Subsequent Agitation Research Articles

Subacute Thyroiditis With Very Elevated Thyroglobulin Level in a Patient on Chronic Adalimumab Therapy

Background: Viral infections are a well-recognized cause of subacute thyroiditis (SAT), but other etiologies are occasionally seen. Here we present a case of SAT in a patient receiving chronic tumor necrosis factor inhibitor (TNF-i) therapy. Serum thyroglobulin (Tg) levels in healthy individuals have been reported and range 1.40-29.2ng/mL in males and 1.50-38.5ng/mL. There are no known serum Tg levels of reference in SAT. Clinical Case: A 43-year-old woman with a history of psoriasis treated with adalimumab presented to her primary care physician (PCP) 2 months after her mother had noticed the patient’s new goiter. Patient recalled upper respiratory infection symptoms lasting 1.5 weeks, and subsequent agitation, insomnia, and a low-grade fever preceding the development of goiter. She denied neck compressive symptoms aside from mild dysphagia. She has been treated with adalimumab 40mg subcutaneous injection weekly for psoriasis with good results for the past 3.5 years and was on norethindrone 0.35mg daily for contraception. Her thyroid exam with her PCP revealed a diffuse painless goiter and she was clinically euthyroid. Labs revealed a TSH 1.44mIU/L [0.45-5.33], TT3 104ng/dL [60-181], fT3 3.3pg/mL [2.3-4.2], fT4 0.83ng/dL [0.89-1.76], and Tg 288.7ng/mL [1.6-50]. Thyroid antibodies (Tg, thyroid peroxidase and thyroid stimulating immunoglobulin) were negative. She tested negative for COVID-19. The neck ultrasound showed an enlarged pseudonodular thyroid gland with a heterogenous parenchyma and diffuse hypervascularity bilaterally (right lobe, 7.4 x 2.8 x 3.0 cm; left lobe, 8.4 x 3.2 x 3.6 cm; isthmus, 9 mm). A month later, repeat labs showed TSH 1.56 mIU/L, TT3 85 ng/dL, fT4 0.74 ng/dL, and Tg 231.2 ng/mL. She was subsequently referred to Endocrine Clinic 4 months after her initial presentation. She had a persistent diffuse painless goiter, minimally decreased in size, and she remained clinically euthyroid. Labs included a TSH 1.75 mIU/L and fT4 0.78 ng/dL. Conclusion: There are known associations of SAT with chronic TNF-i therapy in patients with psoriasis. Viral infections are an identified cause, but other triggers in chronic TNF-i therapy may exist. Serum Tg is elevated during SAT, but in this case Tg elevation was very significant. Although normal serum Tg levels are established in healthy individuals, there are no known reference values during SAT. Tg levels should not be used in acute illness period to evaluate illness severity or the resolution of SAT.

The Relationship Between Anxiety and Incident Agitation in Alzheimer's Disease.

Agitation in Alzheimer's disease (AD) has been hypothesized to be an expression of anxiety, but whether anxiety early in the course of dementia could be a risk factor for developing later agitation is unknown. We used the Alzheimer's Disease Neuroimaging Initiative (ADNI) database to examine the longitudinal relationship between anxiety and incident agitation in individuals with a diagnosis of AD at baseline or during follow-up. Longitudinal neuropsychiatric symptom data from AD individuals who were agitation-free at study baseline (N = 272) were analyzed using mixed effects regression models to test the longitudinal relationship between baseline and incident anxiety with incident agitation. Anxiety at baseline was not associated with subsequent agitation, but there was a positive linear relationship between incident anxiety and agitation over the study duration. Baseline apathy and delusions were consistently associated with subsequent agitation and greater disease severity and illness duration also appeared to be risk factors for agitation. Our findings support the concept that anxiety and agitation are likely to be distinct rather than equivalent constructs in mild-moderate AD. Future longitudinal cohort studies are needed to replicate these findings and further characterize potential risk factors for agitation, such as apathy and delusions.

