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Immune thrombocytopenia (ITP) is an autoimmune disease causing platelet destruction, and is a common cause of symptomatic thrombocytopenia in children. Intravenous immune globulin (IVIG) is a treatment for ITP that increases the platelet counts of most patients within 24 to 48 hours. This study aimed to calculate the rate of rise in pediatric ITP after a dose of IVIG and to analyze if patient characteristics affected the rate. For 116 children treated for ITP with IVIG at Hershey Medical Center, the rate of rise of the platelet count for all patients was calculated. The rate of rise ranged from -0.1 to +4.2 K/µL/hour (average 1.3, median 1.2). 78% of patients had a rate of rise of over 0.5 K/µL/hour. There was a statistically significant correlation between the rate rise of the platelet count and the initial platelet count (P=0.0197), but rate was not affected by age or sex. This study was able to demonstrate that IVIG is effective in most patients and that demographic features do not affect the rate of rise. By providing a nomogram showing when to expect a meaningful rise in the platelet count after IVIG, we give guidance for timing of the postinfusion platelet count to avoid administering a second dose. Future studies are needed to test this nomogram prospectively.

INTRODUCTION. Previous research has predominately relied on person-level or single characteristics of drinking episodes to characterise patterns of drinking that may confer risk. This research often relies on self-report measures. Advancements in wearable alcohol biosensors provide a multi-faceted objective measure of drinking. The current study aimed to characterise drinking episodes using data derived from a wearable alcohol biosensor. METHODS. Participants (n = 45) were adult heavy drinkers who wore the Secure Continuous Remote Alcohol Monitoring (SCRAM) bracelet and reported on their drinking behaviours. Cluster analysis was used to evaluate unique combinations of alcohol episode characteristics. Associations between clusters and self-reported person and event-level factors were also examined in univariable and multivariable models. RESULTS. Results suggested three unique clusters: Cluster 1 (most common, slowest rate of rise to and decline from peak), Cluster 2 (highest peak transdermal alcohol concentration and area under the curve) and Cluster 3 (fastest rate of decline from peak). Univariable analyses distinguished Cluster 1 as having fewer self-reported drinks and fewer episodes that occurred on weekends relative to Cluster 2. The effect for number of drinks remained in multivariable analyses. DISCUSSION AND CONCLUSIONS. This is the first study to characterise drinking patterns at the event-level using objective data. Results suggest that it is possible to distinguish drinking episodes based on several characteristics derived from wearable alcohol biosensors. This examination lays the groundwork for future studies to characterise patterns of drinking and their association with consequences of drinking behaviour.

Microbubbles (MBs) are optimal ultrasound contrast agents because their unique acoustic response allows for exquisite sensitivity in vivo. This unique response is derived from MBs’ elasticity that allows them to oscillate differently from surrounding tissues. While the main use of MBs in the clinic is for cardiac and perfusion imaging, imparting MBs with bioresponsive properties would expand their use to detect pathophysiologic changes. This can be achieved by damping MBs’ oscillations to silence their signal and rescuing it when they encounter the biomarker of interest to improve detection and specificity of diseases such as deep vein thrombosis (DVT). Here, we demonstrate that conjugating perfluorobutane-filled MBs with hyaluronic acid (HA) and cross-linking HA with biodegradable linkers eliminates harmonic signal because of increased MB stiffness and decreased oscillation. In this proof-of-concept study, we used a reversible pH-sensitive cross-linker to establish and validate this targeted and activatable pH-sensitive MB (pH-MB) platform. Conjugation of HA to MBs and targeting of pH-MBs to CD44-positive cells were validated. Harmonic signal loss due to stiffening of pH-MBs’ shell was confirmed using a clinical ultrasound scanner equipped with Cadence contrast pulse sequencing. pH-MBs imaged before and after acidification increased harmonic signal fivefold. Because the cleavage of the cross-linker we used is reversible, harmonic signal was silenced again when the acidic suspension was neutralized, confirming that harmonic signal is dependent on the cross-linked HA. The rate of rise and the magnitude of harmonic signal increase could be manipulated by varying the phospholipid composition and the number of HA cross-linkers, indicating that the platform can be tuned to the desired response needed. In this study, we established the feasibility of using targeted and activatable MBs and plan to apply this platform to aid in the diagnosis and management of patients with DVT and potentially other conditions.

To assess the postnatal rate of rise (ROR) of total serum bilirubin (TSB) in very low birth weight (VLBW) preterm infants, to determine risk factors associated with a rapid rise (>90th percentile), and to compare ROR and hour-specific TSB at postnatal 12–48 h with data of term infants retrieved from the literature. Retrospective analysis of 2430 routine TSB concentrations obtained between birth and initiation of phototherapy in 483 VLBW infants. TSB increased by a median (interquartile range) ROR of 0.15 (0.11–0.19) mg/dL/h. The 50th percentile of TSB was below the 40th percentile of (near-)term counterparts at 12–48 h. TSB ROR correlated with the age at initiation (RS = −0.687; p 90th percentile (>0.25 mg/dL/h) was associated with lower gestational ages [27.2 (25.4–29.3) vs. 28.4 (26.4–30.4) weeks], lower birth weights [978 (665–1120) vs. 1045 (814–1300) g], and lower 5-min Apgar scores [7 (7–8) vs. 8 (7–9)]. ROR of TSB is an indicator for early and prolonged phototherapy. While hour-specific TSB and ROR at 12–48 h are lower than those reported for (near-)term infants, TSB appears to rise more rapidly in infants with low gestational age, low birth weight, and low 5-min Apgar score.

