Prognostic importance of hyponatremia in patients with acute pulmonary embolism.

Rationale: Although associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of hyponatremia, a marker of neurohormonal activation, in patients with acute pulmonary embolism (PE) is unknown. Objectives: To examine the associations between hyponatremia and mortality and hospital readmission rates for patients hospitalized with PE. METHODS: We evaluated 13,728 patient discharges with a primary diagnosis of PE from 185 hospitals in Pennsylvania (January 2000 to November 2002). We used random-intercept logistic regression to assess the independent association between serum sodium levels at the time of presentation and mortality and hospital readmission within 30 days, adjusting for patient (race, insurance, severity of illness, use of thrombolytic therapy) and hospital factors (region, size, teaching status). Measurements and Main Results: Hyponatremia (sodium ?135 mmol/L) was present in 2,907 patients (21.1%). Patients with a sodium level greater than 135, 130-135, and less than 130 mmol/L had a cumulative 30-day mortality of 8.0, 13.6, and 28.5% (P < 0.001), and a readmission rate of 11.8, 15.6, and 19.3% (P < 0.001), respectively. Compared with patients with a sodium greater than 135 mmol/L, the adjusted odds of dying were significantly greater for patients with a sodium 130-135 mmol/L (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.33-1.76) and a sodium less than 130 mmol/L (OR, 3.26; 95% CI, 2.48-4.29). The adjusted odds of readmission were also increased for patients with a sodium of 130-135 mmol/L (OR, 1.28; 95% CI, 1.12-1.46) and a sodium less than 130 mmol/L (OR, 1.44; 95% CI, 1.02-2.02). Conclusions: Hyponatremia is common in patients presenting with PE, and is an independent predictor of short-term mortality and hospital readmission.

Derivation and validation of a prognostic model for pulmonary embolism.

RATIONALE: An objective and simple prognostic model for patients with pulmonary embolism could be helpful in guiding initial intensity of treatment. OBJECTIVES: To develop a clinical prediction rule that accurately classifies patients with pulmonary embolism into categories of increasing risk of mortality and other adverse medical outcomes. METHODS: We randomly allocated 15,531 inpatient discharges with pulmonary embolism from 186 Pennsylvania hospitals to derivation (67%) and internal validation (33%) samples. We derived our prediction rule using logistic regression with 30-day mortality as the primary outcome, and patient demographic and clinical data routinely available at presentation as potential predictor variables. We externally validated the rule in 221 inpatients with pulmonary embolism from Switzerland and France. MEASUREMENTS: We compared mortality and nonfatal adverse medical outcomes across the derivation and two validation samples. MAIN RESULTS: The prediction rule is based on 11 simple patient characteristics that were independently associated with mortality and stratifies patients with pulmonary embolism into five severity classes, with 30-day mortality rates of 0-1.6% in class I, 1.7-3.5% in class II, 3.2-7.1% in class III, 4.0-11.4% in class IV, and 10.0-24.5% in class V across the derivation and validation samples. Inpatient death and nonfatal complications were <or= 1.1% among patients in class I and <or= 1.9% among patients in class II. CONCLUSIONS: Our rule accurately classifies patients with pulmonary embolism into classes of increasing risk of mortality and other adverse medical outcomes. Further validation of the rule is important before its implementation as a decision aid to guide the initial management of patients with pulmonary embolism.

Statistical Summaries of Selected Iowa Streamflow Data Through September 1996, HR-395, 1998

Statistical summaries of streamflow data collected at 156 streamflow-gaging stations in Iowa are presented in this report. All gaging stations included for analysis have at least 10 years of continuous record collected before or through September 1996. The statistical summaries include (1) statistics of monthly and annual mean discharges; (2) monthly and annual flow durations; (3) magnitudes and frequencies of instantaneous peak discharges (flood frequencies); and (4) magnitudes and frequencies of high and low discharges. Also presented for each gaging station is a graph of the annual mean flows and, for most stations, selected values from the most-recent stage-discharge rating table.

