Trailer, labeling system, control system, and program for field implementation of computerized hole selection for layflat irrigation pipe

A system for installing and labeling lay flat irrigation pipe in flooded rice and furrow irrigated fields, and a trailer for laying a roll of pipe in an irrigated field. The trailer includes a flexible hitch assembly positioned at a first end of the trailer, wherein the hitch assembly couples the trailer to a vehicle. The trailer also includes a distribution assembly positioned at a second end of the trailer, wherein the distribution assembly includes a spindle and wherein the distribution assembly couples the roll of pipe to the trailer; and a gooseneck frame including a first end coupled to the hitch assembly and a second end coupled to the distribution assembly, with an upper member between the first end and the second end of the gooseneck, wherein the upper member of the gooseneck is elevated relative to the hitch assembly. The trailer may also include offset tandem wheels with a furrow assembly to facilitate the creation of a furrow ditch and for traversing flood irrigated levees for the purposes of installing lay-flat polyethylene pipe for irrigation. The trailer may also include an adjustable telescoping hitch to adjust to various vehicle hitch heights. The system includes a labeling system for indicating the punch size needed along the pipeline during installation. A computerized hole selection plan is developed and transferred to a microprocessor device, where sensors or a global positioning system is co-locate the device so the punch label can be applied along the pipe during installation

Trailer, labeling system, control system, and program for field implementation of computerized hole selection for layflat irrigation pipe

A system for installing and labeling lay flat irrigation pipe in flooded rice and furrow irrigated fields, and a trailer for laying a roll of pipe in an irrigated field. The trailer includes a flexible hitch assembly positioned at a first end of the trailer, wherein the hitch assembly couples the trailer to a vehicle. The trailer also includes a distribution assembly positioned at a second end of the trailer, wherein the distribution assembly includes a spindle and wherein the distribution assembly couples the roll of pipe to the trailer; and a gooseneck frame including a first end coupled to the hitch assembly and a second end coupled to the distribution assembly, with an upper member between the first end and the second end of the gooseneck, wherein the upper member of the gooseneck is elevated relative to the hitch assembly. The trailer may also include offset tandem wheels with a furrow assembly to facilitate the creation of a furrow ditch and for traversing flood irrigated levees for the purposes of installing lay-flat polyethylene pipe for irrigation. The trailer may also include an adjustable telescoping hitch to adjust to various vehicle hitch heights. The system includes a labeling system for indicating the punch size needed along the pipeline during installation. A computerized hole selection plan is developed and transferred to a microprocessor device, where sensors or a global positioning system is co-locate the device so the punch label can be applied along the pipe during installation

When does sedentary behavior become sleep? A proposed framework for classifying activity during sleep-wake transitions

The Sedentary Behavior Research Network recently published a consensus definition for sedentary behavior as ‘any waking behavior characterized by an energy expenditure ≤1.5 metabolic equivalents, while in a sitting, reclining, or lying posture.’ While this is a great step toward theoretical and methodological unity, further clarity around issues of classifying sedentary behavior while in bed is needed, specifically during sleep-wake transitions. A thigh-worn inclinometer with a 24-h wear protocol is recommended for best practice assessment of sedentary behavior, but this method introduces challenges for activity classification and data reduction. The constant stream of data collection does not distinguish waking sedentary activities in bed, e.g., watching television or reading, from sleep. Moreover, correct classification during sleep-wake transitions is not well established. Sleep-related behaviors can include time spent trying to fall asleep (sleep onset latency), night awakenings while attempting to fall back asleep (wakefulness after sleep onset), and unsuccessful attempts to fall back asleep in the morning (wakefulness after sleep offset). While these behaviors technically fit into the current definition of sedentary behavior, sleep-related behaviors belong in the sleep domain, are a normal part of the sleep-wake cycle, and are not likely an intervention target for sedentary behavior reduction. For these reasons, we argue that sleep-related behaviors should not be classified as sedentary. The research implications of using this framework for classifying sedentary behavior via 24-h thigh inclinometers include that diaries must ask participants to report the time they got into bed, began attempting to fall asleep (‘lights out’), woke up for the day, and got out of bed for the day. Using these diaries, researchers must manually extract the relevant period of wakefulness (and remove sleep-related and sleep time). The importance of this more burdensome protocol for researchers and participants, and across various subject populations, should be evaluated in future research

Independent evaluation of a simple clinical prediction rule to identify right ventricular dysfunction in patients with shortness of breath

