ABSTRACT
Community-acquired pneumonia is a common condition and 6-24% of patients will fail to improve as expected. We present a patient who was initially treated for community-acquired pneumonia but did not make the anticipated recovery. We explore potential differentials, and the investigation and management of the rare condition we subsequently diagnosed.
Subject(s)
Actinomycosis/diagnosis , Actinomycosis/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Cough/etiology , Cryptogenic Organizing Pneumonia/diagnosis , Diagnosis, Differential , Diagnostic Errors , Dyspnea/etiology , Female , Humans , Middle Aged , Pneumonia/diagnosis , Pneumonia/drug therapy , Weight LossABSTRACT
In this article we examine the low-temperature specific heat of slow-cooled Cu(0.2)Ag(2.8)SbSeTe(2) and the thermoelectric performance of quenched samples. We find that the low-temperature specific heat is dominated by two Einstein terms of approximate energies of 2.5 and 5 meV. The specific-heat behavior is consistent with the amorphous low-temperature thermal conductivity behavior and validates the glassy nature of the structure. We performed the synthesis of quenched samples in an attempt to eliminate the presence of micro-cracks, whose existence presumably enhances electronic scattering. We find that quenching eliminates the presence of micro-cracks but does not result in an improvement of the figure of merit. Specifically, the highest ZT obtained in the quenched samples (ZT = 1.5), though very competitive, is still significantly less that the ZT obtained in the slow-cooled samples (ZT = 1.75).
Subject(s)
Alloys/chemistry , Copper/chemistry , Selenium/chemistry , Silver/chemistry , Tellurium/chemistry , Thermal Conductivity , Cold Temperature , Electric Conductivity , Electric Impedance , Electronics/methods , Hot Temperature , Microscopy, Electron, Transmission/methods , Models, Chemical , Temperature , VibrationABSTRACT
In order to compare the performance of four pleural drainage units (PDU [Emerson Post-Operative Pump, Pleur-Evac, Sentinel Seal, Thora-Klex]), we created an animal model of bronchopleural fistula that simulated the type of air leak seen clinically (mean maximal flow = 5 L/min). The PDU were tested at 0 cm (water seal), -20 cm and -40 cmH2O suction. Compared to water seal, -20 cmH2O suction significantly increased the ability of all four PDU to evacuate air via the chest tube and abolished small differences in chest tube air leak seen among the PDU at water seal. An increase in suction to -40 cmH2O did not significantly alter flow via the chest tube. Previously demonstrated differences among the PDU in handling large air flows were not seen in this lower flow model of bronchopleural fistula. However, because of their higher resistance, use of the Sentinel Seal and of the Thora-Klex was technically impractical even at air leaks of 4 to 5 L/min.
Subject(s)
Bronchial Fistula/therapy , Drainage/instrumentation , Fistula/therapy , Pleural Diseases/therapy , Animals , Dogs , Suction/instrumentationABSTRACT
Young (mean age = 23.41 years) and older (mean age = 69.41 years) adults studied a list of 80 words. They were tested immediately and 7 days later for both yes/no recognition and for ability to complete fragments such as E D L M, with words, some of which had been studied previously. The fragment completion task was not described as a memory test and subjects were encouraged to respond to all word fragments. Younger adults scored higher on recognition than older adults but not on fragment completion. These results, similar to those obtained with amnesics, suggest that older adults are impaired on tasks which require a conscious effort to recognize an event but that memory without awareness is unaffected by age.
Subject(s)
Aging , Awareness/physiology , Cognition/physiology , Dissociative Disorders/physiology , Memory/physiology , Adult , Aged , Female , Humans , Language Tests , Male , Middle Aged , Neuropsychological Tests , Stochastic ProcessesABSTRACT
We quantified the mechanical work of breathing in six normal subjects during assisted mechanical ventilation. Using two volume-cycled ventilators of different design, we investigated the influence of minute ventilation (VE) and machine settings of trigger sensitivity and flow during CO2-driven hyperventilation to moderate and high levels (12-24 L/min). Work estimates were derived from plots of esophageal and airway pressure against inflation volume. Peak flow and trigger sensitivity were important determinants of the energy expended, and for each combination of machine settings the work done by the subject per liter of ventilation increased with VE. During assisted ventilation the subject expended energy equivalent to 33-50 percent of the work of passive inflation, even under the most favorable conditions of VE, sensitivity and flow. Under the least favorable conditions of VE, sensitivity and flow, the subject's inspiratory work of breathing substantially exceeded the energy needed by the ventilator to inflate the passive thorax. These observations imply that exertion of the respiratory muscles continues throughout inflation during assisted mechanical ventilation and call attention to the possibility that inappropriate selection of ventilatory mode or machine settings may contribute to respiratory muscle fatigue and dyspnea.