BACKGROUND AND OBJECTIVES: Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine phototherapy recommendations. Our objective was to evaluate predictive models that incorporate the difference between the last total serum bilirubin (TSB) before discharge and the American Academy of Pediatrics phototherapy threshold (Δ-TSB) to predict a postdischarge TSB above the phototherapy threshold by using a single graph. METHODS: We studied 148 162 infants born at ≥35 weeks’ gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017 whose TSB did not exceed phototherapy levels and who did not receive phototherapy during the birth hospitalization. We compared 3 logistic models (Δ-TSB; Δ-TSB-Plus, which included additional variables; and the Bhutani Nomogram) by using the area under the receiver operating characteristic curve (AUC) in a 20% validation subset. RESULTS: A total of 2623 infants (1.8%) exceeded the phototherapy threshold postdischarge. The predicted probability of exceeding the phototherapy threshold after discharge ranged from 56% for a predischarge Δ-TSB 0 to 1 mg/dL below the threshold to 0.008% for Δ-TSB >7 mg/dL below the threshold. Discrimination was better for the Δ-TSB model (AUC 0.93) and the Δ-TSB-Plus model (AUC 0.95) than for the Bhutani Nomogram (AUC 0.88). CONCLUSIONS: The use of Δ-TSB models had excellent ability to predict postdischarge TSB above phototherapy thresholds and may be simpler to use than the Bhutani Nomogram.

Central systolic blood pressure (cSBP, the peak of the central waveform) is usually regarded as the determinant of peripheral systolic blood pressure with amplification of peripheral systolic blood pressure (pSBP) measured with reference to cSBP. However, the earlier portion of the central waveform up to the first systolic shoulder (P1) may be the major determinant of pSBP. We performed in silico simulation studies and examined previously acquired experimental data (n = 131) in which peripheral and central blood pressure waveforms had been acquired both invasively and noninvasively to examine the determinants of pSBP. Measurements were made at baseline and during perturbation of hemodynamics by inotropic and vasoactive drugs. In silico simulations using a central-to-peripheral transfer function demonstrated that pSBP is dependent on P1 and the rate of change (dP/dt) of central pressure up to the time of P1 but not cSBP. In computational simulations, peripheral reflection in the radial artery was closely related to dP/dt, and 97% of the variability in amplification as measured with reference to P1 was explained by dP/dt. In vivo, amplification of pSBP over P1 was correlated with dP/dt (R > 0.75, P < 0.0001 for all data sets), and P1 and dP/dt were independently correlated with pSBP, explaining 90% of the variability in pSBP. We conclude that P1 and dP/dt are major determinants of pSBP and that pSBP and cSBP are, in part, determined by different cardiac, central, and peripheral vascular properties.NEW & NOTEWORTHY Peripheral systolic BP is determined mainly by the first shoulder and the rate of rise of the central systolic blood pressure waveform rather than the peak of this waveform (central systolic BP). Peripheral and central systolic blood pressure are determined by different cardiac and vascular properties.

Purpose To compare real-time intraocular pressure (IOP) response to occlusion break event in 2 phacoemulsification systems. Setting Iladevi Cataract and IOL Research Center, India. Design Randomized, experimental study. Methods Rabbits were randomized to:Group I (n = 10 eyes), Centurion Vision system with active fluidics, or, Group II (n = 10 eyes), Centurion with Active Sentry. Within each group, parameter set 1 (IOP 30 mm Hg, aspiration flow rate [AFR] 20 mL/min, and vacuum 600 mm Hg) and parameter set 2 (IOP 50 mm Hg, AFR 25 mL/min, and vacuum 600 mm Hg) were tested. Real-time rate of drop and rise of IOP after occlusion break event (mm Hg per second) and percentage reduction of IOP from maximum during nuclear fragment removal were compared. Results 10 rabbits (20 eyes) were included. Rate of drop of IOP after occlusion break was not significantly different between groups. Rate of rise of IOP was statistically significantly higher in Group II with both parameter sets (199.09 ± 69.28 vs 94.33 ± 45.66 in parameter set 1, P = .006; and 256 ± 45.05 vs 165.25 ± 51.80 in parameter set 2, P = .005), suggesting faster recovery to baseline IOP after occlusion break. The mean percentage reduction of IOP from maximum was significantly higher in Group I (P = .003). Conclusions Rise of IOP to baseline after occlusion break event was faster and mean percentage reduction of IOP from maximum during nuclear fragment removal was lower when using the Centurion Vision system with the Active Sentry upgrade compared with the traditional handpiece. The ability to sense IOP at the level of the handpiece with the Active Sentry upgrade allows faster mitigation of surge response.

Objectives To study trends in Bacillus Calmette-Guerin (BCG) utilization for nonmuscle invasive bladder cancer (NMIBC) before and during national BCG shortages. Methods The National Cancer Database was used to identify patients with localized NMIBC. Multivariate logistic regression was used to assess factors associated with BCG use. Temporal trends in BCG use were studied using segmented regression analysis. Results We identified 238,279 patients with NMIBC from 2004 to 2015. Overall, 33,660 (14.1%) patients with NMIBC received intravesical BCG during the study period. Segmented regression revealed a slower rate of rise of BCG utilization following major supply interruptions in 2011 and 2012 (2004-2012: +0.62% increase per year [P Conclusions BCG utilization for NMIBC increased significantly over the study period, possibly representing increased adoption of national guidelines for BCG in NMIBC. In the years following interruptions in BCG supply, BCG use appears to have been rationed based on clinical risk, with the steepest declines in BCG use occurring in the lowest risk patients.