Standardizing admission and discharge processes to improve patient flow: A cross sectional study

Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00¿am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann¿Whitney test for non-normal continuous variables. Results:The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p<0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p<0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p<0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00¿am was 5 patients in 2007 and 3 patients in 2009 (p<0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Floods of June 17, 1990 and July 9, 1993, Along Squaw Creek and the South Skunk River in Ames, Iowa, and Vicinity, HR-140, 1996

Water-surface-elevation profiles and peak discharges for the floods of June 17, 1990, and July 9, 1993, along Squaw Creek and the South Skunk River, in Ames, Iowa, are presented in this report. The maximum flood-peak discharge of 24,300 cubic feet per second for the streamflow-gaging station on Squaw Creek at Ames, Iowa (station number 05470500) occurred on July 9, 1993. This discharge was 80 percent larger than the 100-year recurrence-interval discharge and exceeded the previous record flood-peak discharge of June 17, 1990, by 94 percent. The July 9, 1993, flood-peak discharge of 26,500 cubic feet per second on the South Skunk River below Squaw Creek (station number 05471000) was also a peak of record, exceeding the previous record flood-peak discharge of June 27,1975, by 80 percent, and the 100-year recurrence-interval discharge by 60 percent. A flood history describes rainfall conditions for floods that occurred during 1990 and 1993.

Floods of July 12, 1972, March 19, 1979, and June 15, 1991, in the Turkey River, Northeast Iowa, HR-140, 1996

Water-surface-elevation profiles and peak discharges for the floods of July 12, 1972, March 19, 1979, and June 15, 1991, in the Turkey River Basin, northeast Iowa, are presented in this report. The profiles illustrate the 1979 and 1991 floods along the Turkey River in Fayette and Clayton Counties and along the Volga River in Clayton County; the 1991 flood along Roberts Creek in Clayton County and along Otter Creek in Fayette County; and the 1972 flood along the Turkey River in Winneshiek and Fayette Counties. Watersurface elevations for the flood of March 19, 1979, were collected by the Iowa Natural Resources Council. The June 15, 1991, flood on the Turkey River at Garber (station number 05412500) is the largest known flood-peak discharge at the streamflow-gaging station for the period 1902-95. The peak discharge for June 15, 1991, of 49,900 cubic feet per second was 1.4 times larger than the 100-year recurrence-interval discharge. The report provides information on flood stages and discharges and floodflow frequencies for streamflow-gaging stations in the Turkey River Basin using flood information collected during 1902-95. Information on temporary bench marks and reference points established in the Turkey River Basin during 1981, 1992, and 1996 also is included in the report. A flood history describes rainfall conditions for floods that occurred during 1922, 1947, 1972, 1979, and 1991.

06031-014 City of Carpenter Sewage Treatment System Project Final Report

The Mitchell County Soil and Water Conservation District is applying on behalf of the incorporated community of Carpenter to construct a wastewater collection and treatment system to assist in the environmental cleanup and protection of Deer Creek. IDNR water monitoring of the community tile line has shown consistently elevated levels of fecal coliform bacteria indicating the presence of untreated sewage water. These are obvious health threats to the downstream users and wildlife in Deer Creek and the Cedar River. A new sewer system for the community of Carpenter will eliminate illegal discharges into the creed and be the first step in the overall protection of the stream.

05036-013 Joint Drainage District 1-10 Fnial Report

Install new tile system to eliminate the use of 20 agricultural drainage wells (ADW) that have been ruled by EPA to be "vunerable to spills from manure lagoons, direct discharges from septic tanks and accidental releases of materails used in farming". The project includes a tile system that will provide an outlet for all the tile connected to the ADWs and close all 20 ADWs in the drainage district. The pipe ranges in size from 42" to 8" in diameter and approximately 48,000 lineal feet to be installed.

05021-008 Clear Creek Watershed Final Report Report

The Iowa County Soil and Water Conservation District is applying on behalf of the unincorporated community of Conroy to construct a wastewater collection and treatment system to assist in the cleanup and protection of the Clear Creek Watershed. Conroy sits at the headwaters of Clear Creek. Monitoring of the watershed has shown consistently high levels of E.coli bacteria and chloride near the upper end of the creek. In addition, toilet paper and fecal material have been observed on numerous occasions. These are obvious health threats to the residents of the watershed. The monitoring of the watershed, coupled with lab analysis, suggest septic inputs are negatively impacting the headwaters of Clear Creek. A new sewer system for the community of Conroy will eliminate illegal discharges into the creek and be the first step in the overall protection of the watershed and the water quality therein.

Floods in the Nishnabotna River Basin, Iowa, HR-140, 1991

Flood-elevation profiles and flood-peak discharges for floods during 1972, 1982, and 1987 in the Nishnabotna River basin are given in the report. The profiles are for the 1972 flood on the West and East Nishnabotna Rivers, the 1982 flood on Indian Creek, and the 1987 flood on the lower West Nishnabotna River. A flood history describes rainfall conditions and reported damages for floods occurring 1947, 1958, 1972, 1982, and 1987. Discharge for the 1982 flood on Indian Creek is 1.1 times larger than the 100-year recurrence interval discharge.