Modification and photocatalytic activity of open channel TiO2 nanotubes array synthesized by anodization process

Titanium dioxide nanotubes (TNTs) with an open-top-tube morphology were synthesized by adjusting the anodization parameters. The main effective parameters were determined to be the multi-step anodization, alteration of anodization time, and agitation of the electrolyte. The simultaneous influence of agitation and prolonging the anodization time was studied on the obtained structure. The multi-step anodization process was shown to be a promising approach to obtain well-ordered TiO2 nanotubes. Accordingly, the entrance of the tubes came to be opened and the diameter of the surface pores increased from ~45 to 60 nm. By increasing the anodization time, chemical etching intensifies, especially on the upper part of the TNTs resulting in the formation of a nanograss structure. Applying agitation in prolonged anodization process showed to have destructive effects on the surface ordering and synthesis of nanograss free TNTs. However, it was found that subsequent agitation using ultrasonic pulses is an effective approach to obtain an open-top tube morphology. The DRS results indicated no difference in the band gap energy for different steps and anodization times. The photocatalytic activity of the open-top-tube TNTs was found to be promising in the degradation of methylene blue (MB) reaching 85% after 480 min irradiation.

Reforma universitária de Córdoba

Ao celebrar o centenário da Reforma Universitária que aconteceu em 1918 em Córdoba, na Argentina, trazemos ao debate a importância de estudar essa experiência de rebelião contra a hierarquia universitária, ao passo que destacamos também sua atualidade, principalmente no que diz respeito à necessidade de democratização da universidade e sua vinculação a classe trabalhadora e setores populares. Objetivamos contribuir para que essa experiência seja conhecida pela ampla maioria dos estudantes no Brasil, indicando também sua relevância para (re)construir um novo movimento estudantil numa perspectiva emancipadora. Para isso, realizamos uma revisão histórico-bibliográfica sobre o que propunha e o que significou a referida reforma em termos de autonomia e democratização, e que assinalou o nascimento de uma nova geração latino-americana, provocando agitações posteriores em outros países do subcontinente. Ressaltamos que essa experiência evidencia o papel ativo do movimento estudantil enquanto ator social na promoção de mudanças sociais pautadas por uma orientação inerente à luta de classes e na concretude da construção de um projeto que vislumbra uma nova hegemonia na sociedade. Como conclusões, destacamos a atualidade da luta pela democratização e o objetivo de vincular a universidade aos problemas da sociedade, terreno fértil para o desenvolvimento de uma educação emancipadora e popular.

Acute myocardial infarction and stroke secondary to valve thrombosis following transcatheter aortic valve replacement-what can happen when antiplatelet agents are stopped.

An 84-year-old woman was hospitalised for a fall with subsequent agitation and vomiting. She had a past medical history of coronary artery bypass grafting performed 18 years ago. In the 8 months prior to her admission, she underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Post procedure, the patient had been instructed to take dual antiplatelet therapy (DAPT) for 6 months but had stopped these herself earlier than the recommendation.

Patterns of New Physical Problems Emerging in Long-Term Care Residents With Dementia.

Individuals receiving skilled nursing care have multiple comorbid conditions that impact comfort and resource use. The current study describes variations in the trajectories of new physical problems emerging over 8 weeks and the predictive value for future health and behavior in a sample of 72 residents with dementia. Residents had two to 37 new physical problems occurring over 8 weeks. Sixty-five percent of the sample had five or more new problems and were identified by three unstable trajectories. Common problems, illnesses, and symptoms accounted for 28.2% of the variance in subsequent new physical problems (p < 0.001) and 25.7% of the variance in subsequent agitation (p < 0.001). This study found more new problems than earlier studies that only examined new acute illness. Findings suggest a higher intensity of need for skilled assessment and treatment than may be available in many long-term care organizations. [Journal of Gerontological Nursing, xx(x), xx-xx.].

