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BACKGROUND The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome. The novel fourth-generation cryoballoon (CB4) incorporates a 40% shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE). METHODS AND RESULTS Three hundred consecutive patients with paroxysmal or persistent atrial fibrillation were prospectively enrolled. The first 150 consecutive patients underwent CB2 based PVI (CB2 group) and the last 150 consecutive patients were treated with the CB4 (CB4 group). A total of 594/594 (100%, CB4) and 589/594 (99.2%, CB2) pulmonary veins (PVs) were successfully isolated utilizing the CB4 and CB2, respectively (p = .283). The real-time PVI visualization rate was 47% (CB4) and 39% (CB2; p = .005) and the mean freeze cycle duration 200 ± 90 s (CB4) and 228 ± 110 s (CB2; p

Objectives Electrical stimulation of the vestibular system (VeNS) has been shown to improve Insomnia Severity Index (ISI) when delivered during sleep. We hypothesize that repeated electrical vestibular stimulation, when delivered prior to sleep onset, will improve ISI scores. The primary aim of this study was to assess the effect that VeNS had on ISI scores when delivered prior to sleep onset. A secondary aim was to provide initial data indicating “length of time to effect” that will allow more appropriate design of a larger randomized control trial (RCT). Methods The present study was an experimental study (pre and post without control). The participants acted as self-controls. After recording the baseline values, electrical vestibular nerve stimulation was administered as intervention once in a day for 30 min, 1 h prior to sleep onset using ML1000 device (Neurovalens, UK) for 14 days. Results There was significant decrease in the ISI scores followed by the electrical vestibular nerve stimulation. Further, participants reported a significant increase in well-rested sleep post the intervention period. Conclusions This study supports our hypothesis that VeNS has a positive impact on ISI scores when delivered on a regular basis prior to sleep onset.

For Overactive Bladder (OAB) treatment, pharmacotherapy is currently deemed as a second option. However, in the current publications related to OAB, there is a significant research gap concerning the time-toeffect and duration of OAB pharmacotherapy. Such data is vital for effective and successful treatment of OAB, and hence, the study aimed to find information in this gap to assist healthcare providers in their daily activities in treating OAB. The study utilized the Web of Science databases, MEDLINE, Cochrane Library, and PubMed Central to find and collect the highest number of data. The literature review showed limited research concerning the time-to-effect and optimal treatment duration for OAB. However, based on the available data, it can be stated that the time-to-effect of OAB pharmacotherapy would be after seven days of the initial treatment. Besides, patients with OAB can be effectively treated for 6 to 12 months before the medications are stopped but patients need to be carefully educated about a risk of symptom reoccurrence and retreatment. Those who require further medications or have a higher risk of symptom reoccurrence may need lifetime pharmacotherapy or different treatment approaches. Further research is needed to focus on the time-to-effect during the first week of medication to accurately determine when first symptom reduction occurs, and carefully follow up for patients that show a positive response after the treatment has been ceased.

Based on the traditional Chinese medicine theory, Renshen Yangrong Tang (RSYRT), which is a mixture of 12 herbs, was commonly used as a pharmacological option in China for fatigue management by correcting Qi deficiency.This randomized controlled Phase II trial investigated the efficacy of RSYRT for reducing cancer-related fatigue.Cancer survivors with moderate or severe fatigue (rated ≥4 on a 0-10 scale) for more than two months were randomized to take herbal extract granules of RSYRT or a low dose of a single herb (huangqi) twice a day for six weeks. Patient-reported fatigue was measured using the MD Anderson Symptom Inventory. Efficacy of RSYRT was evaluated using mixed model to test the differences over time among groups. We also conducted responder analyses and examined time to effect of symptom reduction.None of the 83 evaluable patients (control group 42; intervention group 41) had discomfort or Grade 3 or 4 toxicity. We observed a significantly greater MD Anderson Symptom Inventory-fatigue score reduction in the intervention group than that in the control group (time-by-group interaction: estimate = -0.61 [0.10]; P 0.0001). More patients in the intervention group had a two-point reduction on fatigue than that of the control group (90.2% vs. 52.4%). By Week 4, between-group differences of fatigue reduction on mean severity reached large effect size (intervention group vs. control group: -2.66 vs. -1.36; Cohen's d = 1.0; P 0.0001).Compared with control therapy, RSYRT therapy elicits a statistical and clinical improvement of fatigue severity and functioning. The effectiveness of RSYRT in managing cancer-related fatigue warrants further study in the real world.

