Design, construction, and preliminary testing of a square cross-sectional mixing chamber

Throughout the US, large quantities of chlorine are produced and transported by rail. In the past, train accidents led to deadly accidental releases and the need for mass evacuation. However, moving people unnecessarily may cause pandemonium or danger to health for sensitive members of the public. In these past cases, the models used for evacuation distances did not accurately predict the impact of the chlorine release, but these models did not take into account the reactivity of chlorine. Because chlorine is a highly reactive gas, it is absorbed into the surrounding environment which reduced the amount of chlorine in the air thereby reducing the impact of an accidental release. In this context, the Controlled Environment Reactivity Test (CERT) program was created to determine the extent of the absorption of chlorine with the environment. The Chemical Hazard Research Center (CHRC) at the University of Arkansas is active member of the program. Its facility is used to conduct low wind speed dispersion modeling for various hazardous gases. For the CERT Program, the aim is to create a test chamber designed to provide chemical reactivity (deposition) data for direct use in atmospheric dispersion models. This particular project aimed at designing and constructing a test chamber to provide gas mixtures in preparation for the CERT Tests. Preliminary tests were conducted to validate the set-up. The chamber is made of plywood and clear polycarbonate, powered by a small 2 hp fan used to push the air through the chamber to the room. Based on previous work, High Efficiency Vortex (HEV) mixer design has been adapted to mix test gas with inlet air. The HEV mixer is placed directly after the fan and uses two sets of inline baffles to produce turbulent mixing. The testing included the delivery of the gas (fog) to the chamber, the determination of the optimal setup for all experiments, and the preliminary videos. An optimal height for the inlet nozzle of five inches was determined and the similarity between the fog speed and the air speed on the lowest fog and fan setting has been proven. Finally, the preliminary videos of the chamber flow clearly show a large scale vortical structure which is convected along the length of the test section. This undesirable structure is caused by the fan. A flow straightener could be used to reduce or eliminate this phenomenon

Milton Nascimento and the Clube da Esquina: popular music, politics, and fraternity during Brazil’s military dictatorship (1964-85)

While military leaders and politicians plotted to overthrow the João “Jango” Goulart administration, a youth collective of popular music composers coalesced on the esquinas [street corners] of Belo Horizonte, Brazil. Led by Milton Nascimento, the music of the Clube da Esquina came to epitomize música mineira [music from Minas Gerais state] in the late 1960s and throughout the 1970s. The Clube da Esquina sound is distinctive as much for its lyrics about fraternity and loyalty as it is for its collective approach to music-making and audio production. Nascimento and his collaborators also used music as a form of protest against the dictatorship (1964-85), particularly when a majority of Nascimento’s fifth album Milagre dos Peixes (Odeon, 1973) was censored by the regime. When Nascimento resolved to release the album without lyrics, censors condemned the “aggressive” sound of the voice, and Nascimento described the impact of his voice “como uma arma [like a gun].” Using ethnographic data and archival research, this dissertation documents the social and musical history of Milton Nascimento and his collaborators, who came to be known as the Clube da Esquina, in Minas Gerais in the 1950s through the 1970s. Early chapters argue for Milton Nascimento’s comprehension as an orchestrator of personalities, due to his collective approach to music-making and judicious selection of particular collaborators. Though often described as a regional sound by Brazilian music journalists, Nascimento’s music subverts mineiro stereotypes as often as it confirms them. In particular, Nascimento’s music brought regional pride to Minas Gerais, while recognizing subaltern voices, especially afro-mineiros and the agricultural worker. Latter chapters explore the Clube da Esquina’s contribution to Brazilian canção de protesto [protest song] during the anos de chumbo [leaden years] of the dictatorship (1968-74). The Clube da Esquina used textual themes as well as extra-lyrical strategies to communicate political dissent in combination with regional, national, pan-Latino, and international musical styles. Sonic field analysis is introduced as a method by which to analyze how texture and scale on audio recordings can inform musical meaning. Heard in the historical moment of radical clandestine movements, disappearances and torture, and divisive debates about musical authenticity, the collective constructed a diverse set of symbolic expressions relevant to the socio-political concerns of Brazilian audiences, especially youth

Prescribing trends of proton pump inhibitors, antipsychotics and benzodiazepines of medicare part d providers

