Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts

Background. We have recently shown that the transjugular intrahepatic portosystemic shunt (TIPS) is more effective than paracentesis in the treatment of cirrhotic patients with severe ascites and can prolong survival in selected patients. Although an improved quality of life (QOL) has been suggested in these patients after the TIPS procedure, so far there are no data available to substantiate this assumption. Therefore, the aim of this study was to determine the effect of TIPS on the QOL in cirrhotic patients with refractory or recidivant ascites. Methods: 21 cirrhotic patients who underwent TIPS for refractory or recidivant ascites were investigated. All patients were pretreated with repeated paracentesis for at least 1 year. Before the procedure and at 3 and 6 months during follow-up, the patients themselves rated QOL, fatigue and physical performance on a visual analogue scale (range 0-100). Furthermore, QOL was determined by the QOL index (range 0-10) according to Spitzer. Results: Patients' rating of the QOL on the visual analogue scale significantly increased from 35 +/- 25 (baseline) to 64 +/- 28 (3 months), and 66 +/- 24 (6 months; p = 0.02). Similarly, the QOL index significantly increased from 6.9 +/- 2.0 (baseline) to 8.3 +/- 2.1 (3 months), and 8.6 +/- 1.7 (6 months; p < 0.001). The increase of QOL was more pronounced in patients with complete response to TIPS. Conclusions: We demonstrate that TIPS for refractory or recidivant ascites improves the QOL in patients with cirrhosis. Our data indicates that this improvement is dependent on the response to therapy. Copyright (C) 2002 S. Karger AG, Basel

Simulation of an 1857-like Mw 7.9 San Andreas Fault Earthquake and the Response of Tall Steel Moment Frame Buildings in Southern California – A Prototype Study

In 1857, an earthquake of magnitude 7.9 occurred on the San Andreas fault, starting at Parkfield and rupturing in a southeasterly direction for more than 360 km. Such a unilateral rupture produces significant directivity toward the San Fernando and Los Angeles basins. The strong shaking in the basins due to this earthquake would have had significant long-period content (2-8 s), and the objective of this study is to quantify the impact of such an earthquake on two 18-story steel moment frame building models, hypothetically located at 636 sites on a 3.5 km grid in southern California. End-to-end simulations include modeling the source and rupture of a fault at one end, numerically propagating the seismic waves through the earth structure, simulating the damage to engineered structures and estimating the economic impact at the other end using high-performance computing. In this prototype study, we use an inferred finite source model of the magnitude 7.9, 2002 Denali fault earthquake in Alaska, and map it onto the San Andreas fault with the rupture originating at Parkfield and propagating southward over a distance of 290 km. Using the spectral element seismic wave propagation code, SPECFEM3D, we simulate an 1857-like earthquake on the San Andreas fault and compute ground motions at the 636 analysis sites. Using the nonlinear structural analysis program, FRAME3D, we subsequently analyze 3-D structural models of an existing tall steel building designed using the 1982 Uniform Building Code (UBC), as well as one designed according to the 1997 UBC, subjected to the computed ground motion at each of these sites. We summarize the performance of these structural models on contour maps of peak interstory drift. We then perform an economic loss analysis for the two buildings at each site, using the Matlab Damage and Loss Analysis (MDLA) toolbox developed to implement the PEER loss-estimation methodology. The toolbox includes damage prediction and repair cost estimation for structural and non-structural components and allows for the computation of the mean and variance of building repair costs conditional on engineering demand parameters (i.e. inter-story drift ratios and peak floor accelerations). Here, we modify it to treat steel-frame high-rises, including aspects such as mechanical, electrical and plumbing systems, traction elevators, and the possibility of irreparable structural damage. We then generate contour plots of conditional mean losses for the San Fernando and the Los Angeles basins for the pre-Northridge and modern code-designed buildings, allowing for comparison of the economic effects of the updated code for the scenario event. In principle, by simulating multiple seismic events, consistent with the probabilistic seismic hazard for a building site, the same basic approach could be used to quantify the uncertain losses from future earthquakes

Chaotic Orbits in Thermal-Equilibrium Beams: Existence and Dynamical Implications