Background: The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging and reproducible clinical outcome data. The latest- -generation cryoballoon (CB3) incorporates a 40% shorter distal tip, thus allowing for an increased rate of PVI real-time signal recording and facilitating individualized ablation strategies taking the time-to- -effect (TTE) into account. However, whether this characteristic translates into favorable clinical success has not been evaluated yet. Herein was investigated 1-year clinical success after CB3 in comparison to CB2 based-PVI. Methods: One hundred and ten consecutive patients with paroxysmal or short-standing persistent atrial fibrillation (AF) underwent CB2 (n = 55 patients) -or CB3 (n = 55 patients) -based PVI. The freeze-cycle duration was set to TTE + 120 s if TTE could be recorded, otherwise a fixed freeze-cycle duration of 180 s was applied. Results: A total of 217/218 (99%, CB3) and 217/217 (100%, CB2) pulmonary veins (PV) were successfully isolated. The real-time PVI visualization rate was 69.2% (CB3) and 54.8% (CB2; p = 0.0392). The mean freeze-cycle duration was 194 ± 77 s (CB3) and 206 ± 85 s (CB2; p = 0.132), respectively. During a median follow-up of 409 days (interquartile range [IQR] 378–421, CB3) and 432 days (IQR 394–455, CB2) 73.6% (CB3) and 73.1% of patients (CB2) remained in stable sinus rhythm after a single procedure (p = 0.806). Conclusions: A higher rate of real-time electrical PV recordings was seen using the CB3 as compared to CB2. There was no difference in 1-year clinical follow-up.

Spinal cord injury (SCI) often results in the devastating loss of motor, sensory, and autonomic function. After SCI, the interruption of descending sympathoexcitatory pathways disrupts supraspinal control of blood pressure (BP). A common clinical consequence of cardiovascular dysfunction after SCI is orthostatic hypotension (OH), a debilitating condition characterized by rapid profound decreases in BP when assuming an upright posture. OH can result in a diverse array of insidious and pernicious health consequences. Acute effects of OH include decreased cardiac filling, cerebral hypoperfusion, and associated presyncopal symptoms such as lightheadedness and dizziness. Over the long term, repetitive exposure to OH is associated with a drastically increased prevalence of heart attack and stroke, which are leading causes of death in those with SCI. Current recommendations for managing BP after SCI primarily include pharmacologic interventions with prolonged time to effect. Because most episodes of OH occur in less than 3 minutes, this delay in action often renders most pharmacologic interventions ineffective. New innovative technologies such as epidural and transcutaneous spinal cord stimulation are being explored to solve this problem. It might be possible to electrically stimulate sympathetic circuitry caudal to the injury and elicit rapid modulation of BP to manage OH. This review describes autonomic control of the cardiovascular system before injury, resulting cardiovascular consequences after SCI such as OH, and the clinical assessment tools for evaluating autonomic dysfunction after SCI. In addition, current approaches for clinically managing OH are outlined, and new promising interventions are described for managing this condition.

Background: Third-generation cryoballoon (CB3) is characterized by a 40% shorter distal tip designed to increase the rate of pulmonary veins real-time signal recording in order to measure time necessary to isolate veins, the “Time to effect” (TTE). Few data are currently available on clinical follow up of CB3 treated patients. Methods: Sixtyeight consecutive patients (mean age 57.8 ± 9.6 years, 48 male) with paroxysmal or persistent atrial fibrillation (AF) were enrolled. Thirthyfour (25 paroxysmal AF) underwent to a 28 mmCB3 pulmonary veins isolation and were compared to 34 treated (21 paroxysmal AF) with 28 mmCB2. Results: CB3 use was correlated to significant increase of the possibility to measure TTE in every treated veins (left superior 82,35% vs 23,53%, left inferior 70,59% vs 38,24%, right superior 58,82% vs 14,71%, right inferior 52,94% vs 17,65%). When it is measured, TTE wasn't different between two groups. Higher nadir temperature was observed in CB3 patients (−39.4 ± 5.2 °C vs −43.0 ± 7.2 °C, p = 0.03). CB3 procedures were shorter (91.4 ± 21.7 vs 110.9 ± 31.8 min, p = 0.018), with a significant reduction in cryoenergy delivery time (24.2 ± 8.5 vs 20.3 ± 6.7 min, p

