953 resultados para tracheal aspiration procedure
Resumo:
Tetrodotoxin (TTX) is one of the most potent marine neurotoxins reported. The global distribution of this toxin is spreading with the European Atlantic coastline now being affected. Climate change and increasing pollution have been suggested as underlying causes for this. In the present study, two different sample preparation techniques were used to extract TTX from Trumpet shells and pufferfish samples. Both extraction procedures (accelerated solvent extraction (ASE) and a simple solvent extraction) were shown to provide good recoveries (80-92%). A UPLC-MS/MS method was developed for the analysis of TTX and validated following the guidelines contained in the Commission Decision 2002/657/EC for chemical contaminant analysis. The performance of this procedure was demonstrated to be fit for purpose. This study is the first report on the use of ASE as a mean for TTX extraction, the use of UPLC-MS/MS for TTX analysis, and the validation of this method for TTX in gastropods.
Resumo:
Achalasia is a neurodegenerative motility disorder of the oesophagus resulting in deranged oesophageal peristalsis and loss of lower oesophageal sphincter function. Historically, annual achalasia incidence rates were believed to be low, approximately 0.5-1.2 per 100000. More recent reports suggest that annual incidence rates have risen to 1.6 per 100000 in some populations. The aetiology of achalasia is still unclear but is likely to be multi-factorial. Suggested causes include environmental or viral exposures resulting in inflammation of the oesophageal myenteric plexus, which elicits an autoimmune response. Risk of achalasia may be elevated in a sub-group of genetically susceptible people. Improvement in the diagnosis of achalasia, through the introduction of high resolution manometry with pressure topography plotting, has resulted in the development of a novel classification system for achalasia. This classification system can evaluate patient prognosis and predict responsiveness to treatment. There is currently much debate over whether pneumatic dilatation is a superior method compared to the Heller's myotomy procedure in the treatment of achalasia. A recent comparative study found equal efficacy, suggesting that patient preference and local expertise should guide the choice. Although achalasia is a relatively rare condition, it carries a risk of complications, including aspiration pneumonia and oesophageal cancer. The risk of both squamous cell carcinoma and adenocarcinoma of the oesophagus is believed to be significantly increased in patients with achalasia, however the absolute excess risk is small. Therefore, it is currently unknown whether a surveillance programme in achalasia patients would be effective or cost-effective.
Resumo:
Gastro-oesophageal reflux (GOR)-related aspiration is associated with respiratory disease, but the current "gold standard" investigation, the lipid-laden macrophage index (LLMI), is flawed. A specific marker of GOR-related aspiration should originate in the stomach, but not the lung. An assay to detect gastric pepsin in the bronchoalveolar lavage (BAL) of children was developed and validated.
Resumo:
Despite the fact that the UK has highest potential in the EU to generate renewable energy from wind, it lags behind its European partners. The departure point for this study is provided by the fact that the land use planning system has been perceived by some to create difficulties in pursuit of the achievement of National Action Plan targets. In the course of a review of literature, legislation, policy and case files a number of issues emerge relating not only to operational practice but structural concerns regarding knowledge, legitimacy and ethics. These are scrutinised in an empirical investigation which provides insights into the ontologies behind how knowledge is used and abused. Concerns are highlighted regarding the tactical manipulation of knowledges and the difficulties associated with objectifying evidence so that it can be understood, validated and authenticated. The paper concludes by reflecting on the implications for the regulatory framework, the legitimisation of decisions and the ethics of the profession and how these, in turn, are conditioned by the production, use and transparency of planning knowledge.
Resumo:
An approach for seismic damage identification of a single-storey steel concentrically braced frame (CBF) structure is presented through filtering and double integration of a recorded acceleration signal. A band-pass filter removes noise from the acceleration signal followed by baseline correction being used to reduce the drift in velocity and displacement during numerical integration. The pre-processing achieves reliable numerical integration that predicts the displacement response accurately when compared to the measured lateral in-plane displacement of the CBF structure. The lateral displacement of the CBF structure is used to infer buckling and yielding of bracing members through seismic tests. The level of interstorey drift of the CBF during a seismic excitation allows the yield and buckling of the bracing members to be identified and indirectly detects damage based on exceedance of calculated displacement limits. The calculated buckling and yielding displacement threshold limits used to identify damage are demonstrated to accurately identify initial buckling and yielding in the bracing members.
