Sources d'exposition aux phtalates dans une unité de soins néonatals [Phthalate exposure in the neonatal intensive care unit].

There are growing concerns on long-term health consequences, notably on fertility rates, of plasticizers such as phthalates. While di(2-ethylhexyl)phthalate (DEHP) is currently used in several medical devices, newborns in the neonatal intensive care unit are both more exposed and more vulnerable to DEHP. The objectives of this study were to identify, count, and describe possible sources of DEHP in a neonatal care unit. Our method consisted in the listing and the inspection of the information on packaging, complemented by contact with manufacturers when necessary. According to the results, 6% of all products and 10% of plastic products contained some DEHP; 71% of these involved respiratory support devices. A vast majority of the items showed no information on the content of DEHP. Further research is needed, particularly to determine the effects of such an early exposure and to study and develop safer alternatives.

Prospective study of the barriers to nutritional support in a paediatric intensive care unit : P16

Introduction and aim: Children hospitalised in a paediatric intensive care unit (PICU) are mainly fed by nutritional support (NS) which may often be interrupted. The aims of the study were to verify the relationship between prescribed (PEI) and actual energy intake (AEI) and to identify the reasons for NS interruption. Methods: Prospective study in a PICU. PEI and AEI from day 1 to 15, type of NS (enteral, parenteral, mixed), position of the feeding tube, interruptions in NS and reasons for these were noted. Inter - ruptions were classified in categories of barriers and their frequency and duration were analysed. Results: Fifteen children (24 ± 25.2 months) were studied for 84 days. The NS was exclusively enteral (69%) or mixed (31%). PEI were significantly higher than AEI (54.7 ± 32.9 vs 49.2 ± 33.6 kcal/kg, p = 0.0011). AEI represented 93% of the PEI. Ninety-eight interruptions were noted and lasted 189 h, i.e. 9.4% of the evaluated time. The most frequent barriers were nursing procedures, respiratory physiotherapy and unavailability of intravenous access. The longest were caused by the necessity to stop NS for surgery or diagnostic studies, to treat burns or to carry out medical procedures. Conclusion: AEI in PICU were inferior by 7% to PEI, considerably lower than in adult studies. Making these results available to medical staff for greater anticipation and compensation could reduce NS interruptions. Starving protocols should be reconsidered.

Drug utilisation in a neonatal intensive care unit of a swiss university hospital

Introduction Medication errors in hospitalsmay occur at any step of the medication process including prescription, transcription, preparation and administration, and may originate with any of the actors involved. Neonatal intensive care units (NICU) take care of extremely frail patients in whom errors could have dramatic consequences. Our objective was to assess the frequency and nature of medication errors in the NICU of a university hospital in order to propose measures for improvement.Materials & Methods The design was that of an observational prospective study over 4 consecutivemonths. All patients receiving C 3drugs were included. For each patient, observations during the different stages were compiled in a computer formulary and compared with the litterature. Setting: The 11-bed NICU of our university hospital.Main outcome measures:(a) Frequency and nature of medication errors in prescription,transcription, preparation and administration.(b) Drugs affected by errors.Results 83 patients were included. 505 prescriptions and transcriptions, 447 preparations and 464 administrations were analyzed. 220 medications errors were observed: 102 (46.4%) at prescription, 25 (11.4%) at transcription, 19 (8.6%) at preparation and 73 (33.2%) at administration. Uncomplete/ambiguous orders (24; 23.5%) were the most common errors observed at prescription, followed by wrong name (21; 20.6%), wrong dose (17; 16.7%) and omission (15; 14.7%). Wrong time (33; 45.2%) and wrong administration technique (31; 42.5%) were the most important medication errors during administration. According to the ATC classification, systemic antibacterials (53; 24.1%) were the most implicated, followed by perfusion solutions (40; 18.2%), respiratory system products (30; 13.6%), and mineral supplements and antithrombotic agents (20; 9.1%).Discussions, Conclusion Proposed recommendations: ? Better teaching of neonatal prescription to medical interns;? Improved prescription form to avoid omissions and ambiguities;? Development of a neonatal drug formulary, including prescription,preparation and administration modalities to reduce errors at different stages;? Presence of a clinical pharmacist in the NICU.Disclosure of Interest None Declared

Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference.

