USSP-IAEA Workshop on Advanced Sensors for Safeguards

The IAEA Medium Term Strategy (2006-2011) defines a number of specific goals in respect to the IAEA's ability to provide assurances to the international community regarding the peaceful use of nuclear energy through States adherences to their respective non-proliferation treaty commitments. The IAEA has long used and still needs the best possible sensors to detect and measure nuclear material. The Department of Safeguards, recognizing the importance of safeguards-oriented R&D, especially targeting improved detection capabilities for undeclared facilities, materials and activities, initiated a number of activities in early 2005. The initiatives included letters to Member State Support Programs (MSSPs), personal contacts with known technology holders, topical meetings, consultant reviews of safeguards technology, and special workshops to identify new and novel technologies and methodologies. In support of this objective, the United States Support Program to IAEA Safeguards hosted a workshop on ''Advanced Sensors for Safeguards'' in Santa Fe, New Mexico, from April 23-27, 2007. The Organizational Analysis Corporation, a U.S.-based management consulting firm, organized and facilitated the workshop. The workshop's goal was to help the IAEA identify and plan for new sensors for safeguards implementation. The workshop, which was attended by representatives of seven member states and international organizations, included presentations by technology holders and developers on new technologies thought to have relevance to international safeguards, but not yet in use by the IAEA. The presentations were followed by facilitated breakout sessions where the participants considered two scenarios typical of what IAEA inspectors might face in the field. One scenario focused on an enrichment plant; the other scenario focused on a research reactor. The participants brainstormed using the technologies presented by the participants and other technologies known to them to propose techniques and methods that could be used by the IAEA to strengthen safeguards. Creative thinking was encouraged during discussion of the proposals. On the final day of the workshop, the OAC facilitators summarized the participant's ideas in a combined briefing. This paper will report on the results of the April 2007 USSP-IAEA Workshop on Advanced Sensors for Safeguards and give an overview of the proposed technologies of greatest promise

438: SAFETY AND EFFICACY OF CEFEPIME INTRAVENOUS PUSH VERSUS PIGGYBACK IN GRAM-NEGATIVE BACTEREMIA

Introduction: Gram-negative infections including bacteremia are a major cause of inpatient mortality. Optimizing management is key to improving outcomes. Beta-lactams exhibit optimal antibacterial effects based on the time free concentrations exceed an organism’s minimum inhibitory concentration. Limited data exists assessing outcomes using beta-lactams as intravenous push (IVP) compared to intravenous piggyback (IVPB) in serious infections. This study’s purpose was to compare safety and efficacy of cefepime administered IVP versus IVPB in gram-negative bacteremia. Methods: This was an IRB-approved, retrospective cohort of patients hospitalized January 2014 to December 2021 and administered cefepime for \u3e48 hours for gram-negative bacteremia involving Pseudomonas aeruginosa or AmpC beta-lactamase producing bacteria. Two groups were included: one of patients who received cefepime IVPB and the second of patients who received cefepime IVP. The primary outcome was a desirability of outcome ranking (DOOR) on a five-point ordinal scale including clinical cure (no recurrent bacteremia of initial pathogen, antibiotic escalation, or 30-day in-hospital mortality) and neurologic adverse effects during cefepime treatment up to 30 days inpatient or at discharge. Secondary outcomes included antibiotic escalation, time to defervescence, vasopressor use, and in-hospital mortality. A sample of 127 patients per group provided 80% power. Data was analyzed using measures of central tendency and variability, chi-square, student’s T test, and Mann-Whitney U. Results: A total 254 patients were included with 127 per group. DOOR with clinical cure was similar between the IVPB and IVP groups (105 (82.7%) vs. 104 (81.9%); P=0.656). Escalation of therapy was the most common reason for clinical failure in both the IVPB and IVP groups (17 (13.4%) vs. 18 (14.2%); P=0.856). More patients in the IVP group required vasopressors (13 (10.2%) vs. 28 (22.0%); P=0.011). No difference was found in time to defervescence or in-hospital mortality. Conclusions: When compared to cefepime IVPB in gram-negative bacteremia, treatment with IVP showed no significant difference in instances of clinical cure or adverse effects. Further research in a more severely ill population is needed to evaluate safety and efficacy of cefepime IVPB versus IVP

Improved fluid dynamics similarity, analysis and verification Annual report, 29 Jun. 1965 - 28 Jun. 1966

Fluid mechanics and dynamic reactions in liquid flow, single-phase flow, and two-phase flo

Project #37: Management Guidelines for Patients with COVID-19: Rapid Cycle Improvement

Project’s purpose is to rapidly devise, continually improve, educate, and implement a live and changing COVID-19 management guideline based upon emerging best available evidence. This project also aims to optimize the care of patients with COVID-19 and improve patient outcomes.https://scholarlycommons.henryford.com/qualityexpo2022/1004/thumbnail.jp

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None

Arterial Spin Labeling Cerebral Perfusion Magnetic Resonance Imaging in Migraine Aura: An Observational Study

Background: Changes in cerebral perfusion during migraine with aura (MA) have been assessed mainly using dynamic susceptibility contrast (DSC) magnetic resonance perfusion imaging. A contrast agent-free method to assess these changes would be desirable. We assessed changes in cerebral perfusion during MA using arterial spin labeling (ASL) perfusion magnetic resonance imaging. Methods: We investigated 4 patients with a standardized protocol including ASL perfusion imaging during MA (n = 2) or early headache phase (n = 2) and asymptomatic follow-up. Semiquantitative evaluation was done using a region of interest (ROI) within hypoperfused or hyperperfused areas and corresponding ROIs in the contralateral hemisphere. Relative ratios of mean perfusion in the corresponding ROIs were calculated. DSC imaging was done at initial time points and compared visually with ASL findings. Results: In all patients, regional perfusion changes were detected in the acute phase. These abnorm alities did not respect the boundaries of major cerebral vascular territories but overlapped onto adjoining regions. During MA, adjacent hypoperfused and hyperperfused areas were found, whereas during headache, regional hyperperfusion only was observed. Perfusion abnormalities normalized on follow-up. Conclusions: ASL perfusion imaging is a contrast agent-free method suitable for assessment of reversible perfusion changes during or immediately after MA