Venlafaxine

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ned Z. Carp MD, FACS

  • Associate Professor of Surgery, Jefferson Medical College, Philadelphia,
  • Pennsylvania
  • Chief, Division of General Surgery, Lankenau Hospital, Wynnewood,
  • Pennsylvania

The product is then sent to either a blood bank or cell-processing laboratory where {{The number of cells is determined {{Either the red blood cells or the plasma (the fuid surrounding the cells) may be removed if the donor and recipient do not share the same red blood cell type anxiety symptoms 4 dpo order venlafaxine 75mg fast delivery. If necessary anxiety symptoms throwing up buy cheap venlafaxine 37.5mg line, the harvested bone marrow cells can be frozen and stored for later use anxiety symptoms vs heart attack cheap 75 mg venlafaxine otc. This blood is collected after the baby is born; the collected blood is called a cord blood unit anxiety symptoms 8-10 buy venlafaxine uk. The blood from the umbilical cord and placenta is collected either before or after the placenta is delivered anxiety symptoms explained purchase venlafaxine master card, depending upon the procedure at the hospital anxiety no more buy discount venlafaxine online. The cord blood is collected into a sterile bag; this bag of blood is the cord blood unit. The cord blood unit is transported to a cord blood bank for testing, freezing and long-term storage. The cord blood unit is checked to make sure it has enough blood-forming cells for a transplant. If there are too few cells, the cord blood unit may be used for research to improve the transplantation process for future patients, or it may be discarded. When testing has been completed, the blood is frozen and stored at a very low temperature, usually in liquid nitrogen, for future use. Conditioning Conditioning? is a term used for the therapy given to prepare patients for stem cell transplantation. Conditioning is usually a combination of two or more chemotherapy medications, either with or without radiation therapy. Conditioning starts on a negative-numbered day (for example Day Minus 7 [Day 7, Day 6, etc ]). The days after the transplant are referred to as positive-numbered days (Day Plus One [Day +1, Day +2, etc]). This chemotherapy is usually stronger than the chemotherapy received during earlier treatments. These high-dose regimens are particularly useful in treating patients who require stronger, more aggressive anticancer agents. The particular conditioning that the patient receives is based on a number of factors, including {{Type of cancer {{Source of stem cells {{Previous treatments. Certain conditioning regimens may cause difcult side efects, and members of the transplant team will discuss these with the patient before beginning the conditioning therapy. During chemotherapy, the patient will receive intravenous Blood and Marrow Stem Cell Transplantation I 27 fuids for hydration and medications, such as anti nausea drugs, to ease uncomfortable symptoms. Patients who receive allogeneic stem cell transplants also start receiving immunosuppressant medication to prevent graft-versus-host disease. Patients being prepared for a reduced-intensity allogeneic stem cell transplantation receive lower doses of chemotherapy drugs, either with or without radiation, in preparation for the transplant, compared with the dosages given to patients receiving a standard allogeneic stem cell transplant. The goal of this approach is to suppress the immune system enough to allow the donor stem cells to take over and produce a new immune system that will fght the cancer. Total body irradiation uses small doses of radiation delivered to the entire body and can destroy cancer cells throughout the body. These divided doses minimize side efects such as lung injury, nausea and vomiting. The radiation treatments are usually given 1 to 3 times a day over 2 to 4 days immediately before transplantation. For example, some men who have leukemia or lymphoma may receive a boost? or an extra dose of radiation to their groin area to kill cancer cells that may be hidden in the testicles. Some patients have a day or two of rest between their conditioning regimen and their stem cell infusion. Not all patients, however, have a day of rest between their conditioning regimen and transplantation. For patients receiving T-cell depleted allogeneic stem cell transplants, the T cells are removed from the stem cells before they are infused into the patient. T-cell depletion, however, may lead to an increased risk of infections post transplant, or even graft rejection and relapse. For these reasons, T cells are depleted from the stem cell collection only in certain circumstances. For example {{Prior to the transfusion, the patient receives intravenous fuids and medications to help prevent a reaction and reduce side efects during the infusion. Patients are checked frequently for signs of fever, chills, hives, a drop in blood pressure or shortness of breath. The side efects are caused by the preservative that is used to store the stem cells. Immediate Post-Transplant Period After the stem cells are infused, they will travel to the bone marrow and make new blood cells. Engraftment means the new stem cells are working properly and starting to rebuild the immune system. White blood cells are the frst cells to engraft, followed by red blood cells and then platelets. As engraftment occurs, the white blood cells, red blood cells and platelets will begin to increase in number. In addition to infections, the patient is also at risk for anemia (low red blood cell count), bleeding (low platelet count) and other concerns. During the post-transplant period, patients are very vulnerable to infections because they have very low white blood cell counts (a condition called neutropenia). Additionally, patients who have undergone allogeneic stem cell transplantation receive intensive treatments to suppress the immune system to prevent graft-versus-host disease. For example {{Patients receive broad-spectrum antibiotics, antiviral and antifungal agents to prevent infections. Cytomegalovirus is related to the viruses that cause chicken pox and infectious mononucleosis. A healthy immune system keeps the virus from multiplying and causing any further illness. The virus, however, can become a serious problem for people with weakened immune systems. It is possible for the virus to become reactivated after a stem cell transplant and cause a serious infection in any organ of the body. If early detection fnds traces of the virus, antiviral medication can be given to prevent it from spreading. Patients should avoid close contact with anyone who has a cold, fu, chicken pox, measles or any other illness that can spread to the patient. Patients should also avoid contact with people who have had recent immunizations with live viruses. Patients should avoid raw and undercooked meat and fsh, non pasteurized dairy products, raw eggs, raw honey, and unwashed raw vegetables and fruit. They should speak to members of their treatment team for specifc recommendations about an appropriate diet or ask for a referral to a dietitian. Patients with low red blood cell counts may experience weakness, fatigue, and shortness of breath. Transfusions of red blood cells can ease symptoms until the bone marrow begins to produce sufcient numbers of red blood cells. In certain cases where there is a mismatch in blood type, this process can take several months. Thrombocytopenia is a condition in which there is a lower-than-normal number of platelets in the blood. The low number of platelets may result in easy bruising and excessive bleeding from wounds or bleeding from mucous membranes such as the nose, mouth, skin and gastrointestinal tract. In addition to low blood counts, there are other short-term side efects associated with the conditioning regimen. The chemotherapy dosages used before transplantation are usually higher than the dosages used in standard chemotherapy, so the typical side efects of the conditioning regimen chemotherapy may be