisms. We find that migration dynamics of tidal meanders agree with nonlinear theories for river meander evolution. Our results challenge the conventional view of tidal channels as stable landscape features and suggest that meandering tidal channels recapitulate many fluvial counterparts owing to large gradients of tidal prisms across meander wavelengths.

  16. How Tidal Forces Cause Ocean Tides in the Equilibrium Theory

    Science.gov (United States)

    Ng, Chiu-king

    2015-01-01

    We analyse why it is erroneous to think that a tidal bulge is formed by pulling the water surface directly up by a local vertical tidal force. In fact, ocean tides are caused by the global effect of the horizontal components of the tidal forces.

  17. Tidal exchange of larvae of Sesarma catenata (Decapoda, Brachyura)

    African Journals Online (AJOL)

    The tidal exchange of larvae of the salt-marsh grapsid crab Sesarma catenata was studied in the Swartkops estuary, a tidally driven, shallow estuary in Algoa Bay, South Africa. Plankton samples were collected bimonlhly during spring and neap tides from October to March at the tidal inlet. Samples were collected hourly for ...

  18. Tidal Marshes: The Boundary between Land and Ocean.

    Science.gov (United States)

    Gosselink, James

    An overview of the ecology of the tidal marshes along the gulf coast of the United States is presented. The following topics are included: (1) the human impact on tidal marshes; (2) the geologic origins of tidal marshes; (3) a description of the physical characteristics and ecosystem of the marshlands; (4) a description of the marshland food chain…

  19. Field migration rates of tidal meanders recapitulate fluvial morphodynamics.

    Science.gov (United States)

    Finotello, Alvise; Lanzoni, Stefano; Ghinassi, Massimiliano; Marani, Marco; Rinaldo, Andrea; D'Alpaos, Andrea

    2018-02-13

    The majority of tidal channels display marked meandering features. Despite their importance in oil-reservoir formation and tidal landscape morphology, questions remain on whether tidal-meander dynamics could be understood in terms of fluvial processes and theory. Key differences suggest otherwise, like the periodic reversal of landscape-forming tidal flows and the widely accepted empirical notion that tidal meanders are stable landscape features, in stark contrast with their migrating fluvial counterparts. On the contrary, here we show that, once properly normalized, observed migration rates of tidal and fluvial meanders are remarkably similar. Key to normalization is the role of tidal channel width that responds to the strong spatial gradients of landscape-forming flow rates and tidal prisms. We find that migration dynamics of tidal meanders agree with nonlinear theories for river meander evolution. Our results challenge the conventional view of tidal channels as stable landscape features and suggest that meandering tidal channels recapitulate many fluvial counterparts owing to large gradients of tidal prisms across meander wavelengths. Copyright © 2018 the Author(s). Published by PNAS.

  20. Salmon habitat use, tidal-fluvial estuary - Columbia River Estuary Tidal Habitats

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The goal of the tidal-fluvial estuary study is to determine the estuary's contribution to the spatial structure and life history diversity of Columbia River salmon...

  1. Empirical Tidal Dissipation in Exoplanet Hosts From Tidal Spin-up

    Science.gov (United States)

    Penev, Kaloyan; Bouma, L. G.; Winn, Joshua N.; Hartman, Joel D.

    2018-04-01

    Stars with hot Jupiters (HJs) tend to rotate faster than other stars of the same age and mass. This trend has been attributed to tidal interactions between the star and planet. A constraint on the dissipation parameter {Q}\\star {\\prime } follows from the assumption that tides have managed to spin up the star to the observed rate within the age of the system. This technique was applied previously to HATS-18 and WASP-19. Here, we analyze the sample of all 188 known HJs with an orbital period tidal dissipation parameter ({Q}\\star {\\prime }) increases sharply with forcing frequency, from 105 at 0.5 day‑1 to 107 at 2 day‑1. This helps to resolve a number of apparent discrepancies between studies of tidal dissipation in binary stars, HJs, and warm Jupiters. It may also allow for a HJ to damp the obliquity of its host star prior to being destroyed by tidal decay.

  2. 2008 NWFSC Tidal Freshwater Genetics Results

    Energy Technology Data Exchange (ETDEWEB)

    David Teel

    2009-05-01

    Genetic Analysis of Juvenile Chinook Salmon for inclusion in 'Ecology of Juvenile Salmon in Shallow Tidal Freshwater Habitats in the Vicinity of the Sandy River Delta, Lower Columbia River, 2008. Annual Report to Bonneville Power Administration, Contract DE-AC05-76RL01830.'

  3. Methane emission from tidal freshwater marshes

    NARCIS (Netherlands)

    Van der Nat, F.J.; Middelburg, J.J.

    2000-01-01

    In two tidal freshwater marshes, methane emission, production and accumulation in the pore-water have been studied. The two sites differ in their dominant vegetation, i.e., reed and bulrush, and in their heights above sea level. The reed site was elevated in relation to the bulrush site and had

  4. Estuaries and Tidal Marshes. Habitat Pac.

    Science.gov (United States)

    Fish and Wildlife Service (Dept. of Interior), Washington, DC.

    This educational packet consists of an overview, three lesson plans, student data sheets, and a poster. The overview examines estuaries and tidal or salt marshes by discussing the plants and animals in these habitats, marsh productivity, benefits and management of the habitats, historical aspects, and development and pollution. A glossary and list…

  5. Life on the Tidal Mudflats: Elkhorn Slough.

    Science.gov (United States)

    Andresen, Ruth

    Life in an estuarine environment is studied in this set of audio-visual materials prepared for grades 6-12. A 71-frame colored filmstrip, cassette tape narration, and teacher's guide focus upon Elkhorn Slough, a tidal mudflat in the Monterey Bay area, California. Topics examined range from river drainage and the effects of pollution on living…

  6. An optimal tuning strategy for tidal turbines

    Science.gov (United States)

    2016-01-01

    Tuning wind and tidal turbines is critical to maximizing their power output. Adopting a wind turbine tuning strategy of maximizing the output at any given time is shown to be an extremely poor strategy for large arrays of tidal turbines in channels. This ‘impatient-tuning strategy’ results in far lower power output, much higher structural loads and greater environmental impacts due to flow reduction than an existing ‘patient-tuning strategy’ which maximizes the power output averaged over the tidal cycle. This paper presents a ‘smart patient tuning strategy’, which can increase array output by up to 35% over the existing strategy. This smart strategy forgoes some power generation early in the half tidal cycle in order to allow stronger flows to develop later in the cycle. It extracts enough power from these stronger flows to produce more power from the cycle as a whole than the existing strategy. Surprisingly, the smart strategy can often extract more power without increasing maximum structural loads on the turbines, while also maintaining stronger flows along the channel. This paper also shows that, counterintuitively, for some tuning strategies imposing a cap on turbine power output to limit loads can increase a turbine’s average power output. PMID:27956870

  7. Palaemon pacijicus (Stimpson) in eastern Cape tidal

    African Journals Online (AJOL)

    1984-09-25

    Sep 25, 1984 ... seasonally with peak numbers and biomass found in summer ... One part of the programme dealt with the tidal pool ... pools sampled. Unicam spectrophotometer at 458 run. A dilution series was made for each batch of concentrate used. A domestic water meter was coupled to the outlet of a portable pump ...

  8. An optimal tuning strategy for tidal turbines.

    Science.gov (United States)

    Vennell, Ross

    2016-11-01

    Tuning wind and tidal turbines is critical to maximizing their power output. Adopting a wind turbine tuning strategy of maximizing the output at any given time is shown to be an extremely poor strategy for large arrays of tidal turbines in channels. This 'impatient-tuning strategy' results in far lower power output, much higher structural loads and greater environmental impacts due to flow reduction than an existing 'patient-tuning strategy' which maximizes the power output averaged over the tidal cycle. This paper presents a 'smart patient tuning strategy', which can increase array output by up to 35% over the existing strategy. This smart strategy forgoes some power generation early in the half tidal cycle in order to allow stronger flows to develop later in the cycle. It extracts enough power from these stronger flows to produce more power from the cycle as a whole than the existing strategy. Surprisingly, the smart strategy can often extract more power without increasing maximum structural loads on the turbines, while also maintaining stronger flows along the channel. This paper also shows that, counterintuitively, for some tuning strategies imposing a cap on turbine power output to limit loads can increase a turbine's average power output.

  9. Nova Scotia Power : in-stream tidal

    International Nuclear Information System (INIS)

    Meade, K.

    2007-01-01

    The Government of Nova Scotia, the Government of New Brunswick, Nova Scotia Power and others have funded a feasibility study of North American sites for commercial instream tidal power. In July 2007, Nova Scotia Power received partial funding for a demonstration project. This presentation provided information on a demonstration plant for tidal power run by Nova Scotia Power. It discussed the benefits of the Open Hydro technology for this plant. In this simple design, the generator is on the circumference of the turbine. The design does not involve any power transmission systems or any pitching of blades. In addition, the technology is environmentally sound as it is completely shrouded, has low rotational speed, and a large open centre allows fish to pass through, and it does not require lubricants. The last benefit that was presented was the scale up of 250 kW machine deployed in a European test facility. The presentation also discussed the advantages of developing tidal power at this time. It was concluded that tidal energy has significant potential. Although it is intermittent, it is predictable and bulk power system can be scheduled to accommodate it. figs

  10. The history of tidal power in France

    International Nuclear Information System (INIS)

    Banal, M.

    1997-01-01

    The first known use of tidal power in France concerns the tidal mills in general use during the Middle Age along the French coasts. The first research studies of tidal power plants started at the end of the first world war but it is only in 1940 with the stimulus of Robert Gibrat that was created the Research Society for the use of Tides and the Rance plant project. In 1946, Electricite de France (EdF) started again the studies of this company for a greater size project in the Chausey archipelago which was abandoned for the benefit of the Rance project in the 1960's. The start up of the plant took place in 1967 but the other projects were abandoned during the 1980's. This short paper recalls the historical aspects of the development of tidal power in France and focusses on the research and development studies and on the economical, political and legal factors that led to retain the Rance project among others proposed. (J.S.)

  11. Carbon sequestration by Australian tidal marshes

    KAUST Repository

    Macreadie, Peter I.; Ollivier, Q. R.; Kelleway, J. J.; Serrano, O.; Carnell, P. E.; Lewis, C. J. Ewers; Atwood, T. B.; Sanderman, J.; Baldock, J.; Connolly, R. M.; Duarte, Carlos M.; Lavery, P. S.; Steven, A.; Lovelock, C. E.

    2017-01-01

    ) storage in Australia's tidal marshes (323 cores). OC stocks in the surface 1 m averaged 165.41 (SE 6.96) Mg OC ha-1 (range 14-963 Mg OC ha-1). The mean OC accumulation rate was 0.55 ± 0.02 Mg OC ha-1 yr-1. Geomorphology was the most important predictor

  12. Phase lag control of tidally reversing mega-ripple geometry and bed stress in tidal inlets

    Science.gov (United States)

    Traykovski, P.

    2016-02-01

    Recent observations in the Columbia River Mouth, New River Inlet, and Wasque Shoals have shown that tidally reversing mega-ripples are an ubiquitous bedform morphology in energetic tidal inlets. As the name implies, these bedforms reverse asymmetry and migration direction in each half tidal cycle. With wavelengths of 2 to 5 m and heights of 0.2 to 0.5 m, these bedforms are larger than current formed ripples, but smaller than dunes. Unlike dunes which have a depth dependent geometry, observations indicate the tidally reversing mega-ripples geometry is related to the time dependent tidal flow and independent of depth. Previous empirical relations for predicting the geometry of ripples or dunes do not successfully predict the geometry of these features. A time dependent geometric model was developed that accounts for the reversal of migration and asymmetry to successfully predict bedform geometry. The model requires sufficient sediment transport in each half tidal cycle to reverse the asymmetry before the bedforms begin to grow. Both the observations and model indicate that the complete reversal of asymmetry and development of a steep lee face occurs near or after maximum flow in each half tidal cycle. This phase lag in bedform response to tidal forcing also has important implications for bed stress in tidal inlets. Observations of frictional drag in the Columbia River mouth based on a tidal momentum balance of surface slope over 10 km regressed against quadratic near bed velocity show drag coefficients that fall off as CD U-1.4. Reynolds stress measurements performed using the dual ADV differencing technique show similar relations. The Reynolds stress measurements also show a dramatic asymmetry between accelerating flows and decelerating flows with a factor of 5 increase during deceleration. Pulse coherent Doppler profiles of near bed turbulence indicate that the turbulence is dominated by energetic fluctuations in separation zones downstream of steep lee faces. The

  13. TIDAL EVOLUTION OF CLOSE-IN PLANETS

    International Nuclear Information System (INIS)

    Matsumura, Soko; Rasio, Frederic A.; Peale, Stanton J.

    2010-01-01

    Recent discoveries of several transiting planets with clearly non-zero eccentricities and some large obliquities started changing the simple picture of close-in planets having circular and well-aligned orbits. The two major scenarios that form such close-in planets are planet migration in a disk and planet-planet interactions combined with tidal dissipation. The former scenario can naturally produce a circular and low-obliquity orbit, while the latter implicitly assumes an initially highly eccentric and possibly high-obliquity orbit, which are then circularized and aligned via tidal dissipation. Most of these close-in planets experience orbital decay all the way to the Roche limit as previous studies showed. We investigate the tidal evolution of transiting planets on eccentric orbits, and find that there are two characteristic evolution paths for them, depending on the relative efficiency of tidal dissipation inside the star and the planet. Our study shows that each of these paths may correspond to migration and scattering scenarios. We further point out that the current observations may be consistent with the scattering scenario, where the circularization of an initially eccentric orbit occurs before the orbital decay primarily due to tidal dissipation in the planet, while the alignment of the stellar spin and orbit normal occurs on a similar timescale to the orbital decay largely due to dissipation in the star. We also find that even when the stellar spin-orbit misalignment is observed to be small at present, some systems could have had a highly misaligned orbit in the past, if their evolution is dominated by tidal dissipation in the star. Finally, we also re-examine the recent claim by Levrard et al. that all orbital and spin parameters, including eccentricity and stellar obliquity, evolve on a similar timescale to orbital decay. This counterintuitive result turns out to have been caused by a typo in their numerical code. Solving the correct set of tidal

  14. Relativistic tidal properties of neutron stars

    International Nuclear Information System (INIS)

    Damour, Thibault; Nagar, Alessandro

    2009-01-01

    We study the various linear responses of neutron stars to external relativistic tidal fields. We focus on three different tidal responses, associated to three different tidal coefficients: (i) a gravito-electric-type coefficient Gμ l =[length] 2l+1 measuring the lth-order mass multipolar moment GM a 1 ...a l induced in a star by an external lth-order gravito-electric tidal field G a 1 ...a l ; (ii) a gravito-magnetic-type coefficient Gσ l =[length] 2l+1 measuring the lth spin multipole moment GS a 1 ...a l induced in a star by an external lth-order gravito-magnetic tidal field H a 1 ...a l ; and (iii) a dimensionless 'shape' Love number h l measuring the distortion of the shape of the surface of a star by an external lth-order gravito-electric tidal field. All the dimensionless tidal coefficients Gμ l /R 2l+1 , Gσ l /R 2l+1 , and h l (where R is the radius of the star) are found to have a strong sensitivity to the value of the star's 'compactness'c≡GM/(c 0 2 R) (where we indicate by c 0 the speed of light). In particular, Gμ l /R 2l+1 ∼k l is found to strongly decrease, as c increases, down to a zero value as c is formally extended to the 'black hole (BH) limit'c BH =1/2. The shape Love number h l is also found to significantly decrease as c increases, though it does not vanish in the formal limit c→c BH , but is rather found to agree with the recently determined shape Love numbers of black holes. The formal vanishing of μ l and σ l as c→c BH is a consequence of the no-hair properties of black holes. This vanishing suggests, but in no way proves, that the effective action describing the gravitational interactions of black holes may not need to be augmented by nonminimal worldline couplings.

