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2450 Delirium and catatonia: Age matters
- Jo E. Wilson, Richard Carlson, Maria C. Duggan, Pratik Pandharipande, Timothy D. Girard, Li Wang, Jennifer L. Thompson, Rameela Chandrasekhar, Andrew Francis, Stephen E. Nicolson, Robert S. Dittus, Stephan Heckers, E. W. Ely
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 39
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OBJECTIVES/SPECIFIC AIMS: Background: Delirium is a well described form of acute brain organ dysfunction characterized by decreased or increased movement, changes in attention and concentration as well as perceptual disturbances (i.e., hallucinations) and delusions. Catatonia, a neuropsychiatric syndrome traditionally described in patients with severe psychiatric illness, can present as phenotypically similar to delirium and is characterized by increased, decreased and/or abnormal movements, staring, rigidity, and mutism. Delirium and catatonia can co-occur in the setting of medical illness, but no studies have explored this relationship by age. Our objective was to assess whether advancing age and the presence of catatonia are associated with delirium. METHODS/STUDY POPULATION: Methods: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for delirium using the Confusion Assessment for the ICU and for catatonia using the Bush Francis Catatonia Rating Scale. Measures of association (OR) were assessed with a simple logistic regression model with catatonia as the independent variable and delirium as the dependent variable. Effect measure modification by age was assessed using a Likelihood ratio test. RESULTS/ANTICIPATED RESULTS: Results: We enrolled 136 medical and surgical critically ill patients with 452 matched (concomitant) delirium and catatonia assessments. Median age was 59 years (IQR: 52–68). In our cohort of 136 patients, 58 patients (43%) had delirium only, 4 (3%) had catatonia only, 42 (31%) had both delirium and catatonia, and 32 (24%) had neither. Age was significantly associated with prevalent delirium (i.e., increasing age associated with decreased risk for delirium) (p=0.04) after adjusting for catatonia severity. Catatonia was significantly associated with prevalent delirium (p<0.0001) after adjusting for age. Peak delirium risk was for patients aged 55 years with 3 or more catatonic signs, who had 53.4 times the odds of delirium (95% CI: 16.06, 176.75) than those with no catatonic signs. Patients 70 years and older with 3 or more catatonia features had half this risk. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusions: Catatonia is significantly associated with prevalent delirium even after controlling for age. These data support an inverted U-shape risk of delirium after adjusting for catatonia. This relationship and its clinical ramifications need to be examined in a larger sample, including patients with dementia. Additionally, we need to assess which acute brain syndrome (delirium or catatonia) develops first.
A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities
- Catrin Morrissey, Peter E. Langdon, Nicole Geach, Verity Chester, Michael Ferriter, William R. Lindsay, Jane McCarthy, John Devapriam, Dawn-Marie Walker, Conor Duggan, Regi Alexander
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- Journal:
- BJPsych Open / Volume 3 / Issue 1 / January 2017
- Published online by Cambridge University Press:
- 02 January 2018, pp. 41-56
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Background
There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.
AimsThis study identified and developed the domains that should be used to measure treatment outcomes for this population.
MethodA systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts.
ResultsThe final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.
ConclusionsTo index recovery, services need to measure treatment outcomes using this framework.
Central Line–Associated Bloodstream Infections in Neonates with Gastrointestinal Conditions: Developing a Candidate Definition for Mucosal Barrier Injury Bloodstream Infections
- Susan E. Coffin, Sarah B. Klieger, Christopher Duggan, W. Charles Huskins, Aaron M. Milstone, Gail Potter-Bynoe, Bram Raphael, Thomas J. Sandora, Xiaoyan Song, Danielle M. Zerr, Grace M. Lee
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue 11 / November 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. 1391-1399
- Print publication:
- November 2014
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Objective.
To develop a candidate definition for central line–associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants
Design.Multicenter retrospective cohort study.
Setting.Neonatal intensive care units from 14 US children’s hospitals and pediatric facilities.
Methods.A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.
Results.During 2009–2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).
Conclusions.While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.