USE OF SELF-COMPACTING CONCRETE DURING RECONSTRUCTION OF THE BUILDING FOR THE ADMINISTRATION SERVICE CENTRE

Twophase introduction of superplasticizer additive influence on the properties of concrete mixture was researched. The obtained results allowed concreting of strengthening for the columns building. Herewith, 40 % of SP additive together with 12 % of mixing water were introduced directly into the concrete mixer truck at the moment of its arrival to the сonstruction site, with subsequent agitation of concrete mixture.

Preparation of highly concentrated bitumen emulsions by catastrophic phase inversion: Follow-up of the emulsification process

This study focuses on the mechanisms of bitumen emulsification and on the impact of the formulation, when emulsification is carried out in the area of high internal phase ratio (0.9). Kinetics of emulsification were determined using systemic rheology coupled with optical microscopy observations. Microscopic observations revealed a catastrophic phase inversion with formation of abnormal multiple emulsions, occurring very quickly after contacting the bitumen with the aqueous phase containing the surfactant. The direct emulsion thus obtained is then refined during a subsequent agitation step. The viscosity follow-up during the emulsification highlights four steps in the kinetic of catastrophic phase inversion, which have been related to morphological characteristics of the dispersions observed by optical microscopy.

Effects of winter storage conditions and subsequent agitation on gaseous emissions from liquid dairy manure

An understanding of emissions from liquid manure facilities during winter, spring thaw and agitation is needed to improve national emissions inventories in Canada. In this study, liquid dairy manure was stored in six pilot-scale tanks (1.8 m deep × 6.6 m2 surface area) covered by steady-state chambers that enabled greenhouse gas (GHG) and ammonia (NH3) flux measurement. After 158 d of undisturbed storage, three tanks were agitated for 5 d (8 h per day) consecutively. During storage, methane (CH4) flux was correlated with manure temperature at 30 cm depth (P &lt; 0.05). Nitrous oxide (N2O) fluxes occurred only during spring thaw - at rates comparable with agricultural soil during spring thaw. On a carbon dioxide (CO2) equivalent basis, however, cumulative N2O fluxes were negligible compared with CH4 fluxes. Flux of NH3 was correlated positively with manure temperature near the surface and negatively with the presence of ice or a surface crust (P &lt; 0.01). Agitation did not affect N2O and NH3 fluxes, whereas CO2 and CH4 fluxes increased significantly (P &lt; 0.01) as dissolved gas and bubbles were released. Trapped CH4 released during agitation was estimated to be 6.3 g CH4 m-3 manure, and was depleted in 2 d. Considering the entire storage period, agitated tanks (158 d + 5 d agitation) had 6% higher GHG fluxes due to higher CH4 losses than undisturbed tanks (163 d). This CH4 release is small in context of annual fluxes, but may partially explain discrepancies between predicted and measured winter fluxes.Key words: Manure storage, agitation, greenhouse gas emission, ammonia emission, dissolved gas

"The Dark Backward and Abysm of Time": The Tempest and Memory

This essay examines The Tempest in light of models of memory derived from cognitive psychology, sociology, and philosophy, placed within the context of early modern debates about the nature and locus of memory. In The Tempest, Shakespeare stages profound tensions between an individualist, faculty-based model of memory in which the mind is figured as a "cell" bounded by a monodic subject, and the constant threats to such order and control on the part of other minds represented in the play. Attention to the tensions between control and disorder in memory, allows us to understand three critical cruces of the play: 1) Prospero's apparently unmotivated demand for Miranda's attention during the exposition of 1.2; 2) the destruction of the masque by a moment of forgetting, and the subsequent agitation caused; 3) the play's own apparent amnesia about the founding narrative recounted by Prospero, as Alonso increasingly displaces Antonio as the play goes on.