  15. Role of bronchodilation and pattern of breathing in increasing tidal expiratory flow with progressive induced hypercapnia in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Finucane, Kevin E; Singh, Bhajan

    2018-01-01

    Hypercapnia (HC) in vitro relaxes airway smooth muscle; in vivo, it increases respiratory effort, tidal expiratory flows (V̇ exp ), and, by decreasing inspiratory duration (Ti), increases elastic recoil pressure (Pel) via lung viscoelasticity; however, its effect on airway resistance is uncertain. We examined the contributions of bronchodilation, Ti, and expiratory effort to increasing V̇ exp with progressive HC in 10 subjects with chronic obstructive pulmonary disease (COPD): mean forced expiratory volume in 1 s (FEV 1 ) 53% predicted. Lung volumes (Vl), V̇ exp , esophageal pressure (Pes), Ti, and end-tidal Pco 2 ([Formula: see text]) were measured during six tidal breaths followed by an inspiratory capacity (IC), breathing air, and at three levels of HC. V̇ exp and V̇ with submaximal forced vital capacities breathing air (V̇ sFVC ) were compared. Pulmonary resistance ( Rl) was measured from the Pes-V̇ relationship. V̇ exp and Pes at end-expiratory lung volume (EELV) + 0.3 tidal volume [V̇ (0.3Vt) and Pes (0.3Vt) , respectively], Ti, and Rl correlated with [Formula: see text] ( P pulmonary disease (COPD), progressive HC increases tidal expiratory flows by inducing bronchodilation and via an increased rate of inspiration and lung viscoelasticity, a probable increase in lung elastic recoil pressure, both changes increasing expiratory flows, promoting lung emptying and a stable end-expiratory volume. Bronchodilation with HC occurred despite optimal standard bronchodilator therapy, suggesting that in COPD further bronchodilation is possible.

  16. Light rays and the tidal gravitational pendulum

    Science.gov (United States)

    Farley, A. N. St J.

    2018-05-01

    Null geodesic deviation in classical general relativity is expressed in terms of a scalar function, defined as the invariant magnitude of the connecting vector between neighbouring light rays in a null geodesic congruence projected onto a two-dimensional screen space orthogonal to the rays, where λ is an affine parameter along the rays. We demonstrate that η satisfies a harmonic oscillator-like equation with a λ-dependent frequency, which comprises terms accounting for local matter affecting the congruence and tidal gravitational effects from distant matter or gravitational waves passing through the congruence, represented by the amplitude, of a complex Weyl driving term. Oscillating solutions for η imply the presence of conjugate or focal points along the rays. A polarisation angle, is introduced comprising the orientation of the connecting vector on the screen space and the phase, of the Weyl driving term. Interpreting β as the polarisation of a gravitational wave encountering the light rays, we consider linearly polarised waves in the first instance. A highly non-linear, second-order ordinary differential equation, (the tidal pendulum equation), is then derived, so-called due to its analogy with the equation describing a non-linear, variable-length pendulum oscillating under gravity. The variable pendulum length is represented by the connecting vector magnitude, whilst the acceleration due to gravity in the familiar pendulum formulation is effectively replaced by . A tidal torque interpretation is also developed, where the torque is expressed as a coupling between the moment of inertia of the pendulum and the tidal gravitational field. Precessional effects are briefly discussed. A solution to the tidal pendulum equation in terms of familiar gravitational lensing variables is presented. The potential emergence of chaos in general relativity is discussed in the context of circularly, elliptically or randomly polarised gravitational waves encountering the null

  17. Environmental consequences of tidal power in a hyper-tidal muddy regime: the Severn estuary

    International Nuclear Information System (INIS)

    Kirby, R.

    1997-01-01

    Muddy hyper-tidal regimes, such as the Severn Estuary in the UK, are especially difficult for plants and animals. The difficulties stem from the semi-diurnal and semi-lunar energy fluctuations. On spring tides entrained fine sediment induces elevated suspended sediment concentrations such that photosynthesis is inhibited. On neap tides much of the entrained fine sediment is deposited on the sub-tidal bed over periods of several days to form ephemeral dense layers, which reach in excess of 100 G/l and rapidly become anaerobic on stagnation. Such occasional bed faunas as develop are characterised by very large numbers of immature individuals of a few species. One of the few organisms able to cope with the extreme conditions is the siliceous reef-building worn Sabellaria. Arising from the long term suppression in its calcareous fauna, erosion and winnowing of these Holocene clays fails to give rise to lag shell deposits, called chenier ridges, found elsewhere in eroding muddy inter-tidal systems. A tidal power barrage would shift the regime from hyper-tidal to macro-tidal decrease in turbidity would permit photosynthesis and phytoplankton growth, so stimulating the higher food chain. Ironically, perhaps, cleaning up the sewage discharges in the estuary, in the absence of barrage construction would lead to a wading bird crash whereas barrage construction would lead to an improved carrying capacity. (author)

  18. Flow paths of water and sediment in a tidal marsh: relations with marsh developmental stage and tidal inundation height

    NARCIS (Netherlands)

    Temmerman, S.; Bouma, T.J.; Govers, G.; Lauwaet, D.

    2005-01-01

    This study provides new insights in the relative role of tidal creeks and the marsh edge in supplying water and sediments to and from tidal marshes for a wide range of tidal inundation cycles with different high water levels and for marsh zones of different developmental stage. Net import or export

  19. Tidal and residual currents across the northern Ryukyu Island chain observed by ferryboat ADCP

    Science.gov (United States)

    Liu, Zhao-Jun; Nakamura, Hirohiko; Zhu, Xiao-Hua; Nishina, Ayako; Dong, Menghong

    2017-09-01

    Ferryboat Acoustic Doppler Current Profiler (ADCP) data from 2003 to 2012 are used to estimate the tidal and residual currents across the northern Ryukyu Island chain (RIC) between the islands of Okinawa and Amamioshima. In this region, the M2 tide current is the strongest tidal component, and the K1 tide current is the strongest diurnal tidal component. The corresponding maximum amplitudes are 40 and 34 cm s-1, respectively. After removal of the tidal currents, the mean volume transport, 1.5 ± 2.7 Sv, flows into the East China Sea (ECS) from the western North Pacific through four channels in this area. In an empirical orthogonal function (EOF) analysis performed to clarify the temporal and spatial variability of currents through the four channels, the first two EOF modes account for 71% and 18% of the total variance, respectively. The EOF1 mode shows a clear bottom-intensified mode through the deep channel, which is likely to be formed by the propagation of bottom-trapped long topographic Rossby wave caused by the impingement of westward-propagating mesoscale eddies upon the eastern slope of the northern RIC. The EOF2 mode has significant seasonal variability and may be driven by the wind stress prevailing over the Kuroshio flow region around the northern RIC in October-November. This study provides observational evidence of the water exchanges across the northern RIC, which is essential for constructing a circulation scheme in the North Pacific subtropical western boundary region.

  20. Tidal regimes and salt marshes - the River Hamble analogue

    International Nuclear Information System (INIS)

    Gray, A.J.; Moy, I.L.; Warman, E.A.; Dawson, F.H.; Henville, P.

    1993-01-01

    Construction of estuarine tidal-energy barrages has a potentially major effect on the tidal regime of the estuary, particularly upstream of a barrage. Because tidal regime largely controls the distribution and species composition of intertidal plant and animal communities, it is important to understand how barrages may affect such communities. The main objectives of the research described in this report were to relate recent changes in tidal regime within an embanked area of salt marsh and mudflat to changes in the distribution of plant species. This was to test predictions about tidal control of species' range and to assess the site's suitability as an analogue of post-barrage conditions. (author)

  1. Evaluation of a combination of low-dose ketamine and low-dose midazolam in terminal dyspnea-attenuation of "double-effect"

    Directory of Open Access Journals (Sweden)

    Abhijit Kanti Dam

    2008-01-01

    Full Text Available Aim: Of all symptoms in palliative medicine those concerning respiration are most excruciating and difficult to treat. Reticence about the use of morphine for palliation of dyspnea is common, especially in nonmalignant diseases, as there is a fear of causing respiratory depression, particularly where Chronic Obstructive Pulmonary Disease (COPD exists. This factor is also compounded by the lack of availability of morphine in parts of developing countries. Ketamine has excellent anesthetic and analgesic effects in addition to being easily available. It produces bronchodilatation and does not produce respiratory or cardiovascular depression. The author seeks to evaluate the role of low-dose (0.2 mg/kg ketamine and midazolam (0.02 mg/kg in the attenuation of terminal dyspnea. Methods: Sixteen patients with terminal dyspnea, admitted to the Critical Care Unit (CCU with cancer and other noncancer diagnoses were recruited. The subjective component of dyspnea was assessed using the Graphic Rating Scale (GRS, which has values from 0 - 10, 10 being maximum dyspnea. Each patient received a low-dose of ketamine and midazolam for relief of dyspnea. All the patients received low-flow (2 L/min. oxygen therapy via nasal cannula. Immediately after admission, all the patients were reassured and nursed in a decubitus position of their choice. The GRS was recorded at the point of admission, 10 minutes after starting oxygen therapy, and ten minutes after administration of low-dose ketamine and midazolam. Hemodynamic parameters were also recorded at these three points. Result: All the patients who enrolled in our study had significant dyspnea at admission, as was evident from the GRS scores of 8.250 (SD 0.91, respiratory rate of 28.56 (SD 5.0, mean arterial blood pressure (MABP of 102.7 (SD 14.63, pulse rate of 115.62 (SD 23.3, and SpO2 of 92.43 (SD 2.38. All the patients benefited from the combination of ketamine and midazolam, as evidenced by the statistically

  2. Tidal disruption of fuzzy dark matter subhalo cores

    Science.gov (United States)

    Du, Xiaolong; Schwabe, Bodo; Niemeyer, Jens C.; Bürger, David

    2018-03-01

    We study tidal stripping of fuzzy dark matter (FDM) subhalo cores using simulations of the Schrödinger-Poisson equations and analyze the dynamics of tidal disruption, highlighting the differences with standard cold dark matter. Mass loss outside of the tidal radius forces the core to relax into a less compact configuration, lowering the tidal radius. As the characteristic radius of a solitonic core scales inversely with its mass, tidal stripping results in a runaway effect and rapid tidal disruption of the core once its central density drops below 4.5 times the average density of the host within the orbital radius. Additionally, we find that the core is deformed into a tidally locked ellipsoid with increasing eccentricities until it is completely disrupted. Using the core mass loss rate, we compute the minimum mass of cores that can survive several orbits for different FDM particle masses and compare it with observed masses of satellite galaxies in the Milky Way.

  3. Tidal Friction in the Earth and Ocean

    Science.gov (United States)

    Ray, R. D.

    2006-12-01

    "Tidal Friction" is a classic subject in geophysics, with ties to some of the great scientists of the Victorian era. The subject has been reinvigorated over the past decade by space geodesy, and particularly by the Topex/Poseidon satellite altimeter mission. In fact, the topic has now taken on some significance in oceanography, with potential implications for problems of mixing, thermocline maintenance, and the thermohaline circulation. Likewise, tidal measurements have become sufficiently precise to reveal new information about the solid earth. In this respect, the tidal force is an invaluable "probe" of the earth, at frequencies well outside the seismic band. This talk will "follow the energy" of tides while noting some important geophysical implications at each stage. In the present earth-moon-sun configuration, energy for tides is extracted from the earth's rotation. Ancient eclipses bear witness to this, and the discrepancy between Babylonian (and other) observations and tidal predictions yields unique information about the mantle and the overlying fluid envelope. Complementary information comes from tidal anelasticity estimates, which are now available at frequencies ranging from semidiurnal to fortnightly, monthly, and 18.6 years. These data, when combined with various kinds of gravity measurements, are relevant to the present-day sea-level problem. Solid-earth tidal dissipation represents less than 5% of the system total. As has long been realized, the largest energy sink is the ocean. About 70% of the oceanic dissipation occurs in shallow seas (the traditional sink) and 30% in the deep ocean, generally near rugged bottom topography. The latter represents a substantial amount of power, roughly 1 gigawatt, available for generation of internal tides and other baroclinic motions. Experiments like HOME are helping unravel the links between barotropic tides, internal tides, turbulence, and mixing. The latter opens possible linkages to climate, and recent work

  4. Tidal power dams in the Bay of Fundy

    International Nuclear Information System (INIS)

    Walsun, W. van

    1998-01-01

    The challenges of harnessing tidal power and the construction of dams and tidal power plants in a tidal-ocean environment such as the Bay of Fundy in New Brunswick are discussed. In the 1966-1988 series of studies, three sites were chosen at the Bay of Fundy as being the most promising, namely (1) site B9 in Minas Basin at the entrance to Cobequid Bay, (2) site A8 at the narrow neck beyond the entrance to Cumberland Basin, and (3) site A6 at the entrance to Shepody Bay. All the sites are located at the head of the Bay of Fundy because that is where the maximum tidal ranges are found and a basin's tidal energy potential is proportional to the square of its tidal range. Site B9 was determined to have the greatest tidal power potential but no plant has ever been built because reports have stated that a solid conventional tidal power barrage at site B9 would increase the tidal range at Boston by as much as 30 cm. Rather than abandoning the site for this reason, an installation consisting of a series of piers from shore to shore with hydraulic turbines mounted in the spaces between piers, was suggested. A simple mathematical model has been developed for determining the operation of this tidal fence. The cost of energy, generated by the tidal fence at site B9 was also calculated. Further studies are suggested to determine the exact environmental effect of the tidal fence on the tidal regime. If environmental problems persist, machines with larger discharge capabilities could be considered to reduce the interference of the fence with natural tidal movements. 9 refs., 6 figs

  5. Experiments on topographies lacking tidal conversion

    Science.gov (United States)

    Maas, Leo; Paci, Alexandre; Yuan, Bing

    2015-11-01

    In a stratified sea, internal tides are supposedly generated when the tide passes over irregular topography. It has been shown that for any given frequency in the internal wave band there are an infinite number of exceptions to this rule of thumb. This ``stealth-like'' property of the topography is due to a subtle annihilation of the internal waves generated during the surface tide's passage over the irregular bottom. We here demonstrate this in a lab-experiment. However, for any such topography, subsequently changing the surface tide's frequency does lead to tidal conversion. The upshot of this is that a tidal wave passing over an irregular bottom is for a substantial part trapped to this irregularity, and only partly converted into freely propagating internal tides. Financially supported by the European Community's 7th Framework Programme HYDRALAB IV.

  6. Power Generation for River and Tidal Generators

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, Eduard [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wright, Alan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Donegan, James [Ocean Renewable Power Company (ORPC), Portland, ME (United States); Marnagh, Cian [Ocean Renewable Power Company (ORPC), Portland, ME (United States); McEntee, Jarlath [Ocean Renewable Power Company (ORPC), Portland, ME (United States)

    2016-06-01

    Renewable energy sources are the second largest contributor to global electricity production, after fossil fuels. The integration of renewable energy continued to grow in 2014 against a backdrop of increasing global energy consumption and a dramatic decline in oil prices during the second half of the year. As renewable generation has become less expensive during recent decades, and it becomes more accepted by the global population, the focus on renewable generation has expanded from primarily wind and solar to include new types with promising future applications, such as hydropower generation, including river and tidal generation. Today, hydropower is considered one of the most important renewable energy sources. In river and tidal generation, the input resource flow is slower but also steadier than it is in wind or solar generation, yet the level of water turbulent flow may vary from one place to another. This report focuses on hydrokinetic power conversion.

  7. Tidal Disruption Events from Eccentric Nuclear Disks

    Science.gov (United States)

    Wernke, Heather N.; Madigan, Ann-Marie

    2018-04-01

    Stars that get too close to a supermassive black hole are in danger of being tidally disrupted. Stellar two-body relaxation is commonly assumed to be the main driver of these events. Recent work has shown, however, that secular gravitational torques from eccentric nuclear disks can push stars to extreme eccentricities at much higher rates than predicted by two-body relaxation. This work did not include the effects of general relativity, however, which could quench secular torques via rapid apsidal precession. Here we show that, for a star in danger of disruption, general relativity acts on a timescale of less than an orbital period. This short timescale means that general relativity does not have enough time to have a major effect on the orbit. When driven by secular torques from eccentric nuclear disks, tidal disruption event rates are not affected by general relativity.

  8. The influence of neap-spring tidal variation and wave energy on sediment flux in salt marsh tidal creeks

    Science.gov (United States)

    Lacy, Jessica; Ferner, Matthew C.; Callaway, John C.

    2018-01-01

    Sediment flux in marsh tidal creeks is commonly used to gage sediment supply to marshes. We conducted a field investigation of temporal variability in sediment flux in tidal creeks in the accreting tidal marsh at China Camp State Park adjacent to northern San Francisco Bay. Suspended-sediment concentration (SSC), velocity, and depth were measured near the mouths of two tidal creeks during three six-to-ten-week deployments: two in winter and one in summer. Currents, wave properties and SSC were measured in the adjacent shallows. All deployments spanned the largest spring tides of the season. Results show that tidally-averaged suspended-sediment flux (SSF) in the tidal creeks decreased with increasing tidal energy, and SSF was negative (bayward) for tidal cycles with maximum water surface elevation above the marsh plain. Export during the largest spring tides dominated the cumulative SSF measured during the deployments. During ebb tides following the highest tides, velocities exceeded 1 m/s in the narrow tidal creeks, resulting in negative tidally-averaged water flux, and mobilizing sediment from the creek banks or bed. Storm surge also produced negative SSF. Tidally-averaged SSF was positive in wavey conditions with moderate tides. Spring-tide sediment export was about 50% less at a station 130 m further up the tidal creek than at the creek mouth. The negative tidally-averaged water flux near the creek mouth during spring tides indicates that in the lower marsh, some of the water flooding directly across the bay--marsh interface drains through the tidal creeks, and suggests that this interface may be a pathway for sediment supply to the lower marsh as well.

