99 research outputs found

    Adaptive servoventilation improves cardiac function and respiratory stability

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    Cheyne–Stokes respiration (CSR) in patients with chronic heart failure (CHF) is of major prognostic impact and expresses respiratory instability. Other parameters are daytime pCO2, VE/VCO2-slope during exercise, exertional oscillatory ventilation (EOV), and increased sensitivity of central CO2 receptors. Adaptive servoventilation (ASV) was introduced to specifically treat CSR in CHF. Aim of this study was to investigate ASV effects on CSR, cardiac function, and respiratory stability. A total of 105 patients with CHF (NYHA ≥ II, left ventricular ejection fraction (EF) ≤ 40%) and CSR (apnoea–hypopnoea index ≥ 15/h) met inclusion criteria. According to adherence to ASV treatment (follow-up of 6.7 ± 3.2 months) this group was divided into controls (rejection of ASV treatment or usage <50% of nights possible and/or <4 h/night; n = 59) and ASV (n = 56) adhered patients. In the ASV group, ventilator therapy was able to effectively treat CSR. In contrast to controls, NYHA class, EF, oxygen uptake, 6-min walking distance, and NT-proBNP improved significantly. Moreover, exclusively in these patients pCO2, VE/VCO2-slope during exercise, EOV, and central CO2 receptor sensitivity improved. In CHF patients with CSR, ASV might be able to improve parameters of SDB, cardiac function, and respiratory stability

    Cost-Effectiveness of Peer-Delivered Interventions for Cocaine and Alcohol Abuse among Women: A Randomized Controlled Trial

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    <div><h3>Aims</h3><p>To determine whether the additional interventions to standard care are cost-effective in addressing cocaine and alcohol abuse at 4 months (4 M) and 12 months (12 M) from baseline.</p> <h3>Method</h3><p>We conducted a cost-effectiveness analysis of a randomized controlled trial with three arms: (1) NIDA's Standard intervention (SI); (2) SI plus a Well Woman Exam (WWE); and, (3) SI, WWE, plus four Educational Sessions (4ES).</p> <h3>Results</h3><p>To obtain an additional cocaine abstainer, WWE compared to SI cost 7,223at4Mand7,223 at 4 M and 3,611 at 12 M. Per additional alcohol abstainer, WWE compared to SI cost 3,611and3,611 and 7,223 at 4 M and 12 M, respectively. At 12 M, 4ES was dominated (more costly and less effective) by WWE for abstinence outcomes.</p> <h3>Conclusions</h3><p>To our knowledge, this is the first cost-effectiveness analysis simultaneously examining cocaine and alcohol abuse in women. Depending on primary outcomes sought and priorities of policy makers, peer-delivered interventions can be a cost-effective way to address the needs of this growing, underserved population.</p> <h3>Trial Registration</h3><p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01235091">NCT01235091</a></p> </div

    Scaling Parameters for Dynamic Diffusion-Reaction over Porous Catalysts

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    The effect of diffusion resistance in porous solid catalysts on reaction rate during periodic cycling of CO concentration is shown for CO oxidation over Pt/Al2O3 by numerical simulation. At some cycling frequencies, the average reaction rate during cycling is higher than the steady-state rate at the mean CO concentration, as expected for this nonlinear, reactant-inhibited reaction. In order to identify major aspects of dynamic diffusion-reaction behavior, a simple kinetic mechanism that shows the main features of CO oxidation and other reactions with significant inhibition by reactants is investigated. A single dimensionless parameter group, the dynamic diffusion coefficient, is added when going from steady-state to unsteady-state diffusion-reaction equations. In the dynamic diffusion coefficient, the rate at which the gas-phase reactant diffuses is reduced by the surface adsorption capacity of the catalyst. The frequency at which the peak average rate occurs is controlled by the dynamic diffusion coefficient
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