Infect Control Hosp Epidemiol 2014;35(11):1391–1399
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. 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Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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An All-Volunteer Army? Recruitment and its Problems
- Lawrence J. Korb, Sean E. Duggan
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- Journal:
- PS: Political Science & Politics / Volume 40 / Issue 3 / July 2007
- Published online by Cambridge University Press:
- 10 July 2007, pp. 467-471
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- July 2007
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The current condition of Army manpower, like the situation in Iraq, is grave and deteriorating. The January 2007 decision by the George W. Bush administration to send additional ground combat and support troops to the wars in Iraq and Afghanistan has thrown the Army's manpower shortages into stark relief. This latest escalation, however, not only runs the risk of breaking the all-volunteer Army but also undermines our national security. Several questions must therefore be addressed: Is an all-volunteer Army desirable? What are the current difficulties facing Army recruitment and retention? What consequences have the wars in Iraq and Afghanistan had on the service? Before engaging a more substantive discussion which includes the present demographics of the force and the recruitment process, one point should be made clear. We believe the all-volunteer model is the right one and should be maintained if at all possible.
The effects of fenoldopam on renal blood flow and tubular function during aortic cross-clamping in anaesthetized dogs
- M. Halpenny, F. Markos, H. M. Snow, P. F. Duggan, E. Gaffney, D. P. O'Connell, G. D. Shorten
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- Journal:
- European Journal of Anaesthesiology / Volume 17 / Issue 8 / August 2000
- Published online by Cambridge University Press:
- 16 August 2006, pp. 491-498
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- August 2000
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Postoperative renal impairment is a recognized complication of infrarenal aortic cross-clamping. Fenoldopam, a selective dopamine agonist, may increase renal blood flow and decrease tubular oxygen consumption. The objective of this study was to quantify the effects of fenoldopam (0.1 μg kg−1 min−1) on renal blood flow and renal tubular function in anaesthetized dogs that have undergone aortic cross clamping. Eight labrador dogs were selected to receive either saline or fenoldopam (0.1 μg kg−1 min−1) intravenously. Arterial pressure, heart rate, renal blood flow, urinary output, fractional excretion of sodium, creatinine clearance and lithium clearance were measured (a) prior to infusions of saline or fenoldopam (b) 1 h after commencing the infusion (c) during a 90 min period of infrarenal aortic cross-clamping with concurrent infusion of fenoldopam or saline and (d) for 1 h after simultaneous aortic declamping and discontinuation of the infusions. There was no haemodynamic instability upon commencing the infusion of fenoldopam (0.1 μg kg−1 min−1). Creatinine clearance (2.03±0.5–2.45±0.3 mL min−1 kg−1 (mean±SD)), urine output (0.23±0.16–0.35±0.23 mL min−1 (mean±SD)), and fractional excretion of sodium (0.7±0.52–1.3±0.73% (mean±SD)) increased (P < 0.05), following commencement of the fenoldopam infusion. Fractional excretion of sodium (1.2±0.7% (mean±SD)) and urine output (0.36±0.21 mL min−1 (mean±SD)) were maintained during the aortic cross-clamp period (P < 0.05). Renal blood flow increased when the fenoldopam infusion was commenced (145±43.3–161±39.2 mL min−1 (mean±SD)) and remained greater than baseline during the aortic cross-clamping period (152±44 mL min−1 (mean±SD)), although these increases did not reach statistical significance. The most striking abnormalities observed by electron microscopy were marked disruption of the microvillus brush border in proximal tubules, vacuolation and separation of epithelial cells on basolateral infolds. The changes were similar in the two groups. In conclusion fenoldopam (0.1 μg kg−1 min−1) may have renoprotective effects which persist during infrarenal aortic cross clamping.
Serving the interests of the Journal's readers
- C. Adams, E. da Silva Freire Coutinho, L. Duggan, L. Roberts, K. Wahlbeck
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- Journal:
- The British Journal of Psychiatry / Volume 175 / Issue 5 / November 1999
- Published online by Cambridge University Press:
- 03 January 2018, pp. 493-494
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- November 1999
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The Effect of Growth Temperature and Substrate Misorientation on Degree of Order and Antiphase Domain Size in Ga0.52In0.48P Epilayers Grown on GaAs (001) Substrates by Gs-Mbe
- C. Meenakarn, A. E. Staton-bevan, S. P. Najda, G. Duggan, A. H. Kean
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- Journal:
- MRS Online Proceedings Library Archive / Volume 523 / 1998
- Published online by Cambridge University Press:
- 10 February 2011, 235
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- 1998
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A Transmission Electron Microscopy (TEM), Photoluminescence (PL) and Photoluminescence Excitation Spectroscopy (PLE) investigation has been conducted on Ga0.52In0.48P epilayers grown on (001) GaAs substrates by Gas-Source Molecular Beam Epitaxy.For Ga0.52In0.48P epilayers grown on exact (001) GaAs substrates, increasing the growth temperature from 480°C to 535°C increased the antiphase domain plate thickness, t, from 7.3±0.4 to 17.4±0.9 Å, and decreased the long range order parameter, n, from 0.32 to 0.18±0.1. For epilayers grown at 530°C, on GaAs(001) substrates off-cut 0°, 7°, 10° and 15° towards [111]A, increasing the substrate misorientation from 0° to 15° decreased the antiphase domain plate thickness, from 12.3±0.6 to 6.0±0.3 Å. The long range order parameter also decreased from 0.19 to 0.10±0.01.