To easily understand and systematically express the behaviors of the industrial systems, various system modeling techniques have been developed. Particularly, the importance of system modeling has been greatly emphasized in recent years since modern industrial systems have become larger and more complex.Multilevel flow modeling (MFM) is one of the qualitative modeling techniques, applied for the representation and reasoning of target system characteristics and phenomena. MFM can be applied to industrial systems without additional domain-specific assumptions or detailed knowledge, and qualitative reasoning regarding event causes and consequences can be conducted with high speed and fidelity.However, current MFM techniques have a limitation, i.e., the dynamic features of a target system are not considered because time-related concepts are not involved. The applicability of MFM has been restricted since time-related information is essential for the modeling of dynamic systems. Specifically, the results from the reasoning processes include relatively less information because they did not utilize time-related data.In this article, the concepts of time-to-detect and time-to-effect were adopted from the system failure model to incorporate time-related issues into MFM, and a methodology for enhancing MFM-based reasoning with time-series data was suggested. Keywords: Multilevel Flow Modeling, Time-series Data, Time-to-Detect, Time-to-Effect

Background Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children. Methods Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8 ± 4.1 (4.2–18) years, 61.7% males] with Wolf–Parkinson–White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP). Results The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13 ± 5.5 (4.4–22.9) months. Mean procedure and fluoroscopy times were 144 ± 45 (55–262) min and 1.8 ± 1.4 (0.1–5.6) min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171 ± 53 min vs 135 ± 38 min, p

Background: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an established treatment modality for patients suffering from paroxysmal or persistent atrial fibrillation (AF). Recently, the n...

The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome data. The novel third-generation cryoballoon (CB3) incorporates a 40 % shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE). Thirty consecutive patients with paroxysmal or short-standing persistent atrial fibrillation underwent CB3-based PVI and were compared to 30 patients treated with the CB2. Individual freeze-cycle duration was set to TTE + 120 s for both groups. A total of 118 (CB3) and 119 (CB2) pulmonary veins (PV) were identified and all PVs successfully isolated utilizing the CB3 and CB2, respectively. The real-time PVI visualization rate was 74 % (CB3) and 40 % (CB2; p = 0.001) and the mean freeze-cycle duration 204 ± 88 s (CB3) and 215 ± 90 s (CB2; p = 0.15). Per individual PV, a shorter mean freeze-duration was found for the CB3 and the right superior PVs (188 ± 92 vs. 211 ± 124 s, p = 0.04) and right inferior PVs (192 ± 75 vs. 200 ± 37 s, p = 0.02). No differences were found for the left-sided PVs. A higher rate of real-time electrical PV recordings is seen using the novel CB3 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.

Expenditure for discovery and development of a new crop protection product is now approaching the $ 300 million mark, while at the same time underpinning information gaps in environmental safety assessment. Large information gaps also exist for the safety of a vast number of existing chemicals in commerce. Addressing safety information gaps of new and existing chemicals with increased conventional toxicity testing would skyrocket costs and animal usage and contravene the 3Rs principles to refine, reduce, and replace animal testing. There is a great need to improve predictive safety assessment with minimum animal use. Recent progress in the understanding of the molecular biology of chemical dose response relationships, which has confirmed general applicability of the Druckrey-Kupfmuller theorem for receptor-mediated toxicity, can now be employed at an early stage of product development to identify (and eliminate) hazardous chemicals using short-term chronic dose response tests in invertebrates. Time-to-effect (TTE) approaches can identify hazardous chemicals with time-cumulative toxicity. This approach would shift research and development programs to chemicals with ascertained strictly dosedependent toxicity, for which no-observable-adverse-effect levels (NOAELs) can be reliably established with short-term tests, which could make a myriad of resource-intensive animal studies obsolete.