BACKGROUND: Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction. Our goal is to validate this previously derived CDR by measuring the prevalence of RV dysfunction and outcomes in dyspneic emergency department patients. METHODS: A secondary analysis of a prospective observational multicenter study that enrolled patients presenting with suspected PE was performed. We included patients with persistent dyspnea, a nonsignificant CTPA, and formal echo performed. Right ventricular dysfunction was defined as RV hypokinesis and/or dilation with or without moderate to severe tricuspid regurgitation. RESULTS: A total of 7940 patients were enrolled. Two thousand six hundred sixteen patients were analyzed after excluding patients without persistent dyspnea and those with a significant finding on CTPA. One hundred ninety eight patients had echocardiography performed as standard care. Of those, 19% (95% confidence interval [CI], 14%-25%) and 33% (95% CI, 25%-42%) exhibited RV dysfunction and isolated RV dysfunction, respectively. Patients with isolated RV dysfunction or overload were more likely than those without RV dysfunction to have a return visit to the emergency department within 45 days for the same complaint (39% vs 18%; 95% CI of the difference, 4%-38%). CONCLUSION: This simple clinical prediction rule predicted a 33% prevalence of isolated RV dysfunction or overload. Patients with isolated RV dysfunction had higher recidivism rates and a trend toward worse outcomes

Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multi-center study

Study Objective—Prediction rules for pulmonary embolism (PE) employ variables explicitly shown to estimate the probability of PE. However, clinicians often use variables that have not been similarly validated, yet are implicitly believed to modify probability of PE. The objective of this study was to measure the predictive value of 13 implicit variables. Methods—Patients were enrolled in a prospective cohort study from 12 centers in the United States; all had an objective test for PE (D-dimer, CT angiography, or V/Q scan). Clinical features including 12 predefined previously validated (explicit) variables and 13 variables not part of existing prediction rules (implicit) were prospectively recorded at presentation. The primary outcome was VTE (venous thromboembolism: PE or deep venous thrombosis), diagnosed by imaging up to 45 days after enrollment. Variables with adjusted odds ratios from logistic regression with 95% confidence intervals not crossing unity were considered significant. Results—7,940 patients (7.2% VTE+) were enrolled. Mean age was 49±17 years and 67% were female. Eight of 13 implicit variables were significantly associated with VTE; those with an adjusted OR >1.5 included non-cancer related thrombophilia (1.99), pleuritic chest pain (1.53), and family history of VTE (1.51). Implicit variables that predicted no VTE outcome included: substernal chest pain, female gender, and smoking. Nine of 12 explicit variables predicted a positive outcome of VTE, including unilateral leg swelling, recent surgery, estrogen, hypoxemia and active malignancy. Conclusions—In symptomatic outpatients being considered for possible PE, non-cancer related thrombophilia, pleuritic chest pain, and family history of VTE increase probability of PE or DVT. Other variables that are part of existing pretest probability systems were validated as important predictors in this diverse sample of US Emergency department patients

Randomized Trial of Tenecteplase or Placebo with Low Molecular Weight Heparin for Acute Submassive Pulmonary Embolism: Assessment of Patient-Oriented Cardiopulmonary Outcomes at Three Months

Background: Acute submassive pulmonary embolism (PE) with right ventricular (RV) injury and/or concomitant deep venous thrombosis can cause persistent symptoms that degrade quality of life. We tested the hypothesis that intravenous tenecteplase would improve the probability of a favorable outcome at three months after submassive PE. Methods: Multicenter randomized double-blind, placebo controlled trial. Eligible patients were ambulatory at baseline, had image-proven acute PE, a systolic blood pressure > 90 mm Hg and RV dysfunction (abnormal echocardiography, troponin or brain natriuretic peptide). Patients received anticoagulation with low molecular weight heparin (LMWH) and either tiered-dose tenecteplase or saline in an opaque syringe. Composite favorable outcome: 5 day survival to hospital discharge without shock, intubation, or major hemorrhage (any intracranial bleed or need for surgical or medical intervention for acute anemia), and at 90 days, normal RV on resting echocardiography, 6 minute walk distance>330 m, no dyspnea at rest, and no recurrent PE or DVT. Self-perception of wellness was assessed by the SF-16, VEINES-QOL and rank on 1-10 ordinal scale. Results: 83 patients were enrolled, including 33 women, 52 Caucasians, mean age 55+/-14 years, 43 received placebo, 40 received tenecteplase, and 38 had concomittant DVT. A favorable composite outcome occurred in 17/43(40%, 95% CI: 25-56%) treated with placebo, versus 26/40 (65%, 95% CI: 48-79%) treated with tenecteplase, p=0.02 Fisher’s exact. Acute deterioration occurred in 3 patients treated with placebo: fatal PE (1), intubation (1), thrombectomy (1) and in one patient treated with tenecteplase who had a fatal intracranial hemorrhage. At three months, a nonfavorable outcome was found in 23 additional patients treated with placebo, versus 13 patients treated with tenecteplase. Assessments of wellness were consistently higher in the tenecteplase group (e.g., p=0.03 for ordinal scale rank). Conclusions: In this randomized trial, patients with submassive PE treated with LMWH and tenecteplase were more likely to have a favorable patient-oriented outcome at three months than patients treated with LMWH and saline placebo