more intense, especially during the weeks after transplantation. It is important for patients to notify their doctor or nurse of any side efects so they can be treated. The following areas are especially sensitive to chemotherapy drugs and radiation therapy: {{Gastrointestinal Tract. Doctors often give anti nausea medication along with chemotherapy to try to prevent it. Patients should inform their doctor or nurse how well the medicines are controlling the nausea and vomiting. Patients may also experience diarrhea, intestinal cramps and rectal or anal ulceration. When needed, an agent such as the epidermal (skin type cells) growth factor palifermin (Kepivance), given intravenously, can be used to prevent or minimize the efects of oral mucositis. Palifermin stimulates the cells that line the mouth and gastrointestinal tract to grow and develop. A reaction called interstitial pneumonia? can occur as a result of infection or damage from intensive therapy. High doses of chemotherapy, especially when accompanied by total body irradiation therapy, can damage the cells in the lungs. Patients typically experience a dry non productive cough Blood and Marrow Stem Cell Transplantation I 31 or shortness of breath. This side efect can be very severe and prevent the efcient exchange of oxygen in the lungs. It may occur at any time?from a few days after high-dose chemotherapy to several months after treatment?and may even occur after a patient has returned home. It is important for patients who experience shortness of breath or a new cough after transplantation to bring this to the immediate attention of their doctor or nurse since interstitial pneumonia can be a serious or even fatal complication. Skin efects are evaluated and treated to help make patients more comfortable and to prevent serious complications. Leaky blood vessels may result from the accumulated injury caused by chemotherapy and radiation therapy. Medications such as corticosteroids, which decrease infammation, are sometimes used to manage this complication. Many centers now employ the use of blood thinners to reduce the chance of clots forming. Being out of bed and walking can also help reduce the likelihood of the formation of blood clots. Diseases, such as myeloma, also put the patient at higher risk of blood vessel issues. The blood vessels that lead into and pass through the liver are prone to blockage after transplantation. It is generally temporary, and hair growth resumes when the drugs are discontinued. As hair grows back, it is important to keep the scalp protected from the sun, heat and cold. The new hair may be a diferent color or texture and it may be thinner than it was before the transplant. This usually develops within the frst 100 days after transplantation, but it can occur later. It is one of the leading causes of medical problems and death after an allogeneic stem cell transplantation. Graft Failure Graft failure occurs when the transplanted stem cells (the graft) fail to move into the bone marrow and make new blood cells. In allogeneic stem cell transplantation, graft failure is more common when the patient and donor are not well matched and when the patient receives T cell depleted transplants. It can also occur in patients who receive a graft that has a low number of stem cells, such as a single umbilical cord unit. The most common treatment for graft failure is a second transplant, either using stem cells from the same donor or from a diferent donor. Other treatment options may include donor lymphocyte infusion or treatment within the setting of a clinical trial. Combination chemotherapy is a treatment option for patients with aggressive disease. Early Recovery (From discharge up to about one year) Once engraftment has occurred and early side efects or complications have been resolved, members of the transplant team will begin working on discharging the patient. A patient is ready for discharge when {{Engraftment has occurred and the patient is producing sufcient numbers of healthy white blood cells, red blood cells and platelets. The patient or his or her caregivers should call the doctor or nurse immediately if there are any symptoms of infection, including {{Fever or chills {{Coughing, sneezing, runny nose, sore throat or shortness of breath {{Nausea, vomiting or diarrhea {{Blood in the urine or pain during urination {{Rash or cold sores. Initially, doctor visits may be frequent, and allogeneic transplant patients may need follow-up visits several times per week. If all is going as anticipated, the central venous catheter can be removed and the frequency of follow-up visits can gradually be decreased. At some visits, bone marrow aspirations and biopsies will be done to check blood cell growth in the bone marrow. In general, there is a shorter recovery period after autologous stem cell transplantation than after allogeneic stem cell transplantation. In an autologous transplant, it often takes the immune system 3 to 12 months to recover. For an allogeneic transplant, it often takes at least 6 to 12 months to recover nearly normal blood cell levels and immune cell function. The recovery time a stem cell transplant recipient needs before he or she feels normal? or returns to work or school is diferent for each person. During the recovery period, the stem cells are creating new blood cells, and the cells in the mouth, stomach, intestines, hair, and muscles are regrowing. The body is exerting energy to make these new cells, and fatigue and weakness are not unusual. For most people, the frst few months to one year after transplant remain a time of recovery. As patients regain more strength, they may begin slowly resuming daily activities.

The mixed biliary and alcoholic etiology is possible anxiety lightheadedness cheap venlafaxine 37.5mg on-line, the acute episode being triggered by a substantial meal associated with alcohol anxiety videos purchase cheap venlafaxine line, in a patient with gallstones anxiety symptoms shaking order venlafaxine australia. The alcoholic and biliary etiology are responsible for 80-90% of acute pancreatitis cases anxiety free stress release formula buy venlafaxine 37.5 mg without prescription. In general anxiety xanax and copd purchase venlafaxine 150mg fast delivery, acute pancreatitis can be classified as acute alcoholic pancreatitis (A) anxiety natural supplements venlafaxine 37.5 mg on line, acute biliary pancreatitis (B), and non-alcoholic non biliary (non-A non-B) acute pancreatitis. The clinical presentation of acute pancreatitis is typical, characterized by "band-like" pain or epigastric pain, often with posterior radiation. Lipase higher than 3 times the upper limit of normal in the presence of clinical signs, is a diagnosis criteria. The pancreatic outline becomes unclear and an enlarged hyperechoic omental bursa may be observed in severe necrotic forms (Figs. The omental bursa is a virtual cavity, delimited anteriorly by the stomach and posteriorly by the anterior margin of the pancreas. In acute necrotic-hemorrhagic pancreatitis, an enlargement and an increase in the echogenicity of the omental bursa occur through cytosteatonecrosis (Fig. The paretic intestinal loops may be filled with anechoic fluid and are visible in peripancreatic areas. Frequently, this obstacle cannot be overcome by the use of a high performance ultrasound machines by an experienced ultrasonographist. First, potential gallstones should be searched for, which can involve small calculi or, more rarely, only biliary sludge, possibly with cholesterol macro-crystals. The diagnostic elements are: enlarged, hypoechoic pancreas; hypoechoic pancreatic areas of tissue necrosis; enlarged hyperechoic omental bursa; fluid collections around the pancreas or at a distance (parieto-colic gutters). Seconds after SonoVue bolus, the pancreas enhances, but necrotic areas will not enhance (allowing to assess the extension of necrotic areas). It can assess pancreatic size, necrotic areas, the changes in the omental bursa, fluid effusions. In some situations, peripancreatic