Cardiac disease in chronic uremia: management

Heart disease is a common cause of morbidity in end-stage renal disease (ESRD) patients. The management of heart disease in these patients requires a multidimensional approach to the management of heart failure, coronary disease, and arrhythmias, and to risk factors such as hypertension, anemia, secondary hyperparathyroidism, and electrolyte/acid-base disturbances. Coronary artery disease management includes use of antianginal drugs and revascularization of coronary arteries with angioplasty +/- stent placement or coronary artery bypass grafting. The long-term outcomes of these procedures need to be assessed and improved. Hypertension occupies a major role in the pathogenesis of heart disease in ESRD, and early and adequate control of hypertension is likely to have a major impact on the progression of cardiac disease. This entails the achievement of optimal volume status, combined with the appropriate use of antihypertensive agents such as calcium channel blockers, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, vasodilators, alpha-blockers, and central sympatholytic drugs. In ESRD patients, specific dialysis-related complications such as intradialytic hypotension and pericardial effusion may have additional effects on cardiac function and require attention. The choice of dialysate composition and membrane may influence clinical outcomes with specific effects on cardiac performance.     

Experimental peri-implant tissue breakdown around hydroxyapatite-coated implants

Factor V Leiden mutation was initially detected in thrombophilic patients and relatives by PCR RFLP (Restriction Fragment Length Polymorphism) according to Bertina (1). This technique presents some drawbacks and the current trend is to simplify the diagnosis. We describe a technique of Allele Specific Amplification (ASA) which is optimized in terms of reliability: an additional mismatch in antepenultimate position enables to obtain the same specificity as PCR RFLP. Furthermore, coamplification of internal control warrants an optimal sensitivity. All the PCR have been simplified: the DNA extraction improvement allows to analyse the genotype with only a few microliters of whole blood whatever the anticoagulant and the procedure of preservation (freezing, dried blood spots, storage at +4 degrees C for several days). This technique saves time. Moreover, full automation of the ASA technique may be shortened thanks to the lack of extraction and the positive/negative reading of the PCR signal.     

Radiation and scattering from ferrite-tuned cavity-backed slotantennas: theory and experiment

A three-dimensional finite-element method hybridized with the spectral/spatial domain method of moments is presented for the analysis of ferrite-tuned cavity-backed slot antennas. The cavity, which is partially filled with magnetized ferrite layers, is flush mounted on an infinite ground plane with possible dielectric or magnetic overlay. The antenna operates primarily in the ultrahigh-frequency band. The finite-element method is used to solve for the electric-field distribution inside the cavity, whereas the spectral-domain approach is used to solve for the exterior region. An asymptotic extraction of the exponential behavior of the Green's function followed by a spatial evaluation of the resulting integral is used to improve computational speed. Radar cross section, input impedance, return loss, gain, and efficiency of ferrite-tuned cavity-backed slots (CBS) are calculated for various biasing conditions. Numerical results are compared with experimental data     

A new actigraph for long-term registration of the duration andintensity of tremor and movement

Actigraphy, the long-term measurement of human movement with a small solid state recorder, is gaining acceptance as a useful method in many research fields. Currently available actigraphs assess or estimate the movement duration per time interval. However, the output gives no information on movement type or intensity, and cannot be used in subjects suffering from tremor. The present paper describes a new type of actigraph, that has been developed primarily for the long-term evaluation of motor symptoms in Parkinson patients. The device is the first to discriminate tremor from other movements and to assess both duration and intensity of the two types of movement. It is based on a Motorola 68HC805B6 microcontroller and contains: an accelerometer, programmable gain stages, programmable low- and highpass filters, a programmable level comparator, a peak detector, interface circuits, a real time clock, data storage, and control circuitry. The micro-controller performs a period amplitude sequence analysis (PASA) on the conditioned accelerometer signal, and stores four output variables (tremor duration, tremor amplitude, movement duration, and movement amplitude) at the end of programmable time intervals. The analysis of fluctuations in the motor symptoms of, e.g., Parkinson patients using this actigraph can be of great help in the pharmacological management of symptoms     

