轨道机车车载储能装置

本文介绍了针对轻轨列车的新型储能装置——新一代牵引变流器MITRAC TC520。该装置安装在MITRAC Energy Saver ES500型号的轻轨列车上。这种新型列车于2009年6月交付运行,目前越来越多这一类型列车由曼海姆公共交通运行商RNV投入商业运行。本文所阐述的使用超级电容的车载储能装置在原型轻轨车上运行超过四年时间,证明了其合理性。本装置可节省30%能量。目前RNV公司在19列轻轨车上装上这种MITRAC节能器,这个成功的项目得到RNV公司客户的一致好评。在地铁列车上安装MITRAC装置最直接的技术效果就是节能,并且减少了第三轨的能量需求,同时可以作为停电时的辅助救援手段保证列车继续运行到下一个车站,保证乘客安全。     

Minnesota Multiphasic Personality Inventory (MMPI) cluster groups among chronically ill patients: relationship to illness adjustment and treatment outcome

Cluster analysis of the MMPI has been utilized widely in the chronic low back pain literature to try to identify reliable patient subtypes predictive of treatment outcome. We extended this methodology to patients with heterogeneous chronic medical conditions by replicating prototypic MMPI cluster group profiles and by relating cluster groups to clinical baseline and outcome data. Subjects were two independent samples (n = 254 and n = 263) of chronically ill patients admitted to an inpatient medicine/psychiatry unit. Using a four-cluster solution, similar cluster profile groups were replicated in both samples. Consistent differences emerged between cluster groups on functional impairment, psychiatric diagnoses, depression, and psychosomatic symptoms. Cluster group membership also predicted changes in functional impairment and depression six months after treatment. Results are discussed in terms of similarities between chronic low back pain and chronic illness and tailoring treatment to different patient types.     

Outcome measures for low back pain research. A proposal for standardized use

STUDY DESIGN: An international group of back pain researchers considered recommendations for standardized measures in clinical outcomes research in patients with back pain. OBJECTIVES: To promote more standardization of outcome measurement in clinical trials and other types of outcomes research, including meta-analyses, cost-effectiveness analyses, and multicenter studies. SUMMARY OF BACKGROUND DATA: Better standardization of outcome measurement would facilitate comparison of results among studies, and more complete reporting of relevant outcomes. Because back pain is rarely fatal or completely cured, outcome assessment is complex and involves multiple dimensions. These include symptoms, function, general well-being, work disability, and satisfaction with care. METHODS: The panel considered several factors in recommending a standard battery of outcome measures. These included reliability, validity, responsiveness, and practicality of the measures. In addition, compatibility with widely used and promoted batteries such, as the American Academy of Orthopaedic Surgeons Lumbar Cluster were considered to minimize the need for changes when these instruments are used. RESULTS: First, a six-item set was proposed, which is sufficiently brief that it could be used in routine care settings for quality improvement and for research purposes. An expanded outcome set, which would provide more precise measurement for research purposes, includes measures of severity and frequency of symptoms, either the Roland or the Oswestry Disability Scale, either the SF-12 or the EuroQol measure of general health status, a question about satisfaction with symptoms, three types of "disability days," and an optional single item on overall satisfaction with medical care. CONCLUSION: Standardized measurement of outcomes would facilitate scientific advances in clinical care. A short, 6-item questionnaire and a somewhat expanded, more precise battery of questionnaires can be recommended. Although many considerations support such recommendations, more data on responsiveness and the minimally important change in scores are needed for most of the instruments.     

Preventing disability from work-related low-back pain. New evidence gives new hope--if we can just get all the players onside

Tumor necrosis factor (TNF) is a proinflammatory cytokine playing a central role in the expression of endothelial adhesion molecules required for the recruitment of inflammatory cells. Proliferative glomerulonephritis induced by anti-glomerular basement membrane (GBM) antibody is characterized by the recruitment of inflammatory cells in the glomerulus followed by capillary damage and crescent formation. The glomerular pathology may be due to a large extent to TNF induction. We therefore tested this hypothesis in TNF-deficient mice. Anti-GBM antibody administration in sensitized wild-type mice resulted in deposition of immune complexes, followed by increased intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) expression, as well as the influx of polymorphonuclear neutrophils (PMNs), lymphocytes, and macrophages. Distinct proteinuria preceded proliferative glomerulonephritis characterized by crescent formation. In the absence of TNF, the development of proteinuria was delayed and the formation of crescents was almost completely prevented. Although the deposition of immune complexes in glomeruli was comparable in both groups, the up-regulation of ICAM-1 and VCAM-1, as well as the influx of PMNs and lymphocytes, but not of monocytes, was dramatically reduced in TNF-deficient mice. Therefore, we conclude that TNF plays a key role in the recruitment of inflammatory cells and in the subsequent development of proliferative glomerulonephritis.     