collections or pseudocysts (anechoic lesions with hyperechoic walls) may be observed, whose size and evolution can be monitored by ultrasound (Figs. If these lesions are not completely anechoic and if there is a suspicion of pancreatic abscess (a hypo/anechoic lesion), ultrasound guided fine needle aspiration should be performed. Then, the collection can be drained by ultrasound guided placement of a drain tube. Other etiological factors are less common: hyperparathyroidism, chronic familial pancreatitis, etc. In more than 90% of cases, the cause is chronic alcohol consumption (years) in pathological doses. The toxic dose for the pancreas is higher than 60-70 grams pure alcohol/day for men and 30-40 grams/day for women. Pain exacerbation occurs especially in acute episodes, generated in particular by alcohol consumption. Vomiting is frequent and may be related to digestive obstruction due to a hypertrophic pancreas. For the specific testing of pancreatitis, serum lipase (which is organ specific) is preferred. Direct tests include the secretin test and the Lundt test, which consist of collecting pancreatic juice and measuring its pancreatic enzyme and bicarbonate content. Another functional test in chronic pancreatitis is fecal elastase 1 (an easy, sensitive modern test), which diagnoses pancreatic disease even in its early stages. Measurement of steatorrhea over 24 h is a useful test, which shows pancreatic lipase insufficiency (it is considered to be pathological, if lipid excretion is higher than 7 g lipids/day after normal eating). The examiner should be familiar with the normal appearance of the pancreatic parenchyma (in all its variants), with Wirsung duct assessment (1-2 mm in size in normal cases), and with changes that can be seen regarding the pancreas outline and structure (assessment of abnormal pancreatic heterogeneity or parenchymal calcifications). Epigastric transverse and sagittal sections are used with the inferior vena cava and the aorta as landmarks. Thus, the pancreatic isthmus is found before the inferior vena cava (so, the head of the pancreas is situated to the right of the vein), and the body of the pancreas is found before the aorta (thus, the tail of the pancreas is situated left of the aorta). When it is difficult to visualize the entire pancreas, 500-700 ml plain of water will be administered, which will form an ultrasound window in the gastric antrum, enabling the correct anterior delimitation of the organ. In chronic pancreatitis, the parenchymal structure will be inhomogeneous due to fibrotic areas (Fig. Usually they are small, difficult to see by ultrasound, but sometimes they are large, generating a posterior shadow (Figs. The duct appears as too visible? in some cases, because of its enlargement (Figs. Anyway, when a Wirsung duct larger than 2 mm is seen, or when it has an irregular, sinuous trajectory, the diagnosis of chronic pancreatitis is highly probable. In order to differentiate the two, the spleno-portal axis must be detected, possibly by following the portal vein up to the hilum. These vascular elements will be very easy to be visualized using color Doppler or power Doppler. In this case, it is relatively difficult to distinguish a chronic cephalic pancreatitis from a pancreatic head cancer. They appear as anechoic lesions, with hyperechoic walls, with different locations and sizes (Figs. For the tail of the pancreas, the presence of cysts in very distal locations could be a trap, especially in areas that are difficult to explore by ultrasound. In these case, the tail of the pancreas should be examined in procubitus using the ultrasound window of the left kidney. Ultrasound guided diagnostic aspiration can be performed to differentiate it from cystadenocarcinoma or therapeutic cyst puncture is also possible. Based on the size of pseudocysts, the fluid volume of the cyst can be assessed (using the sphere formula) and the amount of pancreatic fluid that must be extracted can be estimated. In the presence of a pancreatic pseudocyst, the problem arises whether it is a sequelae of acute pancreatitis or if it is a consequence of chronic pancreatitis (according to the Cambridge classification). We conducted a personal study in 30 patients with pancreatic pseudocysts detected by ultrasound. Using these criteria, we found that 9 out of 30 patients included in the study met other imaging criteria for chronic pancreatitis. In our group, 30% of the patients had pseudocysts as a complication of chronic pancreatitis and 70% of the cases had pancreatic pseudocysts as sequelae of an acute pancreatitis episode. In order to demonstrate it, exploratory paracentesis should be performed and the amylase content in the fluid will be measured (increased values for pancreatic etiology). Ultrasound guided paracentesis should be performed if the amount of fluid is small. The ultrasound aspect of pancreatic ascites is mostly of dense ascites (the anechoic image includes small moving echoic particles or the appearance is slightly hypoechoic, not completely anechoic). Also, it is difficult to distinguish a pancreatic pseudocyst with septa from a pancreatic cystadenoma or cystadenocarcinoma or from a mucinous pancreatic tumor (Figs. Computed tomography is useful for the evaluation of the pancreas and chronic pancreatitis. At the same time, due to current facilities of endoscopic ultrasound, ultrasound guided biopsy will be possible for any lesion suspected of malignancy. Pancreatic cysts are also easy to evaluate revealing potential malignant lesions (endocystic protrusions). Pancreatic cancers include pancreatic carcinoma, endocrine pancreatic tumors, cystic pancreatic tumors, ampullary tumor (ampulloma). Pancreatic carcinoma is a relatively common tumor, which is slightly more frequent in men than in women. Obstructive jaundice is usually the first sign that leads to the diagnosis of a pancreatic head tumor. For tumors located in the pancreatic body and tail and sometimes in the pancreatic head, the most common clinical signs are rapid weight loss, epigastric or band-like pain, loss of appetite, carcinomatous ascites or metastatic liver. The ultrasound appearance of pancreatic carcinoma is quite typical and consists of a hypoechoic mass in the pancreas, 1-5 cm in size (Figs. Vessels invasion can be demonstrated using power Doppler or contrast enhanced ultrasound, and is useful for preoperative evaluation (Fig. If pancreatic carcinoma develops on the background of chronic pancreatitis (a 5-30-fold increased risk), the diagnosis is difficult, particularly for the head of the pancreas. If these have failed, ultrasound-guided fine needle (23-22 gauge) biopsy will be performed in the suspect area. Other methods to facilitate the diagnosis of pancreatic carcinoma are the use of harmonic ultrasound in order to improve the tumor delimitation, 3D ultrasound, the use of ultrasound contrast agents (for diagnosis and for the assessment of adjacent vascular invasion, especially in the spleno portal axis or in the superior mesenteric vein). Endoscopic ultrasound can see very small tumors and accurately assess vascular invasion (by endoscopic Doppler ultrasound). It also allows to collect a sample from the suspected lesion using endoscopic ultrasound guided biopsy. The preoperative assessment of pancreatic carcinoma is indispensable for assessing tumor extension and vascular invasion (it establishes the operability or non-operability of a case). One of their characteristics is the high hepatic mestastasis rate, even when they are small. The clinical presentation of endocrine pancreatic tumors depends on the type of hormone secreted. The ultrasound appearance of endocrine tumors is that of generally small, well delimited pancreatic masses (5-20 mm), hyper or hypoechoic. Due to the proximity to the examined organ, as well as to the sensitivity and specificity of the method, endoscopic ultrasound enables detection of tumors millimeters in sizes. In general, the ultrasound or echoendoscopic appearance will not allow differentiation