  9. Integrating tidal and nontidal ecological assessments

    Science.gov (United States)

    Mark Southerland; Roberto Llanso

    2016-01-01

    The Maryland Department of Natural Resources (DNR) has a long history of conducting rigorous assessments of ecological conditions in both tidal and nontidal waters. The Long-Term Benthic (LTB) Monitoring Program and the Maryland Biological Stream Survey (MBSS) both use reference-based indicators of benthic invertebrate communities to provide areawide estimates of ...

  10. The commercial prospects for tidal stream power

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    The prospects for obtaining energy from tidal currents were examined in 1993 when it was concluded that, although the UK resource is large, the unit cost of energy would be relatively high. Interest has continued, however, and in December 2000 the Energy Technology Support Unit (ETSU), on behalf of the Department of Trade and Industry (DTI), commissioned Binnie Black and Veatch (BBV) to re-examine these prospects from a commercial point of view. (author)

  11. Effect of tidal fields on star clusters

    Science.gov (United States)

    Chernoff, David; Weinberg, Martin

    1991-01-01

    We follow the dynamical evolution of a star cluster in a galactic tidal field using a restricted N-body code. We find large asymmetric distortions in the outer profile of the cluster in the first 10 or so crossing times as material is lost. Prograde stars escape preferentially and establish a potentially observable retrograde rotation in the halo. We present the rate of particle loss and compare with the prescription proposed by Lee and Ostriker (1987).

  12. Tidal power from the River Mersey

    International Nuclear Information System (INIS)

    1991-01-01

    The studies described in this report relate to work carried out since those reported upon in the stage I Mersey Barrage Report on the possible construction of a tidal power barrage on the Mersey Estuary. The objectives of the work were to review basic engineering, re-assess cost and energy output, improve engineering configuration, quantify social, industrial and regional effects, determine preferred alignment, review the main environmental impacts, assess economic viability and financing and identify further study requirements. (UK)

  13. Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea

    NARCIS (Netherlands)

    Bayes-Genis, Antoni; Lloyd-Jones, Donald M.; van Kimmenade, Roland R. J.; Lainchbury, John G.; Richards, A. Mark; Ordoñez-Llanos, Jordi; Santaló, Miquel; Pinto, Yigal M.; Januzzi, James L.

    2007-01-01

    BACKGROUND: Amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) testing is useful for diagnostic and prognostic evaluation in patients with dyspnea. An inverse relationship between body mass index (BMI); (calculated as weight in kilograms divided by height in meters squared) and NT-proBNP

  14. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rajashree Ranjita

    2016-07-01

    Conclusions: Findings indicate that IAYT benefits coal miners with COPD, reducing dyspnea; fatigue and PR, and improving functional performance and peripheral capillary SpO2%. Yoga can now be included as an adjunct to conventional therapy for pulmonary rehabilitation programs for COPD patients.

  15. Tidal controls on river delta morphology

    Science.gov (United States)

    Hoitink, A. J. F.; Wang, Z. B.; Vermeulen, B.; Huismans, Y.; Kästner, K.

    2017-09-01

    River delta degradation has been caused by extraction of natural resources, sediment retention by reservoirs, and sea-level rise. Despite global concerns about these issues, human activity in the world’s largest deltas intensifies. Harbour development, construction of flood defences, sand mining and land reclamation emerge as key contemporary factors that exert an impact on delta morphology. Tides interacting with river discharge can play a crucial role in the morphodynamic development of deltas under pressure. Emerging insights into tidal controls on river delta morphology suggest that--despite the active morphodynamics in tidal channels and mouth bar regions--tidal motion acts to stabilize delta morphology at the landscape scale under the condition that sediment import during low flows largely balances sediment export during high flows. Distributary channels subject to tides show lower migration rates and are less easily flooded by the river because of opposing non-linear interactions between river discharge and the tide. These interactions lead to flow changes within channels, and a more uniform distribution of discharge across channels. Sediment depletion and rigorous human interventions in deltas, including storm surge defence works, disrupt the dynamic morphological equilibrium and can lead to erosion and severe scour at the channel bed, even decades after an intervention.

  16. Tidally Driven Failure Along Europa's Rhadamanthys Linea

    Science.gov (United States)

    Cameron, M.; Konter, B.; Pappalardo, R. T.

    2013-12-01

    The surface of Europa is crosscut by a dense network of fractures and there are many candidate faults for studying past tectonic activity. To better understand the role of tidal stress sources and implications for faulting on Europa, we investigate the relationship between shear and normal stresses at Rhadamanthys Linea, a northwest oriented fracture in the northern hemisphere. Previous work on Agenor Linea, a right-lateral strike-slip fracture in the southern hemisphere, suggests that both tidal diurnal and non-synchronous rotation (NSR) stresses play a critical role in the mechanics of Coulomb shear failure on Europa. At Agenor Linea, shear failure from diurnal tidal stress mechanisms is difficult to achieve because the relatively large over¬burden stress (ie., 1.2 MPa at 1 km depth) dominates the stress field; however, MPa order stresses from NSR permit right-lateral shear failure along the west side of the fault at shallow depths (Astypalea Linea and Conamara Chaos will also be investigated, offering a unique comparison of geologic activity of fractures residing in geographically diverse locations of Europa.

  17. Numerical Simulations of the Effects of a Tidal Turbine Array on Near-Bed Velocity and Local Bed Shear Stress

    Directory of Open Access Journals (Sweden)

    Philip A. Gillibrand

    2016-10-01

    Full Text Available We apply a three-dimensional hydrodynamic model to consider the potential effects of energy extraction by an array of tidal turbines on the ambient near-bed velocity field and local bed shear stress in a coastal channel with strong tidal currents. Local bed shear stress plays a key role in local sediment dynamics. The model solves the Reynold-averaged Navier-Stokes (RANS equations on an unstructured mesh using mixed finite element and finite volume techniques. Tidal turbines are represented through an additional form drag in the momentum balance equation, with the thrust imparted and power generated by the turbines being velocity dependent with appropriate cut-in and cut-out velocities. Arrays of 1, 4 and 57 tidal turbines, each of 1.5 MW capacity, were simulated. Effects due to a single turbine and an array of four turbines were negligible. The main effect of the array of 57 turbines was to cause a shift in position of the jet through the tidal channel, as the flow was diverted around the tidal array. The net effect of this shift was to increase near-bed velocities and bed shear stress along the northern perimeter of the array by up to 0.8 m·s−1 and 5 Pa respectively. Within the array and directly downstream, near-bed velocities and bed shear stress were reduced by similar amounts. Changes of this magnitude have the potential to modify the known sand and shell banks in the region. Continued monitoring of the sediment distributions in the region will provide a valuable dataset on the impacts of tidal energy extraction on local sediment dynamics. Finally, the mean power generated per turbine is shown to decrease as the turbine array increased in size.

  18. Tidal controls on earthquake size-frequency statistics

    Science.gov (United States)

    Ide, S.; Yabe, S.; Tanaka, Y.

    2016-12-01

    The possibility that tidal stresses can trigger earthquakes is a long-standing issue in seismology. Except in some special cases, a causal relationship between seismicity and the phase of tidal stress has been rejected on the basis of studies using many small events. However, recently discovered deep tectonic tremors are highly sensitive to tidal stress levels, with the relationship being governed by a nonlinear law according to which the tremor rate increases exponentially with increasing stress; thus, slow deformation (and the probability of earthquakes) may be enhanced during periods of large tidal stress. Here, we show the influence of tidal stress on seismicity by calculating histories of tidal shear stress during the 2-week period before earthquakes. Very large earthquakes tend to occur near the time of maximum tidal stress, but this tendency is not obvious for small earthquakes. Rather, we found that tidal stress controls the earthquake size-frequency statistics; i.e., the fraction of large events increases (i.e. the b-value of the Gutenberg-Richter relation decreases) as the tidal shear stress increases. This correlation is apparent in data from the global catalog and in relatively homogeneous regional catalogues of earthquakes in Japan. The relationship is also reasonable, considering the well-known relationship between stress and the b-value. Our findings indicate that the probability of a tiny rock failure expanding to a gigantic rupture increases with increasing tidal stress levels. This finding has clear implications for probabilistic earthquake forecasting.

  19. Tidally influenced alongshore circulation at an inlet-adjacent shoreline

    Science.gov (United States)

    Hansen, Jeff E.; Elias, Edwin P.L.; List, Jeffrey H.; Erikson, Li H.; Barnard, Patrick L.

    2013-01-01

    The contribution of tidal forcing to alongshore circulation inside the surfzone is investigated at a 7 km long sandy beach adjacent to a large tidal inlet. Ocean Beach in San Francisco, CA (USA) is onshore of a ∼150 km2 ebb-tidal delta and directly south of the Golden Gate, the sole entrance to San Francisco Bay. Using a coupled flow-wave numerical model, we find that the tides modulate, and in some cases can reverse the direction of, surfzone alongshore flows through two separate mechanisms. First, tidal flow through the inlet results in a barotropic tidal pressure gradient that, when integrated across the surfzone, represents an important contribution to the surfzone alongshore force balance. Even during energetic wave conditions, the tidal pressure gradient can account for more than 30% of the total alongshore pressure gradient (wave and tidal components) and up to 55% during small waves. The wave driven component of the alongshore pressure gradient results from alongshore wave height and corresponding setup gradients induced by refraction over the ebb-tidal delta. Second, wave refraction patterns over the inner shelf are tidally modulated as a result of both tidal water depth changes and strong tidal flows (∼1 m/s), with the effect from currents being larger. These tidally induced changes in wave refraction result in corresponding variability of the alongshore radiation stress and pressure gradients within the surfzone. Our results indicate that tidal contributions to the surfzone force balance can be significant and important in determining the direction and magnitude of alongshore flow.

  20. Satellite Tidal Magnetic Signals Constrain Oceanic Lithosphere-Asthenosphere Boundary Earth Tomography with Tidal Magnetic Signals

    Science.gov (United States)

    Grayver, Alexander V.; Schnepf, Neesha R.; Kuvshinov, Alexey V.; Sabaka, Terence J.; Chandrasekharan, Manoj; Olsen, Niles

    2016-01-01

    The tidal flow of electrically conductive oceans through the geomagnetic field results in the generation of secondary magnetic signals, which provide information on the subsurface structure. Data from the new generation of satellites were shown to contain magnetic signals due to tidal flow; however, there are no reports that these signals have been used to infer subsurface structure. Here we use satellite-detected tidal magnetic fields to image the global electrical structure of the oceanic lithosphere and upper mantle down to a depth of about 250 km. The model derived from more than 12 years of satellite data reveals an Approximately 72 km thick upper resistive layer followed by a sharp increase in electrical conductivity likely associated with the lithosphere-asthenosphere boundary, which separates colder rigid oceanic plates from the ductile and hotter asthenosphere.

  1. Daily functioning of dyspnea, self-esteem and physical self in patients with moderate COPD before, during and after a first inpatient rehabilitation program.

    Science.gov (United States)

    Ninot, Gregory; Moullec, Gregory; Desplan, Jacques; Prefaut, Christian; Varray, Alain

    2007-11-30

    Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge. Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV1 = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge. 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p self-esteem and physical self scores between the two home periods (p self-worth at home post-discharge compared to pre-admission (p self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.

  2. From Globular Clusters to Tidal Dwarfs: Structure Formation in the Tidal Tails of Merging Galaxies

    Science.gov (United States)

    Knierman, Karen A.; Gallagher, Sarah C.; Charlton, Jane C.; Hunsberger, Sally D.; Whitmore, Bradley; Kundu, Arunav; Hibbard, J. E.; Zaritsky, Dennis

    2003-09-01

    Using V and I images obtained with the Wide Field Planetary Camera 2 (WFPC2) of the Hubble Space Telescope, we investigate compact stellar structures within tidal tails. Six regions of tidal debris in the four classic ``Toomre sequence'' mergers: NGC 4038/39 (``Antennae''), NGC 3256, NGC 3921, and NGC 7252 (``Atoms for Peace'') have been studied in order to explore how the star formation depends on the local and global physical conditions. These mergers sample a range of stages in the evolutionary sequence and tails with and without embedded tidal dwarf galaxies. The six tails are found to contain a variety of stellar structures, with sizes ranging from those of globular clusters up to those of dwarf galaxies. From V and I WFPC2 images, we measure the luminosities and colors of the star clusters. NGC 3256 is found to have a large population of blue clusters (0.2<~V-I<~0.9), particularly in its western tail, similar to those found in the inner region of the merger. In contrast, NGC 4038/39 has no clusters in the observed region of the tail, only less luminous point sources likely to be individual stars. NGC 3921 and NGC 7252 have small populations of clusters along their tails. A significant cluster population is clearly associated with the prominent tidal dwarf candidates in the eastern and western tails of NGC 7252. The cluster-rich western tail of NGC 3256 is not distinguished from the others by its dynamical age or by its total H I mass. However, the mergers that have few clusters in the tail all have tidal dwarf galaxies, while NGC 3256 does not have prominent tidal dwarfs. We speculate that star formation in tidal tails may manifest itself either in small structures like clusters along the tail or in large structures such as dwarf galaxies, but not in both. Also, NGC 3256 has the highest star formation rate of the four mergers studied, which may contribute to the high number of star clusters in its tidal tails. Based in part on observations obtained with the

  3. Tidal effects on groundwater contamination at Pekan, Pahang

    International Nuclear Information System (INIS)

    Nor Dalila Desa; Dominic, J.A.; Mohd Muzamil Mohd Hashim; Kamarudin Samuding; Mohd Faizun Khalid; Mod Omar Hassan; Kamaruzaman Mohamad

    2014-01-01

    The meeting of coastal ground water and the sea is a unique and dynamic hydro geologic boundary phenomenon that has fascinated groundwater engineers and scientists for the past century. The variation of seawater level resulting from tidal fluctuations is usually neglected in regional groundwater flow studies. In this study the effects of seawater tidal on groundwater are investigated using geophysical together with conventional method. Comparative result between these two methods shown how tidal fluctuations effects groundwater in study area. (author)

  4. Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case

    Directory of Open Access Journals (Sweden)

    Leonidas Laskaridis

    2012-01-01

    Full Text Available Urinothorax (UT is a rare and often undiagnosed condition, defined as the presence of urine in the pleural cavity due to the retroperitoneal leakage of urine accumulation, known as urinoma, into the pleural space. UT usually is a transudative pleural effusion that presents in patients with obstructive uropathy and it may occur following surgical procedures in the ureter or kidney such as ESWL, PCNL, and URS. Its diagnosis requires a high degree of clinical suspicion since the respiratory symptoms tend to be absent or mild and the urological signs tend to dominate. However, UT may rarely present with severe and acute dyspnea as well. The objectives of this study are to describe two new cases of this rare entity, a bilateral case and an ipsilateral case focusing on the side that occurs according to the affected renal insult, and to alert the physicians to include UT in their differential diagnosis of pleural effusions especially in patients with recent urinary tract disorders.

  5. Assessment of regional ventilation and deformation using 4D-CT imaging for healthy human lungs during tidal breathing.

    Science.gov (United States)

    Jahani, Nariman; Choi, Sanghun; Choi, Jiwoong; Iyer, Krishna; Hoffman, Eric A; Lin, Ching-Long

    2015-11-15

    This study aims to assess regional ventilation, nonlinearity, and hysteresis of human lungs during dynamic breathing via image registration of four-dimensional computed tomography (4D-CT) scans. Six healthy adult humans were studied by spiral multidetector-row CT during controlled tidal breathing as well as during total lung capacity and functional residual capacity breath holds. Static images were utilized to contrast static vs. dynamic (deep vs. tidal) breathing. A rolling-seal piston system was employed to maintain consistent tidal breathing during 4D-CT spiral image acquisition, providing required between-breath consistency for physiologically meaningful reconstructed respiratory motion. Registration-derived variables including local air volume and anisotropic deformation index (ADI, an indicator of preferential deformation in response to local force) were employed to assess regional ventilation and lung deformation. Lobar distributions of air volume change during tidal breathing were correlated with those of deep breathing (R(2) ≈ 0.84). Small discrepancies between tidal and deep breathing were shown to be likely due to different distributions of air volume change in the left and the right lungs. We also demonstrated an asymmetric characteristic of flow rate between inhalation and exhalation. With ADI, we were able to quantify nonlinearity and hysteresis of lung deformation that can only be captured in dynamic images. Nonlinearity quantified by ADI is greater during inhalation, and it is stronger in the lower lobes (P < 0.05). Lung hysteresis estimated by the difference of ADI between inhalation and exhalation is more significant in the right lungs than that in the left lungs. Copyright © 2015 the American Physiological Society.