Phase mixing of chaotic orbits exponentially distributes these orbits through their accessible phase space. This phenomenon, commonly called ``chaotic mixing'', stands in marked contrast to phase mixing of regular orbits which proceeds as a power law in time. It is operationally irreversible; hence, its associated e-folding time scale sets a condition on any process envisioned for emittance compensation. A key question is whether beams can support chaotic orbits, and if so, under what conditions? We numerically investigate the parameter space of three-dimensional thermal-equilibrium beams with space charge, confined by linear external focusing forces, to determine whether the associated potentials support chaotic orbits. We find that a large subset of the parameter space does support chaos and, in turn, chaotic mixing. Details and implications are enumerated.Comment: 39 pages, including 14 figure

Ultrabroad-bandwidth multifrequency Raman generation

We report on the modeling of transient stimulated rotational Raman scattering in H2 gas. We predict a multifrequency output, spanning a bandwidth greater than the pump frequency, that may be generated without any significant delay with respect to the pump pulses. The roles of dispersion and transiency are quantified

Production of Enhanced Beam Halos via Collective Modes and Colored Noise

We investigate how collective modes and colored noise conspire to produce a beam halo with much larger amplitude than could be generated by either phenomenon separately. The collective modes are lowest-order radial eigenmodes calculated self-consistently for a configuration corresponding to a direct-current, cylindrically symmetric, warm-fluid Kapchinskij-Vladimirskij equilibrium. The colored noise arises from unavoidable machine errors and influences the internal space-charge force. Its presence quickly launches statistically rare particles to ever-growing amplitudes by continually kicking them back into phase with the collective-mode oscillations. The halo amplitude is essentially the same for purely radial orbits as for orbits that are initially purely azimuthal; orbital angular momentum has no statistically significant impact. Factors that do have an impact include the amplitudes of the collective modes and the strength and autocorrelation time of the colored noise. The underlying dynamics ensues because the noise breaks the Kolmogorov-Arnol'd-Moser tori that otherwise would confine the beam. These tori are fragile; even very weak noise will eventually break them, though the time scale for their disintegration depends on the noise strength. Both collective modes and noise are therefore centrally important to the dynamics of halo formation in real beams.Comment: For full resolution pictures please go to http://www.nicadd.niu.edu/research/beams

Age-dependent differences in human brain activity using a face- and location-matching task: An fMRI study

Purpose: To evaluate the differences of cortical activation patterns in young and elderly healthy subjects for object and spatial visual processing using a face- and location-matching task. Materials and Methods: We performed a face- and a location-matching task in 15 young (mean age: 28 +/- 9 years) and 19 elderly (mean age: 71 +/- 6 years) subjects. Each experiment consisted of 7 blocks alternating between activation and control condition. For face matching, the subjects had to indicate whether two displayed faces were identical or different. For location matching, the subjects had to press a button whenever two objects had an identical position. For control condition, we used a perception task with abstract images. Functional imaging was performed on a 1.5-tesla scanner using an EPI sequence. Results: In the face-matching task, the young subjects showed bilateral (right 1 left) activation in the occipito-temporal pathway (occipital gyrus, inferior and middle temporal gyrus). Predominantly right hemispheric activations were found in the fusiform gyrus, the right dorsolateral prefrontal cortex (inferior and middle frontal gyrus) and the superior parietal gyrus. In the elderly subjects, the activated areas in the right fronto-lateral cortex increased. An additional activated area could be found in the medial frontal gyrus (right > left). In the location-matching task, young subjects presented increased bilateral (right > left) activation in the superior parietal lobe and precuneus compared with face matching. The activations in the occipito-temporal pathway, in the right fronto-lateral cortex and the fusiform gyrus were similar to the activations found in the face-matching task. In the elderly subjects, we detected similar activation patterns compared to the young subjects with additional activations in the medial frontal gyrus. Conclusion: Activation patterns for object-based and spatial visual processing were established in the young and elderly healthy subjects. Differences between the elderly and young subjects could be evaluated, especially by using a face-matching task. Copyright (c) 2007 S. Karger AG, Basel