of a pancreatic carcinoma from an endocrine tumor. An anechoic pancreatic image detected by ultrasound is in most cases a pancreatic pseudocyst. If there is no history of acute pancreatitis and no imaging signs of chronic pancreatitis, a cystic pancreatic tumor should be suspected. On ultrasound, the head of the pancreas appears as inhomogeneous, poorly delimited. In approximately 60% of the cases, mucinous cystadenoma or cystadenocarcinoma develops in the tail of the pancreas (Fig. A hypoechoic rather than hyperechoic appearance or of inner excrescences suggests the diagnosis of carcinoma (Figs. Ultrasound guided percutaneous or echoendoscopic biopsy from the cyst is useful; it will evidence a free-running mucinous fluid. The last will easily visualize microcysts in microcystic adenoma or will reveal excrescences inside the cyst in pancreatic cystadenocarcinoma. It clinically manifests through a progressive, painless jaundice syndrome, sometimes accompanied by anemia (exulceration of the papilla with occult digestive bleeding). Duodenoscopy with a lateral view endoscope allows to visualize the papilla and diagnostic biopsy. In conclusion, although diagnosing pancreatic pathology is one of the most difficult tasks for the ultrasonographist, we must emphasize that the value of ultrasound in pancreatic diseases depends to a large extent on the experience, the competence and the ambition of the examiner. Continuous training, solid theoretical knowledge along with high performance equipment will lead to very good diagnostic results that will frequently compete with other much more sophisticated (and expensive) diagnostic methods. The clinical examination of such a patient requires adequate, preferably natural light. Initially, jaundice becomes visible in the conjunctiva, then on the skin (with the increase of bilirubin values). Clinical examination: in a jaundice patient it is very important to determine the etiology. Medical history and objective examination sometimes reveal the diagnosis, but ultrasound or other diagnostic methods should establish the causes of the jaundice syndrome. In general, jaundice in a teenager or in a young adult most frequently indicates acute viral hepatitis. Jaundice in an elderly patient is most frequently caused by a pancreatic or bile duct cancer or by parenchymal decompensated liver cirrhosis. The onset of the jaundice can be established by anamnesis and can be of assistance in clinical thinking. An onset associated with dyspeptic syndrome and sub fever may suggest acute viral hepatitis. A history of chronic hepatitis suggests parenchymal decompensation in chronic liver disease. Progressive and painless jaundice syndrome accompanied by progressive weight loss in an elderly person may suggest a pancreatic head or bile duct tumor. Anamnesis should be conducted having in mind the possible types of jaundice and their onset. The presence of an increased abdominal volume suggests ascites and mixed decompensation in liver cirrhosis. The presence of spider naevi on the anterior or posterior thorax is also suggestive for cirrhosis. Chronic scratching lesions support the presence of chronic cholestasis (primary biliary cirrhosis, ampulloma, cholangiocarcinoma, etc. Palpation of the abdomen also helps in the diagnosis: the nature of hepatomegaly, the presence of splenomegaly or ascites. The liver will have a normal consistency in acute viral hepatitis; a significantly increased consistency in cirrhosis. Hepatomegaly will be hard on palpation in neoplastic jaundice (primitive or secondary). In case of a pancreatic head neoplasm or ampulloma, the fundus of the gallbladder will be distended (the Courvoisier-Terrier sign). In current practice, an increase in both bilirubin types is found in both hepatocellular and obstructive jaundice (perhaps with a slight predominance of conjugated bilirubin in obstructive jaundice). Intermittent subjaundice or jaundice episodes, related to physical exercise, prolonged fasting, may occur.

Buy 37.5mg venlafaxine mastercard. Anxiety Disorders: Integrated Christian Cognitive-Behavioral Therapy.

venlafaxine 37.5 mg low price

Mirobalano (Indian Gooseberry). Venlafaxine.

  • How does Indian Gooseberry work?
  • Lowering cholesterol and triglyceride levels, cancer, indigestion, eye problems, joint pain, diarrhea, obesity, diabetes, and other conditions.
  • Are there safety concerns?
  • Dosing considerations for Indian Gooseberry.
  • What is Indian Gooseberry?

Source: http://www.rxlist.com/script/main/art.asp?articlekey=96763

The exposed group anxiety from alcohol order generic venlafaxine online, made up of painters and mechanics in the overhaul department anxiety 4th hereford cattle purchase 75 mg venlafaxine with visa, was chosen to maximize the exposure contrast yet minimize differences in potential confounders between exposed and nonexposed groups anxiety symptoms blurred vision buy venlafaxine 75 mg lowest price. Exposures were typically within state and federal guidelines for dichloromethane exposure anxiety symptoms gi discount 37.5mg venlafaxine mastercard. Data collection occurred in three phases: (1) an initial questionnaire was given to all retired members of the airline mechanics union to identify eligible workers; (2) a telephone survey was conducted to collect medical anxiety 5 things images cheap venlafaxine amex, demographic anxiety gas purchase venlafaxine 150 mg without prescription, and general employment criteria; and (3) subjects who qualified were then recruited to participate in the medical evaluation. Sixty percent of the 1,758 retirees responded to the questionnaire; 259 met the eligibility criteria. Ninety-one men qualified for the medical evaluation based on the telephone survey; 25 retirees exposed to solvents and 21 unexposed retirees participated in the evaluation. All were men between the ages of 55 and 75 without a history of alcoholism or any neurological disorder. The medical evaluation asked about the occurrence of 33 different symptoms in the past year, physiological measurement of odor and color vision senses, auditory response potential, hand grip strength, and measures of reaction time (simple, choice, and complex), short-term visual memory and visual retention, attention, and spatial ability. In an analysis of potential response bias, attempts were made to contact 30% of the questionnaire nonrespondents, with 46% contacted and 31% completing the telephone interview. The only difference found between those who responded to the mailed questionnaire and those who did not was a higher percentage of diagnosed heart disease among the nonrespondents who were 2. Those who were eligible but did not participate in the medical evaluation were similar to the exam participants on all characteristics included in the interview. The only difference was a higher prevalence of gout among the unexposed who did not participate compared to the unexposed who did participate. Suicide risk is not an outcome that was a primary hypothesis of the cohort studies, but it may be relevant given the potential neuropsychological effects of dichloromethane. A similar relative risk estimate was seen in the highest exposure group in the study of triacetate fiber production workers in Maryland (Gibbs, 1992), but this increased risk was not seen in the updated study by Tomenson. Information on suicide was not included in the analysis of civilian Air Force base workers (Radican et al. Blood samples were collected before and after shifts from 136 Rock Hill and 132 Narrows workers. For the Rock Hill workers, personal monitoring for dichloromethane exposure was done during the shift. The P50 group means were lower among exposed compared with referents, among smokers compared with nonsmokers, and among men compared with women. The production process was the same as the process at the Hoechst Celanese Rock Hill plant, except the Belgium plant was newer with better engineering controls to significantly reduce overall levels of the dichloromethane, acetone, and methanol used in