  6. Tidal sails : an alternative to turbines for harvesting tidal current energy

    Energy Technology Data Exchange (ETDEWEB)

    Hanssen, J.E. [Tidal Sails, Haugesund (Norway)

    2008-07-01

    Tidal sail technology harnesses the energy of tidal streams in order to produce electricity. Tidal currents move the sails that are attached to wires that rotate generator wheels to produce electricity. The technology has a low impact on the surrounding environment and is simple to install. This presentation discussed the methods used to determine the influence of relative sail velocity and measure estimated energy output levels. The sails were recently tested at an on-grid tidal stream pilot in the Norwegian Arctic. A 300 kW turbine installed at the site demonstrated that the site was suitable for a full-scale development of 20 tripod-mounted 600 kW turbines placed at 50 m depth. It was estimated that the 10 strings of 1000 m length provided between 200 and 250 GWh per year. The sails have also been used at a high speed site in Washington state in the United States. The 25 m pilot plant was installed to verify site suitability and examine sail behaviour in real, high-flow currents. It is expected that the technology will be fully commercialized by 2011. Other pilot tests are being conducted to examine flow behaviour; mooring and flotation functionality; and launch and lift capabilities. Engineering work is ongoing to examine plant designs, variable sail spacing, and collaborations with key component suppliers. tabs., figs.

  7. Waddenfonds Tidal Texel Demonstration project. BlueTEC Texel Tidal Project: Environmental measurement and performance analysis

    NARCIS (Netherlands)

    Ponsoni, L.; Nauw, J.J.; Smit, M.; Ober, S.; Nichols, C.; Kenkhuis, J.; Schmidt, C.; Buatois, A.; de Haas, P.

    2016-01-01

    In the context of the BlueTEC project, this report starts by introducing theBlueTEC tidal energy platform and reviewing the patterns of circulation of theMarsdiep inlet. The energy resource assessment and the site selection for theplatform's deployment are reported. This document analyses di?erent

  8. Atmospheric dynamics of tidally synchronized extrasolar planets.

    Science.gov (United States)

    Cho, James Y-K

    2008-12-13

    Tidally synchronized planets present a new opportunity for enriching our understanding of atmospheric dynamics on planets. Subject to an unusual forcing arrangement (steady irradiation on the same side of the planet throughout its orbit), the dynamics on these planets may be unlike that on any of the Solar System planets. Characterizing the flow pattern and temperature distribution on the extrasolar planets is necessary for reliable interpretation of data currently being collected, as well as for guiding future observations. In this paper, several fundamental concepts from atmospheric dynamics, likely to be central for characterization, are discussed. Theoretical issues that need to be addressed in the near future are also highlighted.

  9. Physics and observations of tidal disruption events

    Science.gov (United States)

    Mangalam, Arun; Mageshwaran, Tamilan

    2018-04-01

    We describe a model of tidal disruption events (TDEs) with input physical parameters that include the black hole (BH) mass M•, the specific orbital energy E, the angular momentum J, the star mass M⊙ and radius R⊙. We calculate the rise time of the TDEs, the peak bolometric luminosity in terms of these physical parameters and a typical light curve of TDEs for various All Sky Survey (ASS) and Deep Sky Survey (DSS) missions. We then derive the expected detection rates and discuss the follow up of TDEs through observations in various spectral bands from X-rays to radio wavelengths.

  10. Comprehensive Characterization a Tidal Energy Site (Invited)

    Science.gov (United States)

    Polagye, B. L.; Thomson, J. M.; Bassett, C. S.; Epler, J.; Northwest National Marine Renewable Energy Center

    2010-12-01

    Northern Admiralty Inlet, Puget Sound, Washington is the proposed location of a pilot tidal energy project. Site-specific characterization of the physical and biological environment is required for device engineering and environmental analysis. However, the deep water and strong currents which make the site attractive for tidal energy development also pose unique challenges to collecting comprehensive information. This talk focuses on efforts to optimally site hydrokinetic turbines and estimate their acoustic impact, based on 18 months of field data collected to date. Additional characterization efforts being undertaken by the University of Washington branch of the Northwest National Marine Renewable Energy Center and its partners include marine mammal presence and behavior, water quality, seabed geology, and biofouling potential. Because kinetic power density varies with the cube of horizontal current velocity, an accurate map of spatial current variations is required to optimally site hydrokinetic turbines. Acoustic Doppler profilers deployed on the seabed show operationally meaningful variations in flow characteristics (e.g., power density, directionality, vertical shear) and tidal harmonic constituents over length scales of less than 100m. This is, in part, attributed to the proximity of this site to a headland. Because of these variations, interpolation between stationary measurement locations introduces potentially high uncertainty. The use of shipboard acoustic Doppler profilers is shown to be an effective tool for mapping peak currents and, combined with information from seabed profilers, may be able to resolve power density variations in the project area. Because noise levels from operating turbines are expected to exceed regulatory thresholds for incidental harassment of marine mammals known to be present in the project area, an estimate of the acoustic footprint is required to permit the pilot project. This requires site-specific descriptions of pre

  11. Tidal Wetlands and Coastal Ocean Carbon Dynamics

    Science.gov (United States)

    Hopkinson, C.; Wang, S. R.; Forbrich, I.; Giblin, A. E.; Cai, W. J.

    2017-12-01

    Recent overviews of coastal ocean C dynamics have tidal wetlands in a prominent position: a local sink for atmospheric CO2, a local store of OC, and a source of DIC and OC for the adjacent estuary and nearshore ocean. Over the past decade there have been great strides made in quantifying and understanding these flows and linkages. GPP and R of the wetlands are not nearly as imbalanced as thought 30 yrs ago. Heterotrophy of adjacent estuarine waters is not solely due to the respiration of OC exported from the marsh, rather we see the marsh directly respiring into the water during tidal inundation and accumulated marsh DIC draining into tidal creeks. Organic carbon burial on the marsh is still a relatively minor flux, but it is large relative to marsh NEE. Using literature and unpublished data on marsh DIC export, we used examples from Sapelo Island GA USA and Plum Island MA USA to constrain estimates of NEP and potential OC export. P. There remain large uncertainties in quantifying C dynamics of coupled wetland - estuary systems. Gas exchange from the water to atmosphere is one of the largest uncertainties. Work at Sapelo suggests that upwards of 40% of all daily exchange occurs from water flooding the marsh, which is but a few hours a day. This estimate is based on the intercept value for gas exchange vs wind velocity. Another major uncertainty comes from converting between O2 based estimates of metabolism to C. At Sapelo we find PQ and RQ values diverging greatly from Redfield. Finally, C dynamics of the coastal ocean, especially the role of tidal wetlands is likely to change substantially in the future. Studies at Plum Island show a reversal of the 4000 yr process of marsh progradation with marshes eroding away at their edges because of inadequate sediment supply and rising sea level. The fate of eroded OC is questionable. Landward transgression with SLR is the only likely counter to continued wetland loss - but that's a complex social issue requiring new

  12. Ranolazine versus placebo in patients with ischemic cardiomyopathy and persistent chest pain or dyspnea despite optimal medical and revascularization therapy: randomized, double-blind crossover pilot study

    Directory of Open Access Journals (Sweden)

    Shammas NW

    2015-03-01

    Full Text Available Nicolas W Shammas,1 Gail A Shammas,1 Kathleen Keyes,2 Shawna Duske,1 Ryan Kelly,1 Michael Jerin3 1Midwest Cardiovascular Research Foundation, 2Cardiovascular Medicine, Private Corporation, 3St Ambrose University, Davenport, IA, USA Background: Patients with ischemic cardiomyopathy (ICM may continue to experience persistent chest pain and/or dyspnea despite pharmacologic therapy and revascularization. We hypothesized that ranolazine would reduce anginal symptoms or dyspnea in optimally treated ICM patients.Methods: In this randomized, double-blind, crossover-design pilot study, 28 patients with ICM (ejection fraction less or equal 40% were included after providing informed consent. A total of 24 patients completed both placebo and ranolazine treatments and were analyzed. All patients were on treatment with a beta blocker, an angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker, and at least one additional antianginal drug. After randomization, patients received up to 1,000 mg ranolazine orally twice a day, as tolerated, versus placebo. The primary end point was change in angina as assessed by the Seattle Angina Questionnaire (SAQ, or in dyspnea as assessed by the Rose Dyspnea Scale (RDS. Change in the RDS and SAQ score from baseline was compared, for ranolazine and placebo, using the Wilcoxon signed rank test or paired t-test.Results: Patients had the following demographic and clinical variables: mean age of 71.5 years; male (82.1%; prior coronary bypass surgery (67.9%; prior coronary percutaneous intervention (85.7%; prior myocardial infarction (82.1%; diabetes (67.9%; and mean ejection fraction of 33.1%. No statistical difference was seen between baseline RDS score and that after placebo or ranolazine (n=20 (P≥0.05. There was however, an improvement in anginal frequency (8/10 patients (P=0.058, quality of life (8/10 patients (P=0.048, and mean score of all components of the SAQ questionnaire (n=10 (P=0.047 with ranolazine

  13. Sensitivity of growth characteristics of tidal sand ridges and long bed waves to formulations of bed shear stress, sand transport and tidal forcing : A numerical model study

    NARCIS (Netherlands)

    Yuan, Bing; de Swart, Huib E.; Panadès, Carles

    2016-01-01

    Tidal sand ridges and long bed waves are large-scale bedforms that are observed on continental shelves. They differ in their wavelength and in their orientation with respect to the principal direction of tidal currents. Previous studies indicate that tidal sand ridges appear in areas where tidal

  14. Conditions for tidal bore formation in convergent alluvial estuaries

    Science.gov (United States)

    Bonneton, Philippe; Filippini, Andrea Gilberto; Arpaia, Luca; Bonneton, Natalie; Ricchiuto, Mario

    2016-04-01

    Over the last decade there has been an increasing interest in tidal bore dynamics. However most studies have been focused on small-scale bore processes. The present paper describes the first quantitative study, at the estuary scale, of the conditions for tidal bore formation in convergent alluvial estuaries. When freshwater discharge and large-scale spatial variations of the estuary water depth can be neglected, tide propagation in such estuaries is controlled by three main dimensionless parameters: the nonlinearity parameter ε0 , the convergence ratio δ0 and the friction parameter ϕ0. In this paper we explore this dimensionless parameter space, in terms of tidal bore occurrence, from a database of 21 estuaries (8 tidal-bore estuaries and 13 non tidal-bore estuaries). The field data point out that tidal bores occur for convergence ratios close to the critical convergence δc. A new proposed definition of the friction parameter highlights a clear separation on the parameter plane (ϕ0,ε0) between tidal-bore estuaries and non tidal-bore estuaries. More specifically, we have established that tidal bores occur in convergent estuaries when the nonlinearity parameter is greater than a critical value, εc , which is an increasing function of the friction parameter ϕ0. This result has been confirmed by numerical simulations of the two-dimensional Saint Venant equations. The real-estuary observations and the numerical simulations also show that, contrary to what is generally assumed, tide amplification is not a necessary condition for tidal bore formation. The effect of freshwater discharge on tidal bore occurrence has been analyzed from the database acquired during three long-term campaigns carried out on the Gironde/Garonne estuary. We have shown that in the upper estuary the tidal bore intensity is mainly governed by the local dimensionless tide amplitude ε. The bore intensity is an increasing function of ε and this relationship does not depend on freshwater

  15. The origin of neap-spring tidal cycles

    Science.gov (United States)

    Kvale, E.P.

    2006-01-01

    The origin of oceanic tides is a basic concept taught in most introductory college-level sedimentology/geology, oceanography, and astronomy courses. Tides are typically explained in the context of the equilibrium tidal theory model. Yet this model does not take into account real tides in many parts of the world. Not only does the equilibrium tidal model fail to explicate amphidromic circulation, it also does not explain diurnal tides in low latitude positions. It likewise fails to explain the existence of tide-dominated areas where neap-spring cycles are synchronized with the 27.32-day orbital cycle of the Moon (tropical month), rather than with the more familiar 29.52-day cycle of lunar phases (synodic month). Both types of neap-spring cycles can be recognized in the rock record. A complete explanation of the origin of tides should include a discussion of dynamic tidal theory. In the dynamic tidal model, tides resulting from the motions of the Moon in its orbit around the Earth and the Earth in its orbit around the Sun are modeled as products of the combined effects of a series of phantom satellites. The movement of each of these satellites, relative to the Earth's equator, creates its own tidal wave that moves around an amphidromic point. Each of these waves is referred to as a tidal constituent. The geometries of the ocean basins determine which of these constituents are amplified. Thus, the tide-raising potential for any locality on Earth can be conceptualized as the result of a series of tidal constituents specific to that region. A better understanding of tidal cycles opens up remarkable opportunities for research on tidal deposits with implications for, among other things, a more complete understanding of the tidal dynamics responsible for sediment transport and deposition, changes in Earth-Moon distance through time, and the possible influences tidal cycles may exert on organisms. ?? 2006 Elsevier B.V. All rights reserved.

  16. Classification of tidal inlets along the Central east coast of India

    Digital Repository Service at National Institute of Oceanography (India)

    Reddy, N.A.; Vikas, M.; Rao, S.; JayaKumar S.

    ) as long as the alongshore sediment bypasses the tidal inlet. Classification of coastal systems in a broader view is necessary for the management of tidal inlets. There are several methods to classify tidal inlets based on different perspectives namely geo...

  17. Tidal constraints on the interior of Venus

    Science.gov (United States)

    Dumoulin, C.; Tobie, G.; Verhoeven, O.; Rosenblatt, P.; Rambaux, N.

    2017-12-01

    As a prospective study for a future exploration of Venus, we compute the tidal response of Venus' interior assuming various mantle compositions and temperature profiles representative of different scenarios of Venus' formation and evolution. The mantle density and seismic velocities are modeled from thermodynamical equilibria of mantle minerals and used to predict the moment of inertia, Love numbers, and tide-induced phase lag characterizing the signature of the internal structure in the gravity field. The viscoelasticity of the mantle is parameterized using an Andrade rheology. From the models considered here, the moment of inertia lies in the range of 0.327 to 0.342, corresponding to a core radius of 2900 to 3450 km. Viscoelasticity of the mantle strongly increases the potential Love number relative to previously published elastic models. Due to the anelasticity effects, we show that the possibility of a completely solid metal core inside Venus cannot be ruled out based on the available estimate of k2 from the Magellan mission (Konopliv and Yoder, 1996). A Love number k2 lower than 0.27 would indicate the presence of a fully solid iron core, while for larger values, solutions with an entirely or partially liquid core are possible. Precise determination of the Love numbers, k2 and h2, together with an estimate of the tidal phase lag, are required to determine the state and size of the core, as well as the composition and viscosity of the mantle.

  18. Time scales in tidal disruption events

    Directory of Open Access Journals (Sweden)

    Krolik J.

    2012-12-01

    Full Text Available We explore the temporal structure of tidal disruption events pointing out the corresponding transitions in the lightcurves of the thermal accretion disk and of the jet emerging from such events. The hydrodynamic time scale of the disrupted star is the minimal time scale of building up the accretion disk and the jet and it sets a limit on the rise time. This suggest that Swift J1644+57, that shows several flares with a rise time as short as a few hundred seconds could not have arisen from a tidal disruption of a main sequence star whose hydrodynamic time is a few hours. The disrupted object must have been a white dwarf. A second important time scale is the Eddington time in which the accretion rate changes form super to sub Eddington. It is possible that such a transition was observed in the light curve of Swift J2058+05. If correct this provides interesting constraints on the parameters of the system.

  19. Tidal instability in exoplanetary systems evolution

    Directory of Open Access Journals (Sweden)

    Le Gal P.

    2011-02-01

    Full Text Available A new element is proposed to play a role in the evolution of extrasolar planetary systems: the tidal (or elliptical instability. It comes from a parametric resonance and takes place in any rotating fluid whose streamlines are (even slightly elliptically deformed. Based on theoretical, experimental and numerical works, we estimate the growth rate of the instability for hot-jupiter systems, when the rotation period of the star is known. We present the physical process, its application to stars, and preliminary results obtained on a few dozen systems, summarized in the form of a stability diagram. Most of the systems are trapped in the so-called "forbidden zone", where the instability cannot grow. In some systems, the tidal instability is able to grow, at short timescales compared to the system evolution. Implications are discussed in the framework of misaligned transiting systems, as the rotational axis of the star would be unstable in systems where this elliptical instability grows.