Resumo:
Breast augmentation for cosmetic purposes is an increasingly common procedure in the USA and UK. In the USA in 2003, a total of 254 140 breast augmentation procedures were carried out [American Society of Plastic Surgeons, http://www.plasticsurgery.org/newsroom/ Procedural-Statistics-Press-Kit-Index.cfm9-1-2005; 2006.(1)]. It has been previously estimated that between 1 and 1.5 million women in the USA have prosthetic breast implants [Cook RR, Delongchamp RR, Woodbury M, et at. The prevalence of women with breast implants in the United States, 1989. J Clin Epidemiol 1995;48:519-25.(2)]. The UK National Breast Implant Registry has recorded a rise in the numbers of women receiving breast implants, with over 13 000 procedures registered in 2001; an estimated 77% of these were for cosmetic purposes. No association has been found between the presence of breast implants in a breast and an increased risk of breast cancer, and this subject has been comprehensively reviewed elsewhere [Hoshaw SJ, Klein PJ, Clark BD, et al. Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg 2001; 107:1393-407.(3)]. However, as the population of women with breast implants ages, an increasing number of them will develop breast cancer; a reflection of the fact that the incidence of the disease increases with increasing age. Debate continues on the effect of breast implants on the efficacy of mammography in diagnosing breast cancer, and the role of other imaging techniques for this purpose, as well as the limitations that the presence of implants place on percutaneous biopsy techniques. We review the Literature on the radiological and tissue diagnosis of breast cancer in women with a history of previous augmentation mammaplasty. (c) 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Resumo:
Differential Reinforcement of Alternative behaviour (DRA) (Athens & Vollmer, 2010; Cooper, Heron, & Heward, 2007) is a procedure that consists in withholding reinforcement for the targeted inappropriate behaviour while reinforcing behaviours, i.e., that have the same function, but socially more acceptable topographies. DRA has repeatedly proven to be effective in reducing problem behaviours in individuals with autism (Campbell, 2003). On the other hand, a number of single-subject research studies have provided evidence for the use of activity schedules as a means to decrease aggressive behaviour (Dooley et al., 2001; Flannery & Hemer, 1994; Lalli, Casey, Goh, & Merlinoet al., 1994). The purpose of the present study was to evaluate the effectiveness of DRA in combination with the use of an activity schedule. We compared the impact of the visual activities schedule used in combination with a DRA procedure versus the impact of the DRA procedure used alone on problem behaviour of a boy diagnosed with an Autism Spectrum Disorder. An alternating treatments design was used to compare the rate of behaviour problems in each of the two treatment conditions. DRA was delivered as treatment A, while the combination of the activities schedule and DRA was treatment B.
Resumo:
Tephrochronology, a key tool in the correlation of Quaternary sequences, relies on the extraction of tephra shards from sediments for visual identification and high-precision geochemical comparison. A prerequisite for the reliable correlation of tephra layers is that the geochemical composition of glass shards remains unaltered by natural processes (e.g. chemical exchange in the sedimentary environment) and/or by laboratory analytical procedures. However, natural glasses, particularly when in the form of small shards with a high surface to volume ratio, are prone to chemical alteration in both acidic and basic environments. Current techniques for the extraction of distal tephra from sediments involve the ‘cleaning’ of samples in precisely such environments and at elevated temperatures. The acid phase of the ‘cleaning’ process risks alteration of the geochemical signature of the shards, while the basic phase leads to considerable sample loss through dissolution of the silica network. Here, we illustrate the degree of alteration and loss to which distal tephras may be prone, and introduce a less destructive procedure for their extraction. This method is based on stepped heavy liquid flotation and which results in samples of sufficient quality for analysis while preserving their geochemical integrity. In trials, this method out-performed chemical extraction procedures in terms of the number of shards recovered and has resulted in the detection of new tephra layers with low shard concentrations. The implications of this study are highly significant because (i) the current database of distal tephra records and their corresponding geochemical signatures may require refinement and (ii) the record of distal tephras may be incomplete due to sample loss induced by corrosive laboratory procedures. It is therefore vital that less corrosive laboratory procedures are developed to make the detection and classification of distal glass tephra more secure.