The generation of personnel lack in Moroccan administrations is broached in this article from a multi-agency perspective to provide a study framework for the distributed coordination based on communication. We particularly stress the case of courts seeking to assign staff and judges to court cases respecting the necessary time to effect. This problem of personnel generation is shown through the form of distributed constraint satisfaction (DCSP). A set of strategies for modeling the problem with constraints satisfaction has been proposed; one of these strategies is retained to implement a system which generates both the timing sought for each court case and the coordination of agents who will follow it.

Purpose Cryothermal ablation (CTA) for atrioventricular nodal reentrant tachycardia (AVNRT) is considered safer than radiofrequency ablation (RFA) since it eliminates the risk of inadvertent AV block. However, it has not been widely adopted due to high late recurrence rate (LRR). In an effort to improve LRR, we evaluated a new approach to cryothermal mapping (CTM): “time to tachycardia termination” (TTT). Methods This single-center study had 88 consecutive patients who underwent CTA using TTT for AVNRT. The CTA catheter was positioned in sinus rhythm at the posteroseptal tricuspid annulus, and then AVNRT was induced. The CTA target site was identified by prompt tachycardia termination in ≤20 s during CTM. Procedural success was defined as no inducible AVNRT and ≤1 single AV nodal echoes. Results Acute procedural success was achieved in 87 of 88 patients (98.9 %) and was similar to prior studies for both CTA and RFA. No permanent AV block was observed. LRR was 3.7 % at a mean follow-up of 19.7 months. LRR was equivalent to that commonly reported for RFA and improved when compared to conventional CTA. Conclusion TTT for CTA of AVNRT provides enhanced safety and similar long-term efficacy when compared to RFA. Based upon this experience, TTT provides an enhancement to conventional CTA that appears to result in improved long-term outcomes. In light of these findings, it seems reasonable to undertake additional randomized trials to determine whether RFA or CTA using TTT is the optimal approach for the catheter ablation of AVNRT.

BACKGROUND: Limited data exist on procedural and biophysical indicators of pulmonary vein (PV) isolation durability after the cryoballoon ablation of atrial fibrillation (AF). OBJECTIVE: The aim of this study was to investigate the procedural and biophysical characteristics associated with late PV reconnection (PVR) and durable PV isolation (PVI) after cryoablation using the currently available second-generation cryoballoon. METHODS: Data from 435 PVs targeted in 112 consecutive patients who underwent a repeat procedure 14 ± 3 months after an index cryoablation of AF were examined. RESULTS: Altogether, 111 PVs (25.5%) in 71 patients (63.4%) demonstrated PVR whereas 324 PVs (74.5%) exhibited PVI. The number and duration of cryoballoon applications did not differ between PVR and PVI. However, the time to PV isolation (time to effect) was considerably shorter (39.1 ± 11.7 seconds vs 67.6 ± 19.7 seconds; P < .001), the balloon temperature at time to effect was significantly warmer (-32.1°C ± 7.8°C vs -39.4°C ±5.8°C; P < .001), the balloon nadir temperature was slightly cooler (-48.7°C ± 4.6°C vs -47.8°C ± 2.9°C; P = .034), and the total thaw time (56.5 ± 25.4 seconds vs 34.8 ± 9.1 seconds; P < .001) and interval thaw times at 0°C (iTT0; 14.8 ± 10.9 seconds vs 7.1 ± 2.0 seconds; P < .001) and 15°C (54.2 ± 25.4 seconds vs 33.3 ± 9.1 seconds; P < .001) were notably longer with PVI than with PVR. However, only a time to effect of ≤60 seconds and an iTT0 of ≥10 seconds emerged as significant predictors of PV isolation durability. Consequently, in a multivariate model, presence of both criteria predicted

The organizational cultural problems in this particular unit have manifested themselves as a result of prior leadership failures to address them coupled with the crucible of operational stress than exacerbated the display of these bad trends in the overarching organizational culture of the Army in general. The new incoming commander has little time to effect change, and little hope of mitigating much of the operational pressure and stress that will continue to be placed upon his unit. His only recourse and solution in this situation is quickly identify the problem and to set a vision for the organization that is simple, clear and strikes directly at the heart of the cultural issue.