OBJECTIVE: Critically ill patients are at high risk of malnutrition. Insufficient nutritional support still remains a widespread problem despite guidelines. The aim of this study was to measure the clinical impact of a two-step interdisciplinary quality nutrition program. DESIGN: Prospective interventional study over three periods (A, baseline; B and C, intervention periods). SETTING: Mixed intensive care unit within a university hospital. PATIENTS: Five hundred seventy-two patients (age 59 ± 17 yrs) requiring >72 hrs of intensive care unit treatment. INTERVENTION: Two-step quality program: 1) bottom-up implementation of feeding guideline; and 2) additional presence of an intensive care unit dietitian. The nutrition protocol was based on the European guidelines. MEASUREMENTS AND MAIN RESULTS: Anthropometric data, intensive care unit severity scores, energy delivery, and cumulated energy balance (daily, day 7, and discharge), feeding route (enteral, parenteral, combined, none-oral), length of intensive care unit and hospital stay, and mortality were collected. Altogether 5800 intensive care unit days were analyzed. Patients in period A were healthier with lower Simplified Acute Physiologic Scale and proportion of "rapidly fatal" McCabe scores. Energy delivery and balance increased gradually: impact was particularly marked on cumulated energy deficit on day 7 which improved from -5870 kcal to -3950 kcal (p < .001). Feeding technique changed significantly with progressive increase of days with nutrition therapy (A: 59% days, B: 69%, C: 71%, p < .001), use of enteral nutrition increased from A to B (stable in C), and days on combined and parenteral nutrition increased progressively. Oral energy intakes were low (mean: 385 kcal*day, 6 kcal*kg*day ). Hospital mortality increased with severity of condition in periods B and C. CONCLUSION: A bottom-up protocol improved nutritional support. The presence of the intensive care unit dietitian provided significant additional progression, which were related to early introduction and route of feeding, and which achieved overall better early energy balance.

Mechanisms of garnet growth in eclogites of the Zermatt-Saas Fee unit, Western Alps