Background and ObjectivesWhile the number of detected COVID-19 infections are widely available, an understanding of the extent of undetected COVID-19 cases is urgently needed for an effective tackling of the pandemic and as a guide to lifting the lockdown. The aim of this work is to estimate and predict the true number of COVID-19 (detected and undetected) infections in India for short to medium forecast horizons. In particular, using publicly available COVID-19 infection data up to 28th April 2020, we forecast the true number of infections in India till the end of lockdown (3rd May) and five days beyond (8th May).MethodsThe high death rate observed in most COVID-19 hit countries is suspected to be a function of the undetected infections existing in the population. An estimate of the age weighted infection fatality rate (IFR) of the disease of 0.41%, specifically calculated by taking into account the age structure of Indian population, is already available in the literature. In addition, the recorded case fatality rate (CFR= 1%) of Kerala, the first state in India to successfully flatten the curve by consistently reporting single digit new infections from 12-20 April, is used as a second estimate of the IFR. These estimates are used to formulate a relationship between deaths recorded and the true number of infections and recoveries. The estimated undetected and detected cases time series based on these two IFR estimates are then used to fit a discrete time multivariate infection model to predict the total infections at the end of the formal lockdown period.ResultsOver three consecutive fortnight periods during the lockdown, it was noted that the rise in detected infections has decreased by 8.2 times. For an IFR of 0.41%, the rise in undetected infections decreased 2.5 times, while for the higher IFR value of 1%, undetected cases decreased by 2.4 times. The predicted number of total infections in India on 3rd May for both IFRs varied from 2.8 - 6.8 lakhs.Interpretation and ConclusionsThe behaviour of the undetected cases over time effectively illustrates the effects of lockdown and increased testing. From our estimates, it is found that the lockdown has brought down the undetected to detected cases ratio, and has consequently dampened the increase in the number of total cases. However, even though the rate of rise in total infections has fallen, the lifting of the lockdown should be done keeping in mind that 2.3 to 6.4 lakhs undetected cases will already exist in the population by 3rd May.

This paper deals with experimental and numerical investigation on thermal stratification phenomenon conducted in a scaled transparent pool using Particle Image Velocimetry (PIV) technique and Computational Fluid Dynamics (CFD) simulations respectively. Experiments were designed to simulate thermal stratification in a pool with an immersed heat exchanger. In general, pools with an immersed heat exchanger tend to get thermally stratified; preventing mixing and participation of the whole pool during the heat removal process. The study presented in the paper, focuses on quantification of thermal stratification in the pool without shrouds and examines the effect of shrouds on suppression of thermal stratification. The installation of three shrouds divides the pool in four compartments and ensures participation of the whole pool inventory in the heat removal process. In all the four compartments, pool water circulation was observed since the beginning of the heat transfer from the heater. In a three-shroud configuration, because of mixing, rate of rise of temperature of water near the top decreases.

Neonatal jaundice is observed during 1st week of life in approximately 60% of term infants and 80% of preterm infants. All jaundiced newborns are at potential risk for developing severe hyperbilirubinemia if there is uncontrolled or managed inappropriately. The objective of this study is to compare serum bilirubin level of term and preterm babies. A cross-sectional study was conducted with total of 100 newborns babies who were admitted into neonatal unit, babies from obstetric department and who came for checkup and follow up in neonatal unit of Mymensingh Medical College Hospital, Mymensingh during the period August 2006 to January 2007. In this study, mean gestational age of term babies was 38.9±1.22 weeks and of preterm babies was 34.64±1.05 weeks. Mean bilirubin levels observed in term babies 6.68 and 5.72 mg/dl on day 3 and day 5 respectively. In preterm babies, the mean bilirubin levels were 7.16 and 9.09 mg/dl on day 3 and day 5 respectively. Statistically significant differences were observed in bilirubin level on day 5 in both term and preterm groups (p

Background:To assess cardiovascular risk among various hemoglobin (Hb) rates of rise (RoR) in chronic kidney disease (CKD) patients with anemia who have initiated therapy with erythropoiesis stimulating agents (ESAs).Methods:Observational cohort of CKD patients initiating ESA therapy from the Centricity®database, 1990–2011. Proportional hazards models tested the hypothesis that a slower Hb RoR (0 < g/dl/month ⩽ 0.125) is associated with a lower cardiovascular (CV) incidence [composite of fatal/nonfatal myocardial infarction (MI) and stroke] compared with faster RoR (0.125 < g/dl/month ⩽ 2.0, and >2.0 g/dl/month).Results:A total of 9220 patients receiving ESAs were followed for an average of 3.1 years. Slow (group B) RoR versus medium (group C′) and fast (group D′) RoR in Hb, throughout all Hb milestones, was associated with lower risk of the composite endpoint [B (slow) versus D′ (fast) [hazard ratio (HR) = 0.20 (0.11, 0.39), p < 0.0001]; B versus C′ (medium) [HR = 0.34 (0.19, 0.62), p = 0.0004], and C′ versus D′ [HR = 0.60 (0.42, 0.85), p = 0.005]]. Within achieved Hb milestones, HRs were: B versus D′ at milestone ⩾ 14.1 g/dl [HR = 0.17 (0.05, 0.56); p = 0.004] and at milestone 12.6−14.0 [HR = 0.18 (0.07, 0.46), p = 0.0004].Conclusion:Rapid Hb rise is associated with adverse CV outcomes, with markedly lower risk for rates below a threshold trajectory of 0.125 g/dl/month, even with complete correction.

Background Concern exists over exponential growth in cardiac imaging in adults, but there is paucity of such data for cardiac imaging trends in pediatric patients. The aims of this study were to determine temporal trends in the use of noninvasive cardiac imaging and compare these with trends in the use of noncardiac imaging and to identify factors influencing those trends using the Pediatric Health Information Service database. Methods Pediatric inpatient encounter data from January 2004 to December 2017 at 35 pediatric hospitals were extracted from the Pediatric Health Information Service database. Temporal imaging utilization trends in cardiac and noncardiac ultrasound or echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) were assessed using linear mixed-effects models. Models were adjusted for case-mix index, complex chronic conditions, patient age, length of stay, payer source, and cardiac surgical volume. Results A total of 5,869,335 encounters over 14 years were analyzed (median encounters per center per year, 11,411; median patient age, 4 years; median length of stay, 3 days). From 2004 to 2017, the rates of pediatric inpatient cardiac and noncardiac ultrasound and MRI increased, whereas the rate of noncardiac CT decreased. Cardiac CT use increased beginning in 2014 (+0.264 cardiac CT encounters per 1,000 encounters per year), surpassing the rate of rise of cardiac MRI. Case-mix index, cardiac surgical volume, and payer source affected the largest number of imaging trends. Conclusions Among pediatric inpatients, utilization of cardiac and noncardiac ultrasound and MRI has steadily increased. Noncardiac CT use declined and cardiac CT use increased after 2014. Factors influencing imaging trends include case-mix index, cardiac surgical volume, and payer source. This study lays a foundation for investigations of imaging-related resource utilization and outcomes among pediatric inpatients.