Real-time Loss Estimation for Instrumented Buildings

Motivation. A growing number of buildings have been instrumented to measure and record earthquake motions and to transmit these records to seismic-network data centers to be archived and disseminated for research purposes. At the same time, sensors are growing smaller, less expensive to install, and capable of sensing and transmitting other environmental parameters in addition to acceleration. Finally, recently developed performance-based earthquake engineering methodologies employ structural-response information to estimate probabilistic repair costs, repair durations, and other metrics of seismic performance. The opportunity presents itself therefore to combine these developments into the capability to estimate automatically in near-real-time the probabilistic seismic performance of an instrumented building, shortly after the cessation of strong motion. We refer to this opportunity as (near-) real-time loss estimation (RTLE). Methodology. This report presents a methodology for RTLE for instrumented buildings. Seismic performance is to be measured in terms of probabilistic repair cost, precise location of likely physical damage, operability, and life-safety. The methodology uses the instrument recordings and a Bayesian state-estimation algorithm called a particle filter to estimate the probabilistic structural response of the system, in terms of member forces and deformations. The structural response estimate is then used as input to component fragility functions to estimate the probabilistic damage state of structural and nonstructural components. The probabilistic damage state can be used to direct structural engineers to likely locations of physical damage, even if they are concealed behind architectural finishes. The damage state is used with construction cost-estimation principles to estimate probabilistic repair cost. It is also used as input to a quantified, fuzzy-set version of the FEMA-356 performance-level descriptions to estimate probabilistic safety and operability levels. CUREE demonstration building. The procedure for estimating damage locations, repair costs, and post-earthquake safety and operability is illustrated in parallel demonstrations by CUREE and Kajima research teams. The CUREE demonstration is performed using a real 1960s-era, 7-story, nonductile reinforced-concrete moment-frame building located in Van Nuys, California. The building is instrumented with 16 channels at five levels: ground level, floors 2, 3, 6, and the roof. We used the records obtained after the 1994 Northridge earthquake to hindcast performance in that earthquake. The building is analyzed in its condition prior to the 1994 Northridge Earthquake. It is found that, while hindcasting of the overall system performance level was excellent, prediction of detailed damage locations was poor, implying that either actual conditions differed substantially from those shown on the structural drawings, or inappropriate fragility functions were employed, or both. We also found that Bayesian updating of the structural model using observed structural response above the base of the building adds little information to the performance prediction. The reason is probably that Real-Time Loss Estimation for Instrumented Buildings ii structural uncertainties have only secondary effect on performance uncertainty, compared with the uncertainty in assembly damageability as quantified by their fragility functions. The implication is that real-time loss estimation is not sensitive to structural uncertainties (saving costly multiple simulations of structural response), and that real-time loss estimation does not benefit significantly from installing measuring instruments other than those at the base of the building. Kajima demonstration building. The Kajima demonstration is performed using a real 1960s-era office building in Kobe, Japan. The building, a 7-story reinforced-concrete shearwall building, was not instrumented in the 1995 Kobe earthquake, so instrument recordings are simulated. The building is analyzed in its condition prior to the earthquake. It is found that, while hindcasting of the overall repair cost was excellent, prediction of detailed damage locations was poor, again implying either that as-built conditions differ substantially from those shown on structural drawings, or that inappropriate fragility functions were used, or both. We find that the parameters of the detailed particle filter needed significant tuning, which would be impractical in actual application. Work is needed to prescribe values of these parameters in general. Opportunities for implementation and further research. Because much of the cost of applying this RTLE algorithm results from the cost of instrumentation and the effort of setting up a structural model, the readiest application would be to instrumented buildings whose structural models are already available, and to apply the methodology to important facilities. It would be useful to study under what conditions RTLE would be economically justified. Two other interesting possibilities for further study are (1) to update performance using readily observable damage; and (2) to quantify the value of information for expensive inspections, e.g., if one inspects a connection with a modeled 50% failure probability and finds that the connect is undamaged, is it necessary to examine one with 10% failure probability

An Assessment to Benchmark the Seismic Performance of a Code-Conforming Reinforced-Concrete Moment-Frame Building