The band gap energies of these samples, grown by GS-MBE, were close to those reported for fully disordered Ga0.52In0.48P epilayers grown by MOCVD at ∼760°C. This shows that GSMBE is also a good technique to grow GaInP for high band gap optical data storage applications and at lower growth temperatures. The optimum growth conditions in this study were at a growth temperature of 530°C on (001) GaAs substrate with 15° off-cut towards [111]A.
Clarification of the link between polyunsaturated fatty acids and Helicobacter pylori-associated duodenal ulcer disease: a dietary intervention study
- A. E. Duggan, J. C. Atherton, A. Cockayne, M. Balsitis, S. Evison, T. Hale, C. J. Hawkey, R. C. Spiller
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- Journal:
- British Journal of Nutrition / Volume 78 / Issue 4 / October 1997
- Published online by Cambridge University Press:
- 09 March 2007, pp. 515-522
- Print publication:
- October 1997
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Epidemiological evidence has suggested that the declining prevalence of duodenal ulcer disease may be attributable to rising consumption of polyunsaturated fatty acids, a hypothesis supported by in vitro evidence of toxicity of such substances to Helicobacter pylori. The objective of the present study was to establish whether this association is causal. Forty patients with proven infection with H. pylori and endoscopic evidence of past or present duodenal ulcer disease were randomized to receive either polyunsaturated fatty acids (PUFA group), in the form of capsules and margarine, or a placebo (control). Both groups received concurrent H2 antagonist therapy. Efficacy of therapy was determined endoscopically by assessment of ulcer healing while H. pylori status was determined by antral biopsy, urease (EC 3.5.1.5) culture and histological assessment of the severity of H. pylori infection. Antral levels of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) were quantified. Compliance was monitored. Before treatment, both groups were comparable for severity of H. pylori infection, smoking status and levels of LTB4 and PGE2. Despite a significant difference in consumption of linoleic acid (19.9 (se) 1.6) g for PUFA group ν. 6.7 (se 0.8) g for controls (P < 0.01) and linolenic acid (2.6 (se) 0.2) g ν. 0.6 (se 0.03) g (P < 0.01) there was no significant change in either the severity of H. pylori infection or prostaglandin levels in either group at 6 weeks. Consumption of a considerable amount of PUFA does not inhibit the colonization of the stomach by H. pylori nor does this alter the inflammatory changes characteristic of H. pylori gastritis. We conclude that the association between duodenal ulceration and a low level of dietary PUFA is likely to be spurious, probably reflecting the effect of confounding factors such as affluence, social class or smoking.
The Effect of Growth Temperature on Atomic Ordering in Gao.5 2Ino.48P Epilayers Grown on GaAs (001) Substrates by GS-MBE
- C. Meenakarn, A. E. Staton-Bevan, M. D. Dawson, G. Duggan, A. H. Kean, S. P. Najda
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- Journal:
- MRS Online Proceedings Library Archive / Volume 441 / 1996
- Published online by Cambridge University Press:
- 10 February 2011, 21
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- 1996
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A Transmission Electron Microscopy (TEM), Photoluminescence (PL) and Photoluminescence Excitation Spectroscopy (PLE) investigation has been conducted on Ga0 52In0.48P epilayers, grown on GaAs(001) by Gas-Source Molecular Beam Epitaxy. Selected area diffraction in the TEM shows that epilayers grown at temperatures between 480°C and 535°C exhibit CuPt-type ordering with the antiphase domain size increasing with increasing growth temperature. PLE data shows that, in the temperature range 480°C to 535°C the band gap energy of Ga0.52In0-48P epilayers increases with increasing growth temperature from 1.971 to 2.003 (±0.001 eV). For high band gap optical data storage applications these values compare well with the highest band gap energies reported for epilayers grown by MOCVD.