Aims To assess the incidence of late pulmonary vein (PV) reconnection following index PV isolation (PVI) procedure initially achieved with radiofrequency contact-force catheter ablation (CFCA) and second-generation cryoballoon ablation (CB-AdvA). Methods and results A total of 56 consecutive patients (41 male, 73.2%; mean age 60.8 ± 11.8 years) underwent a repeat ablation because of recurrent atrial tachyarrhythmias (ATas) after index PVI achieved with CFCA (30 patients) or CB-AdvA (26 patients). All repeat procedures were performed by the means of CFCA. In the CFCA group, among 119 PVs, 43 (36.1%) showed conduction gaps in 24 patients (1.8 per patient), whereas in the CB-AdvA group among 103 veins, 21 (20.4%) showed a PV reconnection in 18 patients (1.2 per patient) ( P = 0.01). The left superior pulmonary vein was less frequently reconnected following CB-AdvA when compared with CFCA (2/25, 8% vs. 11/29, 37.9%; P = 0.01). In the CFCA group, the mean CF per-vein was lower in reconnecting veins when compared with those persistently isolated (10.9 ± 2.7 vs. 18.6 ± 3.1 g; P < 0.001). In the CB-AdvA group, late PV reconnection was associated with warmer nadir temperature (−48.9 ± 5.1 vs. −51.2 ± 4.7°C; P = 0.05) and longer time-to-isolation (71.1 ± 20.2 vs. 50.2 ± 32.9 s; P = 0.03). Conclusion The rate of late PV reconnection is significantly lower following CB-AdvA when compared with CFCA as index procedure. Lower CF values and warmer nadir temperature with longer time to effect were more frequently associated with PV reconnections in the setting of CFCA and CB-AdvA.

Aims To analyze time-to-effect relationships between systolic blood pressure (SBP) and the risks of development of nephropathy and retinopathy in patients with type 2 diabetes. Methods We retrospectively enrolled 647 patients with type 2 diabetes who first visited our hospital between 1995 and 1996, made ≥1 hospital visit per year, had been followed-up for ≥1 year, and had undergone ≥4 SBP measurements. Of these, 352 with normoalbuminuria and 516 without retinopathy were followed through June 2012. Results Nephropathy developed in 90 patients and retinopathy in 113. Hazard ratios (HRs) for time-dependent SBP-associated nephropathy and retinopathy were the highest during 1 year preceding each endpoint or censoring. The HRs for nephropathy had been steadily lower during the preceding 1–17 years, while that for retinopathy had been lower during the preceding 1–5 years and constant during the preceding 5–17 years. Conclusions The time-to-effect relationship with SBP differed for the development of nephropathy and retinopathy. The long-term effect was obvious for nephropathy and borderline for retinopathy, while the short-term effect was stronger and evident for both. Continuous SBP lowering is necessary to prevent nephropathy, whereas SBP control during the preceding 5 years seems to be important to prevent retinopathy.

This study evaluates 53 overlays (six types of alternating pressure overlays) which were purchased, placed into the hospital pool and examined for mechanical malfunction and mismanagement every working day (excluding 22 days' annual leave) for one year. Reasons for malfunction were recorded and categorised. Results show that 69 mechanical failures and seven cases of physical damage were recorded. There were significant differences between the different types of overlay in performance and the length of time to effect repairs. There were 56 errors in management (mainly units not plugged in or not switched on) and five cases of design features contributing to mismanagement. Although some alternating pressure overlays perform better than others, mechanical unreliability remains a problem for most.

Difficulties of the finite difference method occur when a boundary does not lie on the mesh points in the overlaid meshpoint array but passes between them. To overcome this limitation and at the same time to effect high precision solutions to the curvilinear problem a solution is described which extends the internal space of the geometry to the other side of the enclosing boundary by analytic continuation. The boundary potential itself is incorporated into the values of near mesh points by interpolation from the boundary. Using this technique precisions of the order of \(\sim \!10^{-13}\) have been obtained for the concentric sphere geometry. Thus a fundamental limitation of the finite difference method has been removed.

