The gender specification and cultural sensitivity of depression research with Black Americans: A multidimensional model

http://deepblue.lib.umich.edu/bitstream/2027.42/64287/1/Watkins_Johnson2008.pd

Eddy Current Examination of Spent Nuclear Fuel Canister Closure Welds

The National Spent Nuclear Fuel Program (NSNFP) has developed standardized DOE SNF canisters for handling and interim storage of SNF at various DOE sites as well as SNF transport to and SNF handling and disposal at the repository. The final closure weld of the canister will be produced remotely in a hot cell after loading and must meet American Society of Mechanical Engineers (ASME) Section III, Division 3 code requirements thereby requiring volumetric and surface nondestructive evaluation to verify integrity. This paper discusses the use of eddy current testing (ET) to perform surface examination of the completed welds and repair cavities. Descriptions of integrated remote welding/inspection system and how the equipment is intended function will also be discussed

Remote Welding, NDE and Repair of DOE Standardized Canisters

The U.S. Department of Energy (DOE) created the National Spent Nuclear Fuel Program (NSNFP) to manage DOE’s spent nuclear fuel (SNF). One of the NSNFP’s tasks is to prepare spent nuclear fuel for storage, transportation, and disposal at the national repository. As part of this effort, the NSNFP developed a standardized canister for interim storage and transportation of SNF. These canisters will be built and sealed to American Society of Mechanical Engineers (ASME) Section III, Division 3 requirements. Packaging SNF usually is a three-step process: canister loading, closure welding, and closure weld verification. After loading SNF into the canisters, the canisters must be seal welded and the welds verified using a combination of visual, surface eddy current, and ultrasonic inspection or examination techniques. If unacceptable defects in the weld are detected, the defective sections of weld must be removed, re-welded, and re-inspected. Due to the high contamination and/or radiation fields involved with this process, all of these functions must be performed remotely in a hot cell. The prototype apparatus to perform these functions is a floor-mounted carousel that encircles the loaded canister; three stations perform the functions of welding, inspecting, and repairing the seal welds. A welding operator monitors and controls these functions remotely via a workstation located outside the hot cell. The discussion describes the hardware and software that have been developed and the results of testing that has been done to date

The Effects of Stress Mitigation on Nondestructive Examination

Ultrasonic volumetric and eddy current and visual profile surface inspections of the completed weld securing the outer lid of the Yucca Mountain waste package are required after stress mitigation. However, the technique implemented may affect the ability of the different evaluation techniques to properly characterize the completed weld. An evaluation was performed to determine the extent the nondestructive evaluation techniques are affected by two candidate mitigation processes: controlled plasticity burnishing and laser peening. This report describes the work performed and summarizes the results

Ultrasonic Phased Array Implementation of the Inside Diameter Creeping Wave Sizing Method

This paper describes a technique for implementing the ultrasonic inside diameter (ID) creeping wave technique for detection and sizing ID connected defects using a phased array ultrasonic system. The technique uses multiple focal laws to produce the examination modes. The first focal law is designed to create a shear wave nominally at the critical angle for mode conversion to a longitudinal wave at the ID of a part, thus creating a creeping wave. This focal law is focused at the ID to improve sensitivity. The rest of the laws are designed to create tandem sound paths that progress up a vertical surface directly above the focal point of the creeping wave generation point. When a defect on the inner surface is detected with the creeping wave, the height of the defect can be measured from the response of a set of tandem laws without readjusting the position of the probe. Results from standard one-inch long notches of varying depths are presented

ALPINE2:Efficacy and safety of 14-day vs 28-day inhaled aztreonam for <i>Pa </i>eradication in children with cystic fibrosis