The Growth of GaN Films by Migration-Enhanced Epitaxy
- S. E. Hooper, C. T. Foxon, T. S. Cheng, N. J. Jeffs, G. B. Ren, D. E. Lacklison, J. W. Orton, G. Duggan
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- Journal:
- MRS Online Proceedings Library Archive / Volume 449 / 1996
- Published online by Cambridge University Press:
- 10 February 2011, 325
- Print publication:
- 1996
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Gallium Nitride epitaxial films were grown by migration enhanced epitaxy directly on sapphire (0001) without using any pre-growth substrate nitridation or low temperature buffer layers. In comparison with our material grown directly on sapphire by conventional molecular beam epitaxy, a significant improvement in the surface morphology and layer properties, measured by reflection high energy electron diffraction, X-ray diffraction, scanning electron microscopy, room temperature photoluminescence and the Hall effect, was observed for material grown by migration enhanced epitaxy.
The Structure and Properties of Centrifugally Spray Formed Ti6AI4V
- M. A. Duggan, M. H. Loreito, R. E. Smallman
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- MRS Online Proceedings Library Archive / Volume 362 / 1994
- Published online by Cambridge University Press:
- 15 February 2011, 205
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- 1994
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Ti6AI4V rings have been centrifugally spray deposited with the long term aim of producing sheet which can be superplastically formed. Spray deposition has been carried out under vacuum and under an argon atmosphere in order to assess the significance of gas entrapment during spray forming. Some samples have been HIPped and others have been used for hot rolling trials after spray deposition and the microstructures of these differently treated samples compared. Some preliminary measurements of the room temperature tensile properties have also been made.
The results are briefly discussed in terms of the advantages of using a vacuum spray forming route and in terms of the properties of the spray-formed and HIPped samples.
Mechanical Properties and Microstructure of Cu/Cu-Ni And Cu/Ag Multilayer thin Films
- James E. Krzanowski, Peter Duggan
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- Journal:
- MRS Online Proceedings Library Archive / Volume 356 / 1994
- Published online by Cambridge University Press:
- 21 February 2011, 391
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- 1994
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The mechanical properties of thin-film Cu/Cu-Ni and Cu/Ag multilayers are examined in this study. Films were prepared by magnetron sputter deposition onto cleaved NaCl substrates. The use of a computer-controlled deposition system enabled the multilayer interface width to be varied, as well as the multilayer amplitude and bilayer thickness. The Cu/Cu-Ni multilayers had the form of (001) oriented single crystal films, but for Cu-Ag multilayers only polycrystalline films could be obtained in the (001) orientation. For Cu/Cu-15%Ni multilayers, the tensile strengths were measured and observed to increase with decreasing interface width at constant wavelength. Tensile strengths were also found to increase with increasing composition modulation amplitude. For films with constant interface width but bilayer thicknesses ranging from 10 to 60 nm, the tensile strength was relatively constant. The results are consistent with previous theoretical treatments, particularly the theory of modulus hardening.
The Use of Field-Portable X-ray Fluorescence Technology in the Hazardous Waste Industry
- G. A. Raab, C. A. Kuharic, W. H. Cole III, R. E. Enwall, J. S. Duggan
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- Journal:
- Advances in X-ray Analysis / Volume 33 / 1989
- Published online by Cambridge University Press:
- 06 March 2019, pp. 629-637
- Print publication:
- 1989
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As the Environmental Protection Agency adds ever more sites to the National Priorities List for Superfund clean-up, there is a tremendous need for a fast method of screening for contaminants. In the case of inorganics, we can apply field-portable X-ray fluorescence technology.
With commercially available field-portable X-ray fluorescence equipment using in-situ measurements we can quickly screen a site (hundreds of measurements), input the data to a portable computer, process it, and print a colored concentration isopleth map of the contaminant of interest, all in realtime.
The in-situ measurement approach pioneered by Lockheed is the key to rapid screening capability. Problems arising from particle size distribution, soil heterogeneity, and bulk density are minimized by employing site-specific standards in the construction of our calibration curves. Inherent in these site-specific standards are all the matrix problems which occur in the routine samples.
The strength of field-portable X-ray fluorescence technology is the accuracy of analysis above the quantitation limits. The difficulty in measuring low concentrations near the detection limit is the weak point of field-portable units.
NOTICE: Although this research was funded in part by the U.S. EPA through Contract 68-03-3249 to Lockheed Engineering & Sciences Company, it has not undergone Agency review and does not necessarily reflect Agency policy.