927 resultados para Pressure sore or ulcer sore
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The two environmental management system (EMS) standards EMAS and ISO 14001 have been available in Europe for the last 15 years. ISO 14001 has been taken up at a much larger scale but many firms in the German automotive and engineering industry have certified their EMSs according to both standards. Two research questions are addressed: (i) What explains why companies adopt both EMAS and ISO 14001? (ii) Are EMAS and ISO 14001 complements or substitutes? Based on 21 interviews with industrial and institutional representatives, this study finds that, first, the two standards are adopted for completely different reasons: while ISO 14001 is often done as a response to external pressure, EMAS tends to be motivated internally. Second, it is argued that EMAS and ISO 14001 are likely in a situation of direct competition at present which may well turn into complementarity in the future.
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We present in this study the effect of nature and concentration of lithium salt, such as the lithium hexafluorophosphate, LiPF6; lithium tris(pentafluoroethane)-trifluorurophosphate LiFAP; lithium bis(trifluoromethylsulfonyl)imide, LiTFSI, on the CO2 solubility in four electrolytes for lithium ion batteries based on pure solvent that include ethylene carbonate (EC), dimethyl carbonate (DMC), ethyl methyl carbonate (EMC), diethyl carbonate (DEC), as well as, in the EC:DMC, EC:EMC and EC:DEC (50:50) wt.% binary mixtures as a function of temperature from (283 to 353) K and atmospheric pressure. Based on experimental solubility values, the Henry’s law constant of the carbon dioxide in these solutions with the presence or absence of lithium salt was then deduced and compared with reported values from the literature, as well as with those predicted by using COSMO-RS methodology within COSMOThermX software. From this study, it appears that the addition of 1 mol · dm-3 LiPF6 salt in alkylcarbonate solvents decreases their CO2 capture capacity. By using the same experimental conditions, an opposite CO2 solubility trend was generally observed in the case of the addition of LiFAP or LiTFSI salts in these solutions. Additionally, in all solutions investigated during this work, the CO2 solubility is greater in electrolytes containing the LiFAP salt, followed by those based on the LiTFSI case. The precision and accuracy of the experimental data reported therein, which are close to (1 and 15)%, respectively. From the variation of the Henry’s law constant with temperature, the partial molar thermodynamic functions of dissolution such as the standard Gibbs energy, the enthalpy, and the entropy, as well as the mixing enthalpy of the solvent with CO2 in its hypothetical liquid state were calculated. Finally, a quantitative analysis of the CO2 solubility evolution was carried out in the EC:DMC (50:50) wt.% binary mixture as the function of the LiPF6 or LiTFSI concentration in solution to elucidate how ionic species modify the CO2 solubility in alkylcarbonates-based Li-ion electrolytes by investigating the salting effects at T = 298.15 K and atmospheric pressure.
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Observations of ? Eri (K2 V) have been made with the Space Telescope Imaging Spectrograph on the Hubble Space Telescope. The spectra obtained show a number of emission lines which can be used to determine, or place limits on, the electron density and pressure. Values of the electron pressure are required in order to make quantitative models of the transition region and inner corona from absolute line fluxes, and to constrain semi-empirical models of the chromosphere. Using line flux ratios in Si II and O IV a mean electron pressure of P = NT = 4.8 × 10 cm K is derived. This value is compatible with the lower and upper limits to P found from flux ratios in C III, O V and Fe XII. Some inconsistencies which may be because of small uncertainties in the atomic data used are discussed.
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Background: Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations. Aims: To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills). Methods: Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records. Results: Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa=0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged =5 years) and adults. Conclusions: Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients. © 2012 Primary Care Respiratory Society UK. All rights reserved.
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Objective: Several surveillance definitions of influenza-like illness (ILI) have been proposed, based on the presence of symptoms. Symptom data can be obtained from patients, medical records, or both. Past research has found that agreements between health record data and self-report are variable depending on the specific symptom. Therefore, we aimed to explore the implications of using data on influenza symptoms extracted from medical records, similar data collected prospectively from outpatients, and the combined data from both sources as predictors of laboratory-confirmed influenza. Methods: Using data from the Hutterite Influenza Prevention Study, we calculated: 1) the sensitivity, specificity and predictive values of individual symptoms within surveillance definitions; 2) how frequently surveillance definitions correlated to laboratory-confirmed influenza; and 3) the predictive value of surveillance definitions. Results: Of the 176 participants with reports from participants and medical records, 142 (81%) were tested for influenza and 37 (26%) were PCR positive for influenza. Fever (alone) and fever combined with cough and/or sore throat were highly correlated with being PCR positive for influenza for all data sources. ILI surveillance definitions, based on symptom data from medical records only or from both medical records and self-report, were better predictors of laboratory-confirmed influenza with higher odds ratios and positive predictive values. Discussion: The choice of data source to determine ILI will depend on the patient population, outcome of interest, availability of data source, and use for clinical decision making, research, or surveillance. © Canadian Public Health Association, 2012.