  20. Tidal conversion by a knife-edge

    Science.gov (United States)

    Llewellyn Smith, S. G.; Young, W. R.

    2003-04-01

    We obtain an analytic solution for the generation of internal gravity waves by tidal flow past a vertical barrier of height b in a uniformly stratified ocean of depth h>b and buoyancy frequency N. If b/h is small and N is constant, the radiated power (watts per metre of barrier) is (pi/4) ρ_0 b^2 U^2 N sqrt{1-(f/ω)^2} where ρ_0 is the mean density of seawater, U \\cos (ω t) the incident tidal velocity, and f the Coriolis frequency. The radiated power increases rapidly with b/h; as b/h to 1 the radiated power diverges as ln[(h-b)/b]. By solving an integral equation numerically, we calculate the conversion in a realistically stratified ocean in which the buoyancy frequency increases by a factor of fifty between the abyss and the thermocline. The radiated power is greater by a factor of about three than that of a uniformly stratified ocean with N equal to the vertically averaged buoyancy frequency.

  1. Tidal Dwarf Galaxies and Missing Baryons

    Directory of Open Access Journals (Sweden)

    Frederic Bournaud

    2010-01-01

    Full Text Available Tidal dwarf galaxies form during the interaction, collision, or merger of massive spiral galaxies. They can resemble “normal” dwarf galaxies in terms of mass, size, and become dwarf satellites orbiting around their massive progenitor. They nevertheless keep some signatures from their origin, making them interesting targets for cosmological studies. In particular, they should be free from dark matter from a spheroidal halo. Flat rotation curves and high dynamical masses may then indicate the presence of an unseen component, and constrain the properties of the “missing baryons,” known to exist but not directly observed. The number of dwarf galaxies in the Universe is another cosmological problem for which it is important to ascertain if tidal dwarf galaxies formed frequently at high redshift, when the merger rate was high, and many of them survived until today. In this paper, “dark matter” is used to refer to the nonbaryonic matter, mostly located in large dark halos, that is, CDM in the standard paradigm, and “missing baryons” or “dark baryons” is used to refer to the baryons known to exist but hardly observed at redshift zero, and are a baryonic dark component that is additional to “dark matter”.

  2. Angular momentum transport by tidal acoustic wave

    International Nuclear Information System (INIS)

    Sakurai, T.

    1976-01-01

    An analytical expression of the braking torque on a Jacobian ellipsoid rotating steadily in an enviromental gas is given, based on the assumption that the ellipsoid rotates around its shortest principal axis with an angular momentum slightly larger than that at the bifurcation point of the Maclaurin spheroid. This braking torque is effected by the gravitational interaction between the ellipsoid matter and a spiral density configuration in the environmental gas. This spiral configuration which is called a tidal acoustic wave, is caused by the zone of silence effect in a supersonic flow. With respect to a coordinates system rotating with the ellipsoid, a supersonic region appears outside a certain radius. In this supersonic region, the effect of the non-axisymmetric fluctuation in the ellipsoid potential propagates along the downstream branches of the Mach waves. This one-sided response of the supersonic part causes the tidal acoustic wave. The discussion is restricted to the equatorial plane, and an acoustic approximation of the basic equations is used under the assumption that the self-gravity effect of the environmental gas is negligable in comparison to the main gravity of the ellipsoid. The results are applied to the pre- and post-Main sequence phases of a rotating star, and relating astrophysical problems are discussed. (Auth.)

  3. Angular momentum transport by tidal acoustic wave

    Energy Technology Data Exchange (ETDEWEB)

    Sakurai, T [Kyoto Univ. (Japan). Faculty of Engineering

    1976-05-01

    An analytical expression of the braking torque on a Jacobian ellipsoid rotating steadily in an enviromental gas is given, based on the assumption that the ellipsoid rotates around its shortest principal axis with an angular momentum slightly larger than that at the bifurcation point of the Maclaurin spheroid. This braking torque is effected by the gravitational interaction between the ellipsoid matter and a spiral density configuration in the environmental gas. This spiral configuration which is called a tidal acoustic wave, is caused by the zone of silence effect in a supersonic flow. With respect to a coordinates system rotating with the ellipsoid, a supersonic region appears outside a certain radius. In this supersonic region, the effect of the non-axisymmetric fluctuation in the ellipsoid potential propagates along the downstream branches of the Mach waves. This one-sided response of the supersonic part causes the tidal acoustic wave. The discussion is restricted to the equatorial plane, and an acoustic approximation of the basic equations is used under the assumption that the self-gravity effect of the environmental gas is negligable in comparison to the main gravity of the ellipsoid. The results are applied to the pre- and post-Main sequence phases of a rotating star, and relating astrophysical problems are discussed.

  4. Rapid evolution of a marsh tidal creek network in response to sea level rise.

    Science.gov (United States)

    Hughes, Z. J.; Fitzgerald, D. M.; Mahadevan, A.; Wilson, C. A.; Pennings, S. C.

    2008-12-01

    In the Santee River Delta (SRD), South Carolina, tidal creeks are extending rapidly onto the marsh platform. A time-series of aerial photographs establishes that these channels were initiated in the 1950's and are headward eroding at a rate of 1.9 m /yr. Short-term trends in sea level show an average relative sea level rise (RSLR) of 4.6 mm/yr over a 20-year tide gauge record from nearby Winyah Bay and Charleston Harbor (1975-1995). Longer-term (85-year) records in Charleston suggest a rate of 3.2 mm/yr. RSLR in the SRD is likely even higher as sediment cores reveal that the marsh is predominantly composed of fine-grained sediment, making it highly susceptible to compaction and subsidence. Furthermore, loss in elevation will have been exacerbated by the decrease in sediment supply due to the damming of the Santee River in 1939. The rapid rate of headward erosion indicates that the marsh platform is in disequilibrium; unable to keep pace with RSLR through accretionary processes and responding to an increased volume and frequency of inundation through the extension of the drainage network. The observed tidal creeks show no sinuosity and a distinctive morphology associated with their young age and biological mediation during their evolution. Feedbacks between tidal flow, vegetation and infauna play a strong role in the morphological development of the creeks. The creek heads are characterized by a region denuded of vegetation, the edges of which are densely populated and burrowed by Uca Pugnax (fiddler crab). Crab burrowing destabilizes sediment, destroys rooting and impacts drainage. Measured infiltration rates are three orders of magnitude higher in the burrowed regions than in a control area (1000 ml/min and 0.6 ml/min respectively). Infiltration of oxygenated water enhances decomposition of organic matter and root biomass is reduced within the creek head (marsh=4.3 kg/m3, head=0.6 kg/m3). These processes lead to the removal and collapse of the soils, producing

  5. Characterisation of Tidal Flows at the European Marine Energy Centre in the Absence of Ocean Waves

    Directory of Open Access Journals (Sweden)

    Brian G. Sellar

    2018-01-01

    Full Text Available The data analyses and results presented here are based on the field measurement campaign of the Reliable Data Acquisition Platform for Tidal (ReDAPT project (Energy Technologies Institute (ETI, U.K. 2010–2015. During ReDAPT, a 1 MW commercial prototype tidal turbine was deployed and operated at the Fall of Warness tidal test site within the European Marine Energy Centre (EMEC, Orkney, U.K. Mean flow speeds and Turbulence Intensity (TI at multiple positions proximal to the machine are considered. Through the implemented wave identification techniques, the dataset can be filtered into conditions where the effects of waves are present or absent. Due to the volume of results, only flow conditions in the absence of waves are reported here. The analysis shows that TI and mean flows are found to vary considerably between flood and ebb tides whilst exhibiting sensitivity to the tidal phase and to the specification of spatial averaging and velocity binning. The principal measurement technique was acoustic Doppler profiling provided by seabed-mounted Diverging-beam Acoustic Doppler Profilers (D-ADP together with remotely-operable Single-Beam Acoustic Doppler Profilers (SB-ADP installed at mid-depth on the tidal turbine. This novel configuration allows inter-instrument comparisons, which were conducted. Turbulence intensity averaged over the rotor extents of the ReDAPT turbine for flood tides vary between 16.7% at flow speeds above 0.3 m/s and 11.7% when considering only flow speeds in the turbine operating speed range, which reduces to 10.9% (6.8% relative reduction following the implementation of noise correction techniques. Equivalent values for ebb tides are 14.7%, 10.1% and 9.3% (7.9% relative reduction. For flood and ebb tides, TI values resulting from noise correction are reduced in absolute terms by 3% and 2% respectively across a wide velocity range and approximately 1% for turbine operating speeds. Through comparison with SB-ADP-derived mid

  6. Morphodynamics of the Manyema tidal delta 1 LIST OF TABLES ...

    African Journals Online (AJOL)

    Kheira Kortenbout

    Morphodynamics of the Manyema tidal delta. 1. LIST OF ... Location of Manyema Creek and its associated tidal delta platform at Kunduchi. Fig. 2. ... platform. Beachcomber. Hotel. Whitesands. Hotel. Kunduchi. Beach Hotel. Giraffe. Hotel. INDIAN. OCEAN. Mombasa. Dar es. Salaam. KUNDUCHI. KENYA. TANZANIA.

  7. Anomaly Detection Techniques for the Condition Monitoring of Tidal Turbines

    Science.gov (United States)

    2014-09-29

    turbine design includes many horizontal and vertical axis solutions, some with major structural and operational variations (Aly & El-Hawary, 2011...However, a common focus is the horizontal axis design, holding many similarities with a standard wind turbine . Maintenance on tidal turbines ...However, despite similarities between tidal and wind power turbine design, the operating environment is vastly different. Water is over 800 times

  8. Tidal bending of glaciers: a linear viscoelastic approach

    DEFF Research Database (Denmark)

    Reeh, Niels; Christensen, Erik Lintz; Mayer, Christoph

    2003-01-01

    In theoretical treatments of tidal bending of floating glaciers, the glacier is usually modelled as an elastic beam with uniform thickness, resting on an elastic foundation. With a few exceptions, values of the elastic (Young's) modulus E of ice derived from tidal deflection records of floating...

  9. Flow and sediment transport in an Indonesian tidal network

    NARCIS (Netherlands)

    Buschman, F.A.

    2011-01-01

    The Berau river, situated in east Kalimantan (Indonesia), drains a relatively small catchment area and splits into several interconnected tidal channels. This tidal network connects to the sea. The sea is host to extremely diverse coral reef communities. Also the land side of the region is

  10. Water and suspended sediment division at a stratified tidal junction

    NARCIS (Netherlands)

    Buschman, F.A.; Vegt, van der M.; Hoitink, A.J.F.; Hoekstra, P.

    2013-01-01

    [1] Tidal junctions play a crucial role in the transport of water, salt, and sediment through a delta distributary network. Water, salt and sediment are exchanged at tidal junctions, thereby influencing the transports in the connecting branches and the overall dynamics of the system. This paper

  11. Water and suspended sediment division at a stratified tidal junction

    NARCIS (Netherlands)

    Buschman, F.A.; Vegt, M. van der; Hoitink, A.J.F.; Hoekstra, P.

    2013-01-01

    Tidal junctions play a crucial role in the transport of water, salt, and sediment through a delta distributary network. Water, salt and sediment are exchanged at tidal junctions, thereby influencing the transports in the connecting branches and the overall dynamics of the system. This paper

  12. Detecting areal changes in tidal flats after sea dike construction ...

    Indian Academy of Sciences (India)

    The main objective of this study was to estimate changes in the area of tidal flats that occurred after sea dike construction on the western coast of South Korea using Landsat-TM images. Applying the ISODATA method of unsupervised classification for Landsat-TM images, the tidal flats were identified, and the resulting areas ...

  13. 33 CFR 117.181 - Oakland Inner Harbor Tidal Canal.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Oakland Inner Harbor Tidal Canal. 117.181 Section 117.181 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY... Tidal Canal. The draws of the Alameda County highway drawbridges at Park Street, mile 5.2; Fruitvale...

  14. Relation between tidal damping and wave celerity in estuaries

    NARCIS (Netherlands)

    Savenije, H.H.G.; Veling, E.J.M.

    2005-01-01

    Observations in estuaries indicate that an amplified tidal wave moves considerably faster than is indicated by the classical equation for wave propagation. Similarly, the celerity of propagation is lower if the tidal wave is damped. This phenomenon is clearly observed in the Schelde estuary (located

  15. Potential sites for tidal power in New Jersey.

    Science.gov (United States)

    2014-04-01

    High-resolution simulation is made to model tidal energy along the coastlines of New Jersey (NJ) and its neighbor states with an : unprecedentedly fine grid. On the basis of the simulation, a thorough search is made for sites for tidal power generati...

  16. Ammonium transformation in a nitrogen-rich tidal freshwater marsh

    DEFF Research Database (Denmark)

    Gribsholt, B.; Andersson, M.; Boschker, H.T.S.

    2006-01-01

    The fate and transport of watershed-derived ammonium in a tidal freshwater marsh fringing the nutrient rich Scheldt River, Belgium, was quantified in a whole ecosystem 15N labeling experiment. In late summer (September) we added 15N-NH4+ to the flood water entering a 3477 m2 tidal freshwater marsh...

  17. Tidal power - a major prospect for the 21st century

    International Nuclear Information System (INIS)

    Haws, E.T.

    1997-01-01

    Tidal power technology is reviewed and its prospects for the next century assessed. It is concluded that the technology is now in place and, given the political will to secure financing, tidal power offers a clean, renewable and sustainable source of power for the near future. (UK)

  18. Wave and tidal generation devices reliability and availability

    CERN Document Server

    Tavner, Peter John

    2017-01-01

    To some extent the wave and tidal generation industry is following in the wake of the wind industry, learning from the growing experience of offshore wind farm deployment. This book combines wind industry lessons with wave and tidal field knowledge to explore the main reliability and availability issues facing this growing industry.

  19. Temporal bed level variations in the Yangtze tidal flats (abstract)

    NARCIS (Netherlands)

    Yan, H.; Van Prooijen, B.C.

    2013-01-01

    The Yangtze River is one of the largest rivers in the world and the longest one in Asia. Its estuary forms an important entrance for shipping, but is also a key ecological system. Especially the inter-tidal flats are valuable habitats. The health and integrity of the estuarine tidal flat are however

  20. Land Use in Korean Tidal Wetlands: Impacts and Management Strategies

    Science.gov (United States)

    Hong, Sun-Kee; Koh, Chul-Hwan; Harris, Richard R.; Kim, Jae-Eun; Lee, Jeom-Sook; Ihm, Byung-Sun

    2010-05-01

    The coastal landscapes in southwestern Korea include a diverse array of tidal wetlands and salt marshes. These coastal zones link the ecological functions of marine tidal wetlands and freshwater ecosystems with terrestrial ecosystems. They are rich in biological diversity and play important roles in sustaining ecological health and processing environmental pollutants. Korean tidal wetlands are particularly important as nurseries for economically important fishes and habitats for migratory birds. Diking, draining, tourism, and conversion to agricultural and urban uses have adversely affected Korean tidal wetlands. Recent large development projects have contributed to further losses. Environmental impact assessments conducted for projects affecting tidal wetlands and their surrounding landscapes should be customized for application to these special settings. Adequate environmental impact assessments will include classification of hydrogeomorphic units and consideration of their responses to biological and environmental stressors. As is true worldwide, Korean laws and regulations are changing to be more favorable to the conservation and protection of tidal wetlands. More public education needs to be done at the local level to build support for tidal wetland conservation. Some key public education points include the role of tidal wetlands in maintaining healthy fish populations and reducing impacts of nonpoint source pollution. There is also a need to develop procedures for integrating economic and environmental objectives within the overall context of sustainable management and land uses.

  1. Are Wave and Tidal Energy Plants New Green Technologies?

    Science.gov (United States)

    Douziech, Mélanie; Hellweg, Stefanie; Verones, Francesca

    2016-07-19

    Wave and tidal energy plants are upcoming, potentially green technologies. This study aims at quantifying their various potential environmental impacts. Three tidal stream devices, one tidal range plant and one wave energy harnessing device are analyzed over their entire life cycles, using the ReCiPe 2008 methodology at midpoint level. The impacts of the tidal range plant were on average 1.6 times higher than the ones of hydro-power plants (without considering natural land transformation). A similar ratio was found when comparing the results of the three tidal stream devices to offshore wind power plants (without considering water depletion). The wave energy harnessing device had on average 3.5 times higher impacts than offshore wind power. On the contrary, the considered plants have on average 8 (wave energy) to 20 (tidal stream), or even 115 times (tidal range) lower impact than electricity generated from coal power. Further, testing the sensitivity of the results highlighted the advantage of long lifetimes and small material requirements. Overall, this study supports the potential of wave and tidal energy plants as alternative green technologies. However, potential unknown effects, such as the impact of turbulence or noise on marine ecosystems, should be further explored in future research.