Background Intestinal failure-associated liver disease (IFALD), a multifactorial disease, is common among infants with gastrointestinal surgical disorders (GISDs). Prolonged soy-based intravenous lipid emulsion (S-ILE) intake is associated with IFALD, but preventive studies of limiting S-ILE have been inconclusive. Furthermore, a double-blind, randomized preventive trial (DBRPT) of S-ILE intake has not been performed in infants with GISDs. Our objective was to compare the effect of 1 g/kg/d vs 2 g/kg/d S-ILE intake for 6 weeks on the incidence of IFALD and the rate of rise of direct bilirubin (DB) in infants with GISDs. Methods A DBRPT was conducted in infants with GISDs at ≥34 weeks' gestational age (GA) admitted to the NICU within 72 hours after birth. Infants were randomized in a 1:1 ratio to receive either 1 or 2 g/kg/d S-ILE for 6 weeks. IFALD was defined as DB ≥2 mg/dL. Results Forty infants were studied. The 2 groups had similar clinical characteristics except for GA and blood group incompatibility. Thirty percent of infants in each group developed IFALD (P = .94). However, infants in the group receiving 1 g/kg/d S-ILE (n = 20) had a lower rate of rise of DB compared with infants in the group receiving 2 g/kg/d S-ILE (n = 20). Conclusions Reducing S-ILE intake for 6 weeks in infants with GISD at ≥34 weeks' GA may not prevent IFALD. The extrapolated data on the rate of rise of DB suggest a possible risk of earlier development of IFALD with S-ILE intake of 2 g/kg/d, as compared with 1 g/kg/d, beyond the 6-week study period.

Aim of the Study Elevation of the head and thorax (HUP) during cardiopulmonary resuscitation (CPR) has been shown to double brain blood flow with increased cerebral perfusion pressures (CerPP) after active compression-decompression (ACD) CPR with an impedance threshold device (ITD). However, the optimal angle for HUP CPR is unknown. Methods In Study A, different angles were assessed (20°, 30°, 40°), each randomized over 5-min periods of ACD + ITD CPR, after 8 min of untreated ventricular fibrillation in an anesthetized swine model. Based upon Study A, Study B was performed, where animals were randomized to 1 of 2 sequences: 20°, 30°, 40° or 40°, 30°, 20° with a similar protocol. The primary endpoint was CerPP for both studies. Results In Study A, no optimal HUP angle was observed in 18 pigs. CerPPs for 30° and 40° (mmHg, mean ± SD) were equivalent (44 ± 22 and 47 ± 26, p = 0.18). However, CerPP appeared higher when 40° HUP was performed during the last 5-min of CPR, suggestive of a sequence effect. For Study B, after 17 min of CPR, CerPP (mmHg) were higher with the 20°, 30°, 40° sequence: 60 ± 17 versus 33 ± 18 (p = 0.035). Conclusions No optimal HUP CPR angle was observed. However, controlled progressive elevation of the head and thorax during CPR is more beneficial than an absolute angle or height to maximize CerPP. Further studies are needed to determine the optimal rate of rise during HUP ACD + ITD CPR. Institutional Protocol Number 17-06.

Background As compared to term neonates, those < 35 weeks gestation (wks GA) are at greater risk for both acute and chronic bilirubin encephalopathy (ABE, CBE). Among these with postnatal total bilirubin rate of rise, (TB ROR) at age 0 to 72 hours has been observed because of either loss placental elimination system or increased postnatal production due to hemolysis. The ranges are known to vary > 8.5 umol/L/h in neonates with Rh disease to >3.4 umol/L/h at the 95th percentile track of the hour-specific nomogram. TB ROR in healthy term neonates is Objectives To determine the GA ranges on TB ROR to explore predictive TB ROR in preterm neonates who are more vulnerable with each Design/Methods A multi-site observational study to quantify TB ROR in preterm infants between 28 to 35 weeks. 1804 infants born between January 2013- March 2018 at 28–35 wks GA from three canadian perinatal centres were included and those with Rh disease were excluded. Analysis included infants >27 weeks with at least one TB prior to the initiation of treatment for severe hyperbilirubinemia treatment. Feeding patterns, birth history and maternal health conditions were documented. Results The TB ROR were compared by two prematurity GA groups (28–31 weeks and 32–35 weeks) then per individual gestational age in four time periods in hours, 0–24, 24–48, 48–96, and 96 -120 in 1049 preterm infants using 3065 TB samples. Infants Conclusion Though TB ROR were of similar patterns between prematurity groups (28–31 weeks and 32–35 weeks) it was at higher rate of rise between 13–36 hours and decreasing from 36–72 hours, with a plateau after 72 hours of age. There was a significant difference in the magnitude of TB ROR between prematurity groups at 0–24 hours. Additional research into the clinical care impact on the TB ROR should be conducted to study impact of production and elimination.

Objective: To evaluate the efficacy of a single intravenous (IV) dose of anti-D in severe thrombocytopenia ( Materials and Methods: An open label, investigator-initiated, randomized interventional study was conducted that included thirty dengue patients (all positive for IgM enzyme-linked immunosorbent assay) with severe thrombocytopenia ( 3 ). Patients were randomized to receive anti-D (50 μg/kg single IV dose) plus supportive therapy or supportive therapy alone. Results: The rate of rise in platelet count was significantly high in the intervention group at 24, 36, and 48 h. At the end of 48 h, 60% patients in the intervention group achieved a platelet count of ≥50,000/mm 3 as compared to 6.7% in the control group ( P = 0.0019). The requirement of the platelet concentrate infusion in the control group was significantly higher, i.e. 342 ml (±193) as compared to the intervention group requiring only 187 ml (±79). The intervention group showed a significant improvement in bleeding manifestations in all the patients by 24 h in Grade 2 bleed ( P = 0.032) and by 48 h in Grade 1 bleed ( P = 0.014). Conclusions: Severe thrombocytopenia (≤20,000/mm 3 ) secondary to DEV infection was rapidly and safely reversed by administration of a single dose of 50 μg/kg (250 IU/kg) anti-D IV.