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The two-phase flow of a hydrophobic ionic liquid and water was studied in capillaries made of three different materials (two types of Teflon, FEP and Tefzel, and glass) with sizes between 200µm and 270µm. The ionic liquid was 1-butyl-3-methylimidazolium bis{(trifluoromethyl)sulfonyl}amide, with density and viscosity of 1420kgm and 0.041kgms, respectively. Flow patterns and pressure drop were measured for two inlet configurations (T- and Y-junction), for total flow rates of 0.065-214.9cmh and ionic liquid volume fractions from 0.05 to 0.8. The continuous phase in the glass capillary depended on the fluid that initially filled the channel. When water was introduced first, it became the continuous phase with the ionic liquid forming plugs or a mixture of plugs and drops within it. In the Teflon microchannels, the order that fluids were introduced did not affect the results and the ionic liquid was always the continuous phase. The main patterns observed were annular, plug, and drop flow. Pressure drop in the Teflon microchannels at a constant ionic liquid flow rate, was found to increase as the ionic liquid volume fraction decreased, and was always higher than the single phase ionic liquid value at the same flow rate as in the two-phase mixture. However, in the glass microchannel during plug flow with water as the continuous phase, pressure drop for a constant ionic liquid flow rate was always lower than the single phase ionic liquid value. A modified plug flow pressure drop model using a correlation for film thickness derived for the current fluids pair showed very good agreement with the experimental data. © 2013 Elsevier Ltd.
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Objective: The influence of sex hormones on intraocular pressure (IOP) has been the focus of recent debate. Previous studies investigating the effects of hormone therapy (HT) on IOP in postmenopausal women have produced conflicting results but have been limited by small numbers of participants. The aim of our study was to compare IOP in women without glaucoma taking HT with those not taking HT. Methods: A prospective cross-sectional study of postmenopausal women visiting a single ophthalmic medical practitioner was conducted. All women with a history of intraocular disease, a family history of glaucoma, or refractive error exceeding ±5 diopters were excluded. Applanation tonometry was used to measure IOP, and participants were then asked if they were current HT users. Results: A total of 263 participants were recruited, of whom 91 reported current use of HT; 172 had never used HT. Within the HT group, 33 were taking an estrogen-therapy and 58 were taking a estrogen-progesterone therapy. Mean IOP in the HT group was significantly lower than that in the non-HT group; the mean difference was 1.41 mm Hg (P <0.001). This difference remained statistically significant after statistical correction for age, use of systemic ß-blockers, and time of IOP measurement. There was no significant difference in mean IOP between women taking combined versus those taking estrogen-only preparations. Conclusions: Our study showed that IOP was significantly lower in women taking HT than in those who had never taken HT, even after removing other possible influences on IOP. The IOP-lowering effect of HT deserves further investigation to explore whether it may represent a possible new therapeutic modality for glaucoma. © 2010 by The North American Menopause Society.
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PURPOSE: The purpose of this study was to assess the effect on intraocular pressure (IOP) and the safety and tolerability of oromucosal administration of a low dose of delta-9-tetrahydrocannabinol (?-9-THC) and cannabidiol (CBD). PATIENTS AND METHODS: A randomized, double-masked, placebo-controlled, 4 way crossover study was conducted at a single center, using cannabis-based medicinal extract of ?-9-THC and CBD. Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM of 5 mg ?-9-THC, 20 mg CBD, 40 mg CBD, or placebo. Main outcome measure was IOP. Secondary outcomes included visual acuity, vital signs, and psychotropic effects. RESULTS: Two hours after sublingual administration of 5 mg ?-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs. 27.3 mm Hg, P=0.026). The IOP returned to baseline level after the 4-hour IOP measurement. CBD administration did not reduce the IOP at any time. However, the higher dose of CBD (40 mg) produced a transient elevation of IOP at 4 hours after administration, from 23.2 to 25.9 mm Hg (P=0.028). Vital signs and visual acuity were not significantly changed. One patient experienced a transient and mild paniclike reaction after ?-9-THC administration. CONCLUSIONS: A single 5 mg sublingual dose of ?-9-THC reduced the IOP temporarily and was well tolerated by most patients. Sublingual administration of 20 mg CBD did not reduce IOP, whereas 40 mg CBD produced a transient increase IOP rise. Copyright © 2006 by Lippincott Williams & Wilkins.