  2. Tidal and gravity waves study from the airglow measurements at ...

    Indian Academy of Sciences (India)

    The other waves may be the upward propagating gravity waves or waves resulting from the interaction of inter-mode tidal oscillations, interaction of tidal waves with planetary waves and gravity waves. Some times, the second harmonic wave has higher vertical velocity than the corresponding fundamental wave. Application ...

  3. Seasonal behaviour of tidal inlets in a tropical monsoon area

    NARCIS (Netherlands)

    Lam, N.T.; Stive, M.J.F.; Verhagen, H.J.; Wang, Z.B.

    2008-01-01

    Morphodynamics of a tidal inlet system on a micro-tidal coast in a tropical monsoon influenced region is modelled and discussed. Influences of river flow and wave climate on the inlet morphology are investigated with the aid of process-based state-of-the-art numerical models. Seasonal and episodic

  4. On the superposition of bedforms in a tidal channel

    DEFF Research Database (Denmark)

    Winter, C; Vittori, G.; Ernstsen, V.B.

    2008-01-01

    High resolution bathymetric measurements reveal the super-imposition of bedforms in the Grådyb tidal inlet in the Danish Wadden Sea. Preliminary results of numerical model simulations are discussed: A linear stability model was tested to explain the large bedforms as being caused by tidal system ...

  5. Satellite tidal magnetic signals constrain oceanic lithosphere-asthenosphere boundary

    DEFF Research Database (Denmark)

    Grayver, Alexander V.; Schnepf, Neesha R.; Kuvshinov, Alexey V.

    2016-01-01

    The tidal flow of electrically conductive oceans through the geomagnetic field results in the generation ofsecondary magnetic signals, which provide information on the subsurface structure. Data from the new generation of satellites were shown to contain magnetic signals due to tidal flow; howeve...

  6. The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?

    Directory of Open Access Journals (Sweden)

    Shaffer R. S. Mok

    2013-01-01

    Full Text Available Background. The NT-ProBNP/BNP test has been validated as a marker for determining the etiology of acute dyspnea. In the setting of end-stage renal disease on hemodialysis (ESRD on HD, the utility of the NT-ProBNP/BNP test has not been validated. This study examines the clinical utility of the NT-ProBNP test in the setting of ESRD on HD patients presenting with acute dyspnea. Methods. A retrospective case series of 250 subjects were admitted to Cooper University Hospital, 07/2010-03/2011, with ESRD and HD presenting with dyspnea. The incidences of echocardiography, cardiology consultation, and NT-ProBNP elevated and normal were examined. Correlation coefficients were calculated for NT-ProBNP with age (years, estimated dry weight (kg, amount of fluid removed (L, and ejection fraction (EF in % among other echocardiography parameters. Results. Of the total sample 235 patients had NT-ProBNP levels performed. Cardiology consults were placed in 68.8% and 58% who underwent echocardiography. Of those for whom an echocardiography was performed estimated mean EFs of 54.6%, 50.8%, and 61.7% were observed among the NT-ProBNP elevated group, normal group, and no NT-ProBNP group, respectively. No differences were detected in all other echocardiography measurements. No correlation was observed between NT-ProBNP and age (, baseline EDW (, amount of fluid removed (, or EF (. Conclusion. In the setting of ESRD on HD, the NT-ProBNP test has no clinical utility in determining the etiology of acute dyspnea. This can be demonstrated through echocardiographic and therapeutic parameters measured in this study.

  7. Physiological techniques for detecting expiratory flow limitation during tidal breathing

    Directory of Open Access Journals (Sweden)

    N.G. Koulouris

    2011-09-01

    Full Text Available Patients with severe chronic obstructive pulmonary disease (COPD often exhale along the same flow–volume curve during quiet breathing as they do during the forced expiratory vital capacity manoeuvre, and this has been taken as an indicator of expiratory flow limitation at rest (EFLT. Therefore, EFLT, namely attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFLT leads to small airway injury and promotes dynamic pulmonary hyperinflation, with concurrent dyspnoea and exercise limitation. In fact, EFLT occurs commonly in COPD patients (mainly in Global Initiative for Chronic Obstructive Lung Disease III and IV stage, in whom the latter symptoms are common, but is not exclusive to COPD, since it can also be detected in other pulmonary and nonpulmonary diseases like asthma, acute respiratory distress syndrome, heart failure and obesity, etc. The existing up to date physiological techniques of assessing EFLT are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, noninvasive, practical and accurate new technique.

  8. 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

  9. Admiralty Inlet Pilot Tidal Project Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Collar, Craig [Public Utility District No. 1 of Snohomish County, Everett, WA (United States)

    2015-09-14

    This document represents the final report for the Admiralty Inlet Pilot Tidal Project, located in Puget Sound, Washington, United States. The Project purpose was to license, permit, and install a grid-connected deep-water tidal turbine array (two turbines) to be used as a platform to gather operational and environmental data on tidal energy generation. The data could then be used to better inform the viability of commercial tidal energy generation from technical, economic, social, and environmental standpoints. This data would serve as a critical step towards the responsible advancement of commercial scale tidal energy in the United States and around the world. In late 2014, Project activities were discontinued due to escalating costs, and the DOE award was terminated in early 2015. Permitting, licensing, and engineering design activities were completed under this award. Final design, deployment, operation, and monitoring were not completed. This report discusses the results and accomplishments achieved under the subject award.

  10. Tidal Forces in Dyonic Reissner-Nördstrom Black Hole

    Science.gov (United States)

    Sharif, M.; Kousar, Lubna

    2018-03-01

    This paper investigates the tidal as well as magnetic charge effects produced in dyonic Reissner-Nordström black hole. We evaluate Newtonian radial acceleration using radial geodesics for freely falling test particles. We establish system of equations governing radial and angular tidal forces using geodesic deviation equation and discuss their solutions for bodies falling freely towards this black hole. The radial tidal force turns out to be compressing outside the event horizon whereas the angular tidal force changes sign between event and Cauchy horizons unlike Schwarzschild black hole. The radial geodesic component starts decreasing in dyonic Reissner-Nordström black hole unlike Schwarzschild case. We conclude that magnetic charge strongly affects the radial as well as angular components of tidal force.

  11. Patients with end-stage interstitial lung disease may have more problems with dyspnea than end-stage lung cancer patients

    Directory of Open Access Journals (Sweden)

    Ryo Matsunuma

    2016-01-01

    Full Text Available Introduction: Patients with end-stage interstitial  lung disease (ILD do not appear to receive adequate palliative care despite apparent suffering before death. The aim of this study was to evaluate their signs, symptoms, and treatment received before death. Methods: Patients with ILD and lung cancer (LC who were hospitalized and died in our hospital were enrolled retrospectively. Signs and symptoms and treatments at 7 days, 3 days, and 1 day before death were evaluated and compared between the two groups of patients. Results: A total of 23 patients with ILD and 59 patients with LC group were eligible for participation. Significantly more LC patients had loss of consciousness than ILD patients on 7 days (ILD: LC = 1 [5.6%]:24 [41%], P = 0.013, 3 days (1 [5.6%]:33 [56%], P < 0.001. Significantly more ILD patients had dyspnea than LC patients on 3 days (16 [89%]:38 [64%], P = 0.047 1 day before death (21 [91%]:33 [56%], P = 0.001. On 1 day before death, significantly more LC patients received morphine than ILD patients (2 [8.7%]: 14 [24%], P = 0.015. More ILD patients received sedation (11 [48%]: 11 [19%], P = 0.007. Conclusions: End-stage ILD patients may experience dyspnea more frequently than terminal LC patients, and they need sedation. Morphine should be administered to ILD patients who have dyspnea. Additional prospective studies are needed.

  12. [Effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life for patients with chronic lung disease].

    Science.gov (United States)

    Lee, Chang Kwan

    2007-04-01

    The purpose of this study was to examine the effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life in inpatients with chronic lung disease. This quasi experimental study was designed with a nonequivalent control group pre-post test time series. Twenty three patients were assigned to the experimental group and nineteen to the control group. The inpatient pulmonary rehabilitation program was composed of upper and lower extremity exercise, breathing retraining, inspiratory muscle training, education, relaxation and telephone contacts. This program consisted of 4 sessions with inpatients and 4 weeks at home after discharge. The control group was given a home based pulmonary rehabilitation program at the time of discharge. The outcomes were measured by the Borg score, 6MWD and the Chronic Respiratory Disease Questionnaire(CRQ). There was a statistically significant difference in dyspnea between the experimental group and control group, but not among time sequence, or interaction between groups and time sequence. Also significant improvements in exercise capacity and health related quality of life were found only in the experimental group. An Inpatient pulmonary rehabilitation program may be a useful intervention to reduce dyspnea, and increase exercise capacity and health related quality of life for chronic lung disease patients.

  13. Dyspnea during Advanced Cancer

    Science.gov (United States)

    ... Data Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... cava syndrome in a child is a serious medical emergency because the child's windpipe can become blocked. ...

  14. Understanding the Influence of Retention Basin on Tidal Dynamics in Tidal Estuaries

    Science.gov (United States)

    Kumar, Mohit; Schuttelaars, Henk; Roos, Pieter

    2014-05-01

    Both the tidal motion and suspended sediment concentration (SSC) in tidal embayments and estuaries are influenced by anthropogenic (e.g. deepening ) and natural changes. An example of such an estuary is the Ems estuary, situated on the border of the Netherlands and Germany. The mean tidal range towards the end of the Ems estuary has increased from 1.5m in the 1950s to more than 3m in the 1990s while the suspended concentration has increased by a factor 10. To possibly reduce these negative effects, the construction of retention basin(s) (RB) is considered. In this contribution, the influence of location and geometry of RBs on tidal dynamics and SSC is investigated. For this purpose, a three-dimensional semi-analytic idealized model is developed. This model is an extension of the model proposed by Winant (2007) to arbitrary domain and realistic bathymetry with partial slip boundary condition at the bottom. The sea surface elevation (SSE) is calculated numerically using a finite element method. Next, the three-dimensional velocities are calculated by combining the analytically calculated vertical profiles and the gradients of the SSE which are obtained numerically. Firstly, the influence of a RB on the tidal dynamics in an infinitely long, rectangular, frictionless estuary is considered. The SSE decreases when the RB is located between a node and a landward antinode, consistent with the work of Alebregtse et al. (2013). Secondly, an estuary of finite length is connected to a sea. By varying the width of the sea, not only the effect of the distance of the RB to the landward end plays a role, but also the distance to the open sea becomes important. Finally, we discuss the influence of a RB on the tidal motion and initial sediment transport, considering the Ems estuary with realistic bathymetry. Results show that the SSE at the landward end of the Ems estuary decreases for all locations of the RBs. This decrease is most pronounced for the RB which is closest to the end

  15. Spin-orbital Tidal Dynamics and Tidal Heating in the TRAPPIST-1 Multiplanet System

    Science.gov (United States)

    Makarov, Valeri V.; Berghea, Ciprian T.; Efroimsky, Michael

    2018-04-01

    We perform numerical simulations of the TRAPPIST-1 system of seven exoplanets orbiting a nearby M dwarf, starting with a previously suggested stable configuration. The long-term stability of this configuration is confirmed, but the motion of planets is found to be chaotic. The eccentricity values are found to vary within finite ranges. The rates of tidal dissipation and tidal evolution of orbits are estimated, assuming an Earth-like rheology for the planets. We find that under this assumption, the planets b, d, and e were captured in the 3:2 or higher spin–orbit resonances during the initial spin-down, but slipped further down into the 1:1 resonance. Depending on its rheology, the innermost planet b may be captured in a stable pseudosynchronous rotation. Nonsynchronous rotation ensures higher levels of tidal dissipation and internal heating. The positive feedback between the viscosity and the dissipation rate—and the ensuing runaway heating—are terminated by a few self-regulation processes. When the temperature is high and the viscosity is low enough, the planet spontaneously leaves the 3:2 resonance. Further heating is stopped either by passing the peak dissipation or by the emergence of partial melt in the mantle. In the post-solidus state, the tidal dissipation is limited to the levels supported by the heat transfer efficiency. The tides on the host star are unlikely to have had a significant dynamical impact. The tides on the synchronized inner planets tend to reduce these planets’ orbital eccentricity, possibly contributing thereby to the system’s stability.

  16. A improved tidal method without water level

    Science.gov (United States)

    Luo, xiaowen

    2017-04-01

    Now most tide are obtained use water Level and pressure type water gage, but it is difficult to install them and reading is in low accuracy in this method . In view of above-mentioned facts, In order to improve tide accuracy, A improved method is introduced.sea level is obtained in given time using high-precision GNSS buoy combined instantaneous position from pressure gage. two steps are as following, (1) the GNSS time service is used as the source of synchronization reference in tidal measurement; (2) centimeter-level sea surface positions are obtained in real time using difference GNSS The improved method used in seafloor topography survey,in 145 cross points, 95% meet the requirements of the Hydrographic survey specification. It is effective method to obtain higher accuracy tide.

  17. Design and optimization of tidal turbine airfoil

    Energy Technology Data Exchange (ETDEWEB)

    Grasso, F. [ECN Wind Energy, Petten (Netherlands)

    2011-07-15

    In order to increase the ratio of energy capture to the loading and thereby to reduce cost of energy, the use of specially tailored airfoils is needed. This work is focused on the design of an airfoil for marine application. Firstly, the requirements for this class of airfoils are illustrated and discussed with reference to the requirements for wind turbine airfoils. Then, the design approach is presented. This is a numerical optimization scheme in which a gradient based algorithm is used, coupled with RFOIL solver and a composite Bezier geometrical parameterization. A particularly sensitive point is the choice and implementation of constraints; in order to formalize in the most complete and effective way the design requirements, the effects of activating specific constraints are discussed. Particularly importance is given to the cavitation phenomenon. Finally, a numerical example regarding the design of a high efficiency, tidal turbine airfoil is illustrated and the results are compared with existing turbine airfoils.

  18. Assimilating data into open ocean tidal models

    Science.gov (United States)

    Kivman, Gennady A.

    The problem of deriving tidal fields from observations by reason of incompleteness and imperfectness of every data set practically available has an infinitely large number of allowable solutions fitting the data within measurement errors and hence can be treated as ill-posed. Therefore, interpolating the data always relies on some a priori assumptions concerning the tides, which provide a rule of sampling or, in other words, a regularization of the ill-posed problem. Data assimilation procedures used in large scale tide modeling are viewed in a common mathematical framework as such regularizations. It is shown that they all (basis functions expansion, parameter estimation, nudging, objective analysis, general inversion, and extended general inversion), including those (objective analysis and general inversion) originally formulated in stochastic terms, may be considered as utilizations of one of the three general methods suggested by the theory of ill-posed problems. The problem of grid refinement critical for inverse methods and nudging is discussed.

  19. Will Restored Tidal Marshes Be Sustainable?

    Directory of Open Access Journals (Sweden)

    Michelle Orr

    2003-10-01

    Full Text Available We assess whether or not restored marshes in the San Francisco Estuary are expected to be sustainable in light of future landscape scale geomorphic processes given typical restored marsh conditions. Our assessment is based on a review of the literature, appraisal of monitoring data for restored marshes, and application of vertical accretion modeling of organic and inorganic sedimentation. Vertical accretion modeling suggests that salt marshes in San Pablo Bay will be sustainable for moderate relative sea level rise (3 to 5 mm yr-1 and average sediment supply (c. 100 mg L-1. Accelerated relative sea level rise (above 6 mm yr-1 and/or reduced sediment supply (50 mg L-1 will cause lowering of the marsh surface relative to the tide range and may cause shifts from high to low marsh vegetation by the year 2100. Widespread conversion of marsh to mudflat-"ecological drowning"-is not expected within this time frame. Marshes restored at lower elevations necessary to aid the natural development of channel systems (c. 0.5 m below mean higher high water are predicted to accrete to high marsh elevations by the year 2100 for moderate relative sea level rise and sediment supply conditions. Existing rates of sediment accretion in restored fresh water tidal marshes of the Delta of greater than 9 mm yr-1 and slightly lower drowning elevations suggest that these marshes will be resilient against relatively high rates of sea level rise. Because of higher rates of organic production, fresh water marshes are expected to be less sensitive to reduced sediment availability than salt marshes. The ultimate long-term threat to the sustainability of tidal marshes is the interruption of coastal rollover-the process by which landward marsh expansion in response to sea level rise compensates for shoreline erosion. Bay front development now prevents most landward marsh expansion, while shoreline erosion is expected to accelerate as sea level rises.