Patient based methods for assessing adverse events in clinical trials in rheumatology. Progress report for the OMERACT Drug Toxicity Working Party. Outcome Measures in Rheumatology

There has been increasing recognition in recent years that the measurement of drug related toxicities in rheumatology clinical trials has been sub-optimal. The OMERACT Drug Toxicity Working Party was established to address this issue. The first task of the working party was to identify a minimum set of attributes of drug related toxicity that would be important to patients, clinicians, investigators, and policymakers. The working party then developed consensus on a standard set of properties for instruments to measure these attributes. Existing instruments in the field of rheumatology were ascertained by literature review and by contact with experts in the field. Four instruments were ascertained and evaluated using the guidelines developed by the working party. This report outlines the progress and preliminary results of these activities.     

Salsalate, a nonacetylated salicylate, is as efficacious as diclofenac in patients with rheumatoid arthritis. Salsalate-Diclofenac Study Group

OBJECTIVE: To investigate the efficacy of salsalate, a nonacetylated salicylate, in the treatment of patients with rheumatoid arthritis (RA). METHODS: Three hundred and one patients meeting the ACR criteria for RA were drawn from 16 centers. After withdrawal of nonsteroidal antiinflammatory drugs (NSAID) and subsequent flare, patients were randomized to receive either salsalate or diclofenac for 8 weeks, according to a double blind, double dummy protocol. Initial doses of salsalate 3.0 g/day and diclofenac 75 mg/day were titrated for the first 5 weeks. The primary outcome measure was a multivariate analysis at 8 weeks of tender joint count, pain, visual analog scale score, and physician's global assessment. RESULTS: One hundred and ninety patients completed the study. The mean stabilized dose of salsalate was 3.55 g/day, and that of diclofenac 112 mg/day. Discontinuations were due to lack of efficacy (17 salsalate vs 15 diclofenac); adverse events [19 salsalate (mainly tinnitus and hearing loss; p = 0.0001 and p = 0.04, respectively) vs 9 diclofenac]; laboratory abnormalities (3 salsalate vs 1 diclofenac); and other reasons, including protocol violations, intercurrent illness, and personal factors (24 salsalate vs 23 diclofenac). Both treatments produced significant improvement from flare (p < 0.0001). Post hoc power analysis showed that the study had sufficient power (0.60 to 0.90) to detect clinically important differences between the 2 drugs in the primary outcome measures; however, no statistically significant (p = 0.29) or clinically important treatment differences were recorded. Other than a difference in erythrocyte sedimentation rate that favored salsalate, there were no significant differences in secondary outcome measures between the 2 groups. All outcomes showed a tendency for more improvement with salsalate. CONCLUSION: Salsalate is as efficacious as diclofenac. Salsalate may be considered an alternative to other NSAID in the first line treatment of patients with RA.     

A randomized controlled trial to assess the incidence of new onset hypertension in patients after shock wave lithotripsy for asymptomatic renal calculi

PURPOSE: To answer the question of whether extracorporeal shock wave lithotripsy (ESWL*) induces hypertension, a prospective, randomized controlled trial of normotensive patients with asymptomatic renal calculi was designed. MATERIALS AND METHODS: Patients were randomized to receive immediate ESWL versus observation, reserving ESWL for the onset of symptoms. The rates of new onset hypertension were evaluated for both groups. RESULTS: There was no observed difference in the incidence of hypertension between the treatment and observation groups. CONCLUSIONS: The risk of hypertension in patients undergoing ESWL therapy is similar to that of a control cohort of initially observed asymptomatic patients.     

Assessment of depressive symptoms during inpatient rehabilitation for spinal cord injury: Is there an underlying somatic factor when using the PHQ?

Objective: To test the hypothesis that a 2-factor solution, including a somatic factor, best accounts for the response pattern to the Patient Health Questionnaire-9 (PHQ-9) during inpatient rehabilitation after spinal cord injury (SCI). Research Design: 568 adults with traumatic SCI were administered the PHQ-9 during inpatient rehabilitation. The PHQ-9 was developed to identify depressive disorders based on DSM-IV criteria. Results: Maximum likelihood confirmatory factor analysis was used to compare unidimensional and alternative 2-factor models. The results suggested that the 2-factor solution with 3 somatic items (sleep disturbance, poor energy, appetite change) was a better solution than either a unidimensional model or 2-factor model that included psychomotor retardation as a fourth somatic item. The root mean square error of approximation with 3 somatic items fell within the acceptable range of less than .08 (.073). The 2 factors were highly correlated (.76) but within the acceptable range (less than .80). Conclusions: There may be 2 underlying factors with the PHQ-9, including a somatic factor, when measuring depressive symptoms during inpatient rehabilitation for SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for alcoholism among persons with recent traumatic brain injury.

This study examined the clinical utility of various brief screening procedures for identifying persons with a prior history of alcoholism among patients with recent traumatic brain injury (TBI). Participants were 50 patients assessed for various aspects of alcohol use and abuse during their acute rehabilitation hospitalization. Predictive indicators were tested against the Michigan Alcoholism Screening Test (MAST) as the criterion measure. Results indicated the 13-item Short Michigan Alcoholism Screening test is a good proxy for the longer MAST in this population. The two screening questions by M. Cyr and S. Wartman (1988) also have some limited utility. Practical implications of the results are discussed with a view toward adopting universal screening for alcoholism among persons with recent TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)