Work‐Related Outcomes After a Myocardial Infarction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90385/1/phco.24.16.1515.50946.pd

Dose-response effects of exercise training on the subjective sleep quality of postmenopausal women: exploratory analyses of a randomised controlled trial

Objective: To investigate whether a dose-response relationship existed between exercise and subjective sleep quality in postmenopausal women. This objective represents a post hoc assessment that was not previously considered. Design: Parallel-group randomised controlled trial. Setting: Clinical exercise physiology laboratory in Dallas, Texas. Participants: 437 sedentary or overweight/obese postmenopausal women. Intervention: Participants were randomised to one of four treatments, each of 6 months of duration: a non-exercise control treatment (n=92) or one of three dosages of moderate-intensity exercise (50% of VO2peak), designed to meet 50% (n=151), 100% (n=99) or 150% (n=95) of the National Institutes of Health Consensus Development Panel physical activity recommendations. Exercise dosages were structured to elicit energy expenditures of 4, 8 or 12 kilocalories per kilogram of body weight per week (KKW), respectively. Analyses were intent to treat. Primary outcome measures: Continuous scores and odds of having significant sleep disturbance, as assessed by the Sleep Problems Index from the 6-item Medical Outcomes Study Sleep Scale. Outcome assessors were blinded to participate radomisation assignment. Results: Change in the Medical Outcomes Study Sleep Problems Index score at 6 months significantly differed by treatment group (control: -2.09 (95% CI -4.58 to 0.40), 4 KKW: -3.93 (-5.87 to -1.99), 8 KKW: -4.06 (-6.45 to -1.67), 12 KKW: -6.22 (-8.68 to -3.77); p=0.04), with a significant dose-response trend observed (p=0.02). Exercise training participants had lower odds of having significant sleep disturbance at postintervention compared with control (4 KKW: OR 0.37 (95% CI 0.19 to 0.73), 8 KKW: 0.36 (0.17 to 0.77), 12 KKW: 0.34 (0.16 to 0.72)). The magnitude of weight loss did not differ between treatment conditions. Improvements in sleep quality were not related to changes in body weight, resting parasympathetic control or cardiorespiratory fitness. Conclusion: Exercise training induced significant improvement in subjective sleep quality in postmenopausal women, with even a low dose of exercise resulting in greatly reduced odds of having significant sleep disturbance

Health‐Related Quality of Life in Patients 7 Months After a Myocardial Infarction: Factors Affecting the Short Form‐12

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90293/1/phco.22.17.1616.34121.pd

Factors Associated With Positive D-dimer Results in Patients Evaluated for Pulmonary Embolism

Objectives:  Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE. Methods:  This was a prospective, multicenter, observational study. Emergency department (ED) patients evaluated for PE with a quantitative D-dimer were eligible for inclusion. The main outcome of interest was a positive D-dimer. Odds ratio (ORs) and 95% confidence intervals (CIs) were determined by multivariable logistic regression. Adjusted estimates of relative risk were also calculated. Results:  A total of 4,346 patients had D-dimer testing, of whom 2,930 (67%) were women. A total of 2,500 (57%) were white, 1,474 (34%) were black or African American, 238 (6%) were Hispanic, and 144 (3%) were of other race or ethnicity. The mean (±SD) age was 48 (±17) years. Overall, 1,903 (44%) D-dimers were positive. Model fit was adequate (c-statistic = 0.739, Hosmer and Lemeshow p-value = 0.13). Significant positive predictors of D-dimer positive included female sex; increasing age; black (vs. white) race; cocaine use; general, limb, or neurologic immobility; hemoptysis; hemodialysis; active malignancy; rheumatoid arthritis; lupus; sickle cell disease; prior venous thromboembolism (VTE; not under treatment); pregnancy and postpartum state; and abdominal, chest, orthopedic, or other surgery. Warfarin use was protective. In contrast, several variables known to be associated with PE were not associated with positive D-dimer results: body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment). Conclusions:  Many factors are associated with a positive D-dimer test. The effect of these factors on the usefulness of the test should be considered prior to ordering a D-dimer