Disaster recovery planning in an automated manufacturingenvironment

Disasters may strike at any moment in any location. When they do, no distinction is made about the type of firm that is being affected, whether it is a bank or a manufacturing plant. Most firms do not plan for possible disasters, and those that do have typically focused on computer and data contingency planning. In this paper, the focus is shifted to incorporate disaster recovery planning for manufacturing enterprises, especially those that are automated. Automated manufacturing enterprises have characteristics that put them at an increased risk to disasters. The methodological framework proposed in this paper will aid manufacturing organizations and their managers in reducing the risks associated with unanticipated disasters. The framework is termed the “Manufacturing Operations Recovery and Resumption” model. Recommended activities and tools for effective management of this methodology are identified     

Gyrotron coaxial cylindrical resonators with corrugated innerconductor: Theory and experiment

Gyrotron coaxial resonators with a longitudinally slotted inner cylinder are examined analytically using a surface impedance model, from which expressions for the electromagnetic field, ohmic quality (Q) factor, and characteristic equation of the transverse eigenvalues χ _m,p are obtained. The major attributes of such resonators are expressed by the dependence of χ_m,p on the parameter C-defined as the ratio of the outer to inner radii of the coaxial structure. In that connection, the effect of the corrugation parameters on χ_m,p is particularly investigated on the basis of an expression derived for the slope function dχ_m,p,p/dC. It is shown that the χ_m,p(C) curve may either exhibit oscillatory behavior or present a flat portion over a wide range of C depending on the corrugation parameters chosen. The theory is checked against experiment in which resonant frequencies and total Q factors were measured for TE modes operating in the range of 8-16 GHz in a coaxial cavity with 40 slots. Good agreement is found in that the magnitude of the relative error in frequency is less than 0.5%. Corrugated coaxial resonators prove to be relevant to megawatt gyrotrons where highly selective cavities are required to ensure high conversion efficiency     

Neural network congestion controller in prioritised ATM switch

A neural network (NN) scheme is proposed for congestion control in an ATM switch with time priorities. It is shown that in a prioritised switch it is necessary to monitor the buffer to be controlled as well as buffers with higher priorities. Furthermore, it is shown that the NN scheme in a time prioritised switch gives lower cell loss and delay when compared to the conventional binary scheme     

Nonoperative management of esophageal perforations. Is it justified?

OBJECTIVE: Experiences obtained with nonoperative treatment (NOT), i.e. total prohibition of per oral food intake for a minimum of 7 days, administration of combinations of broad-spectrum antibiotics, and parenteral hyperalimentation, are described in the management of esophageal perforations. SUMMARY BACKGROUND DATA: The place, value, and indication of NOT in the management of esophageal perforation has not yet been unequivocally defined. As a result, contradictory data have been published regarding the outcome of NOT. METHODS: During the past 15 years (1979 to 1994), 20 of 86 patients (23.3%) with esophageal perforation have been treated nonoperatively from the outset. In this group, perforations were located to the upper, middle, and lower third of the esophagus in 50%, 30%, and 20%, respectively. In the operative management group (OT)--in which conservative (drainage, endeprothesis), reconstructive (suture, reinforced suture), and radical (resection) surgical methods were applied--lesions were preponderantly located in the lower one third of the esophagus (56.1%--37/66). As to the interval between the perforation and the onset of treatment, 14 patients had been diagnosed within 24 hours, whereas in 6 cases treatment had been begun beyond 24 hours. RESULTS: NOT could be successfully carried out in 16 patients; the decision to use NOT had to be revised in 4 other cases (Table 1). Two patients were lost; the mortality rate was 10% (2 of 20). The rate of complications was lower in the NOT group (20%, or 4 of 20) than in the OT group (50%, or 33 of 66). CONCLUSIONS: NOT can be suggested for the treatment of intramural perforations. In the case of transmural perforation, this approach should be taken into consideration if the esophageal lesion is circumscribed, is not in neoplastic tissue, is not in the abdominal cavity, and is not accompanied by simultaneous obstructive esophageal disease; in addition, symptoms and signs of septicemia should be absent.     

Estimating the cost of an interview survey using geographic information system software

Estimating the cost of interview surveys is difficult but important. A geographic information system (GIS) was used to determine the shortest time route to survey 533 medical facility locations in Perth. The results provided time and cost estimates for undertaking the survey and the interviewer agreed to a contract for the job on the basis of these estimates.