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Aim - To evaluate the comparative efficacy and tolerance of latanoprost versus timolol through a meta-analysis of randomised controlled trials (RCTs). Methods - Systematic retrieval of RCTs of latanoprost versus timolol to allow pooling of results from head to head comparison studies. Quality of trials was assessed based on randomisation, masking, and withdrawal. Sensitivity analyses were used to estimate the effects of quality of study on outcomes. The data sources were Medline, Embase, Scientific Citation Index, Merck Glaucoma, and Pharmacia and Upjohn ophthalmology databases. There were 1256 patients with open angle glaucoma or ocular hypertension reported in 11 trials of latanoprost versus timolol. The main outcome measures were (i) percentage intraocular pressure (IOP) reduction for efficacy; (ii) relative risk, risk difference, and number needed to harm for side effects such as hyperaemia, conjunctivitis, increased pigmentation, hypotension, and bradycardia expressed as dichotomous outcomes; and (iii) reduction in systemic blood pressure and heart rate as side effects. Results - Both 0.005% latanoprost once daily and 0.5% timolol twice daily reduced IOP. The percentage reductions in IOP from baseline (mean (SE)) produced by latanoprost and timolol were 30.2 (2.3) and 26.9 (3.4) at 3 months. The difference in IOP reduction between the two treatments were 5.0 (95% confidence intervals 2.8, 7.3). However, latanoprost caused iris pigmentation in more patients than timolol (relative risk = 8.01, 95% confidence intervals 1.87, 34.30). The 2 year risk with latanoprost reached 18% (51/277). Hyperaemia was also more often observed with latanoprost (relative risk = 2.20, 95% confidence intervals 1.33, 3.64). Timolol caused a significant reduction in heart rate of 4 beats/minute (95% confidence interval 2, 6). Conclusion - This meta-analysis suggests that latanoprost is more effective than timolol in lowering IOP. However, it often causes iris pigmentation. While current evidence suggests that this pigmentation is benign, careful lifetime evaluation of patients is still justified.
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PURPOSE: To consider whether STZ-induced hyperglycemia renders rat retinal function and ocular blood flow more susceptible to acute intraocular pressure (IOP) challenge.
METHODS: Retinal function (electroretinogram, ERG) was measured during acute IOP challenge (10-100 mmHg, 5 mmHg increments, 3 min/step, vitreal cannulation) in adult Long-Evans rats (6-week old, citrate: n=6, STZ: n=10) 4 weeks after citrate buffer or streptozotocin (STZ, 65 mg/kg, blood glucose > 15 mmol/l) injection. At each IOP, dim and bright flash (-4.56, -1.72 log cd.s.m^-2) ERG responses were recorded to measure inner retinal and ON-bipolar cell function, respectively. Ocular blood flow (laser Doppler flowmetry, citrate; n=6, STZ; n=10) was also measured during acute IOP challenge. Retinae were isolated for qPCR analysis of nitric oxide synthase mRNA expression endothelial, eNos; inducible, iNos; neuronal, nNos).
RESULTS: STZ-induced diabetes increased the susceptibility of inner retinal (IOP at 50% response, 60.1, CI: 57.0-62.0 mmHg vs. citrate: 67.5, CI: 62.1-72.4 mmHg) and ON-bipolar cell function (STZ: 60.3, CI: 58.0-62.8 mmHg vs. citrate: 65.1, CI: 58.0-62.78 mmHg) and ocular blood flow (43.9, CI: 40.8-46.8 vs. citrate: 53.4, CI: 50.7-56.1 mmHg) to IOP challenge. Citrate eyes showed elevated eNos mRNA (+49.7%) after IOP stress, an effect not found in STZ-diabetic eyes (-5.7%, P<0.03). No difference was observed for iNos or nNos (P>0.05) following IOP elevation.
