Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial

Introduction: Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV. Methods: A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay. Results: Of the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (95% confidence interval (CI) 0.87 to 2.64; P = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (95% CI: 1.22 to 5.69; P < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; 95% CI 1.17 to 3.63; P < 0.004). Conclusions: The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV.

A comparison of time-motion performance between age groups in judo matches

The aim of this study was to compare time-motion indicators during judo matches performed by athletes from different age groups. The following age groups were analysed: Pre-Juvenile (13-14 years, n=522), Juvenile (15-16 years, n 353); Junior (19 years, n = 349) and Senior (>20 years, n = 587). The time-motion indicators included: Total Combat Time, Standing Combat Time, Displacement Without Contact, Gripping Time, Groundwork Combat Time and Pause Time. Analysis of variance (ANOVA) one-way and the Tukey test, as well as the Kruskal-Wallis test and Mann-Whitney (for non-parametric data), were conducted, using P < 0.05 as significance level. The results showed that all analysed groups obtained a median of 7 (first quantile - 3, third quantile - 12) sequences of combat/pause cycles. In total time of combat, the result was: for Total Combat Time, Standing Combat Time and Gripping Time: Pre-Juvenile and Senior were significantly longer than Juvenile and Junior. Considering Displacement Without Contact, Junior was significantly longer than all other age groups. For Groundwork Combat Time, Senior was significantly longer than all other age groups and Pre-Juvenile was longer than Junior. These results can be used to improve the physiological performance in intermittent practices, as well as technicaltactical training during judo sessions.

Bioenergetics and neuromuscular determinants of the time to exhaustion at velocity corresponding to (V) over dotO(2)max in recreational long-distance runners

Bertuzzi, R, Bueno, S, Pasqua, LA, Acquesta, FM, Batista, MB, Roschel, H, Kiss, MAPDM, Serrao, JC, Tricoli, V, and Ugrinowitsch, C. Bioenergetics and neuromuscular determinants of the time to exhaustion at velocity corresponding to (V) over dotO(2)max in recreational long-distance runners. J Strength Cond Res 26(8): 2096-2102, 2012-The purpose of this study was to investigate the main bioenergetics and neuromuscular determinants of the time to exhaustion (T-lim) at the velocity corresponding to maximal oxygen uptake in recreational long-distance runners. Twenty runners performed the following tests on 5 different days: (a) maximal incremental treadmill test, (b) 2 submaximal tests to determine running economy and vertical stiffness, (c) exhaustive test to measured the T-lim, (d) maximum dynamic strength test, and (e) muscle power production test. Aerobic and anaerobic energy contributions during the T-lim test were also estimated. The stepwise multiple regression method selected 3 independent variables to explain T-lim variance. Total energy production explained 84.1% of the shared variance (p = 0.001), whereas peak oxygen uptake ((V) over dotO(2)peak) measured during T-lim and lower limb muscle power ability accounted for the additional 10% of the shared variance (p = 0.014). These data suggest that the total energy production, (V) over dotO(2)peak, and lower limb muscle power ability are the main physiological and neuromuscular determinants of T-lim in recreational long-distance runners.

Homicide and public security indicator trends in the city of Sao Paulo between 1996 and 2008: a time-series ecological study

The scope of this paper was to analyze the association between homicides and public security indicators in Sao Paulo between 1996 and 2008, after monitoring the unemployment rate and the proportion of youths in the population. A time-series ecological study for 1996 and 2008 was conducted with Sao Paulo as the unit of analysis. Dependent variable: number of deaths by homicide per year. Main independent variables: arrest-incarceration rate, access to firearms, police activity. Data analysis was conducted using Stata. IC 10.0 software. Simple and multivariate negative binomial regression models were created. Deaths by homicide and arrest-incarceration, as well as police activity were significantly associated in simple regression analysis. Access to firearms was not significantly associated to the reduction in the number of deaths by homicide (p>0,05). After adjustment, the associations with both the public security indicators were not significant. In Sao Paulo the role of public security indicators are less important as explanatory factors for a reduction in homicide rates, after adjustment for unemployment rate and a reduction in the proportion of youths. The results reinforce the importance of socioeconomic and demographic factors for a change in the public security scenario in Sao Paulo.

A peculiar Maxwell's Demon observed in a time-dependent stadium-like billiard

The dynamics of a driven stadium-like billiard is considered using the formalism of discrete mappings. The model presents a resonant velocity that depends on the rotation number around fixed points and external boundary perturbation which plays an important separation rule in the model. We show that particles exhibiting Fermi acceleration (initial velocity is above the resonant one) are scaling invariant with respect to the initial velocity and external perturbation. However, initial velocities below the resonant one lead the particles to decelerate therefore unlimited energy growth is not observed. This phenomenon may be interpreted as a specific Maxwell's Demon which may separate fast and slow billiard particles. (C) 2012 Elsevier B.V. All rights reserved.