A two-channel configured analog microcircuit, intended for applications in optoelectronic devices of space equipment, is created on complementary bipolar transistors. The different combination of microcircuit pins and connection of external RC-elements allow one to create several analog units with specified values of the conversion coefficient of the input signal, bandwidth, rate of rise, and consumed current. The maximal gain of the microcircuit with an open negative feedback loop exceeds 75 dB, and the bandwidth at the 20-fold gain is more than 19.4 MHz. The circuit designs of separate stages of the microcircuit and experimental characteristics are given.

[Purpose] To clarify the characteristics of postural control in badminton players by examining their lower-limb muscle activity during upper-limb elevation. [Subjects and Methods] Fourteen badminton players and 14 non-players were studied. The subjects were instructed to perform an upper-limb elevation task in order to measure the activities of the biceps femoris and biceps brachii. [Results] When elevating the dominant hand, the mean biceps femoris integrated electromyogram showed markedly higher values in the player group, for the contralateral compared with the ipsilateral leg. Similarly, when elevating the dominant hand, the difference in the maximum integrated electromyogram response time between the ipsilateral and contralateral legs was significantly smaller in the players compared with non-players. [Conclusion] It may be possible to reduce the time needed to elevate the dominant hand by shifting lower-limb activity from the ipsilateral to the contralateral leg more quickly, while increasing the rate of rise in contralateral leg muscle activity.

A new model to simulate return stroke lightning current is presented. The idea for the model arose from the observation that measured lightning current has two quite different parts (fast rise and slow decay). Experimental measurement differentiates three segments in the rising portion: 1) increasing rate of rise, 2) relatively constant rate of rise, and 3) decreasing rate of rise. We propose two functions to represent the return stroke current waveshape, which closely resemble the first and the third segments, and compare them with previously developed models. In fact, we develop two versions of the proposed model: 1) version A: which creates waveshapes close to the waveshapes obtained by the model given in International Standard IEC 62305-1, and 2) version B: which creates waveshapes more similar to the mean waveshapes obtained by the measurement. It is worth pointing out that in both versions we can calculate model parameters using simple formulas.

Closed vessel firing of gun propellant at different loading densities is conducted for evaluation of its ballistic parameters. Although in actual gun applications, loading densities are higher, but for closed vessel evaluation standard loading density is taken as 0.2 g/cc for interior ballistic calculations of guns. Closed vessel evaluation of standard triple-base propellant in hepta-tubular configuration with loading density varying in the range of 0.2 g/cc to 0.3 g/cc is conducted for the evaluation of salient ballistic parameters. It is observed that maximum pressure increases with increase in loading density of propellants. As loading density increases, rate of rise of pressure also increases. Accordingly, a rise in burning rate is also observed. However, the burning rate index (α) and coefficient (β) of the power law of burning (r = βP α ) is found independent of loading density. The average values of these burning rate parameters are calculated as (α =) 0.78 and (β =) 0.45 for the studied propellant. Defence Science Journal, Vol. 65, No. 2, March 2015, pp.126-130, DOI:http://dx.doi.org/10.14429/dsj.65.8158

Objective The aim of this study is to determine whether a transcutaneous bilirubin (TcB) value obtained within 6 hours of birth (early transcutaneous bilirubin [ETcB]) either alone, or used to calculate an early rate of rise (E-ROR) in TcB, will identify those neonates who are at a higher risk for subsequent jaundice. Study Design ETcB values were obtained from a convenience sample of neonates admitted to the newborn nursery. E-ROR was calculated as the average hourly increase between ETcB and subsequent TcB obtained at 18 to 36 hours of age. TcB percentile values at various ages were obtained from a previously published and cross-validated nomogram. The predictive values relating ETcB, E-ROR, and TcB at 18 to 36 hours of age to TcB at 42 to 66 hours of age were determined, and receiver-operator characteristic curves were compared. Results A total of 516 late preterm and term neonates were studied. ETcB was higher ( p = 0.003) in those neonates who subsequently received phototherapy ( n = 15), and negative predictive value was always ≥ 0.96; positive predictive value (PPV) ranged from 0.04 to 0.06. Compared with ETcB, TcB at 18 to 36 hours was more likely to predict significant jaundice at 42 to 66 hours of age. Conclusion Given the observed low PPV, ETcB is not useful in identifying infants who develop subsequent hyperbilirubinemia. However, it may be helpful in identifying those neonates at a low risk of subsequent hyperbilirubinemia.

The present work deals with studying fatigue life and electrical properties of chip-on-glass (COG) assemblies undergoing the coupling loads of temperature, electrical current and hygrothermal stress by shear fatigue tests. Firstly, as the COG assemblies are exposed in hygrothermal environment, an increased hygrothermal aging time leads to an increased relative resistance of COG assemblies. Secondly, during the fatigue experiments, the fatigue life of COG assemblies decreases with an increase of hygrothermal aging time. The change of relative resistance displays different trends under different aging degrees. When the hygrothermal aging time is less than 96 h, the relative resistance increases rapidly in the initial stage, then the rate of rise decreases subsequently, and finally the relative resistance falls to a stable value suddenly. By contrast, the relative resistance of COG assemblies having more than 168 h hygrothermal aging increases rapidly with increasing fatigue cycles. Owing to the effects of hygrothermal aging and fatigue on the change of assemblies’ resistance, the total of relative resistance increases with increasing hygrothermal aging time. Finally, the hygrothermal aging damage defined as life reduction after degradation aggravates exponentially with aging time on the basis of the Miner’s linear damage rule. The fatigue life prediction model based on the Miner’s linear damage rule and the Basquin’s equation is proposed and yielded to good prediction for the COG assemblies undergoing hygrothermal aging.