Background: Proton pump inhibitors, benzodiazepines, and antipsychotics are considered potentially inappropriate medications in older adults according to the American Geriatric Society Beers Criteria, and deprescribing algorithms have been developed to guide use of these drug classes. The objective of this study was to describe the number of beneficiaries prescribed these medications, provider specialty and regional trends in prescribing, and the aggregate costs for these claims in Medicare Part D. Methods: This was a retrospective cross-sectional study using publicly available Medicare Provider Utilization and Payment Data: Part D Prescriber data for years 2013–2019. Descriptive statistics and the Cochrane-Armitage test were used to summarize the trends. Results: Overall, 30.1%, 25.6%, 4.6% of Medicare Part D beneficiaries had a proton pump inhibitor, benzodiazepine, and antipsychotic claim in 2013, respectively. These rates decreased to 27.5%, 17.5%, 4.1% in 2019 (p-value \u3c 0.0001). However, the number of standardized 30-day claims increased from 63 million in 2013 to 84 million in 2019 for proton pump inhibitors, remained steady for benzodiazepines and slightly increased (10 million to 13 million) for antipsychotics. Total aggregate costs decreased by almost $1.5 billion for proton pump inhibitor,$100 million for benzodiazepine, and $700 million for antipsychotic from 2013 to 2019 (p-value \u3c 0.0001). Almost 93% of gastroenterologists prescribed a proton pump inhibitor, and 60% of psychiatrists prescribed benzodiazepines and antipsychotics all seven years. The Other region had the highest percentage of providers prescribing all three classes and the highest number of standardized 30-day benzodiazepine claims. Conclusions: The overall rate of use of proton pump inhibitors, benzodiazepines, and antipsychotics decreased from 2013–2019 among Medicare Part D beneficiaries. Despite the increase in raw number of standardized 30-day claims, the costs decreased which is likely due to generics made available. These prescribing trends may aid in identifying and targeting potential deprescribing interventions

Concordance Between Electronic Health Record Data and Medicare Part D Claims Data for Oral Anticancer Drug Use

Real-world evidence from electronic health records (EHRs) and claims data are being evaluated for use in regulatory decision-making.1,2 The objective of our study was to determine the concordance between EHR and Medicare Part D (MPD) claims data for the receipt of oral anticancer agents, a rapidly growing treatment option for cancer

How Do We Define High and Low Dose Intensity of Heart Failure Medications: A Scoping Review

BACKGROUND: Older adults with heart failure often experience adverse drug events with high doses of heart failure medications. Recognizing whether a patient is on a high or low dose intensity heart failure medication can be helpful for daily practice, since it could potentially guide the physician on which symptoms to look for, whether from overdosing or underdosing. However, the current guideline does not provide sufficient information about the dose intensity below the target dose. Furthermore, the definition of high or low-intensity heart failure medication is unclear, and there is no consensus. METHODS: To close the knowledge gap, we conducted a scoping review of the current literature to identify the most frequently used definition of high versus low doses of heart failure medications. We searched Pubmed, Embase, CINAHL, and Cochrane Library using comprehensive search terms that can capture the intensity of heart failure medications. RESULTS: We reviewed 464 articles, including 144 articles that had information about beta-blockers (BB), 179 articles about angiotensin-converting enzyme inhibitors (ACEi), 75 articles about angiotensin receptor blockers (ARB), 80 articles about diuretics, 37 articles about mineralocorticoid receptor antagonists (MRA), and 33 articles about angiotensin receptor-neprilysin inhibitor (ARNI). For hydralazine with isosorbide dinitrate or ivabradine, we could not identify any eligible articles. We identified 40 medications with most frequently used definitions of dose intensity. Four medications (nadolol, pindolol, cilazapril, and torsemide) did not reach consensus in definitions. Most of the BBs, ACEis, or ARBs used the definition of low being \u3c 50% of the target dose and high being ≥ 50% of the target dose from the guideline. However, for lisinopril and losartan, the most commonly used definitions of high or low were from pivotal clinical trials with a pre-defined definition of high or low. CONCLUSION: Our comprehensive scoping review studies identified the most frequently used definition of dose intensity for 40 medications but could not identify the definitions for 4 medications. The results of the current scoping review will be helpful for clinicians to have awareness whether the currently prescribed dose is considered high - requiring close monitoring of side effects, or low - requiring more aggressive up-titration

Optimization of Drug Prescription and Medication Management in Older Adults with Cardiovascular Disease

Cardiovascular disease increases incrementally with age and elderly patients concomitantly sustain multimorbidities, with resultant prescription of multiple medications. Despite conforming with disease-specific cardiovascular clinical practice guidelines, this polypharmacy predisposes many elderly individuals with cardiovascular disease to adverse drug events and non-adherence. Patient-centered care requires that the clinician explore with each patient his or her goals of care and that this shared decision-making constitutes the basis for optimization of medication management. This approach to aligning therapies with patient preferences is likely to promote patient satisfaction, to limit morbidity, and to favorably affect healthcare costs

Supportive Care in Older Adults with Cancer: Across the Continuum

Supportive care is an essential component of anti-cancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anti-cancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent