Double-heater-wire circuits and heat-and-moisture exchangers and the risk of ventilator-associated pneumonia

Objective: To compare the incidence of ventilator-associated pneumonia (VAP) in patients ventilated in intensive care by means of circuits humidified with a hygroscopic heat-and-moisture exchanger with a bacterial viral filter (HME) or hot-water humidification with a heater wire in both inspiratory and expiratory circuit limbs (DHW) or the inspiratory limb only (SHW). Design: A prospective, randomized trial. Setting: A metropolitan teaching hospital's general intensive care unit. Patients: Three hundred eighty-one patients requiring a minimum period of mechanical ventilation of 48 hrs. Interventions: Patients were randomized to humidification with use of an HME (n = 190), SHW (n = 94), or DHW (n = 97). Measurements and Main Results. Study end points were VAP diagnosed on the basis of Clinical Pulmonary Infection Score (CPIS) (1), HME resistance after 24 hrs of use, endotracheal tube resistance, and HME use per patient. VAP occurred with similar frequency in all groups (13%, HME; 14%, DHW; 10%, SHW; p = 0.61) and was predicted only by current smoking (adjusted odds ratio [AOR], 2.1; 95% confidence interval [CI], 1.1-3.9; p =.03) and ventilation days (AOR, 1.05; 95% Cl, 1.0-1.2; p =.001); VAP was less likely for patients with an admission diagnosis of pneumonia (AOR, 0.40; 95% Cl, 0.4-0.2; p =.04). HME resistance after 24 hrs of use measured at a gas flow of 50 L/min was 0.9 cm H2O (0.4-2.9). Endotracheal tube resistance was similar for all three groups (16-19 cm H2O min/L; p =.2), as were suction frequency, secretion thickness, and blood on suctioning (p =.32, p =.06, and p =.34, respectively). The HME use per patient per day was 1.13. Conclusions: Humidification technique does not influence either VAP incidence or secretion characteristics, but HMEs may have air-flow resistance higher than manufacturer specifications after 24 hrs of use.

Comparison between myocardial integrated backscatter and strain rate imaging in the quantitative assessment of subepicardial function post-myocardial infarction

Transmural extent of infarction (TME) may be an important determinant of functional recovery and remodeling. Recent animal data suggest that strain rate imaging (SRI) maybe able to identify subendocardial ischemia.We compared SRI and cyclic variation of integrated backscatter (CVIB) for predicting TME in the quantitative assessment of regional subepicardial function. Forty-nine (n = 49) postmyocardial infarct patients (61±10 years, EF 41±10%) underwent tissue Doppler echocardiography (TDE) and contrast enhanced magnetic resonance imaging (CMR). A15 mm×2mm sampling volume (tracked to wall motion) was placed over the long axis subepicardial region of each segment during TDE offline analysis to measure peak longitudinal systolic strain rate (SR), peak longitudinal systolic strain (PS), and CVIB. Findingswere compared with TME classified into two categories of scar thickness by CMR: Non-transmural (TME≤50%), and transmural (TME > 50%). Of 213 segments identified with resting wall motion abnormalities, 145 segments showed delayed hyperenhancement on CMR. SR, PS and CVIB were similar with no significant differences between transmural and non-transmural infarcts regardless of the echo modality.

Advanced Fibre Bragg Grating fabrication systems and devices

This thesis address the creation of fibre Bragg grating based sensors and the fabrication systems which are used to manufacture them. The information is presented primarily with experimental evidence, backed up with the current theoretical concepts. The issues involved in fabricating high quality fibre Bragg gratings are systematically investigated. Sources of errors in the manufacturing processes are detected, analysed and reduced to allow higher quality gratings to be fabricated. The use of chirped Moiré gratings as distributed sensors is explored, the spatial resolution is increased beyond that of any previous work and the use of the gratings as distributed load sensors is also presented. Chirped fibre Bragg gratings are shown to be capable of operating as in-situ wear sensors, capable of accurately measuring the wear or erosion of the surface of a material. Two methods of measuring the wear are compared, giving a comparison between an expensive high resolution method and a cheap lower resolution method. The wear sensor is also shown to be capable of measuring the physical size and location of damage induced on the surface of a material. An array method is demonstrated to provide a high survivability such that the array may be damaged yet operate with minimal degradation in performance.

Strategic logistics outsourcing:an integrated QFD and fuzzy AHP approach

This paper develops an integratedapproach, combining quality function deployment (QFD), fuzzy set theory, and analytic hierarchy process (AHP) approach, to evaluate and select the optimal third-party logistics service providers (3PLs). In the approach, multiple evaluating criteria are derived from the requirements of company stakeholders using a series of house of quality (HOQ). The importance of evaluating criteria is prioritized with respect to the degree of achieving the stakeholder requirements using fuzzyAHP. Based on the ranked criteria, alternative 3PLs are evaluated and compared with each other using fuzzyAHP again to make an optimal selection. The effectiveness of proposed approach is demonstrated by applying it to a Hong Kong based enterprise that supplies hard disk components. The proposed integratedapproach outperforms the existing approaches because the outsourcing strategy and 3PLs selection are derived from the corporate/business strategy.

Strategic logistics outsourcing: an integrated QFD and AHP approach

Third-party logistics service providers (3PLs) play a vital role in contemporary supply chain management. Evaluation and selection of the right 3PLs depends on a wide range of quantitative and qualitative criteria rather than cost-based factors. Although various multi-criteria decision making approaches have been proposed, they have not considered the impact of business objectives and requirements of company stakeholders on the evaluating criteria. To enable the "voice" of company stakeholders is considered, this paper develops an integrated approach for selecting 3PL strategically. In the approach, multiple evaluating criteria are derived from the requirements of company stakeholders using a series of house of quality (HOQ). The importance of evaluating criteria is prioritized with respect to the degree of achieving the stakeholder requirements using analytic hierarchy process (AHP). Based on the ranked criteria, alternative 3PLs are evaluated and compared with each other using AHP again to make an optimal selection.