Continuous assessment of electrical epileptic activity in acute stroke.

OBJECTIVE: To determine the incidence and risk factors of electrical seizures and other electrical epileptic activity using continuous EEG (cEEG) in patients with acute stroke. METHODS: One hundred consecutive patients with acute stroke admitted to our stroke unit underwent cEEG using 10 electrodes. In addition to electrical seizures, repetitive focal sharp waves (RSHWs), repetitive focal spikes (RSPs), and periodic lateralized epileptic discharges (PLEDs) were recorded. RESULTS: In the 100 patients, cEEG was recorded for a mean duration of 17 hours 34 minutes (range 1 hour 12 minutes to 37 hours 10 minutes). Epileptic activity occurred in 17 patients and consisted of RSHWs in seven, RSPs in seven, and PLEDs in three. Electrical seizures occurred in two patients. On univariate Cox regression analysis, predictors for electrical epileptic activity were stroke severity (high score on the National Institutes of Health Stroke Scale) (hazard ratio [HR] 1.12; p = 0.002), cortical involvement (HR 5.71; p = 0.021), and thrombolysis (HR 3.27; p = 0.040). Age, sex, stroke type, use of EEG-modifying medication, and cardiovascular risk factors were not predictors of electrical epileptic activity. On multivariate analysis, stroke severity was the only independent predictor (HR 1.09; p = 0.016). CONCLUSION: In patients with acute stroke, electrical epileptic activity occurs more frequently than previously suspected.

Ydinvoimalan paineakun mallinnus

Tässä työssä on käytetty VTT:n ja Fortumin kehittämääAPROS simulaatio-ohjelmistoa vesi-ilma -täytteisen paineakun käyttäytymisen tutkimiseen. Tavoitteena oli tarkastella APROSin paineakkumallin käyttäytymistä alhaisessa lämpötilassa käyttäen 6-yhtälömallia sekä rakentaa vaihtoehtoiseksi laskentamenetelmäksi kaksi analyyttistä laskentamallia korvaamaan APROSin sisäinen laskenta. Kyseiset analyyttiset mallit ovat isentrooppinen ja isoterminen ja ne on rakennettu kokonaan käyttäen APROSin omia moduuleja. Työ sisältää APROSin version 5.06 sekä työn aikana kehitetyn kehitysversion vertailut eri alkulämpötiloista alkaneissa paisunnoissa, vertailun Pactelin purkaus¬kokeesta saadulla massavirralla sekä osion, jossa analyyttiset mallit on yhdistetty kokonaiseen Pactelin APROS-malliin. Myös purkauksen kulkeutumista primääripiirissä on tarkasteltu. Simulaatiot vahvistavat, että versiolla 5.06 on vaikeuksia paineen laskennassa, kun paisunnan alkulämpötila on alle 30 ºC. Kehitysversiossa painekäyttäytyminen on selvästi parantunut, mutta versio kärsii ongelmista, jotka liittyvät kaasun lämpötilan painumiseen APROSin sisäisten rajoitusten alapuolelleja tätä kautta ongelmiin materiaali¬ominaisuuksien ennustamisessa. Tämän johdosta APROSin kehitysversio päätyy erilaisiin tuloksiin myös tilanteissa, joissa alkuperäinen 5.06 ei kärsi alhaisen lämpötilan ongelmista. Analyyttisistä malleista isentrooppinen malli päätyy antamaan säännönmukaisesti muita malleja ja versioita alempia paineita. Isoterminen malli sen sijaan näyttää päätyvän version 5.06 kanssa melko samankaltaisiin tuloksiin. On kuitenkin muistettava, että kummatkin analyyttiset mallit olettavat kaasun olevan kuivaa ja jättävät massasiirron faasien välillä kokonaan huomiotta.

Electrical source imaging for presurgical focus localization in epilepsy patients with normal MRI.