This report describes a state-of-the-art performance-based earthquake engineering methodology that is used to assess the seismic performance of a four-story reinforced concrete (RC) office building that is generally representative of low-rise office buildings constructed in highly seismic regions of California. This “benchmark” building is considered to be located at a site in the Los Angeles basin, and it was designed with a ductile RC special moment-resisting frame as its seismic lateral system that was designed according to modern building codes and standards. The building’s performance is quantified in terms of structural behavior up to collapse, structural and nonstructural damage and associated repair costs, and the risk of fatalities and their associated economic costs. To account for different building configurations that may be designed in practice to meet requirements of building size and use, eight structural design alternatives are used in the performance assessments. Our performance assessments account for important sources of uncertainty in the ground motion hazard, the structural response, structural and nonstructural damage, repair costs, and life-safety risk. The ground motion hazard characterization employs a site-specific probabilistic seismic hazard analysis and the evaluation of controlling seismic sources (through disaggregation) at seven ground motion levels (encompassing return periods ranging from 7 to 2475 years). Innovative procedures for ground motion selection and scaling are used to develop acceleration time history suites corresponding to each of the seven ground motion levels. Structural modeling utilizes both “fiber” models and “plastic hinge” models. Structural modeling uncertainties are investigated through comparison of these two modeling approaches, and through variations in structural component modeling parameters (stiffness, deformation capacity, degradation, etc.). Structural and nonstructural damage (fragility) models are based on a combination of test data, observations from post-earthquake reconnaissance, and expert opinion. Structural damage and repair costs are modeled for the RC beams, columns, and slabcolumn connections. Damage and associated repair costs are considered for some nonstructural building components, including wallboard partitions, interior paint, exterior glazing, ceilings, sprinkler systems, and elevators. The risk of casualties and the associated economic costs are evaluated based on the risk of structural collapse, combined with recent models on earthquake fatalities in collapsed buildings and accepted economic modeling guidelines for the value of human life in loss and cost-benefit studies. The principal results of this work pertain to the building collapse risk, damage and repair cost, and life-safety risk. These are discussed successively as follows. When accounting for uncertainties in structural modeling and record-to-record variability (i.e., conditional on a specified ground shaking intensity), the structural collapse probabilities of the various designs range from 2% to 7% for earthquake ground motions that have a 2% probability of exceedance in 50 years (2475 years return period). When integrated with the ground motion hazard for the southern California site, the collapse probabilities result in mean annual frequencies of collapse in the range of [0.4 to 1.4]x10 -4 for the various benchmark building designs. In the development of these results, we made the following observations that are expected to be broadly applicable: (1) The ground motions selected for performance simulations must consider spectral shape (e.g., through use of the epsilon parameter) and should appropriately account for correlations between motions in both horizontal directions; (2) Lower-bound component models, which are commonly used in performance-based assessment procedures such as FEMA 356, can significantly bias collapse analysis results; it is more appropriate to use median component behavior, including all aspects of the component model (strength, stiffness, deformation capacity, cyclic deterioration, etc.); (3) Structural modeling uncertainties related to component deformation capacity and post-peak degrading stiffness can impact the variability of calculated collapse probabilities and mean annual rates to a similar degree as record-to-record variability of ground motions. Therefore, including the effects of such structural modeling uncertainties significantly increases the mean annual collapse rates. We found this increase to be roughly four to eight times relative to rates evaluated for the median structural model; (4) Nonlinear response analyses revealed at least six distinct collapse mechanisms, the most common of which was a story mechanism in the third story (differing from the multi-story mechanism predicted by nonlinear static pushover analysis); (5) Soil-foundation-structure interaction effects did not significantly affect the structural response, which was expected given the relatively flexible superstructure and stiff soils. The potential for financial loss is considerable. Overall, the calculated expected annual losses (EAL) are in the range of $52,000 to$97,000 for the various code-conforming benchmark building designs, or roughly 1% of the replacement cost of the building ($8.8M). These losses are dominated by the expected repair costs of the wallboard partitions (including interior paint) and by the structural members. Loss estimates are sensitive to details of the structural models, especially the initial stiffness of the structural elements. Losses are also found to be sensitive to structural modeling choices, such as ignoring the tensile strength of the concrete (40 EAL) or the contribution of the gravity frames to overall building stiffness and strength (15 change in EAL). Although there are a number of factors identified in the literature as likely to affect the risk of human injury during seismic events, the casualty modeling in this study focuses on those factors (building collapse, building occupancy, and spatial location of building occupants) that directly inform the building design process. The expected annual number of fatalities is calculated for the benchmark building, assuming that an earthquake can occur at any time of any day with equal probability and using fatality probabilities conditioned on structural collapse and based on empirical data. The expected annual number of fatalities for the code-conforming buildings ranges between 0.05*10 -2 and 0.21*10 -2 , and is equal to 2.30*10 -2 for a non-code conforming design. The expected loss of life during a seismic event is perhaps the decision variable that owners and policy makers will be most interested in mitigating. The fatality estimation carried out for the benchmark building provides a methodology for comparing this important value for various building designs, and enables informed decision making during the design process. The expected annual loss associated with fatalities caused by building earthquake damage is estimated by converting the expected annual number of fatalities into economic terms. Assuming the value of a human life is$3.5M, the fatality rate translates to an EAL due to fatalities of $3,500 to$5,600 for the code-conforming designs, and $79,800 for the non-code conforming design. Compared to the EAL due to repair costs of the code-conforming designs, which are on the order of$66,000, the monetary value associated with life loss is small, suggesting that the governing factor in this respect will be the maximum permissible life-safety risk deemed by the public (or its representative government) to be appropriate for buildings. Although the focus of this report is on one specific building, it can be used as a reference for other types of structures. This report is organized in such a way that the individual core chapters (4, 5, and 6) can be read independently. Chapter 1 provides background on the performance-based earthquake engineering (PBEE) approach. Chapter 2 presents the implementation of the PBEE methodology of the PEER framework, as applied to the benchmark building. Chapter 3 sets the stage for the choices of location and basic structural design. The subsequent core chapters focus on the hazard analysis (Chapter 4), the structural analysis (Chapter 5), and the damage and loss analyses (Chapter 6). Although the report is self-contained, readers interested in additional details can find them in the appendices