AIM To identify neonates at risk of haemolytic hyperbilirubinaemia through near-concurrent measurements of total serum/plasma bilirubin (TB) or transcutaneous bilirubin (TcB) and end-tidal breath carbon monoxide (CO), corrected for ambient CO (ETCOc), an index of bilirubin production and haemolysis. METHODS Paired TB/TcB (mg/dL) and ETCOc (ppm) measurements were obtained in newborns (n = 283) at 20 to

Background and objective The incidence of diabetes has been on the rise and the rate of rise since the turn of this century has been phenomenal. One of the various battling issues faced by diabetics all over the globe is the management of diabetic wounds. Currently, there are several management strategies to deal with the treatment of diabetic wounds. The conventional methods have several limitations. One of the major limitations is the rate and progression of healing of a diabetic wound when adopting a conventional diabetic wound management therapy. Lately, several nano techniques and nano products have emerged in the market that offer promising results for such patients. The treatment outcomes are achieved more efficiently with such nanomedical products. Methods This review attempts to consider the currently available nanotechnological applications in the management of diabetic wounds. We take a deeper look into the available nanotherapeutic agents and the different nanocarriers that could be used in the management of diabetic wound healing. Lately, researchers around the globe have started providing evidences on the effective use of such nanoparticles in various fields of Medicine extending from genetics to various other branches of medicine. This also includes the management of diabetic wounds. Conclusion This paper discusses the challenges faced with these nanotherapies and nanoparticles with regard to the treatment of diabetic wounds.

High-Temperature Superconductor (HTS) breaker is a new type of breaker, which is proposed to safeguard HTS based power-engineering applications. It has advantage of less prestriking voltage effect over conventional breaker for equipment like HTS transformer. For a breaker application, saw-tooth Transient Recovery Voltage (TRV) is described by high Rate of Rise of Recovery Voltage (RRRV). In this study, the improved values of RRRV shows good prospect for safeguarding HTS equipment with the proposed breaker arc model. The obtained values exhibit that the HTS breaker arc model can achieve lower effect on the RRRV (up to 70%) by optimizing the parameters of arc and design model. The comprehensive arc model for HTS breaker plays an important role in this study to assess the interrupting efficiency and its influence on current interruption study.

Right Ventricular failure (RVF) contributes significantly to early mortality after Left Ventricular Assisting Device (LVAD) implantation. At present, there is no good predictor of post-LVAD RV function. Echocardiographic (echo) RV dP/dt is a non-invasive parameter measuring the rate of rise in the

This study proposes a new housing need and demand assessment model centering on small-scale housing development projects and happy house development projects that reflected the recent changes in rental and small sized apartment centered public housing policies and development paradigms. The housing need and demand assessment model of public housing development projects consists of quantitative evaluation factors such as potential need indicator and demand pressure indicator and qualitative evaluation factors such as local condition indicator. The potential need indicators of small sized housing development projects are calculated by subtracting the stock of already-supplied constructed rental and purchased rental housings from the potential quantity of need drawn from the small regions such as -eup, -myeon, and -dong. In the potential need indicators of happy house development projects, the potential need is calculated from those who are expected to receive a happy house in the unit of -si, -gun, and -gu. In small-sized housing development projects, demand pressure indictors are the number and the proportion of those who opened a subscription deposit, the number of those who received basic livelihood security and the number of those who were patriots and veterans. The demand pressure indicators of the happy house development projects are stock ratio of small-sized houses, rate of rise in housing rent price, level of housing rent price, and rate of monthly rent house.

The present study compared the effects of 12 weeks of muscle power training performing one or three sets on muscle quality assessed by echo intensity (MQEI) and index (MQindex), muscle power-related outcomes, and functional capacity in older women. Participants were randomly assigned into two groups: 1SET (n = 13) and 3SET (n = 13). Lower limb muscle power and vertical jump height were measured during a countermovement jump, maximal rate of torque development (MRTD), and root mean square (RMS) of electromyography signals and rate of rise (RER) of quadriceps maximal electromyography activation during unilateral knee extension at 0–50 and 0–200 ms, MQEI, MQindex (absolute muscle power/MQEI, and MRTD/MQEI) and functionally in both groups using timed-up-and-go were evaluated before and after training. There were significant and similar (p 0.05). In conclusion, similar neuromuscular adaptations and improvements in the functional performance occurred in both groups.

Objective To examine changes in arterial blood pressure (ABP) after birth in extremely preterm infants. Study Design Prospective observational study of infants 230/7 – 266/7 weeks gestational age (GA). Antihypotensive therapy use and ABP measurements were recorded for the first 24 hours. Results A cohort of 367 infants had 18,709 ABP measurements recorded. ABP decreased for the first three hours, reached a nadir at 4 – 5 hours, then increased at an average rate of 0.2 mmHg / hour. The rise in ABP from hour 4 – 24 was similar for untreated infants (n=164) and infants given any antihypotensive therapy (n=203), a fluid bolus (n=135), or dopamine (n=92). GA specific trends were similar. ABP tended to be lower as GA decreased, but varied widely at each GA. Conclusion Arterial blood pressure increased spontaneously over the first 24 postnatal hours for extremely preterm infants. The rate of rise in ABP did not change with antihypotensive therapy.

In this article, an advanced cooling surface based on micro-post arrays with non-homogeneous configurations is investigated and compared with conventional micro-post arrays with homogeneous configuration. The capillary performance of micro-post arrays are characterized using the capillary rate of rise experiments and numerical simulations which take into account the meniscus curvature. The experimental and numerical results show that that the capillary performance of the micro-post wick can be significantly enhanced, compared with the homogeneous type wick, by employing non-homogeneous configurations. The capillary performance is shown to be primarily a function of the solid fraction and increases linearly with decreasing solid fraction, regardless of the wick configuration, when the solid fraction is larger than 0.25. However, the capillary performance is found to be significantly reduced when the solid fraction falls below approximately 0.25.