PURPOSE: Patients with magnetic resonance (MR)-negative focal epilepsy (MRN-E) have less favorable surgical outcomes (between 40% and 70%) compared to those in whom an MRI lesion guides the site of surgical intervention (60-90%). Patients with extratemporal MRN-E have the worst outcome (around 50% chance of seizure freedom). We studied whether electroencephalography (EEG) source imaging (ESI) of interictal epileptic activity can contribute to the identification of the epileptic focus in patients with normal MRI. METHODS: We carried out ESI in 10 operated patients with nonlesional MRI and a postsurgical follow-up of at least 1 year. Five of the 10 patients had extratemporal lobe epilepsy. Evaluation comprised surface and intracranial EEG monitoring of ictal and interictal events, structural MRI, [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), ictal and interictal perfusion single photon emission computed tomography (SPECT) scans. Eight of the 10 patients also underwent intracranial monitoring. RESULTS: ESI correctly localized the epileptic focus within the resection margins in 8 of 10 patients, 9 of whom experienced favorable postsurgical outcomes. DISCUSSION: The results highlight the diagnostic value of ESI and encourage broadening its application to patients with MRN-E. If the surface EEG contains fairly localized spikes, ESI contributes to the presurgical decision process.

Wastewater Treatment of Diesel Power Plant

Diplomityön tavoitteena on selvittää Wärtsilän dieselvoimalaitosten jätevedenkäsittelyn vallitseva tila. Tutkimuksessa keskitytään raskaspolttoöljykäyttöisiin voimalaitoksiin. Työssä selvitetään yleisimmät dieselvoimalaitosten jätevesille asetetut vaatimukset. Selvitys tehdään keräämälläja tutkimalla dieselvoimalaitosten jätevesille sovellettuja standardeja. Työssä selvitetään myös dieselvoimalaitokselta ulostulevan jäteveden laatu sekä nykyisen jätevedenkäsittelyjärjestelmän toiminta. Selvitys tehdään keräämällä ja tutkimalla yrityksen sisäisiä tietoja, sekä ottamalla ja analysoimalla jätevesinäytteitä. Näytteiden otto ja analysointi toteutetaan vierailemallakahdessa voimalaitoksessa sekä yhdessä muussa kohteessa. Jäteveden laatu ennen ja jälkeen käsittelyn määritetään. Myös öljynjalostusteollisuuden jätevedenkäsittelyä tarkastellaan kirjallisuuteen pohjautuen. Tarkastelun tavoitteena on hankkia tietoa jätevedenkäsittelystä kohteissa, joissa jäteveden laatu vastaa dieselvoimalaitoksella syntyvää jätevettä. Vertailun vuoksi myös öljynjalostusteollisuudelle asetetuttuja jätevesistandardeja tutkitaan. Lisäksi työssä tutkitaan myös joitakin muita jätevedenkäsittelymenetelmiä. Diplomityön tuloksena määritetään dieselvoimalaitosten jätevedenkäsittelyn tulevaisuuden haasteet ja mahdollisuudet.

Poistevesijakeiden ominaisuuksien vaikutukset paperitehdasintegraatin jätevesien käsittelyssä

Työssä käsitellään paperitehdasintegraatin synnyttämien poistevesijakeiden ominaisuuksien vaikutuksia jäteveden käsittelyyn, käyttökustannuksiin ja päätöksentekoon jatkossa. Poistevesien muodostama jätevesikuormitus on kasvanut valkaistujen tuotteiden osuuden kasvaessa integraatin kokonaistuotannosta. Tehdasintegraatti on hakenut uutta ympäristölupaa vuonna 2004. Vesistöpäästölupa-arvojen voidaan lupaharkintamenettelyn perusteella arvioida kiristyvän. Poistevesijakeissa on aineryhmiä, joista osa on jäteveden puhdistamolla heikosti hajoavia. Suunniteltu tuotantolinjan muutos neutraaliprosessiksi lisää heikosti hajoavien aineryhmien osuutta kokonaiskuormituksesta. Jäteveden puhdistamon käyttökustannukset muodostuvat käytetyistä kemikaaleista, energiasta ja henkilöstökustannuksista. Puhdistamon kuormituksen muuttuminen vaikuttaa käyttökustannuksiin suhteellisen vähän. Poikkeuksellisten päästöjen minimoiminen jälkipuhdistusvaiheessa saattaa kaksinkertaistaa jäteveden puhdistamon kemikaalikustannukset. Jätevesikuormituksen mahdollisesti kasvaessa suhteessa päästölupa-arvoihin joudutaan harkitsemaan investointeja. Biologisen käsittelyn suorituskyvyn jäädessä riittämättömäksi toimenpiteet tulee kohdistaa tuotannon poistevesijakeiden ominaisuuksien muuttamiseen poistevesijakeiden erilliskäsittelyillä tai tuotantoprosessien optimoinnilla.