CONCLUSIONS: STZ-induced diabetes increased functional susceptibility during acute IOP challenge. This functional vulnerability is associated with a reduced capacity for diabetic eyes to upregulate eNOS expression and to autoregulate blood flow in response to stress.
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Purpose: To determine relationship between the magnitude of intraocular pressure (IOP) during a fixed-duration episode of acute elevation and the loss of retinal function and structure 4 weeks later in rats.
Methods: Unilateral elevation of IOP (105 minutes) was achieved manometrically in adult Brown Norway rats (9 groups; n = 4 to 8 each, 10–100 mm Hg and sham control). Full-field ERGs were recorded simultaneously from treated and control eyes 4 weeks after IOP elevation. Scotopic ERG stimuli were white flashes (26.04 to 2.72 log cd.s.m^-2). Photopic ERGs were recorded (1.22 to 2.72 log cd.s.m22) after 15 min of light adaptation (150 cd/m2). Relative amplitude (treated/control, %) of ERG components versus IOP was described with a cummulative normal function. Retinal ganglion cell (RGC) layer density was determined post mortem by histology.
Results: All ERG components failed to recover completely normal amplitudes by 4 weeks after the insult if IOP was 70 mmHg or greater during the episode. There was no ERG recovery at all if IOP was 100 mmHg. Outer retinal (photoreceptor) function demonstrated the least sensitivity to prior acute IOP elevation. ERG components reflecting inner retinal function were correlated with post mortem RGC layer density.
Conclusions: Retinal function recovers after IOP normalization, such that it requires a level of acute IOP elevation approximately 10 mmHg higher to cause a pattern of permanent dysfunction similar to that observed during the acute event. There is a ‘threshold’ for permanent retinal functional loss in the rat at an IOP between 60 and 70 mmHg if sustained for 105 minutes or more.
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Raman spectra in the range of the totally symmetric stretching mode of the [PF6]− anion, νs(PF6), have been measured for 1-alkyl-3-methylimidazolium ionic liquids [CnC1im][PF6], for n = 4, 6, and 8, as a function of pressure at room temperature. The ionic liquids [C6C1im][PF6] and [C8C1im][PF6] remain in an amorphous phase up to 3.5 GPa, in contrast to [C4C1im][PF6], whichcrystallizes above ∼0.5 GPa. Equations of state based either on a group contribution model or Carnahan-Starling-van der Waals model have been used to estimate the densities of the ionic liquids at high pressures. The shifts of the vibrational frequency of νs(PF6) with density observed in [C6C1im][PF6] and in [C8C1im][PF6] have been calculated by a hard-sphere model of a pseudo-diatomic solute under short-range repulsive interactions with the neighboring particles. The stochastic model of Kubo for vibrational dephasing has been used to obtain the amplitude of vibrational frequency fluctuation, ⟨Δω 2⟩, and the relaxation time of frequency fluctuation, τ c , as a function of density by Raman band shape analysis of the νs(PF6) mode of [C6C1im][PF6] and [C8C1im][PF6].
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Pressure-sensitive adhesives (PSAs) have applications in the fields of packaging, joining, wound care, and personal care. Depending on the application of the PSA, different performance tests are carried out when new products are developed or the quality of the existing products is checked. Tack is the property of an adhesive that enables it to form instant bond on the surface under light pressure. The tack of a PSA strongly depends on the way the bond is created. Parameters such as the bonded area, contact time and the nature of tack materials all affect the tack force measured. In the development of any PSA, it is desirable to correlate the performance related properties such as tack and peel strength to the rheological behaviour. Finding these correlations would make it possible to evaluate the performance of a PSA using its rheological characteristics. In this investigation we have studied the influence of rheological behaviour of three different PSAs on their tackiness. The three different PSAs used in this study are a low molecular weight rosin ester, high molecular weight rosin ester, and dicyclopentadiene. Various rheological properties such as viscosity, phase angle, and elastic and viscous moduli are measured versus the frequency and temperature. Also the tack properties at various removal speeds and temperatures are evaluated. Analysis of the results indicates different performances of the three PSAs which could be related to their rheological properties, especially the phase angle, at different frequencies and temperatures. The PSA with high molecular weight rosin ester is more sensitive to temperature changes and showed drastic changes in tackiness from high temperature to low temperature. On the other hand, rosin ester with low molecular weight is less sensitive to temperature changes. © 2010 VSP.