Viscometric characterisation of cement grout for prediction of prepacked concrete construction

The ability of cement grout to penetrate voids of aggregate media, during the injection process of prepacked concrete construction, is strongly dependent on its viscosity. This paper reports experimental work on the viscometric characteristics of cement grout for the prediction of prepacked grouting process. Various factors influencing the measured results have been identified. Shear history dependent viscosity of cement grout requires that an experimental programme should be designed: (a) to ensure repeatability; and (b) to obtain meaningful results for the concerned construction process. Due consideration has been given to establish proper mixing and measuring programmes. Results were obtained through a set of carefully selected parameters to simulate the shear history during the grouting process. The Bingham model was adopted to characterise the shear rate dependency of the apparent viscosity. Time dependency of the Bingham parameters was obtained from a series of tests of the same batch under the specified initial mixing condition and subsequent agitation. Thixotropy loop tests were also carried out to analyse the sensitivity of the internal structure of cement grout to further shearing, thus comparing the mixing effect on rheological property of cement grout.

Viscometric characterisation of cement grout for prediction of prepacked concrete construction

The ability of cement grout to penetrate voids of aggregate media, during the injection process of prepacked concrete construction, is strongly dependent on its viscosity. This paper reports experimental work on the viscometric characteristics of cement grout for the prediction of prepacked grouting process. Various factors influencing the measured results have been identified. Shear history dependent viscosity of cement grout requires that an experimental programme should be designed: (a) to ensure repeatability; and (b) to obtain meaningful results for the concerned construction process. Due consideration has been given to establish proper mixing and measuring programmes. Results were obtained through a set of carefully selected parameters to simulate the shear history during the grouting process. The Bingham model was adopted to characterise the shear rate dependency of the apparent viscosity. Time dependency of the Bingham parameters was obtained from a series of tests of the same batch under the specified initial mixing condition and subsequent agitation. Thixotropy loop tests were also carried out to analyse the sensitivity of the internal structure of cement grout to further shearing, thus comparing the mixing effect on rheological property of cement grout.

Theory of Flocculation, Subsidence and Refiltration Rates of Colloidal Dispersions Flocculated by Polyelectrolytes

AbstractThe flocculation and subsequent subsidence of colloidal suspensions are markedly increased by the addition of flocculating agents; for example various starches and recently developed synthetic polymers.The rate of flocculation depends not only upon the extent of adsorption of the agent (flocculant) but also upon the order of mixing and the character and extent of the subsequent agitation which determines the character of the floc formed. Electrolytes flocculate by reducing the electrostatic repulsions between charged particles, but long chain polymers produce flocs by a bridging mechanism which overcomes electrostatic repulsions.Quantitative relationships are developed between the optimum concentration of flocculant and the rates of flocculation, subsidence, and particularly rate of filtration through the filter cake.

The Chemical Constitution of the Tubercle Bacillus

1. Dried tubercle bacilli extracted with hot solutions of spirit, alcohol, alcohol-ether, Aronson's mixture, yield large percentages of fatty substances.2. On filtering the boiling extracts a white acid-fast precipitate deposits on cooling.3. The filtrates on evaporation can be saponified by soda, and on subsequent agitation with ether and water two extracts can be obtained —an ethereal and a watery extract.4. The ethereal extract contains fat which is not acid-fast.5. By saponifying the dried ethereal extract with alcoholic potash and decomposing the resulting soaps with sulphuric acid a mixture of fatty acids is obtained containing probably oleic, isocetinic and myristinic acids. None of these are acid-fast.6. The watery extract (soap) on decomposition yielded a fatty acid with a melting point corresponding to lauric acid.7. The filtrates also yield lipochromes to which the cultures of tubercle bacillus owe their colour.8. The white acid-fast precipitate obtained by the original extraction can be saponified, but with great difficulty.9. By prolonged boiling with alcoholic potash the acid-fast precipitate is decomposed and results in the deposition of an acid-fast snow-white flaky powder, and a non-acid-fast filtrate of fatty acids.10. The chemical examination of the white flaky powder shows it to be an alcohol.11. Acid- and alcohol-fastness of the tubercle bacillus is due to the presence of an alcohol.