Empirical studies of community participation in health services commonly tie effectiveness to the perceived legitimacy of community representatives among health staff. This article examines the underlying assumption that legitimacy is the major pathway to influence for community representatives. It takes a different vantage point from previous research in its examination of data (primarily through 34 in-depth interviews, observation and recording of 26 meetings and other interactions documented in field notes) from a 3-year study of community representatives’ action in a large health region in Australia. The analysis primarily deploys Michel de Certeau’s ideas of Strategy and Tactic to understand the action and effects of the generally ‘weaker players’ in the spaces and places dominated by powerful institutions. Through this lens, we can see the points where community representatives are active participants following their own agenda, tactically capitalising on cracks in the armour of the health service to seize opportunities that present themselves in time to effect change. Being able to see community representatives as active producers of change, not simply passengers following the path of the health service, challenges how we view the success of community participation in health.

Midazolam is increasingly used in reptiles as part of a multidrug induction for general anesthesia. Studies of its use as a sole sedative are limited to a few reports in turtles and crocodiles. A retrospective review was carried out to assess the clinical efficacy of midazolam as a sedative in reptiles at the National Aquarium, Baltimore, Maryland. Medical procedures from 48 events involving 34 individuals were included in the review. Information obtained included species, age, sex, body weight, type of procedure performed, dosage of midazolam administered, use of a concurrent analgesic, time to effect, use of a reversal agent, and efficacy of sedation (acceptable vs. unacceptable). Midazolam was used in a wide variety of small- to medium-sized turtles, lizards, and snakes. Diagnostic imaging (e.g., radiography) and minor surgical procedures—in combination with local anesthetics (e.g., distal digit amputation)—were the most common procedures performed. The median dosage of midazolam was 0.3 mg/kg...

Every patient presenting to a hospital emergency department must have a medical screening examination to determine whether an emergency medical condition exists. If there is no emergency medical condition, the Act does not apply. Any patient who is found to have an emergency medical condition must be stabilized. If necessary. the appropriate on-call physician must be consulted to administer necessary stabilizing treatment. Once the patient has been stabilized, the Act no longer applies. If a hospital is unable to provide the necessary stabilizing treatment, arrangements must be made for an appropriate transfer to a facility with the capacity to provide treatment. A hospital with specialized capabilities or facilities may not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual. If a woman is in active labor and there is insufficient time to effect an appropriate transfer safely. maternal and newborn care must be provided to the woman and her infant.

A small-scale combustion module and animal exposure system for evaluating flaming combustion and toxicity of smoke from burning polymers has been developed at the University of Pittsburgh and designated the UPitt II method. It is a radical departure from previous attempts to evaluate toxicity of smoke from burning polymers and represents a significant improvement over previous systems because well-defined burning conditions can be established over a wide range of imposed heat flux and ventilation levels, not possible to examine with previous methods. Thus, smoke toxicity can be evaluated under a range of burning conditions and differences in toxic potency and time to effect can be evaluated. A potential smoke hazard (PSH) index was developed which integrates the material performance characteristics which determine ease of ignition of a polymer with toxic potency, time to death, and rate of generation of toxicants. This paper describes sublethal endpoints that can be used with the UPitt II method and modifications to the PSH index for evaluating the toxicity of smoke generated by burning polymers.

Introduction Greater occipital nerve blocks (GONB) are used in the management of primary headaches. Methods The severity (verbal rating scale), duration (minutes) and frequency (per day) of headaches before and after GONB was compared in 74 cluster headache (CH) patients. Time to effect, duration of effect and complications were additionally assessed. Results 17 (23.0%) patients had episodic and 57 (77.0%) had chronic CH. The mean age (standard deviation) was 47.2 (11.4) years, with a preponderance of male sex (62.2%) and right GONB (52.7%). A significant reduction in mean frequency (3.8 (1.9) vs 1.5 (2.3), p Conclusions GONB are an effective procedure in three-quarters of CH cases, providing approximately 3 weeks of benefit with minimal complications. GONB can be considered at the onset of a cluster bout and offer a transitional therapy while waiting for preventive headaches to work in both episodic and chronic CH.