the process. Smoking status was defined based on a health assessment questionnaire, with smokers smoking at least one cigarette per day. Special efforts were made to recruit men with a history of heart disease because this group was postulated to be most likely to demonstrate positive findings. The evaluation examined ventricular and supraventricular ectopic activity and S-T segment depression in the exposed and nonexposed groups. Comparisons were also made between cardiac performance during work hours and nonwork hours to discern possible short term effects of recent exposure. Comparing the findings for the 24 exposed and 26 referent volunteers indicated no difference in ventricular or supraventricular ectopic activity or S-T segment depression. There was no difference comparing work and nonwork hours among exposed volunteers. Summary of Studies of Health Effects Other Than Cancer the clinical and workplace studies of the influence of dichloromethane exposure on health effects other than cancer are summarized below: Neurological effects. The acute effects of dichloromethane exposure on neurological function seen in numerous case reports were also seen in experimental studies in humans (Putz et al. Relatively less is known about the potential long-term effects of chronic exposures in humans. Some data from studies of workers suggest that the effects of dichloromethane are relatively short-lived. No difference in four neurological symptoms was seen in an analysis of exposed workers (average exposure 475 ppm,? Other data suggest an increase in prevalence of neurological symptoms among workers (Cherry et al. Rather, these analyses provide evidence of an increased prevalence of neurological symptoms among workers with average exposures of 75?100 ppm (Cherry et al. The increased risk of suicide (approximately a twofold increased risk) seen in two of the worker cohort studies (Hearne and Pifer, 1999; Gibbs, 1992) is an additional 53 indication of potential neurological consequences of dichloromethane exposure. Thus, given the suggestions from the currently available studies, the statement that there are no long-term neurological effects of chronic exposures to dichloromethane cannot be made with confidence. To date, there is little evidence of cardiac damage related to dichloromethane exposure in the cohort studies of dichloromethane-exposed workers that examined ischemic heart disease mortality risk (Table 4 2) or in two small cardiac monitoring studies (Ott et al. However, limitations in these cohort mortality studies should be noted, including the healthy worker effect and the absence of data pertaining to workers who died before the establishment of the analytic cohort (Gibbs et al. Only limited and somewhat indirect evidence pertaining to immune-related effects of dichloromethane in humans is available. No risk was seen in the broad category of infectious and parasite-related mortality reported by Hearne and Pifer (1999), but there was some evidence of an increased risk for influenza and pneumonia-related mortality at two cellulose triacetate fiber production work sites in Maryland and South Carolina (Gibbs, 1992). Slightly elevated risks of mortality due to influenza and pneumonia were seen among the male workers in the high exposure group in Maryland (7 observed, 5. Among females, there were few observed or expected cases (in Maryland, 1 observed, 0. Cervical cancer is viral mediated (human papilloma virus), and immunosuppression is a risk factor for development of this disease, as seen by the increased risk in immunocompromised patients and people taking immunosuppressant medications (Leitao et al. In a cohort study of civilian Air Force base workers, an increased risk of bronchitis-related mortality, based on four exposed cases, was seen among the men who had been exposed to dichloromethane, with a hazard ratio of 9. This collection of studies indicates that immune suppression, and a potentially related susceptibility to specific types of infectious diseases, may be a relevant health outcome for consideration with respect to dichloromethane exposure. Two of these studies were based in the Rock Hill, South Carolina, cellulose triacetate fiber plant (Soden, 1993; Ott et al. There is some evidence of increasing levels of serum bilirubin with increasing dichloromethane exposure in Ott et al. These studies do not provide clear evidence of hepatic damage in dichloromethane-exposed workers, to the extent that this damage could be detected by these serologic measures; however, these data are limited and, thus, the absence, presence, or extent of hepatic damage is not known with certainty. Studies pertaining to various reproductive effects and dichloromethane exposure from workplace settings or environmental settings have examined possible associations with spontaneous abortion (Taskinen et al. Of these, the data pertaining to spontaneous abortion provide the strongest evidence of an adverse effect of dichloromethane exposure, particularly with respect to the case-control study in which the strongest association was seen specifically with the higher frequency category of dichloromethane exposure (Taskinen et al. However, it is a small study (44 cases, 130 controls) with limited quantitative exposure assessment and multiple exposures (although the association seen with dichloromethane was among the highest seen among the solvents) and so cannot be considered to firmly establish the role of dichloromethane in induction of miscarriage. Identification and Selection of Studies for Evaluation of Cancer Risk Seventeen epidemiologic studies of cancer risk were identified and included in this evaluation: four cohorts for which the primary solvent exposure was to dichloromethane (two in film production settings and two in cellulose triacetate fiber production), one large cohort of civilian employees at a military base with exposures to a variety of solvents but that included an assessment specifically of dichloromethane exposure, and twelve case-control studies of specific cancers with data on dichloromethane exposure. The analysis was based on exposure to a combined group of chlorinated methanes. The study setting, methods (including exposure assessment techniques), results pertaining to incidence or mortality from specific cancers, and primary strengths and limitations are summarized in Appendix D (Sections D. When two papers of the same cohort were available, the results from the longer period of follow-up are emphasized in the summary. Information from earlier reports is used when these reports contain more details regarding working conditions, study design, and exposure assessment. Summary of Cancer Studies by Type of Cancer the cohort and case-control studies with data relevant to the issue of dichloromethane exposure and cancer risk are summarized in Tables 4-3 and 4-4, respectively. The strongest of the cohort studies in terms of design are two of the triacetate film base production cohorts (Cohort 1 in New York and the United Kingdom cohort, reported in Hearne and Pifer (1999) and Tomenson et al. The start of eligibility for cohort entrance corresponds with the beginning of the time when the exposure potential at the work site began, and the follow-up period is relatively long (mean? Although Cohort 2 of the New York film base production study has similar exposure data and follow-up, this cohort was limited to workers employed between 1964 and 1970 and, therefore, would have missed anyone leaving (possibly because of illness or death) before this time. In addition, because of the overlap between Cohort 1 and Cohort 2, including both cohorts in an evaluation would be double-counting experiences of some individuals. Several limitations of the triacetate film base production cohorts should be noted, however. Exposures in small, poorly ventilated work areas are also often much higher than those seen in these film base production cohorts (Estill and Spencer, 1996; Anundi et al. Other limitations include the limited power to detect a risk of