  20. TIDALLY DRIVEN DYNAMOS IN A ROTATING SPHERE

    International Nuclear Information System (INIS)

    Cébron, D.; Hollerbach, R.

    2014-01-01

    Large-scale planetary or stellar magnetic fields generated by a dynamo effect are mostly attributed to flows forced by buoyancy forces in electrically conducting fluid layers. However, these large-scale fields may also be controlled by tides, as previously suggested for the star τ-boo, Mars, or the early Moon. By simulating a small local patch of a rotating fluid, Barker and Lithwick have recently shown that tides can drive small-scale dynamos by exciting a hydrodynamic instability, the so-called elliptical (or tidal) instability. By performing global magnetohydrodynamic simulations of a rotating spherical fluid body, we investigate if this instability can also drive the observed large-scale magnetic fields. We are thus interested in the dynamo threshold and the generated magnetic field in order to test if such a mechanism is relevant for planets and stars. Rather than solving the problem in a geometry deformed by tides, we consider a spherical fluid body and add a body force to mimic the tidal deformation in the bulk of the fluid. This allows us to use an efficient spectral code to solve the magnetohydrodynamic problem. We first compare the hydrodynamic results with theoretical asymptotic results and numerical results obtained in a truly deformed ellipsoid, which confirms the presence of elliptical instability. We then perform magnetohydrodynamic simulations and investigate the dynamo capability of the flow. Kinematic and self-consistent dynamos are finally simulated, showing that the elliptical instability is capable of generating a dipole-dominated large-scale magnetic field in global simulations of a fluid rotating sphere

  1. Dynamics of Tidally Locked, Ultrafast Rotating Atmospheres

    Science.gov (United States)

    Tan, Xianyu; Showman, Adam P.

    2017-10-01

    Tidally locked gas giants, which exhibit a novel regime of day-night thermal forcing and extreme stellar irradiation, are typically in several-day orbits, implying slow rotation and a modest role for rotation in the atmospheric circulation. Nevertheless, there exist a class of gas-giant, highly irradiated objects - brown dwarfs orbiting white dwarfs in extremely tight orbits - whose orbital and hence rotation periods are as short as 1-2 hours. Spitzer phase curves and other observations have already been obtained for this fascinating class of objects, which raise fundamental questions about the role of rotation in controlling the circulation. So far, most modeling studies have investigated rotation periods exceeding a day, as appropriate for typical hot Jupiters. In this work we investigate the dynamics of tidally locked atmospheres in shorter rotation periods down to about two hours. With increasing rotation rate (decreasing rotation period), we show that the width of the equatorial eastward jet decreases, consistent with the narrowing of wave-mean-flow interacting region due to decrease of the equatorial deformation radius. The eastward-shifted equatorial hot spot offset decreases accordingly, and the westward-shifted hot regions poleward of the equatorial jet associated with Rossby gyres become increasingly distinctive. At high latitudes, winds becomes weaker and more geostrophic. The day-night temperature contrast becomes larger due to the stronger influence of rotation. Our simulated atmospheres exhibit small-scale variability, presumably caused by shear instability. Unlike typical hot Jupiters, phase curves of fast-rotating models show an alignment of peak flux to secondary eclipse. Our results have important implications for phase curve observations of brown dwarfs orbiting white dwarfs in ultra tight orbits.

  2. Dwarf Galaxies Swimming in Tidal Tails

    Science.gov (United States)

    2005-01-01

    This false-color infrared image from NASA's Spitzer Space Telescope shows little 'dwarf galaxies' forming in the 'tails' of two larger galaxies that are colliding together. The big galaxies are at the center of the picture, while the dwarfs can be seen as red dots in the red streamers, or tidal tails. The two blue dots above the big galaxies are stars in the foreground. Galaxy mergers are common occurrences in the universe; for example, our own Milky Way galaxy will eventually smash into the nearby Andromeda galaxy. When two galaxies meet, they tend to rip each other apart, leaving a trail, called a tidal tail, of gas and dust in their wake. It is out of this galactic debris that new dwarf galaxies are born. The new Spitzer picture demonstrates that these particular dwarfs are actively forming stars. The red color indicates the presence of dust produced in star-forming regions, including organic molecules called polycyclic aromatic hydrocarbons. These carbon-containing molecules are also found on Earth, in car exhaust and on burnt toast, among other places. Here, the molecules are being heated up by the young stars, and, as a result, shine in infrared light. This image was taken by the infrared array camera on Spitzer. It is a 4-color composite of infrared light, showing emissions from wavelengths of 3.6 microns (blue), 4.5 microns (green), 5.8 microns (orange), and 8.0 microns (red). Starlight has been subtracted from the orange and red channels in order to enhance the dust features.

  3. Ambient Noise in an Urbanized Tidal Channel

    Science.gov (United States)

    Bassett, Christopher

    In coastal environments, when topographic and bathymetric constrictions are combined with large tidal amplitudes, strong currents (> 2 m/s) can occur. Because such environments are relatively rare and difficult to study, until recently, they have received little attention from the scientific community. However, in recent years, interest in developing tidal hydrokinetic power projects in these environments has motivated studies to improve this understanding. In order to support an analysis of the acoustic effects of tidal power generation, a multi-year study was conducted at a proposed project site in Puget Sound (WA) are analyzed at a site where peak currents exceeded 3.5 m/s. From these analyses, three noise sources are shown to dominate the observed variability in ambient noise between 0.02-30 kHz: anthropogenic noise from vessel traffic, sediment-generated noise during periods of strong currents, and flow-noise resulting from turbulence advected over the hydrophones. To assess the contribution of vessel traffic noise, one calendar year of Automatic Identification System (AIS) ship-traffic data was paired with hydrophone recordings. The study region included inland waters of the Salish Sea within a 20 km radius of the hydrophone deployment site in northern Admiralty Inlet. The variability in spectra and hourly, daily, and monthly ambient noise statistics for unweighted broadband and M-weighted sound pressure levels is driven largely by vessel traffic. Within the one-year study period, at least one AIS transmitting vessel is present in the study area 90% of the time and over 1,363 unique vessels are recorded. A noise budget for vessels equipped with AIS transponders identifies cargo ships, tugs, and passenger vessels as the largest contributors to noise levels. A simple model to predict received levels at the site based on an incoherent summation of noise from different vessel types yields a cumulative probability density function of broadband sound pressure

  4. Tidal River Management (TRM and Tidal Basin Management (TBM: A case study on Bangladesh

    Directory of Open Access Journals (Sweden)

    Talchabhadel Rocky

    2016-01-01

    Full Text Available Bangladesh is the biggest delta of the world. Construction of numbers of polders is one of the flood resilient approach. But the presence of coastal polders de-linked the flood plain. The siltation in river causes riverbeds to become higher than the adjacent crop lands, and vast area under the polders became permanently water logged rendering large tract of land uncultivable. The current practice is temporarily de-poldering by cutting embankment. This is a natural water management process with very little human interventions but it needs strong participation and consensus with a great deal of sacrifice by the stakeholders for a specific period (3 to 5 years or even more[1]. An attempt has been made to study the phenomena of tidal basin management reviewing some secondary data and processes involved in successfully operated tidal basins of Bangladesh. And preliminary laboratory experiments are carried out to precisely look into the suspended sediment transport. With varying outflow discharge and sediment supply, the transport processes are investigated. 3D sediment transport model developed using openFOAM has good agreement with experimental result and can be used to better understand effectiveness of tidal basin management.

  5. The O-C2 angle established at occipito-cervical fusion dictates the patient's destiny in terms of postoperative dyspnea and/or dysphagia.

    Science.gov (United States)

    Izeki, Masanori; Neo, Masashi; Takemoto, Mitsuru; Fujibayashi, Shunsuke; Ito, Hiromu; Nagai, Koutatsu; Matsuda, Shuichi

    2014-02-01

    We have revealed that the cause of postoperative dyspnea and/or dysphagia after occipito-cervical (O-C) fusion is mechanical stenosis of the oropharyngeal space and the O-C2 alignment, rather than total or subaxial alignment, is the key to the development of dyspnea and/or dysphagia. The purpose of this study was to confirm the impact of occipito-C2 angle (O-C2A) on the oropharyngeal space and to investigate the chronological impact of a fixed O-C2A on the oropharyngeal space and dyspnea and/or dysphagia after O-C fusion. We reviewed 13 patients who had undergone O-C2 fusion, while retaining subaxial segmental motion (OC2 group) and 20 who had subaxial fusion without O-C2 fusion (SA group). The O-C2A, C2-C6 angle and the narrowest oropharyngeal airway space were measured on lateral dynamic X-rays preoperatively, when dynamic X-rays were taken for the first time postoperatively, and at the final follow-up. We also recorded the current dyspnea and/or dysphagia status at the final follow-up of patients who presented with it immediately after the O-C2 fusion. There was no significant difference in the mean preoperative values of the O-C2A (13.0 ± 7.5 in group OC2 and 20.1 ± 10.5 in group SA, Unpaired t test, P = 0.051) and the narrowest oropharyngeal airway space (17.8 ± 6.0 in group OC2 and 14.9 ± 3.9 in group SA, Unpaired t test, P = 0.105). In the OC2 group, the narrowest oropharyngeal airway space changed according to the cervical position preoperatively, but became constant postoperatively. In contrast, in the SA group, the narrowest oropharyngeal airway space changed according to the cervical position at any time point. Three patients who presented with dyspnea and/or dysphagia immediately after O-C2 fusion had not resolved completely at the final follow-up. The narrowest oropharyngeal airway space and postoperative dyspnea and/or dysphagia did not change with time once the O-C2A had been established at O-C fusion. The O-C2A established at O

  6. Assessment of tidal circulation and tidal current asymmetry in the Iroise sea with specific emphasis on characterization of tidal energy resources around the Ushant Island.

    Science.gov (United States)

    Thiébaut, Maxime; Sentchev, Alexei

    2015-04-01

    We use the current velocity time series recorded by High Frequency Radars (HFR) to study circulation in highly energetic tidal basin - the Iroise sea. We focus on the analysis of tidal current pattern around the Ushant Island which is a promising site of tidal energy. The analysis reveals surface current speeds reaching 4 m/s in the North of Ushant Island and in the Fromveur Strait. In these regions 1 m/s is exceeded 60% of time and up to 70% of time in center of Fromveur. This velocity value is particularly interesting because it represents the cut-in-speed of the most of marine turbine devices. Tidal current asymmetry is not always considered in tidal energy site selection. However, this quantity plays an important role in the quantification of hydrokinetic resources. Current velocity times series recorded by HFR highlights the existence of a pronounced asymmetry in current magnitude between the flood and ebb tide ranging from -0.5 to more 2.5. Power output of free-stream devices depends to velocity cubed. Thus a small current asymmetry can generate a significant power output asymmetry. Spatial distribution of asymmetry coefficient shows persistent pattern and fine scale structure which were quantified with high degree of accuracy. The particular asymmetry evolution on both side of Fromveur strait is related to the spatial distribution of the phase lag of the principal semi-diurnal tidal constituent M2 and its higher order harmonics. In Fromveur, the asymmetry is reinforced due to the high velocity magnitude of the sixth-diurnal tidal harmonics. HF radar provides surface velocity speed, however the quantification of hydrokinetic resources has to take into account the decreasing of velocity with depth. In order to highlight this phenomenon, we plot several velocity profiles given by an ADCP which was installed in the HFR study area during the same period. The mean velocity in the water column calculated by using the ADCP data show that it is about 80% of the

  7. Observed tidal braking in the earth/moon/sun system

    Science.gov (United States)

    Christodoulidis, D. C.; Smith, D. E.; Williamson, R. G.; Klosko, S. M.

    1987-01-01

    The low degree and order terms in the spherical harmonic model of the tidal potential were observed through the perturbations which are induced on near-earth satellite orbital motions. Evaluations of tracking observations from 17 satellites and a GEM-T1 geopotential model were used in the tidal recovery which was made in the presence of over 600 long-wavelength coefficients from 32 major and minor tides. Wahr's earth tidal model was used as a basis for the recovery of the ocean tidal terms. Using this tidal model, the secular change in the moon's mean motion due to tidal dissipation was found to be -25.27 + or - 0.61 arcsec/century squared. The estimation of lunar acceleration agreed with that observed from lunar laser ranging techniques (-24.9 + or - 1.0 arcsec/century squared), with the corresponding tidal braking of earth's rotation being -5.98 + or - 0.22 x 10 to the minus 22 rad/second squared. If the nontidal braking of the earth due to the observed secular change in the earth's second zonal harmonic is considered, satellite techniques yield a total value of the secular change of the earth's rotation rate of -4.69 + or - 0.36 x 10 to the minus 22 rad/second squared.

  8. Derivation of Delaware Bay tidal parameters from space shuttle photography

    International Nuclear Information System (INIS)

    Zheng, Quanan; Yan, Xiaohai; Klemas, V.

    1993-01-01

    The tide-related parameters of the Delaware Bay are derived from space shuttle time-series photographs. The water areas in the bay are measured from interpretation maps of the photographs with a CALCOMP 9100 digitizer and ERDAS Image Processing System. The corresponding tidal levels are calculated using the exposure time annotated on the photographs. From these data, an approximate function relating the water area to the tidal level at a reference point is determined. Based on the function, the water areas of the Delaware Bay at mean high water (MHW) and mean low water (MLW), below 0 m, and for the tidal zone are inferred. With MHW and MLW areas and the mean tidal range, the authors calculate the tidal influx of the Delaware Bay, which is 2.76 x 1O 9 m 3 . Furthermore, the velocity of flood tide at the bay mouth is determined using the tidal flux and an integral of the velocity distribution function at the cross section between Cape Henlopen and Cape May. The result is 132 cm/s, which compares well with the data on tidal current charts

  9. Vertical Distribution of Tidal Flow Reynolds Stress in Shallow Sea

    Institute of Scientific and Technical Information of China (English)

    SONG Zhi-yao; NI Zhi-hui; LU Guo-nian

    2009-01-01

    Based on the results of the tidal flow Reynolds stresses of the field observations,indoor experiments,and numerical models,the parabolic distribution of the tidal flow Reynolds stress is proposed and its coefficients are determined theoretically in this paper.Having been well verified with the field data and experimental data,the proposed distribution of Reynolds stress is also compared with numerical model results,and a good agreement is obtained,showing that this distribution can well reflect the basic features of Reynolds stress deviating from the linear distribution that is downward when the tidal flow is of acceleration,upward when the tidal flow is of deceleration.Its dynamics cause is also discussed preliminarily and the influence of the water depth is pointed out from the definition of Reynolds stress,turbulent generation,transmission,and so on.The established expression for the vertical distribution of the tidal flow Reynolds stress is not only simple and explicit,but can also well reflect the features of the tidal flow acceleration and deceleration for further study on the velocity profile of tidal flow.

  10. Diurnal, semidiurnal, and fortnightly tidal components in orthotidal proglacial rivers.

    Science.gov (United States)

    Briciu, Andrei-Emil

    2018-02-22

    The orthotidal rivers are a new concept referring to inland rivers influenced by gravitational tides through the groundwater tides. "Orthotidal signals" is intended to describe tidal signals found in inland streamwaters (with no oceanic input); these tidal signals were locally generated and then exported into streamwaters. Here, we show that orthotidal signals can be found in proglacial rivers due to the gravitational tides affecting the glaciers and their surrounding areas. The gravitational tides act on glacier through earth and atmospheric tides, while the subglacial water is affected in a manner similar to the groundwater tides. We used the wavelet analysis in order to find tidally affected streamwaters. T_TIDE analyses were performed for discovering the tidal constituents. Tidal components with 0.95 confidence level are as follows: O1, PI1, P1, S1, K1, PSI1, M2, T2, S2, K2, and MSf. The amplitude of the diurnal tidal constituents is strongly influenced by the daily thermal cycle. The average amplitude of the semidiurnal tidal constituents is less altered and ranges from 0.0007 to 0.0969 m. The lunisolar synodic fortnightly oscillation, found in the time series of the studied river gauges, is a useful signal for detecting orthotidal rivers when using noisier data. The knowledge of the orthotidal oscillations is useful for modeling fine resolution changes in rivers.

