Patient considerations in the treatment of COPD: focus on the new combination inhaler umeclidinium/vilanterol.

Medication adherence among patients with chronic diseases, such as COPD, may be suboptimal, and many factors contribute to this poor adherence. One major factor is the frequency of medication dosing. Once-daily dosing has been shown to be an important variable in medication adherence in chronic diseases, such as COPD. New inhalers that only require once-daily dosing are becoming more widely available. Combination once-daily inhalers that combine any two of the following three agents are now available: 1) a long-acting muscarinic antagonist; 2) a long acting beta2 agonist; and 3) an inhaled corticosteroid. A new once-daily inhaler with both a long-acting muscarinic antagonist, umeclidinium bromide, and a long acting beta2 agonist, vilanterol trifenatate, is now available worldwide for COPD treatment. It provides COPD patients convenience, efficacy, and a very favorable adverse-effects profile. Additional once-daily combination inhalers are available or will soon be available for COPD patients worldwide. The use of once-daily combination inhalers will likely become the standard maintenance management approach in the treatment of COPD because they improve medication adherence

Statically indeterminate stresses in stiff framed structures

Thesis (M.S.)--University of Illinois, 1915.Typescript

Torsional Dynamic Response of Embedded Footings

A computer program, originally prepared to evaluate stresses and displacements below an axisymmetric surface footing subjected to torsional loadings, has been modified to accommodate embedded footings. The material surrounding the footing can be considered as elastic, nonlinear inelastic or nonlinear inelastic including slip. Layered systems can also be treated. Good agreement was obtained in comparisons with published solutions for elastic systems, as obtained by the finite element method, and by an approximate method. In particular, comparisons were made for variations at maximum amplitude of rotation and dimensionless frequency at maximum amplitude of rotation as functions of the embedment ratio. The influence of soil nonlinearity and slip at the footing boundary were computed for conditions similar to those for a circular embedded footing previously tested in the field. Comparisons of computed and field results showed the importance of including soil nonlinearity and slip at the footing periphery when evaluating test data

Creep Effects on Low-Amplitude Modulus of Clays

The investigation considered effects of on-going or previous drained creep on the low amplitude dynamic shear modulus of normally consolidated artificial and natural clay soils. Resonant column tests using the Hardin and Hall devices determined the low-amplitude shear modulus. Results indicated that the strain-rate of on-going creep determined the kind of effect on shear modulus. High strain-rates produced reduced values whereas low strain-rates slightly increased values of modulus, compared to the no-creep values. Previous creep produced higher values of modulus, when the clay was tested under after-creep isotropic confinement. The rate of secondary increase of shear modulus was not affected by the drained creep action. The behaviors of the remolded kaolinite clay and the undisturbed natural clay were remarkably similar

Bench-to-bedside review: Rare and common viral infections in the intensive care unit – linking pathophysiology to clinical presentation

Viral infections are common causes of respiratory tract disease in the outpatient setting but much less common in the intensive care unit. However, a finite number of viral agents cause respiratory tract disease in the intensive care unit. Some viruses, such as influenza, respiratory syncytial virus (RSV), cytomegalovirus (CMV), and varicella-zoster virus (VZV), are relatively common. Others, such as adenovirus, severe acute respiratory syndrome (SARS)-coronavirus, Hantavirus, and the viral hemorrhagic fevers (VHFs), are rare but have an immense public health impact. Recognizing these viral etiologies becomes paramount in treatment, infection control, and public health measures. Therefore, a basic understanding of the pathogenesis of viral entry, replication, and host response is important for clinical diagnosis and initiating therapeutic options. This review discusses the basic pathophysiology leading to clinical presentations in a few common and rare, but important, viruses found in the intensive care unit: influenza, RSV, SARS, VZV, adenovirus, CMV, VHF, and Hantavirus

A Strategy Based on Aspen Plus for Venting and Leaks from Vessels

PresentationSevere accidents have occurred when vessels release their contained material either accidentally or intentionally to prevent further catastrophic accidents. Several models have been developed to deal with simulating these events where rigorous thermodynamic procedures are used to improve the estimation. The approach developed in this work takes advantage of the commercial software Aspen Plus to estimate all required thermodynamic properties including estimation of sonic releases. The procedure is developed in the Excel environment where the strategy is programmed to call and run an Aspen Plus file, while keeping control on the integration to solve a quasi-steady-state model. The simple Euler method is applied to solve the dynamic release model. Physical characteristics of the vessel can easily be incorporated to detect the releasing phase. The releasing behavior is modelled with the internal models for valves include in Aspen Plus, where sonic estimation is already implemented. Estimation takes advantage of the simulation package and results are in good agreement with experimental data reported in the literature

Anisotropic nonlinear elasticity in a spherical bead pack: influence of the fabric anisotropy

Stress-strain measurements and ultrasound propagation experiments in glass bead packs have been simultaneously conducted to characterize the stress-induced anisotropy under uniaxial loading. These measurements, realized respectively with finite and incremental deformations of the granular assembly, are analyzed within the framework of the effective medium theory based on the Hertz-Mindlin contact theory. Our work shows that both compressional and shear wave velocities and consequently the incremental elastic moduli agree fairly well with the effective medium model by Johnson et al. [J. Appl. Mech. 65, 380 (1998)], but the anisotropic stress ratio resulting from finite deformation does not at all. As indicated by numerical simulations, the discrepancy may arise from the fact that the model doesn't properly allow the grains to relax from the affine motion approximation. Here we find that the interaction nature at the grain contact could also play a crucial role for the relevant prediction by the model; indeed, such discrepancy can be significantly reduced if the frictional resistance between grains is removed. Another main experimental finding is the influence of the inherent anisotropy of granular packs, realized by different protocols of the sample preparation. Our results reveal that compressional waves are more sensitive to the stress-induced anisotropy, whereas the shear waves are more sensitive to the fabric anisotropy, not being accounted in analytical effective medium models.Comment: 9 pages, 8 figure

Produtividade de grãos e componentes de produção da canola de acordo com fontes e doses de nitrogênio.

Avalia a resposta da canola a fontes e doses de nitrogênio aplicadas na semeadura. O experimento foi conduzido em Latossolo Vermelho distroférrico típico, com textura muito argilosa. Utilizou-se delineamento experimental de blocos ao acaso, em arranjo fatorial 7x2, com sete doses de N em superfície na semeadura (0, 20, 40, 60, 80, 100 e 120 kg ha‑1), duas fontes de N (sulfato de amônio e ureia) e quatro repetições. O experimento foi realizado com o híbrido Hyola 61, por dois anos, e foram avaliadas as seguintes variáveis: altura de planta, número de plantas por metro quadrado, massa de matéria seca da parte aérea, massa de síliquas por planta, massa de mil grãos, produtividade de grãos, e teores de proteína e de óleo nos grãos. As variáveis não foram influenciadas pelas fontes de N. A maior produtividade de grãos é alcançada com 88 kg ha‑1 de N. Doses crescentes de N aumentam os teores de proteína e diminuem os de óleo nos grãos de canola