low-incidence cancers (including brain, liver, leukemia, and other forms of hematopoietic cancers) and the lack of women and, thus, lack of data pertaining to breast cancer. In addition, these cohorts used mortality rather than incidence data, which is of particular concern for cancers with a relatively high survival rate, such as non-Hodgkin lymphoma. Although the exposure levels in the cohorts involved in cellulose triacetate fiber production were much higher than those of the film production cohorts, the duration of exposure was relatively short in the South Carolina cohort (Lanes et al. In the Maryland triacetate fiber production plant, duration of exposure was not reported and the length of follow up was relatively short (mean 17 years) (Gibbs et al. Also, the cohort began in 1970, even though production began in 1955, and the missing personnel records made it impossible to recreate an inception cohort. The exposure assessment in the study of civilian Air Force base workers (Radican et al. This Air Force base study was the largest of the cohort studies that included women and presented data pertaining to breast cancer. Summary of cohort studies of cancer risk and dichloromethane exposure a Total n, exposure level and Exposure assessment; b c Reference and Cohort duration, follow-up period Inclusion criteria outcome assessment Results Hearne and Pifer (1999) n = 1,311 men; mean 39 ppm; Began working after Work history (job records) and See Table D-1. Increasing risk across Cellulose triacetate fiber (total n = 2,909); 50?100 ppm in January 1, 1970, for at personal/air monitoring; exposure groups seen for prostate production; low and 350?700 ppm in high least 3 mo (potential death certificate (fields used not cancer and cervical cancer. Summary of cohort studies of cancer risk and dichloromethane exposure a Total n, exposure level and Exposure assessment; b c Reference and Cohort duration, follow-up period Inclusion criteria outcome assessment Results Radican et al. More comprehensive information, when available for other cancers, is shown in the summary tables for each study (see Appendix D). Summary of case-control studies of cancer risk and dichloromethane exposure Location Cancer type, n cases, n controls (source), time period, a reference demographic group Exposure assessment Results Brain Louisiana, New Jersey, Philadelphia; Job exposure matrix applied to detailed See Section D. Summary of case-control studies of cancer risk and dichloromethane exposure Location Cancer type, n cases, n controls (source), time period, a reference demographic group Exposure assessment Results Non-Hodgkin Germany (6 areas); 710 incident lymphoma Job exposure matrix applied to work history See Section D. Probability and intensity ratings; 8 Little difference in risk by probability or limited to 518 cases and 597 controls with specific solvents intensity score. Association with intensity lymphoma 1,428 incident cases, 1,530 population-based (all jobs held at least 5 yrs) ascertained measure: Miligi et al. Association with intensity leukemia 586 incident cases, 1,278 population-based (all jobs held at least 5 yrs) ascertained measure: Costantini et al. Probability and intensity ratings; 10 specific solvents Multiple myeloma Italy (6 areas) Job exposure matrix applied to work history See Section D. Probability and intensity ratings; 10 specific solvents (Table 4-4; page 2 of 3) 61 Table 4-4. Summary of case-control studies of cancer risk and dichloromethane exposure Location Cancer type, n cases, n controls (source), time period, a reference demographic group Exposure assessment Results Multiple myeloma Seattle, Washington and Detroit, Michigan Job exposure matrix applied to work history See Section D. Case-control studies are often designed to examine incidence rather than mortality, which is of particular importance in etiologic research for diseases with relatively high survival rates and diseases in which survival may be strongly related to factors that are difficult to adjust for without detailed data collection. There is a considerable range, however, in the detail and quality of the exposure assessment used in case-control studies. Case-control studies rarely include specific measurements taken at specific work sites of individual study participants. Although it is more difficult to determine absolute exposure levels without these individual measurements, the exposure assessment methodology used in case-control studies can result in useful between-group comparisons of risk if the intra-group variability is less than the intergroup variability in potential exposure levels. The use of death certificate data to classify disease and occupational exposures in the three studies using the large 24-state death certificate database [brain cancer, Cocco et al. Several other case-control studies included diagnoses based on medical records, detailed job-specific and industry-specific questionnaire modules focusing on potential exposure to specific solvents, and included assessment of intensity and probability of exposure (Gold et al. Each of these seven studies did, however, obtain detailed information about all jobs held (or, in the case of the study of childhood leukemia, jobs held in the two years before and during the pregnancy), rather than just the usual or most recent job, and focused on a relatively small number of exposures. Considering the issues described above with respect to the strengths and limitations of the available epidemiologic studies, a summary of the epidemiologic evidence relating to dichloromethane exposure and specific types of cancer can be made, as described below. The available epidemiologic data suggest an association between dichloromethane and brain cancer, liver cancer, and specific hematopoietic cancers, but not lung cancer. These estimates are based on a small number of observations (six cases in New York and four in the United Kingdom) and so are relatively imprecise. In both of these studies, an increasing risk was seen with cumulative exposure in the middle exposure groups. Two case-control studies of dichloromethane exposure and brain cancer have been conducted (Cocco et al. This difference could reflect a more valid measure of relevant exposures in the brain from the intensity measure, as suggested by the study in rats reported by Savolainen et al. The available epidemiologic studies provide evidence of an association between dichloromethane and brain cancer, and this area of research represents a data gap in the understanding of the carcinogenic potential of dichloromethane. The cohort study with the higher exposures, the Rock Hill triacetate fiber production plant, suggested an increased risk of liver cancer (Lanes et al. This observation was based on four cases; three of these cases were biliary duct cancers. No other cohort 64 study has reported an increased risk of liver cancer mortality, although it should be noted that there is no other inception cohort study of a population with exposure levels similar to those of the Rock Hill plant, and no data from a case-control study of liver cancer are available pertaining to dichloromethane exposure. In the stronger cohort studies [Cohort 1 in the New York Eastman Kodak Company triacetate film production study reported by Hearne and Pifer (1999) and the United Kingdom triacetate film production study reported by Tomenson et al. The New York study had also obtained data on smoking history that indicated that it was unlikely that differences in smoking could be masking an effect of dichloromethane (Hearne et al. The only group in any study that had an increased risk for lung cancer was the high-exposure women in the triacetate fiber production cohort in Maryland (Gibbs et al. No case control study of dichloromethane exposure and lung cancer risk is available. The available epidemiologic studies do not provide evidence for an association between dichloromethane and lung cancer, although it should be noted that this conclusion is based on a relatively limited database.