THESIS ABSTRACT Garnets are one of the key metamorphic minerals used to study peak metamorphic conditions or crystallization ages. Equilibrium is typically assumed between the garnet and the matrix. This thesis attempts to understand garnet growth in the Zermatt-Saas Fee (ZSF) eclogites, and discusses consequences for Sm/Nd and Lu/Hf dating and the equilibrium assumption. All studied garnets from the ZSF eclogites are strongly zoned in Mn, Fe, Mg, and Ca. Methods based on chemical zoning patterns and on 3D spatial statistics indicate different growth mechanisms depending on the sample studied. Garnets from the Pfulwe area are grown in a system where surface kinetics likely dominated over intergranular diffusion kinetics. Garnets fram two other localities, Nuarsax and Lago di Cignana, seem to have grown in a system where intergranular diffusion kinetics were dominating over surface kinetics, at least during initial growth. Garnets reveal strong prograde REE+Y zoning. They contain narrow central peaks for Lu + Yb + Tm ± Er and at least one additional small peak towards the rim. The REE Sm + Eu + Gd + Tb ± Dy are depleted in the cores but show one prominent peak close to the rim. It is shown that these patterns cam be explained using a transient matrix diffusion model where REE uptake is limited by diffusion in the matrix surrounding the porphyroblast. The secondary peaks in the garnet profiles are interpreted to reflect thermally activated diffusion due to a temperature increase during prograde metamorphism. The model predicts anomalously low 176Lu/177Hf and 147Sm/144Nd ratios in garnets where growth rates are fast compared to diffusion of the REE, which decreases garnet isochron precisions. The sharp Lu zoning was further used to constrain maximum Lu volume diffusion rates in garnet. The modeled minimum pre-exponential diffusion coefficient which fits the measured central peak is in the order of Do = 5.7* 106 m2/s, taking an activation energy of 270 kJ/mol. The latter was chosen in agreement with experimentally determined values. This can be used to estimate a minimum closure temperature of around 630°C for the ZSF zone. Zoning of REE was combined with published Lu/Hf and Sm/Nd age information to redefine the prograde crystallization interval for Lago di Cignana UHP eclogites. Modeling revealed that a prograde growth interval in the order of 25 m.y. is needed to produce the measured spread in ages. RÉSUMÉ Le grenat est un minéral métamorphique clé pour déterminer les conditions du pic de métamorphisme ainsi que l'âge de cristallisation. L'équilibre entre le grenat et la matrice est requis. Cette étude a pour but de comprendre la croissance du grenat dans les éclogites de la zone de Zermatt-Saas Fee (ZSF) et d'examiner quelques conséquences sur les datations Sm/Nd et Lu/Hf. Tous les grenats des éclogites de ZSF étudiés sont fortement zonés en Mn, Fe, Mg et partiellement en Ca. Les différentes méthodes basées sur le modèle de zonation chimique ainsi que sur les statistiques de répartition spatiale en 3D indiquent un mécanisme de croissance différent en fonction de la localité d'échantillonnage. Les grenats provenant de la zone de Pfulwe ont probablement crû dans un système principalement dominé par la cinétique de surface au détriment de 1a cinétique de diffusion intergranulaire. Les grenats provenant de deux autres localités, Nuarsax et Lago di Cignana, semblent avoir cristallisé dans un système dominé par la diffusion intergranulaire, au moins durant les premiers stades de croissance. Les grenats montrent une forte zonation prograde en Terres Rares (REE) ainsi qu'en Y. Les profils présentent au coeur un pic étroit en Lu + Yb+ Tm ± Er et au moins un petit pic supplémentaire vers le bord. Les coeurs des grenats sont appauvris en Sm + Eu + Gd + Tb ± Dy, mais les bords sont marqués par un pic important de ces REE. Ces profils s'expliquent par un modèle de diffusion matricielle dans lequel l'apport en REE est limité par la diffusion dans la matrice environnant les porphyroblastes. Les pics secondaires en bordure de grain reflètent la diffusion activée par l'augmentation de la température lors du métamorphisme prograde. Ce modèle prédit des rapports 176Lu/177Hf et 147Sm/144Nd anormalement bas lorsque les taux de croissance sont plus rapides que la diffusion des REE, ce qui diminue la précision des isochrones impliquant le grenat. La zonation nette en Lu a permis de contraindre le maximum de diffusion volumique par une approche numérique. Le coefficient de diffusion minimum modélisé en adéquation avec les pics mesurés est de l'ordre de Do = 5.7*10-6 m2/s, en prenant une énergie d'activation ~270 kJ/mol déterminée expérimentalement. Ainsi, la température de clôture minimale est estimée aux alentours de 630°C pour la zone ZSF. Des nouvelles données de zonation de REE sont combinées aux âges obtenus avec les rapports Lu/Hf et Sm/Nd qui redéfissent l'intervalle de cristallisation prograde pour les éclogites UHP de Lago di Cignana. La modélisation permet d'attribuer au minimum un intervalle de croissance prograde de 25 Ma afin d'obtenir les âges préalablement mesurés. RESUME GRAND PUBLIC L'un des principaux buts du pétrologue .métamorphique est d'extraire des roches les informations sur l'évolution temporelle, thermique et barométrique qu'elles ont subi au cours de la formation d'une chaîne de montagne. Le grenat est l'un des minéraux clés dans une grande variété de roches métamorphiques. Il a fait l'objet de nombreuses études dans des terrains d'origines variées ou lors d'études expérimentales afin de comprendre ses domaines de stabilité, ses réactions et sa coexistence avec d'autres minéraux. Cela fait du grenat l'un des minéraux les plus attractifs pour la datation des roches. Cependant, lorsqu'on l'utilise pour la datation et/ou pour la géothermobarométrie, on suppose toujours que le grenat croît en équilibre avec les phases coexistantes de la matrice. Pourtant, la croissance d'un minéral est en général liée au processus de déséquilibre. Cette étude a pour but de comprendre comment croît le grenat dans les éclogites de Zermatt - Saas Fee et donc d'évaluer le degré de déséquilibre. Il s'agit aussi d'expliquer les différences d'âges obtenues grâce aux grenats dans les différentes localités de l'unité de Zermatt-Saas Fee. La principale question posée lors de l'étude des mécanismes de croissance du grenat est: Parmi les processus en jeu lors de la croissance du grenat (dissolution des anciens minéraux, transport des éléments vers le nouveau grenat, précipitation d'une nouvelle couche en surface du minéral), lequel est le plus lent et ainsi détermine le degré de déséquilibre? En effet, les grenats d'une des localités (Pfulwe) indiquent que le phénomène d'adhérence en surface est le plus lent, contrairement aux grenats des autres localités (Lago di Cignana, Nuarsax) dans lesquels ce sont les processus de transport qui sont les plus lents. Cela montre que les processus dominants sont variables, même dans des roches similaires de la même unité tectonique. Ceci implique que les processus doivent être déterminés individuellement pour chaque roche afin d'évaluer le degré de déséquilibre du grenat dans la roche. Tous les grenats analysés présentent au coeur une forte concentration de Terres Rares: Lu + Yb + Tm ± Er qui décroît vers le bord du grain. Inversement, les Terres Rares Sm + Eu + Gd + Tb ± Dy sont appauvries au coeur et se concentrent en bordure du grain. La modélisation révèle que ces profils sont-dus à des cinétiques lentes de transport des Terres Rares. De plus, les modèles prédisent des concentrations basses en éléments radiogéniques pères dans certaines roches, ce qui influence fortement sur la précision des âges obtenus par la méthode d'isochrone. Ceci signifie que les roches les plus adaptées pour les datations ne doivent contenir ni beaucoup de grenat ni de très gros cristaux, car dans ce cas, la compétition des éléments entre les cristaux limite à de faibles concentrations la quantité d'éléments pères dans chaque cristal.

Which factors influence glycemic control in the intensive care unit?

PURPOSE OF REVIEW: Intensive insulin therapy titrated to restore and maintain blood glucose between 80 and 110 mg/dl (4.4-6.1 mmol/l) was found to improve survival of critically ill patients in one pioneering proof-of-concept study performed in a surgical intensive care unit. The external validity of these findings was investigated. RECENT FINDINGS: Six independent prospective randomized controlled trials, involving 9877 patients in total, were unable to confirm the survival benefit reported in the pioneering trial. Several hypotheses were proposed to explain this discrepancy, including the case-mix, the features of the usual care, the quality of glucose control and the risks associated with hypoglycemia. SUMMARY: Before a better understanding and delineation of the conditions associated with and improved outcome by tight glycemic control, the choice of an intermediate glycemic target appears as a safe and effective solution.

Improvements in Air Intake on Frame 6 Gas Turbines

Työssä tarkastellaan kahta kaasuturbiinin imuilman sisäänottojärjestelmän kehitysmenetelmää, imuilman jäähdytystä ja sähköstaattista suodatusta. Imuilman jäähdytysmenetelmien tarkastelussa käytettiin kahta kaasuturbiinin tehonlisäystekniikoiden laskentatyökalua. Arviointi kohdistettiin Glanford Brigg Generating Station -voimalaitoksen kaasuturbiinityyppiin ja paikallisiin englantilaisiin ilmasto-olosuhteisiin. Tarkastelussa olivat kostutusjäähdytys ja overspray. Tuloksia vertailtiin keskenään ja näiden perusteella arvioitiin menetelmien vaikutuksia tehoon, hyötysuhteeseen sekä veden kulutukseen. Sähköstaattisen suodattimen prototyyppi oli rakennettu Briggin voimalaitokselle. Järjestelmää kehitetään kaupalliseksi tuotteeksi ja tätä varten kerättiin tekninen dokumentaatio kokonaisuudeksi, jota voitiin hyödyntää tuotteistusprosessissa. Imuilman jäähdyttämisellä voidaan saavuttaa merkittävä tehonlisäys ilmasto-olosuhteista riippuen. Menetelmällä voidaan myös tasata lämpötilan vuorokausi-vaihtelusta aiheutuvia tehoeroja. Sähköstaattisen suodattimen prototyyppi saavutti kehitysvaiheelle asetetut tavoitteet. Sähköstaattinen suodatus tarjoaa useita etuja perinteiseen mekaaniseen suodatukseen verrattuna.