Predicting Steam Pops with Microwave Radiometry Background The disparity between catheter and tissue temperatures during irrigated RF ablation frustrates one's ability to predict steam pops. Microwave radiometry allows for “volumetric” temperature assessment—i.e., within a circumscribed volume around the catheter tip-permitting, direct assessment of temperature during ablation. The aim of this study was to examine (i) the ability of microwave radiometry to predict steam pops, and (ii) compare this to traditional parameters such as power, catheter temperature, and impedance. Methods and Results Irrigated RF ablation was performed in 8 sheep using the Tempasure ablation catheter in all chambers. Power, impedance, catheter tip, and volumetric temperature were continually monitored. Ablation was terminated after a pop or at 60 seconds. A pop was defined as an audible or visualized pop (intracardiac echocardiography). Predictors of pops were determined by univariate and multivariate GEE logistic regression modeling. A total of 48 pops occurred during 143 lesions applied at 20–50 W. There was no association between the chamber of the heart and the occurrence of pops. The rate of rise of volumetric temperature (greater than 1.5 °C/s) was the single best predictor of pops (OR: 88.8 [95% CI: 12–604], P < 0.0007). Pops only occurred above a maximum volumetric temperature threshold of 89 °C. Conclusions During irrigated RF ablation, steam pop occurrence can be predicted by both, the rate of rise and the maximum volumetric temperature measured by microwave radiometry.

Very Fast Transients (VFT) originate mainly from disconnector switching operations in Gas Insulated Substations (GIS). In order to determine the rate-of-rise of Very Fast Transient Overvoltage (VFTO) in a 550 kV GIS, simulations are carried out using EMTP-RV. Each component of the GIS is modeled by distributed line model and lumped model based on equivalent circuits. The various switching conditions according to closing point-on-wave and trapped charge are simulated, and the results are analyzed. Also, the analysis of travelling wave using a lattice diagram is conducted to verify the simulation results.

The authors have carried out measurement of the current waveforms associated with lightning strokes to wind turbines at south Kyushu. In this paper measured waveforms on summer in 2013 are reported and it is shown that the return strokes with steep rate of rise and/or with high energy are observed in summer. This result is of practical importance for the insulation design of the wind turbine at the area of high lightning activity on summer.

The paper considers the issues of burning metal jumpers on the surface of a semiconductor by current pulses of different shapes. Discovered that the passage of single rectangular current pulse with a duration of no more than 60 μs and an energy of 90 mJ observed the predominance of the processes of melting metal film over the contact melting at the interface. Current pulses of non-rectangular form with a duration of 80 μs and above with energy up to 250 mJ (rate of rise of current up to 50 mAμs) change the priority and the primary mechanism of destruction of the structures becomes contact melting.

The postmenopausal phase is associated with an accelerated rate of rise in the prevalence of vascular dysfunction and hypertension; however, the mechanisms underlying these adverse vascular changes and whether exercise training can reverse the decline in vascular function remains unclear. We examined the function of the vascular prostanoid system in matched pre- and postmenopausal women before and after 12 weeks of exercise training. Twenty premenopausal and 16 early postmenopausal (3.1±0.5 [mean±SE] years after final menstrual period) women only separated by 4 (50±0 versus 54±1) years of age were included. Before the training period, the vasodilator response to intra-arterial infusion of either the prostacyclin analog epoprostenol or acetylcholine was lower (≈13%–41%; P 1a ). To elucidate the role of vasoconstrictor prostanoids, acetylcholine infusion was combined with the cyclooxygenase inhibitor ketorolac and here the vascular response to acetylcholine was reduced to a similar extent in pre- and postmenopausal women. Exercise training increased ( P

This study examined the relationship between intensity of training and changes in hydration status, core temperature, sweat rate and composition and fluid balance in professional football players training in the heat. Thirteen professional football players completed three training sessions; "higher-intensity" (140 min; HI 140), "lower-intensity" (120 min; LI 120) and "game-simulation" (100 min; GS 100). Movement demands were measured by Global Positioning System, sweat rate and concentration were determined from dermal patches and body mass change. Despite similar environmental conditions (26.9 ± 0.1°C and 65.0 ± 7.0% relative humidity [Rh]), higher relative speeds (m · min -1) and increased perceptions of effort and thermal strain were observed in HI 140 and GS 100 compared with LI 120 (P < 0.05). Significantly (P < 0.05) greater sweat rate (L · h -1) and electrolyte losses (g) were observed in HI 140 and GS 100 compared with LI 120. Rate of rise in core temperature was correlated with mean speed (r = 0.85), session rating of perceived exertion (sRPE) (r = 0.61), loss of potassium (K +) (r = 0.51) sweat rate (r = 0.49), and total sweat loss (r = 0.53), with mean speed the strongest predictor. Sodium (Na +) (r = 0.39) and K + (r = 0.50) losses were associated with total distance covered. In hot conditions, individualised rehydration practices should be adopted following football training to account for differences in sweat rate and electrolyte losses in response to intensity and overall activity within a session. © 2012 Copyright Taylor and Francis Group, LLC.