order venlafaxine online from canada

For high frequencies this energy density is large anxiety reduction cheap venlafaxine online mastercard, but just how large depends upon the frequency at which the spectrum cuts o? A second physical manifestation is evident with a Casimir cavity anxiety 5 weeks pregnant purchase venlafaxine discount, which consists of two closely-spaced venom separation anxiety order cheapest venlafaxine, parallel re? The radiation pressure exerted on the exterior side of the plates is larger than on the interior anxiety symptoms breathlessness generic venlafaxine 75mg otc, with the result that the plates are pushed together anxiety lightheadedness buy 75 mg venlafaxine with amex. For this force to be measurable with the currently available experimental techniques anxiety symptoms in cats 75 mg venlafaxine for sale, d must be less than 1 m. Valone [9] describes the electrical noise in resistors and diodes that results from zero-point? For example, in thermophotovoltaics radiation from a heated emitter is converted to electricity. Valone is particularly interested in the use of zero-bias diodes for zero-point energy harvesting, so as to rectify the ambient? In 1871 Maxwell developed a thought experiment in which a tiny demon operates a trapdoor to separate gas in equilibrium intoa thought experiment in which a tiny demon operates a trapdoor to separate gas in equilibrium into two compartments, one holding more energetic molecules and the other holding less energetic ones. Once separated, the resulting temperature diOnce separated, the resulting temperature difference cou? ThThis is a sort ofis is a sort of nonlinear processing, in which the system, consisting of the demon and the compartments, operatesnonlinear processing, in which the system, consisting of the demon and the compartments, operates didifferently on a molecule depending upon its thermal energy. In equilibrium, the second law of thermodynamics applies and no system canside of Equation (2). In equilibrium, the second law of thermodynamics applies and no system can extract power continuously. A detailed balance description of the kinetics of such a situation was developed by Einstein to explaindetailed balance description of the kinetics of such a situation was developed by Einstein to explain the relationship between the emission and absorption spectra of atoms [the relationship between the emission and absorption spectra of atoms [22], and discussed as a22], and discussed as a manifestation of equilibrium by Bridgman [manifestation of equilibrium by Bridgman [23]. If the equilibrium is altered, for example by the addition of a non-equilibrium radiation? The difference between detailed balance and steady state is illustrated withThe di? In the steady-state case shown in Figurestate case shown in Figure 1a, the total flux into any state equals the total flux out of it. Under equilibrium, however, a more restrictive detailed balance must be observed, in which the? In this three-state system each arrow represents one unit ofIllustration of detailed balance. The system in (a) is in steady state, such that the total flux into each state equals the totala) is in steady state, such that the total? This concept of detailed balance can be applied to the extraction of thermal noise from a resistorThis concept of detailed balance can be applied to the extraction of thermal noise from a resistor at ambient (equilibrium) temperature. To optimally transfer power from a source, in this case the noisyat ambient (equilibrium) temperature. To optimally transfer power from a source, in this case the resistor, to a load the load resistance should be adjusted to match that of the source. In that case, thenoisy resistor, to a load the load resistance should be adjusted to match that of the source. In that load generates an equal noise power to that of the source, and an equal power is transferred from thecase, the load generates an equal noise power to that of the source, and an equal power is transferred from the load to the source as was transferred from the source to the load. Because of this detailed balance, no net power can be extracted from a noisy resistor. To analyze the case of extracting energy from thermal noise fluctuations in a diode, consider the energy band diagram for a diode shown in Figure 2, where transitions among three different states Atoms 2019, 7, 51 4 of 18 load to the source as was transferred from the source to the load. For simplicity, five other pairs of transitions are not shown and are assumed to have states are shown. A completely parallel set of processes could be added for and recombination in the junction region. A completely parallel set of processes could be added for these transitions, and would not change the physical principles involved, or the conclusions drawn. Shown are electron transitions between the conduction and valence bands in the p-type region, corresponding to generation rateFigure 2. Shown are electron transitions between the conduction andg, and recombination rate r. Also shown are electron transitions between n-type and p-type conduction band states, corresponding tovalence bands in the p-type region, corresponding to generation rate g, and recombination rate r. Also excitation rateshown are electron transitions between n-type and p-type conduction band states, corresponding toe, and drift rate d. This diagram is used in the text to illustrate photovoltaic carrier collection, recti? This diagram is used in the text to illustrate photovoltaic carrier as proposed by Valone [collection, rectification of thermal fluctuations, and also rectification of zero-point energy fluctuations9]. If the diode operates as a solar cell, light absorbed in the p-type region generates electron-hole pairs, promoting electrons to the conductionFirst consider the case of photovoltaic power generation. If the diode operates as a solar cell, band at a ratelight absorbed in the p-type region generates electron-hole pairs, promoting electrons to theg that depends upon the light intensity and other factors. The the n-type region at ratephotogenerated electrons diffuse to the junction region, where the built-in electric field causes themd. Because gto drift across the junction to the n-type region at rate>> r and d >> e under solar illumination, i. The recombination rate, r, and the excitation electrons to the n-type region, where they are collected to provide power. In this case, however, the generation rate and drift rate across the junction would be much smaller than under solar illumination. In this case, however, a detailed balance is strictly observed, such thatthe generation rate and drift rate across the junction would be much smaller than under solarg = r and d =. Whether this is feasible becomes a questionthermodynamics does not allow for power generation. Whether this is feasible becomes a question at the temperature ofof whether the zero-point energy in a diode is in a state of true equilibrium with its surroundings. Recently, using the principle of maximal entropy, Dannon has shown explicitly that zero-point energy does, in fact, represent a state of thermodynamic equilibrium [has been generally accepted that the vacuum? should be considered to be a state of thermal24]. Recently, using the principle of maximal entropy, Dannon has shown explicitly that zero-point energy does, in fact, represent a state of thermodynamic equilibrium [24]. Therefore, it is clear that the detailed balance argument presented above for the case of thermal fluctuations also applies to ambient zero-point energy fluctuations, and a diode cannot rectify these fluctuations to obtain power. Atoms 2019, 7, 51 5 of 18 Therefore, it is clear that the detailed balance argument presented above for the case of thermal? Harvesting of Vacuum Fluctuations Using a Down-Converter and Antenna-Coupled Recti? In the microwave engineering domain, this rectifying antenna is known as a rectenna [25]. One geometric diode [example is a graphene