The Role of Biomarkers for Starting Antifungals in the Intensive Care Unit

Invasive candidiasis is associated with high mortality rates (35% to 60%), similar to the range reported for septic shock. The most common types include candidemia, frequently observed in immunocompromised patients, and noncandidemic systemic candidiasis, which constitutes the majority of cases in critically ill patients. However, they are difficult to prove and a definite diagnosis usually occurs late in the course of the disease, thus contributing to their bad prognosis. Early empirical treatment improves the prognosis and currently relies on the positive predictive value (PPV) of risk-assessment strategies (colonization index, Candida score, predictive rules) based on combinations of risk factors, but it may have also largely contributed to the overuse of antifungal agents in critically ill patients. In this context, non- culture-based diagnostic methods, including specific and nonspecific biomarkers, may significantly improve the diagnosis of invasive candidiasis. Candida DNA and mannan antigen/antimannan antibodies are of limited interest for the diagnosis of invasive candidiasis as they fail to identify noncandidemic systemic candidiasis, despite early positivity in candidemic patients. The utility of 1,3-beta-D-glucan (b-D-glucan), a panfungal cell wall antigen, has been demonstrated for the diagnosis of fungal infections in immunocompromised patients. Preliminary data suggest that it is also detectable early in critically ill patients developing noncandidemic systemic candidiasis. To take advantage of the high negative predictive value of risk-assessment strategies and the early increase in specific fungal biomarkers in high-risk patients, we propose a practical 2-step approach to improve the selection of patients susceptible to benefit from empirical antifungal treatment.

Monte Carlo derivation of filtered tungsten anode X-ray spectra for dose computation in digital mammography

Abstract Objective: Derive filtered tungsten X-ray spectra used in digital mammography systems by means of Monte Carlo simulations. Materials and Methods: Filtered spectra for rhodium filter were obtained for tube potentials between 26 and 32 kV. The half-value layer (HVL) of simulated filtered spectra were compared with those obtained experimentally with a solid state detector Unfors model 8202031-H Xi R/F & MAM Detector Platinum and 8201023-C Xi Base unit Platinum Plus w mAs in a Hologic Selenia Dimensions system using a direct radiography mode. Results: Calculated HVL values showed good agreement as compared with those obtained experimentally. The greatest relative difference between the Monte Carlo calculated HVL values and experimental HVL values was 4%. Conclusion: The results show that the filtered tungsten anode X-ray spectra and the EGSnrc Monte Carlo code can be used for mean glandular dose determination in mammography.

Control de 6 respiròmetres i anàlisi de les dades

L’aplicació de tècniques respiromètriques és de recent innovació dins l’estudi dels tractaments d’aigües residuals. Aquest conjunt de tècniques ens permeten analitzar dos processos importants dins una planta de tractament biològic: el creixement de la biomassa i el consum del substrat. Això fa que siguin una eina amb gran potencial en l’avaluació dels sistemes de tractament biològic d’aigües residuals. L’objectiu principal d’aquest treball es la realització d’una aplicació capaç de controlar el funcionament de 6 respiròmetres, gestionant el procés del mostreig de les respirometries i l’anàlisi de les dades obtingudes, per obtenir el substrat ràpidament biodegradable (Ss) per a mostres d’aigua residual, i la taxa màxima de creixement específic per a mostres de compost. L’aplicació s’ha desenvolupat sobre l’entorn Microsoft Access, on s’integren la base de dades amb les mostres i els resultats de les respirometries, i els formularis de control que ens permeten gestionar i controlar els processos de mostreig i anàlisi. L’aplicació es comunica amb els sensors i actuadors dels respiròmetres a través del control ActiveX, ADS-OCX, subministrat per TwinCAT, que ens permet capturar les lectures dels sensors i controlar el funcionament dels actuadors. Aquests elements estan connectats a mòduls descentralitzats d’entrades i sortides, comunicats mitjançant el bus Ethernet amb el PC-Industrial, on s’executa l’aplicació. Un cop finalitzada l’aplicació, aquesta controla correctament el mostreig de les respirometries, registrant les lectures de les sondes a la base de dades i controlant l’activació de les vàlvules del respiròmetre. Partint de les mostres obtingudes, o de respirometries externes, importades des de Microsoft Excel, s’ha comprovat el correcte funcionament en el càlcul del substrat ràpidament biodegradable (Ss) i la taxa màxima de creixement específic. Amb l’aplicació desenvolupada, s’ha comprovat el funcionament i les possibilitats que ens ofereix TwinCAT alhora de controlar mòduls d’entrades i sortides, així com la seva comunicació amb aplicacions com Microsoft Access. Això pot afavorir a la utilització d’aquest tipus de tecnologia, per aplicacions futures.