Resumo:
BACKGROUND:
It is compulsory that domestic football/soccer teams in UEFA competitions organise players' pre-participation medicals. Although screening guidelines have been established, these remain controversial. The findings of medical examinations can have lasting consequences for athletes and doctors. No previous studies have reported UEFA pre-participation screening results in semi-professional footballers. This study aims to further knowledge regarding 'normal' data in this population.
METHOD:
Retrospective audit and analysis of records of pre-season medicals for all male first-team players at one semi-professional Northern Ireland Premiership team between 2009-2012. Medicals were conducted by the club doctor following the UEFA proforma. Height, weight, blood pressure (BP), full blood count (FBC), dipstick urinalysis and resting electrocardiogram (ECG) were conducted by an independent nurse. Only one ECG must be documented during a player's career; other tests are repeated yearly.
RESULTS:
89 medicals from 47 players (6 goalkeepers, 11 defenders, 22 midfielders and 8 attackers; mean age 25.0 years (SD 4.86)) were reviewed. Mean height of the players was 179.3 cm (SD 5.90) with a mean weight of 77.6 kg (SD 10.5). Of 89 urine dipsticks, 7 were positive for protein; all 7 were normal on repeat testing following 48 hours of rest. Of 40 ECGs (mean ventricular rate 61.2 bpm (SD 11.6)), one was referred to cardiology (right bundle branch block; prolonged Q-T interval). No players were excluded from participation.
CONCLUSIONS:
This study provides important information about 'normal' values in a population of semi-professional footballers. Urinalysis showing protein is not uncommon but is likely to be normal on repeat testing.
Resumo:
Solar heating systems have the potential to be an efficient renewable energy technology, provided they are sized correctly. Sizing a solar thermal system for domestic applications does not warrant the cost of a simulation. As a result simplified sizing procedures are required. The size of a system depends on a number of variables including the efficiency of the collector itself, the hot water demand and the solar radiation at a given location. Domestic Hot Water (DHW) demand varies with time and is assessed using a multi-parameter detailed model. Secondly, the national energy evaluation methodologies are evaluated from the perspective of solar thermal system sizing. Based on the assessment of the standards, limitations in the evaluation method for solar thermal systems are outlined and an adapted method, specific to the sizing of solar thermal systems, is proposed. The methodology is presented for two common dwelling scenarios. Results from this showed that it is difficult to achieve a high solar fraction given practical sizes of system infrastructure (storage tanks) for standard domestic properties. However, solar thermal systems can significantly offset energy loads due associated DHW consumption, particularly when sized appropriately. The presented methodology is valuable for simple solar system design and also for the quick comparison of salient criteria.
Resumo:
During extreme sea states so called impact events can be observed on the wave energy converter Oyster. In small scale experimental tests these impact events cause high frequency signals in the measured load which decrease confidence in the data obtained. These loads depend on the structural dynamics of the model. Amplification of the loads can occur and is transferred through the structure from the point of impact to the load cell located in the foundation. Since the determination of design data and load cases for Wave Energy Converters originate from scale experiments, this lack of confidence has a direct effect on the development.
Numerical vibration analysis is a valuable tool in the research of the structural load response of Oyster to impact events, but must take into account the effect of the surrounding water. This can be done efficiently by adding an added mass distribution, computed with a linearised potential boundary element method. This paper presents the development and validation of a numerical procedure, which couples the OpenSource boundary element code NEMOH with the Finite Element Analysis tool CodeAster. Numerical results of the natural frequencies and mode shapes of the structure under the influence of added mass due to specific structural modes are compared with experimental results.