Präzision MRT-basierter Gelenkflächen- und Knorpeldickenanalysen im Kniegelenk bei Verwendung einer schnellen Wasseranregungs-Sequenz und eines semiautomatischen Segmentierungs-Algorithmus

The aim of this study was to analyse the precision of three-dimensional joint surface and cartilage thickness measurements in the knee, using a fast, high-resolution water-excitation sequence and a semiautomated segmentation algorithm. The knee joint of 8 healthy volunteers, aged 22 to 29 years, were examined at a resolution of 1.5 mm x 0.31 mm x 0.31 mm, with four sagittal data sets being acquired after repositioning the joint. After semiautomated segmentation with a B-spline Snake algorithm and 3D reconstruction of the patellar, femoral and tibial cartilages, the joint surface areas (triangulation), cartilage volume, and mean and maximum thickness (Euclidean distance transformation) were analysed, independently of the orientation of the sections. The precision (CV%) for the surface areas was 2.1 to 6.6%. The mean cartilage thickness and cartilage volume showed coefficients of 1.9 to 3.5% (except for the femoral condyles), the value for the medial femoral condyle being 9.1%, and for the lateral condyle 6.5%. For maximum thickness, coefficients of between 2.6 and 5.9% were found. In the present study we investigate for the first time the precision of MRI-based joint surface area measurements in the knee, and of cartilage thickness analyses in the femur. Using a selective water-excitation sequence, the acquisition time can be reduced by more than 50%. The poorer precision in the femoral condyles can be attributed to partial Volume effects that occur at the edges of the joint surfaces with a sagittal image protocol. Since MRI is non-invasive, it is highly suitable for examination of healthy subjects (generation of individual finite element models, analysis of functional adaptation to mechanical stimulation, measurement of cartilage deformation in vivo) and as a diagnostic tool for follow-up, indication for therapy, and objective evaluation of new therapeutic agents in osteoarthritis

Chaos and the continuum limit in nonneutral plasmas and charged particle beams

This paper examines discreteness effects in nearly collisionless N-body systems of charged particles interacting via an unscreened r^-2 force, allowing for bulk potentials admitting both regular and chaotic orbits. Both for ensembles and individual orbits, as N increases there is a smooth convergence towards a continuum limit. Discreteness effects are well modeled by Gaussian white noise with relaxation time t_R = const * (N/log L)t_D, with L the Coulomb logarithm and t_D the dynamical time scale. Discreteness effects accelerate emittance growth for initially localised clumps. However, even allowing for discreteness effects one can distinguish between orbits which, in the continuum limit, feel a regular potential, so that emittance grows as a power law in time, and chaotic orbits, where emittance grows exponentially. For sufficiently large N, one can distinguish two different `kinds' of chaos. Short range microchaos, associated with close encounters between charges, is a generic feature, yielding large positive Lyapunov exponents X_N which do not decrease with increasing N even if the bulk potential is integrable. Alternatively, there is the possibility of larger scale macrochaos, characterised by smaller Lyapunov exponents X_S, which is present only if the bulk potential is chaotic. Conventional computations of Lyapunov exponents probe X_N, leading to the oxymoronic conclusion that N-body orbits which look nearly regular and have sharply peaked Fourier spectra are `very chaotic.' However, the `range' of the microchaos, set by the typical interparticle spacing, decreases as N increases, so that, for large N, this microchaos, albeit very strong, is largely irrelevant macroscopically. A more careful numerical analysis allows one to estimate both X_N and X_S.Comment: 13 pages plus 17 figure