Extracorporeal membrane oxygenation in severe hypoxemia: time for reappraisal?

in 2009, during the influenza A (H1N1) epidemic, there were many reported cases of pulmonary infection with severe hypoxemia that was refractory to the ventilatory strategies and rescue therapies commonly used to treat patients with severe acute respiratory distress syndrome. Many of those cases were treated with extracorporeal membrane oxygenation (ECMO), which renewed international interest in the technique. The Extracorporeal Support Study Group was created in order to practice ECMO and to employ it in the treatment of patients with severe hypoxemia. In this article, we discuss the indications for using ECMO and report the case of a patient with refractory hypoxemia who was successfully treated with ECMO.

Junction Field Effect on the Retention Time for One-Transistor Floating-Body RAM

One-transistor floating-body random access memory retention time distribution is investigated on silicon-on-insulator UTBOX devices. It is shown that the average retention time can be improved by two to three orders of magnitude by reducing the body-junction electric field. However, the retention time distribution, which is mainly caused by the generation-recombination center density variation, remains similar.

A multiple time scale survival model with a cure fraction

Many recent survival studies propose modeling data with a cure fraction, i.e., data in which part of the population is not susceptible to the event of interest. This event may occur more than once for the same individual (recurrent event). We then have a scenario of recurrent event data in the presence of a cure fraction, which may appear in various areas such as oncology, finance, industries, among others. This paper proposes a multiple time scale survival model to analyze recurrent events using a cure fraction. The objective is analyzing the efficiency of certain interventions so that the studied event will not happen again in terms of covariates and censoring. All estimates were obtained using a sampling-based approach, which allows information to be input beforehand with lower computational effort. Simulations were done based on a clinical scenario in order to observe some frequentist properties of the estimation procedure in the presence of small and moderate sample sizes. An application of a well-known set of real mammary tumor data is provided.

Effect of sample storage time on detection of hybridization signals in Checkerboard DNA-DNA hybridization

Long-term sample storage can affect the intensity of the hybridization signals provided by molecular diagnostic methods that use chemiluminescent detection. The aim of this study was to evaluate the effect of different storage times on the hybridization signals of 13 bacterial species detected by the Checkerboard DNA-DNA hybridization method using whole-genomic DNA probes. Ninety-six subgingival biofilm samples were collected from 36 healthy subjects, and the intensity of hybridization signals was evaluated at 4 different time periods: (1) immediately after collecting (n = 24) and (2) after storage at -20 degrees C for 6 months (n = 24), (3) for 12 months (n = 24), and (4) for 24 months (n = 24). The intensity of hybridization signals obtained from groups 1 and 2 were significantly higher than in the other groups (p < 0.001). No differences were found between groups 1 and 2 (p > 0.05). The Checkerboard DNA-DNA hybridization method was suitable to detect hybridization signals from all groups evaluated, and the intensity of signals decreased significantly after long periods of sample storage.

On the generalized canonical equations of Hamilton for a time-dependent mass particle

Fundamental principles of mechanics were primarily conceived for constant mass systems. Since the pioneering works of Meshcherskii (see historical review in Mikhailov (Mech. Solids 10(5):32-40, 1975), efforts have been made in order to elaborate an adequate mathematical formalism for variable mass systems. This is a current research field in theoretical mechanics. In this paper, attention is focused on the derivation of the so-called 'generalized canonical equations of Hamilton' for a variable mass particle. The applied technique consists in the consideration of the mass variation process as a dissipative phenomenon. Kozlov's (Stek. Inst. Math 223:178-184, 1998) method, originally devoted to the derivation of the generalized canonical equations of Hamilton for dissipative systems, is accordingly extended to the scenario of variable mass systems. This is done by conveniently writing the flux of kinetic energy from or into the variable mass particle as a 'Rayleigh-like dissipation function'. Cayley (Proc. R Soc. Lond. 8:506-511, 1857) was the first scholar to propose such an analogy. A deeper discussion on this particular subject will be left for a future paper.

On Fermat's principle for causal curves in time oriented Finsler spacetimes

In this work, a version of Fermat's principle for causal curves with the same energy in time orientable Finsler spacetimes is proved. We calculate the second variation of the time arrival functional along a geodesic in terms of the index form associated with the Finsler spacetime Lagrangian. Then the character of the critical points of the time arrival functional is investigated and a Morse index theorem in the context of Finsler spacetime is presented. (C) 2012 American Institute of Physics. [http://dx.doi.org/10.1063/1.4765066]

Effect of Temperature on the Degree of Conversion and Working Time of Dual-Cured Resin Cements Exposed to Different Curing Conditions