  11. Magnetic fields driven by tidal mixing in radiative stars

    Science.gov (United States)

    Vidal, Jérémie; Cébron, David; Schaeffer, Nathanaël; Hollerbach, Rainer

    2018-04-01

    Stellar magnetism plays an important role in stellar evolution theory. Approximatively 10 per cent of observed main sequence (MS) and pre-main-sequence (PMS) radiative stars exhibit surface magnetic fields above the detection limit, raising the question of their origin. These stars host outer radiative envelopes, which are stably stratified. Therefore, they are assumed to be motionless in standard models of stellar structure and evolution. We focus on rapidly rotating, radiative stars which may be prone to the tidal instability, due to an orbital companion. Using direct numerical simulations in a sphere, we study the interplay between a stable stratification and the tidal instability, and assess its dynamo capability. We show that the tidal instability is triggered regardless of the strength of the stratification (Brunt-Väisälä frequency). Furthermore, the tidal instability can lead to both mixing and self-induced magnetic fields in stably stratified layers (provided that the Brunt-Väisälä frequency does not exceed the stellar spin rate in the simulations too much). The application to stars suggests that the resulting magnetic fields could be observable at the stellar surfaces. Indeed, we expect magnetic field strengths up to several Gauss. Consequently, tidally driven dynamos should be considered as a (complementary) dynamo mechanism, possibly operating in radiative MS and PMS stars hosting orbital companions. In particular, tidally driven dynamos may explain the observed magnetism of tidally deformed and rapidly rotating Vega-like stars.

  12. Device interactions in reducing the cost of tidal stream energy

    International Nuclear Information System (INIS)

    Vazquez, A.; Iglesias, G.

    2015-01-01

    Highlights: • Numerical modelling is used to estimate the levelised cost of tidal stream energy. • As a case study, a model of Lynmouth (UK) is implemented and successfully validated. • The resolution of the model allows the demarcation of individual devices on the model grid. • Device interactions reduce the available tidal resource and the cost increases significantly. - Abstract: The levelised cost of energy takes into account the lifetime generated energy and the costs associated with a project. The objective of this work is to investigate the effects of device interactions on the energy output and, therefore, on the levelised cost of energy of a tidal stream project, by means of numerical modelling. For this purpose, a case study is considered: Lynmouth (North Devon, UK), an area in the Bristol Channel in which the first tidal stream turbine was installed − a testimony of its potential as a tidal energy site. A state-of-the-art hydrodynamics model is implemented on a high-resolution computational grid, which allows the demarcation of the individual devices. The modification to the energy output resulting from interaction between turbines within the tidal farm is thus resolved for each individual turbine. The results indicate that significant changes in the levelised cost of energy values, of up to £0.221 kW h −1 , occur due to the aforementioned modifications, which should not be disregarded if the cost of tidal stream energy is to be minimised

  13. Large tidal plants may supply 1,000 TWh / year

    International Nuclear Information System (INIS)

    Lemperiere, F.

    2006-10-01

    Many studies of tidal plants have been made fifty years ago: they were usually devoted to sites with average tidal head over 6 m and reduced works at sea: estuaries such as La Rance (France) or Severn (U.K.) were favoured: preferred corresponding operation was using flow from a high basin to low sea level, supplying power 4 hours from 12. Such solutions had 2 drawbacks: power supply poorly adapted to needs and modified shore tidal ecosystems. Beyond that the power cost was usually higher than from thermal plants and very few plants were built, the main one being the Rance plant in France supplying 0,5 TWh/year with 240 MW. The world theoretical tidal potential is in the same range as the traditional hydropower potential. A new approach of tidal plants based upon solutions existing now and using new operating methods substantiates the possibility of over 1,000 TWh/year of cost efficient tidal energy with limited environmental impact and power supply well adapted to requirements. Over 15 countries may be involved. Tidal plants with heads as low as 4 m may be cost efficient. (author)

  14. Tidal day organic and inorganic material flux of ponds in the Liberty Island freshwater tidal wetland.

    Science.gov (United States)

    Lehman, Peggy W; Mayr, Shawn; Liu, Leji; Tang, Alison

    2015-01-01

    The loss of inorganic and organic material export and habitat produced by freshwater tidal wetlands is hypothesized to be an important contributing factor to the long-term decline in fishery production in San Francisco Estuary. However, due to the absence of freshwater tidal wetlands in the estuary, there is little information on the export of inorganic and organic carbon, nutrient or phytoplankton community biomass and the associated mechanisms. A single-day study was conducted to assess the potential contribution of two small vegetated ponds and one large open-water pond to the inorganic and organic material flux within the freshwater tidal wetland Liberty Island in San Francisco Estuary. The study consisted of an intensive tidal day (25.5 h) sampling program that measured the flux of inorganic and organic material at three ponds using continuous monitoring of flow, chlorophyll a, turbidity and salt combined with discrete measurements of phytoplankton community carbon, total and dissolved organic carbon and nutrient concentration at 1.5 h intervals. Vegetated ponds had greater material concentrations than the open water pond and, despite their small area, contributed up to 81% of the organic and 61% of the inorganic material flux of the wetland. Exchange between ponds was important to wetland flux. The small vegetated pond in the interior of the wetland contributed as much as 72-87% of the total organic carbon and chlorophyll a and 10% of the diatom flux of the wetland. Export of inorganic and organic material from the small vegetated ponds was facilitated by small-scale topography and tidal asymmetry that produced a 40% greater material export on ebb tide. The small vegetated ponds contrasted with the large open water pond, which imported 29-96% of the inorganic and 4-81% of the organic material into the wetland from the adjacent river. This study identified small vegetated ponds as an important source of inorganic and organic material to the wetland and the

  15. A Summary of the San Francisco Tidal Wetlands Restoration Series

    Directory of Open Access Journals (Sweden)

    Larry R. Brown

    2003-10-01

    Full Text Available The four topical articles of the Tidal Wetlands Restoration Series summarized and synthesized much of what is known about tidal wetlands and tidal wetland restoration in the San Francisco Estuary (hereafter “Estuary”. Despite a substantial amount of available information, major uncertainties remain. A major uncertainty with regard to fishes is the net benefit of restored tidal wetlands relative to other habitats for native fishes in different regions of the Estuary given the presence of numerous invasive alien species. With regard to organic carbon, a major uncertainty is the net benefit of land use change given uncertainty about the quantity and quality of different forms of organic carbon resulting from different land uses. A major challenge is determining the flux of organic carbon from open systems like tidal wetlands. Converting present land uses to tidal wetlands will almost certainly result in increased methylation of mercury at the local scale with associated accumulation of mercury within local food webs. However, it is unclear if such local accumulation is of concern for fish, wildlife or humans at the local scale or if cumulative effects at the regional scale will emerge. Based on available information it is expected that restored tidal wetlands will remain stable once constructed; however, there is uncertainty associated with the available data regarding the balance of sediment accretion, sea-level rise, and sediment erosion. There is also uncertainty regarding the cumulative effect of many tidal restoration projects on sediment supply. The conclusions of the articles highlight the need to adopt a regional and multidisciplinary approach to tidal wetland restoration in the Estuary. The Science Program of the CALFED effort provides an appropriate venue for addressing these issues.

  16. Suspended particulate matter flocculation in a natural tidal wetland located in the San Francisco Estuary

    Science.gov (United States)

    Saraceno, J.; Bergamaschi, B. A.; Wright, S. A.; Boss, E.; Downing, B. D.; Fleck, J.; Ganju, N. K.

    2011-12-01

    Suspended mineral and algal particles together comprise suspended particulate matter (SPM). The SPM size distribution influences the quantity and color of light penetration and the adsorption and transport of contaminants such as pesticides and metals. It is widely known that interaction with wetlands alters the size distribution and quality of particles through local primary production, differential settling and particle aggregation, however, our understanding of how tidal wetland processes affect SPM quantity and size spectra has been hampered by the difficulty of directly observing these parameters at tidal time scales. To evaluate how SPM concentration and size varied over tidal time scales and to better understand the relationship between organic matter and sediment characteristics, simultaneous measurements of dissolved organic matter, SPM concentration and organic content as well as in situ surrogates of particle concentration (turbidity, particulate attenuation, volume concentration) and particle size (laser diffraction) were carried out with measurements of current velocity (acoustic Doppler velocity meter) in the main channel of Brown's Island located in the western San Joaquin/Sacramento River Delta, CA. The study period coincided with high estuary sediment levels following a significant precipitation runoff event. In the Brown Island wetland, particle concentration and size dynamics were tied to variations in water level and velocity. Turbidity and attenuation covaried with the volume concentration of particles smaller than 33 um, which on average represented greater than 50% of particle population by volume. On average, these SPM concentration surrogates were three times higher in flood water than in ebb water; consistent with a loss of fine particles on the island. Following the highest flood tide, the decrease in fine particles was coincident with an increase in the concentration of particles larger than 130 um; a finding consistent with particle

  17. Tidal energy UK Government R and D programme. Final report

    International Nuclear Information System (INIS)

    Craig, J.W.; Davies, L.M.; Allington, M.A.

    1996-05-01

    The United Kingdom Government's research programme into the feasibility of exploiting tidal power for electricity generation in Britain's estuaries is described in this document. The history of the research is included from the Severn Barrage Committee in 1978 to the conclusion of the tidal energy barrages programme in 1994. The programme sought to reduce uncertainty on costs, technical performance and environmental and regional effects, in order to firm up on decisions on whether to construct certain specific barrages. It was concluded that, while technically feasible, tidal power from barrages, was and will continue to be uneconomic compared with other energy sources. Other renewable technologies would receive further research. (UK)

  18. Virtual Seafloor Reduces Internal Wave Generation by Tidal Flow

    Science.gov (United States)

    Zhang, Likun; Swinney, Harry L.

    2014-03-01

    Our numerical simulations of tidal flow of a stratified fluid over periodic knife-edge ridges and random topography reveal that the time-averaged tidal energy converted into internal gravity wave radiation arises only from the section of a ridge above a virtual seafloor. The average radiated power is approximated by the power predicted by linear theory if the height of the ridge is measured relative to the virtual floor. The concept of a virtual floor can extend the applicability of linear theory to global predictions of the conversion of tidal energy into internal wave energy in the oceans.

  19. Assessment of Kinetic Tidal Energy Resources Using SELFE

    OpenAIRE

    Manasa Ranjan Behera; Pavel Tkalich

    2014-01-01

    An investigation is carried out to study the theoretical tidal stream energy resource in the Singapore Strait to support the search for renewable energy in the effort to reduce the carbon footprints in the Southeast Asia. The tidal hydrodynamics in the Singapore Strait has been simulated using a Semi-implicit Eulerian-Lagrangian Finite-Element (SELFE) model solving the 3D shallow water equations with Boussinesq approximations. Potential sites, with high tidal current (2.5 m/s) and suitable fo...

  20. Geometric properties of hydraulic-relevant tidal bedforms

    DEFF Research Database (Denmark)

    Winter, Christian; Ferret, Yann; Lefebvre, Alice

    2013-01-01

    of bedform genesis and dynamics is not yet available, various empirical descriptors have been formulated based on extensive data compilations (e.g. Allen, 1968; Flemming, 1988; Francken, 2004). Mean bedform heights H and lengths L were found to scale, e.g H = a * L b in which a=0.03-0.07 and b=0.7-0.9. Due...... on the tidal stage: Whereas the secondary bedforms act as roughness elements throughout the tidal cycle, the large primary bedforms dominate the hydraulics when the tidal flow is in the (dominant) direction of the bedform orientation (e.g. ebb-directed primary bedforms act during ebb currents) when...

  1. Analysis of Tidal Data for Dagang Tidal Gauge and Study of the Changes for the National Height Datum

    Directory of Open Access Journals (Sweden)

    WU Fumei

    2015-07-01

    Full Text Available The main tides affecting Dagang sea level are analyzed and the national height datum is studied by analyzing 1980—2011 hourly tidal data and 1952—2007 monthly mean tidal data. Firstly, the frequencies and amplitudes of main tides including 180 short-period tides and 6 long-period tides are gained by the Fouirer transform. Then the actual amplitudes and their variations of main tides are obtained by the harmonic analysis of the 1980—2011 hourly tidal data, and the changes with about 19 year period can easily be found in the amplitudes of Q1、O1、M2、K1、K2. And then the changes of the mean sea level at Dagang tidal gauge defining national height datum during the period of 1952—2011 are studied by the harmonic analysis and the shifting average of 18.61 year tidal heights. The results of these methods show that the mean sea level at Dagang tidal gauge descended with the speed of 1.07 mm/a and 0.76 mm/a respectively during 1952—1980, and that it ascended with the speed of 1.59 mm/a and 1.62 mm/a respectively during 1980—2011. And finally the difference of 0.14 cm is achieved by the shifting average of 18.61 year tidal heights for 1985 National Height Datum.

  2. Linking freshwater tidal hydrology to carbon cycling in bottomland hardwood wetlands

    Science.gov (United States)

    Carl C. Trettin; Brooke J. Czwartacki; Craig J. Allan; Devendra M. Amatya

    2016-01-01

    Hydrology is recognized as one of the principal factors regulating soil biogeochemical processes in forested wetlands. However, the consequences of tidally mediated hydrology are seldom considered within forested wetlands that occur along tidal water bodies. These tidal water bodies may be either fresh or brackish, and the tidal streams function as a reservoir to...

  3. Tidal variations in the Sundarbans estuarine system, India

    Digital Repository Service at National Institute of Oceanography (India)

    Chatterjee, M.; Shankar, D.; Sen, G.K.; Sanyal, P.; Sundar, D.; Michael, G.S.; Chatterjee, A.; Amol, P.; Mukherjee, D.; Suprit, K.; Mukherjee, A.; Vijith, V.; Chatterjee, S.; Basu, A.; Das, M.; Chakraborti, S.; Kalla, A.; Misra, S.K.; Mukhopadhyay, S.; Mandal, G.; Sarkar, K.

    Situated in the eastern coastal state of West Bengal, the Sundarbans Estuarine System (SES) is India’s largest monsoonal, macro-tidal delta-front estuarine system. It comprises the southernmost part of the Indian portion of the Ganga...

  4. Carbohydrate secretion by phototrophic communities in tidal sediments

    NARCIS (Netherlands)

    de Winder, B.; Staats, N.; Stal, L.J.; Paterson, D.M.

    1999-01-01

    Two different benthic phototrophic communities on tidal flats were investigated for their carbohydrate content and distribution. Carbohydrates were analysed as two operationally defined fractions, related to the difficulty of extraction from the sediment matrix. Water-soluble (colloidal) and EDTA-

  5. Anticorrosion and halobios control for tidal power generating units

    International Nuclear Information System (INIS)

    Shen, J C; Ding, L X

    2012-01-01

    The anticorrosion and halobios control is the key techniquesrelated to the safety and durability of tidal power generating units. The technique of material application, antifouling coating and cathodic protection are often adopted. The technical research, application, updating and development are carried on Jiangxia Tidal Power Station, which is based on the old Unit 1-Unit 5 operated for nearly 30 years, and the new Unit 6 operated in 2007. It is found that stainless steeland the antifouling coating used in Unit 1- Unit 5 are very effective, but cathodic protection is often likely to fail because of the limitation of structure and installation. Analyses and studies for anticorrosion and halobios control techniques of tidal power generating units according to theory, experience and actual effects have been done, which can be for reference to the tidal power station designers and builders.

  6. N-Body Simulations of Tidal Encounters between Stellar Systems

    Indian Academy of Sciences (India)

    tribpo

    Saleh Mohammed Alladin† International Centre for Theoretical Physics, ... concentrate on how the tidal field of the primary changes the mass distribution, energy and angular momentum ..... International School for Advanced Studies, Trieste.

  7. Sears Point Tidal Marsh Restoration Project: Phase I

    Science.gov (United States)

    Information about the SFBWQP Sears Point Tidal Marsh Restoration Project: Phase I project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  8. Measuring and modeling exposure from environmental radiation on tidal flats

    International Nuclear Information System (INIS)

    Gould, T.J.; Hess, C.T.

    2005-01-01

    To examine the shielding effects of the tide cycle, a high pressure ion chamber was used to measure the exposure rate from environmental radiation on tidal flats. A theoretical model is derived to predict the behavior of exposure rate as a function of time for a detector placed one meter above ground on a tidal flat. The numerical integration involved in this derivation results in an empirical formula which implies exposure rate ∝tan-1(sint). We propose that calculating the total exposure incurred on a tidal flat requires measurements of only the slope of the tidal flat and the exposure rate when no shielding occurs. Experimental results are consistent with the model

  9. The structure of turbulence in a rapid tidal flow.

    Science.gov (United States)

    Milne, I A; Sharma, R N; Flay, R G J

    2017-08-01

    The structure of turbulence in a rapid tidal flow is characterized through new observations of fundamental statistical properties at a site in the UK which has a simple geometry and sedate surface wave action. The m