Efficient delivery of microbial biocontrol agents implies a process that requires the least amount of time, effort, and product (and therefore, the least cost), while still delivering the agent in a way that is efficacious. To accomplish this goal, a sufficient quantity of the agent must be delivered in an appropriate state of activity and to the right place at the right time to effect economical control. Activity state of a given microbial biocontrol agent and proper timing and placement of the inoculum are usually more important than introduction of a large population of the agent. Thus, for efficient delivery, we need to consider plant-pathogen-agent interactions in terms of time and space. The choice of delivery system will be dictated by both control strategies and characteristics of the organisms and cropping systems involved.

Purpose To evaluate outcomes of lower urinary tract Botox therapy for incontinence in the paediatric population, and compare the duration of benefit with initial versus repeat injections. Material and methods Eighteen children were treated with lower urinary tract Botox in Western Australia between May 2004 and September 2008. Prospective structured assessment tools (pie charts and voiding diaries) were employed to quantify benefit of Botox in children who had failed conventional treatments for incontinence. ‘Beneficial outcomes’ were >50% reduction in wetting symptoms. Time intervals to improvement, and duration of benefit were assessed. Results Patients had either neurological disease (urodynamically proven neurogenic bladder with spina bifida, or head or spinal cord injuries) or non-neurogenic bladders. Of the 18 patients, 16 had detrusor overactivity treated with bladder wall injections. 2 had severe dysfunctional voiding and were treated with external sphincter injections. Time to effect was 3-7 weeks. Duration of benefit was 6-7 months. 8 of the18 underwent repeat Botox injections. 4 repeat procedures were for neurogenic bladders. Time to improvement was similar with repeat procedures, and duration of benefit was also similar to that after initial injection. Repeat injections for non-neurogenic bladder showed longer duration of benefit than after initial injection. Conclusions This is one of the few reviews assessing repeat lower urinary tract Botox therapy in the paediatric population and from this it is evident that Botox provided significant improvement in paediatric urinary incontinence and that repeat Botox injections provided sustained or longer lasting benefits.

The association of cancer of the esophagus with long-standing achalasia signals an especially lethal disease, for in our experience and in a review of the literature this malignant condition has never been diagnosed in time to effect a permanent surgical cure. Although reported over a century ago, the combination of these two diseases occurs more frequently than is generally realized, for cancer is seen in patients with achalasia seven times more often than in the general population [I]. In an attempt to improve the poor prognosis in’ patients with achalasia and carcinoma, we made a study of 225 cases (4 of ours and 221 in the literature) to determine the salient features in early diagnosis, This study suggests that it may be possible to make the diagnosis in time to perform curative resection.

Some North American manufacturers are selling devices which produce ozone from UV radiation, which is pumped or sucked into spas, presumably to disinfect the water, without having to use chlorine. To test this claim, a private spa used by two people at least once a day was equipped with a UV radiation unit and an ozone (generating by UV) unit. Bacterial analyses were conducted during experiments carried out using chlorine alone, ozone generated by UV radiation, unit and an ozone (generating by UV) unit. Bacterial analyses were conducted during experiments carried out using chlorine alone, ozone generaed by UV radiation, and ozoen in combination with UV radiation. Heterotrophic plate counts, and counts of Staphyiococcus aureus and Pseudomonas aeruginosa were lowest when using chlorine, next lowest when using ozone #x002B; UV radiation, and highest when using UV-generated ozone. It is concluded that insufficient dissolved ozone is present for a sufficient reaction time to effect disinfection of the...

The “pulseless” circulation gas chromatography method was used for the first time to effect the preparative separation of mixtures of isomers that have close properties (α=1.035-1.05), with a separation efficiency that is comparable to the separating capacity of capillary columns.