Cuff-occluded rate of rise of peripheral venous pressure has been proposed to reflect volume changes in experimental studies. The aim of this study was to evaluate changes in cuff-occluded rate of rise of peripheral venous pressure associated with fluid removal by haemodialysis in six adult patients with chronic renal failure on intermittent haemodialysis. Measurements were carried out before and after each haemodialysis session. The volume of fluid removed (indexed to body surface area) linearly correlated with changes in cuff-occluded rate of rise of peripheral venous pressure (r = 0.84; r(2 ) =( ) 0.70; p = 0.037). Cuff-occluded rate of rise of peripheral venous pressure may be feasible for future clinical monitoring of individual fluid balance. (Less)

The paper describes a study carried out to examine the effect of self-compacting concrete (SCC) on the lateral pressure on formwork. This comprised two series: (a) control tests, with SCC and comparative concretes (Portland cement (PC) and superplasticised, high-consistence (SP-HC)) cast in 8·0 m columns and walls, and measurements made of concrete and pore water pressures (ten elements) and (b) site tests, with similar properties considered on actual reinforced SCC members during their construction (seven elements). In the control tests, concrete was poured from above to the rising surface at slow (3·0 m/h) and fast (80·0 m/h) rates of rise (with compaction used in the PC and SP-HC concretes only). The results from these indicate that maximum concrete pressures with SCC were slightly lower than those of the comparative concretes at both rates of rise and in columns and walls. Pore water pressures were less than concrete pressures, except with the fast rate of rise for SCC and SP-HC concrete, where the reverse occurred (with the concretes having similar values or SCC slightly higher), which seemed to relate to the concrete properties/pour details and differences in concrete/pore water pressure measurement methods. Maximum pressures for SCC in the control tests were less than hydrostatic and those calculated using the CIRIA report 108 guidance method ( Clear and Harrison, 1985 ). For the site tests, where base-to-top pouring was mainly used (i.e. concrete was passed by way of a hopper at the top of the formwork through a pipe running to its base and kept in place throughout the pour) maximum pressures for SCC were found to exceed hydrostatic in some cases, indicating that this method may give higher pressures. To investigate this further, data from the literature covering SCC pressure measurements on formwork were examined. These showed general agreement with the results of the current study using base-to-top pours and where concrete pumping from below had been adopted, which tended to be at the upper end of the maximum pressure range for SCC. Consideration is given to how SCC may fit within CIRIA 108 for estimating concrete pressure on formwork.

Measuring saccadic reaction time distributions is an increasingly popular technique, making it possible to obtain a large amount of data non-invasively in a short period of time. Such distributions can often be encapsulated with just two parameters, representing the mean and variance of the rate of rise in the LATER model. For many purposes, both scientific and clinical, this is enough. But for normal as well as pathological subjects, particularly when using more complex tasks, one may often see features that cannot be explained by a simple LATER model. These include early and express saccades, ‘late’ saccades, and (in tasks such as go/no-go and antisaccades) more complex modifications. These features can be explained relatively easily by introducing extra LATER units, and enable them to be quantitatively parameterised; this potentially offers much more precise ways of quantifying the effects of such clinical conditions.

Estimating the fire detection time is one of the important contents of performance-based fire protection design, which can be used to compute required safety egress time (RSET) and to determine the time of aerosol extractors start-up. In spite of that, the computing methods of fire detection time do not exist in current codes of China. Engineers often set a fixed fire detection time depend on their experience. In this thesis, a review is present demonstrating the detection time estimation methods of fire detectors, include fixed temperature heat detectors, rate of rise temperature heat detectors, light-scattering type smoke detectors, ionization-type smoke detectors, beam unit smoke detectors and radiant energy fire detectors.

The paper deals with the method employed to arrest the temperature of vertical nuclear fuel-clad so as to keep clad fairly below the softening temperature. Objective of the paper is to control the generation of solid, liquid and gaseous nuclear waste as a result of split or rupture in clad. The fuel and clad have been modeled. The governing equations with adequate boundary conditions were solved using marching technique. The computer program was developed to predict the rewetting velocity. The paper mainly covers the generation of rewetting transients which were used to predict the rewetting velocities. Method of calculating acceptable rate of rise of clad temperature such that complete clad is saved from attaining softening temperature is discussed in detail in the paper.

Background: Haemolytic jaundice is an important entity in neonatal clinical practice. Because of the decrease in rhesus isoimmunisation since the advent of anti-D immunoglobulin and improved antenatal management strategies, its management in the neonatal period has become less intensive and exchange transfusions rarely performed. Aim: We planned to review the practice of Australasian perinatal units in light of recent advances and recommendations. Methods: An electronic survey was sent to the directors of all 25 tertiary-level perinatal units across Australasia. The questionnaire comprised 20 questions dealing with the management of haemolytic jaundice. Results: Twenty out of the 25 neonatal units responded. Most were aware of the recent American Academy of Pediatrics guidelines, but only eight (40%) based their practice on it. Fifty per cent of neonatal units had written protocols to manage such infants, but almost all had written guidelines for performing exchange transfusions. Seven (35%) units started prophylactic phototherapy; however, the criteria used for early exchange were variable, most related to cord haemoglobin or rate of rise of bilirubin. Few units used high-dose intravenous immunoglobulin in haemolytic jaundice. Average exchange rates (based on the last 2 years) were 3.5/year (0–10). Conclusion: Variable practice was noted across the Australasian units. Written protocols form the backbone of management of jaundice in such babies. The use of intravenous immunoglobulin is minimal, and the information available on its use needs to be critically appraised.

It has been suggested that the caudate nucleus, the input stage of the basal ganglia, facilitates and suppresses saccade initiation based on its anatomical characteristics. Although the involvement of the caudate nucleus in saccade facilitation has been shown previously, it is still unclear whether the caudate nucleus is also involved in saccade suppression. Here, we revealed the direct involvement of the caudate nucleus in saccade suppression by electrical microstimulation in behaving monkeys. We delivered microstimulation to the caudate nucleus while monkeys performed the prosaccade (look toward a peripheral visual stimulus) and antisaccade (look away from the stimulus) paradigm. The reaction times of contralateral saccades were prolonged on both prosaccade and antisaccade trials. The suppression effects on reaction times were stronger on prosaccade trials compared with antisaccade trials. The analysis of reaction time distributions using the linear approach to threshold with ergodic rate model (LATER model) revealed that microstimulation prolonged reaction times by reducing the rate of rise to the threshold for saccade initiation. Microstimulation also worsened correct performance rates for contralateral saccades. The same microstimulation prolonged and/or shortened the reaction times of ipsilateral saccades, although the effects were not as consistent as those on contralateral saccades. We conclude that caudate signals are sufficient to suppress contralateral saccades and influence saccadic decision by controlling contralateral and ipsilateral saccade commands at the same time.