Background: Antibiotic eradication therapies recommended for newly isolated Pseudomonas aeruginosa (Pa) in people with cystic fibrosis (pwCF) can be burdensome. ALPINE2 compared the efficacy and safety of a shortened 14-day course of aztreonam for inhalation solution (AZLI) with 28-day AZLI in paediatric pwCF. Methods: ALPINE2 (a double-blind, phase 3b study) included children aged 3 months to &lt;18 years with CF and new-onset Pa infection. Participants were randomized to receive 75 mg AZLI three times daily for either 28 or 14 days followed by 14 days' matched placebo. The primary endpoint was rate of primary Pa eradication (no Pa detected during the 4 weeks post AZLI treatment). Non-inferiority was achieved if the lower 95% CI bound of the treatment difference between the two arms was above −20%. Secondary endpoints included assessments of Pa recurrence during 108 weeks of follow-up after primary eradication. Safety endpoints included treatment-emergent adverse events (TEAEs). Results: In total, 149 participants were randomized (14-day AZLI, n = 74; 28-day AZLI, n = 75) and 142 (95.3%) completed treatment. Median age: 6.0 years (range: 0.3–17.0). Baseline characteristics were similar between treatment arms. Primary Pa eradication rates: 14-day AZLI, 55.9%; 28-day AZLI, 63.4%; treatment difference (CI), −8.0% (−24.6, 8.6%). Pa recurrence rates at follow-up end: 14-day AZLI, 54.1% (n = 20/37); 28-day AZLI, 41.9% (n = 18/43). TEAEs were similar between treatment arms. No new safety signals were observed. Conclusions: Non-inferiority of 14-day AZLI versus 28-day AZLI was not demonstrated. Both courses were well tolerated, further supporting AZLI short-term safety in paediatric and adolescent pwCF. ClinicalTrials.gov:</p

Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock

Introduction: In this study, we sought to determine the association between red blood cell (RBC) transfusion and outcomes in patients with acute lung injury (ALI), sepsis and shock.Methods: We performed a secondary analysis of new-onset ALI patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial (2000 to 2005) who had a documented ALI risk factor of sepsis or pneumonia and met shock criteria (mean arterial pressure (MAP) < 60 mmHg or vasopressor use) within 24 hours of randomization. Using multivariable logistic regression, we examined the association between RBC transfusion and 28-day mortality after adjustment for age, sex, race, randomization arm and Acute Physiology and Chronic Health Evaluation III score. Secondary end points included 90-day mortality and ventilator-free days (VFDs). Finally, we examined these end points among the subset of subjects meeting prespecified transfusion criteria defined by five simultaneous indicators: hemoglobin < 10.2 g/dL, central or mixed venous oxygen saturation < 70%, central venous pressure ≥ 8 mmHg, MAP ≥ 65 mmHg, and vasopressor use.Results: We identified 285 subjects with ALI, sepsis, shock and transfusion data. Of these, 85 also met the above prespecified transfusion criteria. Fifty-three (19%) of the two hundred eighty-five subjects with shock and twenty (24%) of the subset meeting the transfusion criteria received RBC transfusion within twenty-four hours of randomization. We found no independent association between RBC transfusion and 28-day mortality (odds ratio = 1.49, 95% CI (95% confidence interval) = 0.77 to 2.90; P = 0.23) or VFDs (mean difference = -0.35, 95% CI = -4.03 to 3.32; P = 0.85). Likewise, 90-day mortality and VFDs did not differ by transfusion status. Among the subset of patients meeting the transfusion criteria, we found no independent association between transfusion and mortality or VFDs.Conclusions: In patients with new-onset ALI, sepsis and shock, we found no independent association between RBC transfusion and mortality or VFDs. The physiological criteria did not identify patients more likely to be transfused or to benefit from transfusion. © 2011 Parsons et al. licensee BioMed Central Ltd

Cost-effectiveness of Implementing Low-Tidal Volume Ventilation in Patients With Acute Lung Injury

Background: Despite widespread guidelines recommending the use of lung-protective ventilation (LPV) in patients with acute lung injury (ALI), many patients do not receive this lifesaving therapy. We sought to estimate the incremental clinical and economic outcomes associated with LPV and determined the maximum cost of a hypothetical intervention to improve adherence with LPV that remained cost-effective. Methods: Adopting a societal perspective, we developed a theoretical decision model to determine the cost-effectiveness of LPV compared to non-LPV care. Model inputs were derived from the literature and a large population-based cohort of patients with ALI. Cost-effectiveness was determined as the cost per life saved and the cost per quality-adjusted life-years (QALYs) gained. Results: Application of LPV resulted in an increase in QALYs gained by 15% (4.21 years for non-LPV vs 4.83 years for LPV), and an increase in lifetime costs of $7,233 per patient with ALI ($99,588 for non-LPV vs $106,821 for LPV). The incremental cost-effectiveness ratios for LPV were$22,566 per life saved at hospital discharge and $11,690 per QALY gained. The maximum, cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50 to 90$9,482. Results were robust to a wide range of economic and patient parameter assumptions. Conclusions: Even a costly intervention to improve adherence with low-tidal volume ventilation in patients with ALI reduces death and is cost-effective by current societal standards.NIH F32HL090220.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84154/1/Cooke - CEA LPV.pd