A Monitoring System is described for reporting, in a timely and comprehensive fashion, the important aspects of the development and utilization of geothermal energy in the United States. The Federal program for geothermal energy addresses technological, environmental, institutional, economic and financial problems. The system for monitoring geothermal resource development has been designed to measure progress in developing geothermal energy online and progress in enabling geothermal resources for development, thereby increasing the potential for future exploitation of geothermal resources, as a consequence of successes in the Federal program in solving technological, environmental, institutional, economic and financial problems that currently impede exploitation of geothermal resources. The key indicator of progress in the development of geothermal energy will be ''power online''. Projections of power online will signal deviations from national goals with sufficient warning time to effect corrective action. Correlation of Federal programs with national progress indicators will show where corrective action is needed. Preliminary indicators of geothermal resource development, based on very limited data, are presented. The analyses are illustrative rather than definitive. Some conclusions are drawn from these analyses.

NormalDrosophila melanogaster males rapidly react to changes in the mobility of mutantshibire ts females by performing less courtship when the females are paralyzed and by courting movingshibire ts females vigorously. Mutantoptomotor-blind males, which are unable to respond to certain horizontally moving patterns, sustain abnormally short courtship bouts when tested with normal females, almost never perform orientation, one of the courtship behaviors, and require more time to initiate copulation than normal males. These results suggest that males must perceive female movement to perform normal courtship and copulation. Normal females become stationary before copulation occurs. Normal males mate quickly in response to this change in female behavior, while blind males require more time to effect copulation, prolonging the time that the female remains stationary. Mutantsmellblind females, which do not respond to certain odors, continue to move during the time that they are courted by normal or blind males and also require more time to copulate, suggesting that females may stop moving before mating in response to olfactory cues.

Many different approaches have been attempted to the problem of controlling the processing of a multiprogramming computer system so as to improve performance. In Reference 1, Bowdon, et al. simulate an IBM 360/75 under OS with HASP and adjust job initiation priority based on estimates of processing time to effect a shortest-processing-time discipline. Their simulation demonstrates a dramatic increase in thruput and decrease in turnaround as a result of this job scheduling modification.

Two species of fresh—water snails were found capable of attaching themselves to the feet of killdeer. Once attached and removed from water, the snails remained attached and retained their viability for sufficient lengths of time to effect passive overland dispersal.

THE DEVELOPMENT of hypertension as a result of renal arterial lesions is well established in animals and man.1,2Tests to discover lesions and operative techniques to treat them have been established and documented,3-8but results of cure or substantial improvement in the patients' cardiovascular disease vary considerably in published series.1,4,9,10There is a more critical diagnostic approach today11and operation is less readily undertaken for hypertension.10,12 The purpose of this paper is to present the experiences of one hospital group in studying the patients suspected of having renovascular hypertension (RVH) and to report the conclusions drawn from these studies. Materials and Methods The Patients. —This report concerns patients with hypertension who were seen initially from February 1962 to December 1964, inclusive, although follow-up has been extended beyond this time to effect more complete study. The population examined was highly selected prior to study insofar as investigations were undertaken only on

I THINK I may be permitted to point out that Dr. Croll has missed what I had intended to be the main feature of my criticism of his article on the “Age of the Sun in Relation to Evolution”. I should therefore wish to reiterate that, in his theory, he takes no account of the proper motions of the stars in space. If it be true that suns or stars have been formed by the collision of bodies possessed of great energy, proper motion can be none other than the unused and unconverted energy of the original components. Supposing the forces, before impact, to be equal and opposite in direction, there can be no misunderstanding that the result will be the entire convertion of the “motion of translation to molecular motion”, i.e., heat; but this, according to the law of chances, must be of exceedingly rare occurrence. Yet, from our knowledge of the motions of the stars in space, this, or something very like this, has invariably occurred. Surely here is a reductio ad absurdum. In conclusion I will merely state that I have never yet claimed to have suggested a theory reconciling the age of the sun with prevailing opinions in geological science or with the hypothesis of evolution. Having felt the difficulty, I have endeavoured in some measure to stretch the interval wherein these may have had time to effect their changes, but I have not claimed to have succeeded to the desired extent. I am not, therefore, interested in replying to the former part of Dr. Croll's letter, and indeed, with certain minor reservations, have no hesitation in subscribing to it.