Integration of the Food Waste Disposer Unit to the Existing Sewage System

Among the numerous approaches to food waste treatment, the food waste disposers method (FWDs), as a newcomer, has become slowly accepted by the general public owing to the worries about its impact on the existing sewage system. This paper aims to justify the role of FWDs in the process of urbanization in order to better prepare a city to take good care of the construction of its infrastructure and the solid waste treatment. Both the literatures and the case study help to confirm that FWDs has no negative effects on the wastewater treatment plant and it is also environmental friendly by reducing the greenhouse gas emissions. In the case study, the Lappeenranta waste water treatment plant has been selected in order to figure out the possible changes to a WWTP following the integration of FWDs: the observation shows only minor changes take place in a WWTP, in case of 25% application, like BOD up 7%, TSS up 6% and wastewater flowrate up 6%, an additional sludge production of 200 tons per year and the extra yield of methane up to 10000m3 per year; however, when the utilization rate of FWD is over 75%, BOD, TSS, and wastewater flowrate will experience more significant changes, thus exerting much pressure on the existing WWTP. FWDs can only be used in residential areas or cities equipped with consummate drainage network within the service sphere of WWTP, therefore, the relevant authority or government department should regulate the installation frequency of FWDs, while promoting the accessory application of FWDs. In the meanwhile, WWTP should improve their treatment process in order to expand their capacity for sludge treatment so as to stay in line with the future development of urban waste management.

Spatial variability of mechanical resistance to penetration evaluated with mobile unit on haplic vertisol cultivated with mango

Since the advent of mechanized farming and intensive use of agricultural machinery and implements on the properties, the soil began to receive greater load of machinery traffic, which can cause increased soil compaction. The aim of this study was to evaluate the spatial variability of soil mechanical resistance to penetration (RP) in the layers of 0.00-0.10, 0.10-0.20, 0.20-0.30 and 0.30-0.40m, using geostatistics in an area cultivated with mango in Haplic Vertisol of the northeastern semi-arid, with mobile unit equipped with electronic penetrometer. The RP data was collected in 56 points from an area of 3 ha, and random soil samples were collected to determine the soil moisture and texture. For RP data analysis we used descriptive statistics and geostatistics. The soil mechanical resistance to penetration presented increased variability, with adjustment of the spherical and exponential semivariograms in the layers. We found that 42% of the area in the layer of 0.10-0.20m showed RP values above 2.70 MPa. Maximum values of RP were found in the layer of 0.19-0.27m, predominantly in 56% of the area.

Modeling and Control of the Power Conversion Unit in a Solid Oxide Fuel Cell Environment

In this doctoral thesis, a power conversion unit for a 10 kWsolid oxide fuel cell is modeled, and a suitable control system is designed. The need for research was identified based on an observation that there was no information available about the characteristics of the solid oxide fuel cell from the perspective of power electronics and the control system, and suitable control methods had not previously been studied in the literature. In addition, because of the digital implementation of the control system, the inherent characteristics of the digital system had to be taken into account in the characteristics of the solid oxide fuel cell (SOFC). The characteristics of the solid oxide fuel cell as well the methods for the modeling and control of the DC/DC converter and the grid converter are studied by a literature survey. Based on the survey, the characteristics of the SOFC as an electrical power source are identified, and a solution to the interfacing of the SOFC in distributed generation is proposed. A mathematical model of the power conversion unit is provided, and the control design for the DC/DC converter and the grid converter is made based on the proposed interfacing solution. The limit cycling phenomenon is identified as a source of low-frequency current ripple, which is found to be insignificant when connected to a grid-tied converter. A method to mitigate a second harmonic originating from the grid interface is proposed, and practical considerations of the operation with the solid oxide fuel cell plant are presented. At the theoretical level, the thesis discusses and summarizes the methods to successfully derive a model for a DC/DC converter, a grid converter, and a power conversion unit. The results of this doctoral thesis can also be used in other applications, and the models and methods can be adopted to similar applications such as photovoltaic systems. When comparing the results with the objectives of the doctoral thesis, we may conclude that the objectives set for the work are met. In this doctoral thesis, theoretical and practical guidelines are presented for the successful control design to connect a SOFC-based distributed generation plant to the utility grid.