Objectives: This study evaluated the degree of conversion (DC) and working time (WT) of two commercial, dual-cured resin cements polymerized at varying temperatures and under different curing-light accessible conditions, using Fourier transformed infrared analysis (FTIR). Materials and Methods: Calibra (Cal; Dentsply Caulk) and Variolink II (Ivoclar Vivadent) were tested at 25 degrees C or preheated to 37 degrees C or 50 degrees C and applied to a similar-temperature surface of a horizontal attenuated-total-reflectance unit (ATR) attached to an infrared spectrometer. The products were polymerized using one of four conditions: direct light exposure only (600 mW/cm(2)) through a glass slide or through a 1.5- or 3.0-mm-thick ceramic disc (A2 shade, IPS e.max, Ivoclar Vivadent) or allowed to self-cure in the absence of light curing. FTIR spectra were recorded for 20 min (1 spectrum/s, 16 scans/spectrum, resolution 4 cm(-1)) immediately after application to the ATR. DC was calculated using standard techniques of observing changes in aliphatic-to-aromatic peak ratios precuring and 20-min postcuring as well as during each 1-second interval. Time-based monomer conversion analysis was used to determine WT at each temperature. DC and WT data (n=6) were analyzed by two-way analysis of variance and Tukey post hoc test (p=0.05). Results: Higher temperatures increased DC regardless of curing mode and product. For Calibra, only the 3-mm-thick ceramic group showed lower DC than the other groups at 25 degrees C (p=0.01830), while no significant difference was observed among groups at 37 degrees C and 50 degrees C. For Variolink, the 3-mm-thick ceramic group showed lower DC than the 1-mm-thick group only at 25 degrees C, while the self-cure group showed lower DC than the others at all temperatures (p=0.00001). WT decreased with increasing temperature: at 37 degrees C near 70% reduction and at 50 degrees C near 90% for both products, with WT reduction reaching clinically inappropriate times in some cases (p=0.00001). Conclusion: Elevated temperature during polymerization of dual-cured cements increased DC. WT was reduced with elevated temperature, but the extent of reduction might not be clinically acceptable.

Real-time electrochemical determination of phenolic compounds after benzene oxidation

A sensitive electrochemical sensor was successfully developed on multi-walled carbon nanotubes (MWCNT) and cobalt phthalocyanine (CoPc) modified glassy carbon electrode (GC), and used to detect byproducts formed after the electrolysis of benzene. The GC/MWCNT/CoPc electrode was applied in the detection of phenolic compounds using square wave voltammetry (SWV). The proposed sensor exhibited a sequence in the sensitivity of the tested phenols: catechol > hydroquinone > resorcinol > phenol and 1,4-benzoquinone. The detection limits for individual phenols were also calculated: catechol (15.62 mu g L-1), hydroquinone (17.91 mu g L-1), resorcinol (46.12 mu g L-1), phenol (58.83 mu g L-1) and 1,4-benzoquinone (13.75 mu g L-1). The proposed sensor was successfully applied in the determination of the total amount of phenols formed after the benzene oxidation, and the obtained results were in full agreement with those from the HPLC procedure. (C) 2012 Elsevier B.V. All rights reserved.

Residence Time Distribution Models Derived from Non-Ideal Laminar Velocity Profiles in Tubes

The theoretical E-curve for the laminar flow of non-Newtonian fluids in circular tubes may not be accurate for real tubular systems with diffusion, mechanical vibration, wall roughness, pipe fittings, curves, coils, or corrugated walls. Deviations from the idealized laminar flow reactor (LFR) cannot be well represented using the axial dispersion or the tanks-in-series models of residence time distribution (RTD). In this work, four RTD models derived from non-ideal velocity profiles in segregated tube flow are proposed. They were used to represent the RTD of three tubular systems working with Newtonian and pseudoplastic fluids. Other RTD models were considered for comparison. The proposed models provided good adjustments, and it was possible to determine the active volumes. It is expected that these models can be useful for the analysis of LFR or for the evaluation of continuous thermal processing of viscous foods.

Optimal Code Set Selection and Security Issues in Spectral Phase-Encoded Time Spreading (SPECTS) OCDMA Systems

In this paper, we perform a thorough analysis of a spectral phase-encoded time spreading optical code division multiple access (SPECTS-OCDMA) system based on Walsh-Hadamard (W-H) codes aiming not only at finding optimal code-set selections but also at assessing its loss of security due to crosstalk. We prove that an inadequate choice of codes can make the crosstalk between active users to become large enough so as to cause the data from the user of interest to be detected by other user. The proposed algorithm for code optimization targets code sets that produce minimum bit error rate (BER) among all codes for a specific number of simultaneous users. This methodology allows us to find optimal code sets for any OCDMA system, regardless the code family used and the number of active users. This procedure is crucial for circumventing the unexpected lack of security due to crosstalk. We also show that a SPECTS-OCDMA system based on W-H 32(64) fundamentally limits the number of simultaneous users to 4(8) with no security violation due to crosstalk. More importantly, we prove that only a small fraction of the available code sets is actually immune to crosstalk with acceptable BER (<10(-9)) i.e., approximately 0.5% for W-H 32 with four simultaneous users, and about 1 x 10(-4)% for W-H 64 with eight simultaneous users.