The HELP System for Medical Decision Making

Conference PaperBiomedical Informatic

Utilization of Renewable Oxygenates as Gasoline Blending Components

This report reviews the use of higher alcohols and several cellulose-derived oxygenates as blend components in gasoline. Material compatibility issues are expected to be less severe for neat higher alcohols than for fuel-grade ethanol. Very little data exist on how blending higher alcohols or other oxygenates with gasoline affects ASTM Standard D4814 properties. Under the Clean Air Act, fuels used in the United States must be 'substantially similar' to fuels used in certification of cars for emission compliance. Waivers for the addition of higher alcohols at concentrations up to 3.7 wt% oxygen have been granted. Limited emission testing on pre-Tier 1 vehicles and research engines suggests that higher alcohols will reduce emissions of CO and organics, while NOx emissions will stay the same or increase. Most oxygenates can be used as octane improvers for standard gasoline stocks. The properties of 2-methyltetrahydrofuran, dimethylfuran, 2-methylfuran, methyl pentanoate and ethyl pentanoate suggest that they may function well as low-concentration blends with gasoline in standard vehicles and in higher concentrations in flex fuel vehicles

Occurrence of exercise-induced and spontaneous wide complex tachycardia during therapy with flecainide for complex ventricular arrhythmias: A probable proarrhythmic effect

Flecainide acetate, a new antiarrhythmic agent, possesses favorable pharmacokinetic and hemodynamic properties and demonstrates highly favorable antiarrhythmic activity in patients with ventricular arrhythmias. However, the proarrhythmic potential of flecainide deserves further evaluation. In 7 (13%) of 55 consecutive patients treated with oral flecainide, 200 to 600 mg/day, for complex ventricular arrhythmias (including sustained ventricular tachycardia in 14), we observed the appearance of new or more sustained exercise-induced (five patients) or spontaneous (two patients) wide complex tachycardia. The mechanism of wide complex tachycardia appeared to be ventricular tachycardia in all seven. In our series, episodes were self-remitting or successfully treated. In four patients, wide complex tachycardia did not recur during exercise testing during alternative antiarrhythmic therapy (three patients) or no antiarrhythmic therapy (one patient). These observations raise the possibility of flecainide-related proarrhythmia, manifested as an increased propensity to exercise (activity)-induced wide complex tachycardia, which was not reliably predicted by results of Holter recordings or programmed electrical stimulation. Patients with complex ventricular arrhythmias beginning long-term treatment with oral flecainide should be considered for treadmill exercise testing together with ambulatory monitoring as part of the initial assessment of drug efficacy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26728/1/0000278.pd

Validating Chemistry Faculty Members’ Self-Reported Familiarity with Assessment Terminology

With the increasing emphasis placed upon chemistry instructors and departments to assess and evaluate their courses and curricula, understanding the structure of chemistry faculty members’ knowledge and use of assessment terms and concepts can shed light on potential areas for targeted professional development. Survey research that might accomplish this objective often relies on self-reported responses from the target audience, and such information is sometimes difficult to assess in terms of validity. As an example of an internal mechanism to help establish validity, it is possible to include an “internal standard” item early in the survey. For the sake of understanding faculty members’ familiarity with assessment terminology, an item that asked participants to identify analogous pairs of terms comparing assessment measures (assessment validity and assessment reliability) to laboratory measures (accuracy and precision) served this purpose. Using ordered logistic regression, participants who answered the analogy question completely correctly were more likely to report higher levels of familiarity with the assessment terms. Because the self-reported data appears to be valid, these data can be further used in subsequent analyses in order to determine the general familiarity trends among chemistry faculty regarding assessment terminology

Airborne Emissions from 1961 to 2004 of Benzo[a]pyrene from U.S. Vehicles per km of Travel Based on Tunnel Studies

We identified 13 historical measurements of polycyclic aromatic hydrocarbons (PAHs) in U.S. vehicular traffic tunnels that were either directly presented as tailpipe emission factors in μg per vehicle-kilometer or convertible to such a form. Tunnel measurements capture fleet cruise emissions. Emission factors for benzo[a]pyrene (BaP) for a tunnel fleet operating under cruise conditions were highest prior to the 1980s and fell from more than 30-μg per vehicle-km to approximately 2-μg/km in the 1990s, an approximately 15-fold decline. Total annual U.S. (cruise) emissions of BaP dropped by a lesser factor, because total annual km driven increased by a factor of 2.7 during the period. Other PAH compounds measured in tunnels over the 40-year period (e.g., benzo[ghi]perylene, coronene) showed comparable reduction factors in emissions. PAH declines were comparable to those measured in tunnels for carbon monoxide, volatile organic compounds, and particulate organic carbon. The historical PAH “source terms” determined from the data are relevant to quantifying the benefits of emissions control technology and can be used in epidemiological studies evaluating the health effects of exposure, such as those undertaken with breast cancer in New York State

Health Outcomes of Gastric Bypass Patients Compared to Nonsurgical, Nonintervened Severely Obese

Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention. Three groups of severely obese subjects (N = 1,156, BMI ≥ 35 kg/m2) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population-based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes-related variables, resting metabolic rate (RMR), sleep apnea, and health-related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P < 0.0001, except for diastolic blood pressure and the short form (SF-36) health survey mental component score at P < 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P < 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux-en-Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight-loss intervention was highly effective for weight loss, improved health-related quality of life, and resolution of major obesity-associated complications measured at 2 years

Utilization of Renewable Oxygenates as Gasoline Blending Components

This report reviews the use of higher alcohols and several cellulose-derived oxygenates as blend components in gasoline. Material compatibility issues are expected to be less severe for neat higher alcohols than for fuel-grade ethanol. Very little data exist on how blending higher alcohols or other oxygenates with gasoline affects ASTM Standard D4814 properties. Under the Clean Air Act, fuels used in the United States must be 'substantially similar' to fuels used in certification of cars for emission compliance. Waivers for the addition of higher alcohols at concentrations up to 3.7 wt% oxygen have been granted. Limited emission testing on pre-Tier 1 vehicles and research engines suggests that higher alcohols will reduce emissions of CO and organics, while NOx emissions will stay the same or increase. Most oxygenates can be used as octane improvers for standard gasoline stocks. The properties of 2-methyltetrahydrofuran, dimethylfuran, 2-methylfuran, methyl pentanoate and ethyl pentanoate suggest that they may function well as low-concentration blends with gasoline in standard vehicles and in higher concentrations in flex fuel vehicles