geometric diode [26] but the rectification power efficiency of optical rectennas26] but the recti? The second, and more important question here, is whether this is feasible from fundamental considerations. The second, and more important question here, is whether this is feasible from I address these in turn. The high-intensity oscillation induces interactionsand build its intensity at their resonant frequency. The high-intensity oscillation induces interactions between two spheres of dibetween two spheres of different size such that a lower beat-frequency radiation is emitted from? This lower beat-frequency radiation is said to be then absorbed by an antenna and recti? The down-conversion occurs only after the signals encounter the diode,requires a nonlinear mixer. The non-identical microscopic resonant spheres interactradiation, and collecting, and rectifying it. This radiation is absorbed in with ambient zero-point fields to produce radiation at a beat frequency. Therefore, this step operating with incoming radiation under equilibrium must observe a detailed balance of rates. Regarding steps (b) and (c), under equilibrium a source, antenna and load are in detailed balance, such that the power received by the antenna from the source and transferred to a load is equal to the power transmitted back to the source [28]. If steps (a) and (b) could provide a greater-than-equilibrium concentration of power to the diode, then the diode in step (c) would no longer be operating under equilibrium. However, as argued above, the concentration of power at the diode cannot occur under equilibrium. Mechanical Extraction Using Casimir Cavities the attractive force between two closely spaced conducting, i. This attractive force was later shown to apply also to closely spaced dielectric plates [30], and becomes repulsive under certain conditions [31]. The potential energy associated with the Casimir force is considered next as a source of extractable energy [5,6]. The simplest way to extract energy from Casimir cavities would be to release the closely spaced plates so that they could accelerate together. In this way, the potential energy of the plate separation would be converted to kinetic energy. The Casimir cavity potential would be extracted, albeit into high-entropy thermal energy. If this energy conversion could be carried out as a cyclic process, electrical power obtained from this heat would be subject to the limitations of the Carnot e? Energy Exchange between Casimir Plates and an Electrical Power Supply In 1984, Forward described a di? The attractive Casimir force between spaced-apart coils of the Casimir plates is nearly balanced by the injection of electric charge from an external power supply causing the plates to repel each other. As the plates move together due to the attractive Casimir force, they do work on the repulsive charge, resulting in a charge Atoms 2019, 7, 51 7 of 18? In this way, the coming together of the Casimir plates provides usable energy, and maintains the low entropy of the original attractive potential energy. He used this device concept to demonstrate how one might convert the vacuum fluctuation potential energy from CasimirFigure 4. As the plates approach each other the repulsion of positive like-charges concept to demonstrate how one might convert the vacuum fluctuation potential energy from Casimirattraction to electrical energy. As the plates approach each other the repulsion of positive like-charges results in a current that charges up an external power supply. As the plates approach each other the repulsion of positive like-chargesresults in a current that charges up an external power supply. In a series of publications, Pinto proposed an engine for the extraction of mechanical energy force until the plates have come together, but continuous power extraction would require a cyclicprocess. In a series of publications, Pinto proposed an engine for the extraction of mechanical energy from Casimir cavities [6]. In a series of publications, Pinto proposed an engine for the extraction of mechanical energyfrom Casimir cavities [6]. In step (a) the Casimir cavity plates are allowed to move from Casimir cavities [6]. In step (a) the Casimir cavity plates are allowed to move together in response to their attraction, and the reduction in potential energy is extracted (for depiction of the process is shown in Figure 5. In step (a) the Casimir cavity plates are allowed to movetogether in response to their attraction, and the reduction in potential energy is extracted (for example, example, by the Forward method). Because of the Because of the altered state, the attractive Casimir force is reduced or reversed and the plates can then example, by the Forward method). Because of the altered state, the attractive Casimir force is reduced or reversed and the plates can thenusing less energy than was extracted when they came together, as depicted in step (c). After they are After they are separated, the plates are restored to their original state, and the cycle is repeated. Puthoff analyzed a system of switchable Casimir cavity mirrors and calculated the potential powerby Casimir plates as a function of vibration frequency and mass [32]. Casimir cavity engine for the cyclic extraction of vacuum energy, similar to system proposed Figure 5. Casimir cavity engine for the cyclic extraction of vacuum energy, similar to system proposed by Pinto [6]. In step (a) the Casimir plates move together in response to Casimir attraction, producing by Pinto [6]. In step (a) the Casimir plates move together in response to Casimir attraction, producing Figure 5. In step (the Casimir attraction; In step (a) the Casimir plates move together in response to Casimir attraction, producingc) the plates are pulled apart, using less energy than that which was the Casimir attraction; In step (c) the plates are pulled apart, using less energy than that which was energy that is extracted; In step (obtained in step (a), and then the cycle is repeated. For example, in step (b) shown in Figure 5, electrical charge might were to be used in separating the plates, it would require at least as much energy as had been be drained from at least one of the plates to modify its reflective property. If so, no matter what process were to be used in separating the plates, it would require at least as much energy as had been extracted by their coming together. For example, in step (b) shown in Figure 5, electrical charge might be drained from at least one of the plates to modify its re? This would reduce the Casimir attraction and allow the plates to be pulled apart with minimal force, after which charge would be injected back into the plates to reestablish the Casimir attraction. For a conservative force, the minimum energy required for this draining and injecting back of the electrical charge is the energy that could be obtained from the attractive force of the plates moving together. If the force is conservative then the hydrogenation/de-hydrogenation cycle would require at least as much energy as could be extracted from the Casimir-plate attraction, and the system cycle could not produce power. A similar situation to that of the Casimir force exists with standard electric forces, which clearly are conservative.

References

  • Lam C, Lim KH, Kang DH, et al. Uric acid and preeclampsia. Semin Nephrol. 2005;25:56-60.
  • Robb JA. Mesothelioma versus adenocarcinoma: false-positive CEA and Leu-M1 staining due to hyaluronic acid. Hum Pathol 1989;20(4):400.
  • Shihab OC, How P, West N, et al. Can a novel MRI staging system for low rectal cancer aid surgical planning? Dis Colon Rectum 2011;54(10):1260-1264.
  • Deng DY, Rutman M, Raz S, et al: Presentation and management of major complications of midurethral slings: are complications under-reported?, Neurourol Urodyn 26:46n52, 2007.
  • Del Campo L, Arribas I, Valbuena M, et al: Spiral CT findings in active and remission phases in patients with Crohn disease. J Comput Assist Tomogr 25:792, 2001.