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The accurate definition of the extreme wave loads which act on offshore structures represents a significant challenge for design engineers and even with decades of empirical data to base designs upon there are still failures attributed to wave loading. The environmental conditions which cause these loads are infrequent and highly non-linear which means that they are not well understood or simple to describe. If the structure is large enough to affect the incident wave significantly further non-linear effects can influence the loading. Moreover if the structure is floating and excited by the wave field then its responses, which are also likely to be highly non-linear, must be included in the analysis. This makes the description of the loading on such a structure difficult to determine and the design codes will often suggest employing various tools including small scale experiments, numerical and analytical methods, as well as empirical data if available.
Wave Energy Converters (WECs) are a new class of offshore structure which pose new design challenges, lacking the design codes and empirical data found in other industries. These machines are located in highly exposed and energetic sites, designed to be excited by the waves and will be expected to withstand extreme conditions over their 25 year design life. One such WEC is being developed by Aquamarine Power Ltd and is called Oyster. Oyster is a buoyant flap which is hinged close to the seabed, in water depths of 10 to 15m, piercing the water surface. The flap is driven back and forth by the action of the waves and this mechanical energy is then converted to electricity.
It has been identified in previous experiments that Oyster is not only subject to wave impacts but it occasionally slams into the water surface with high angular velocity. This slamming effect has been identified as an extreme load case and work is ongoing to describe it in terms of the pressure exerted on the outer skin and the transfer of this short duration impulsive load through various parts of the structure.
This paper describes a series of 40th scale experiments undertaken to investigate the pressure on the face of the flap during the slamming event. A vertical array of pressure sensors are used to measure the pressure exerted on the flap. Characteristics of the slam pressure such as the rise time, magnitude, spatial distribution and temporal evolution are revealed. Similarities are drawn between this slamming phenomenon and the classical water entry problems, such as ship hull slamming. With this similitude identified, common analytical tools are used to predict the slam pressure which is compared to that measured in the experiment.
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The methane solubility in five pure electrolyte solvents and one binary solvent mixture for lithium ion batteries – such as ethylene carbonate (EC), propylene carbonate (PC), dimethyl carbonate (DMC), ethyl methyl carbonate (EMC), diethyl carbonate (DEC) and the (50:50 wt%) mixture of EC:DMC was studied experimentally at pressures close to atmospheric and as a function of temperature between (280 and 343) K by using an isochoric saturation technique. The effect of the selected anions of a lithium salt LiX (X = hexafluorophosphate,
<img height="16" border="0" style="vertical-align:bottom" width="27" alt="View the MathML source" title="View the MathML source" src="http://origin-ars.els-cdn.com/content/image/1-s2.0-S0021961414002146-si1.gif">PF6-; tris(pentafluoroethane)trifluorurophosphate, FAP−; bis(trifluoromethylsulfonyl)imide, TFSI−) on the methane solubility in electrolytes for lithium ion batteries was then investigated using a model electrolyte based on the binary mixture of EC:DMC (50:50 wt%) + 1 mol · dm−3 of lithium salt in the same temperature and pressure ranges. Based on experimental solubility data, the Henry’s law constant of the methane in these solutions were then deduced and compared together and with those predicted by using COSMO-RS methodology within COSMOthermX software. From this study, it appears that the methane solubility in each pure solvent decreases with the temperature and increases in the following order: EC < PC < EC:EMC (50:50 wt%) < DMC < EMC < DEC, showing that this increases with the van der Walls force in solution. Additionally, in all investigated EC:DMC (50:50 wt%) + 1 mol · dm−3 of lithium salt electrolytes, the methane solubility decreases also with the temperature and the methane solubility is higher in the electrolyte containing the LiFAP salt, followed by that based on the LiTFSI one. From the variation of the Henry’s law constants with the temperature, the partial molar thermodynamic functions of solvation, such as the standard Gibbs free energy, the enthalpy, and the entropy where then calculated, as well as the mixing enthalpy of the solvent with methane in its hypothetical liquid state. Finally, the effect of the gas structure on their solubility in selected solutions was discussed by comparing methane solubility data reported in the present work with carbon dioxide solubility data available in the same solvents or mixtures to discern the more harmful gas generated during the degradation of the electrolyte, which limits the battery lifetime.