943 resultados para high dependancy unit


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In the last years, the European countries have paid increasing attention to renewable sources and greenhouse emissions. The Council of the European Union and the European Parliament have established ambitious targets for the next years. In this scenario, biomass plays a prominent role since its life cycle produces a zero net carbon dioxide emission. Additionally, biomass can ensure plant operation continuity thanks to its availability and storage ability. Several conventional systems running on biomass are available at the moment. Most of them are performant either in the large-scale or in the small power range. The absence of an efficient system on the small-middle scale inspired this thesis project. The object is an innovative plant based on a wet indirectly fired gas turbine (WIFGT) integrated with an organic Rankine cycle (ORC) unit for combined heat and power production. The WIFGT is a performant system in the small-middle power range; the ORC cycle is capable of giving value to low-temperature heat sources. Their integration is investigated in this thesis with the aim of carrying out a preliminary design of the components. The targeted plant output is around 200 kW in order not to need a wide cultivation area and to avoid biomass shipping. Existing in-house simulation tools are used: They are adapted to this purpose. Firstly the WIFGT + ORC model is built; Zero-dimensional models of heat exchangers, compressor, turbines, furnace, dryer and pump are used. Different fluids are selected but toluene and benzene turn out to be the most suitable. In the indirectly fired gas turbine a pressure ratio around 4 leads to the highest efficiency. From the thermodynamic analysis the system shows an electric efficiency of 38%, outdoing other conventional plants in the same power range. The combined plant is designed to recover thermal energy: Water is used as coolant in the condenser. It is heated from 60°C up to 90°C, ensuring the possibility of space heating. Mono-dimensional models are used to design the heat exchange equipment. Different types of heat exchangers are chosen depending on the working temperature. A finned-plate heat exchanger is selected for the WIFGT heat transfer equipment due to the high temperature, oxidizing and corrosive environment. A once-through boiler with finned tubes is chosen to vaporize the organic fluid in the ORC. A plate heat exchanger is chosen for the condenser and recuperator. A quasi-monodimensional model for single-stage axial turbine is implemented to design both the WIFGT and the ORC turbine. The system simulation after the components design shows an electric efficiency around 34% with a decrease by 10% compared to the zero-dimensional analysis. The work exhibits the system potentiality compared to the existing plants from both technical and economic point of view.

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Lo scopo di questa tesi è la fabbricazione di ossidi complessi aventi struttura perovskitica, per mezzo della tecnica Channel Spark Ablation (CSA). Più precisamente sono stati depositati film sottili di manganite (LSMO), SrTiO3 (STO) e NdGaO3 (NGO). Inoltre nel laboratorio ospite è stata effettuata la caratterizzazione elettrica e dielettrica (spettroscopia di impedenza), mentre per l'analisi strutturale e chimica ci si è avvalsi di collaborazioni. Sono stati fabbricati dispositivi LSMO/STO/Co e se ne è studiato il comportamento magnetoresistivo e la bistabilità elettrica a seconda del carattere epitassiale od amorfo dell'STO. I risultati più promettenti sono stati ottenuti con STO amorfo. Sono stati costruiti diversi set di condensatori nella configurazione Metallo/Isolante/Semiconduttore (MIS), con M=Au, I=STO o NGO ed S=Nb:STO, allo scopo di indagare la dipendenza delle proprietà dielettriche ed isolanti dai parametri di crescita. In particolare ci si è concentrati sulla temperatura di deposizione e, nel caso dei film di STO, anche sulla dipendenza della costante dielettrica dallo spessore del film. Come ci si aspettava, la costante dielettrica relativa dei film di STO (65 per un film spesso 40 nm e 175 per uno di 170 nm) si è rivelata maggiore di quella dei film di NGO per i quali abbiamo ottenuto un valore di 20, che coincide con il valore del bulk. Nonostante l'elevata capacità per unità di area ottenibile con l'STO, la costante dielettrica di questo materiale risulta fortemente dipendente dallo spessore del film. Un ulteriore aspetto critico relativo all'STO è dato dal livello di ossidazione del film: le vacanze di ossigeno, infatti, possono ridurre la resistività dell'STO (nominalmente molto elevata), ed aumentarne la corrente di perdita. Al contrario l'NGO è meno sensibile ai processi tecnologici e, allo stesso tempo, ha un valore di costante dielettrica più alto rispetto ad un tipico dielettrico come l'ossido di silicio.

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Umbilical cord blood (UCB) is a source of hematopoietic stem cells that initially was used exclusively for the hematopoietic reconstitution of pediatric patients. It is now suggested for use for adults as well, a fact that increases the pressure to obtain units with high cellularity. Therefore, the optimization of UCB processing is a priority.

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BACKGROUND: Mortality and morbidity are particularly high in the building industry. The annual rate of non-fatal occupational accidents in Switzerland is 1,133 per 100,000 inhabitants. METHODS: Retrospective analysis of the electronic database of a university emergency centre. Between 2001 and 2011, 782 occupational accidents to construction workers were recorded and analysed using specific demographic and medical keywords. RESULTS: Most patients were aged 30-39 (30.4%). 66.4% of the injured workers were foreigners. This is almost twice as high as the overall proportion of foreigners in Switzerland or in the Swiss labour market. 16% of the Swiss construction workers and 8% of the foreign construction workers suffered a severe injury with ISS >15. There was a trend for workers aged 60 and above to suffer an accident with a high ISS (p = 0.089). CONCLUSIONS: As in other European countries, most patients were in their thirties. Older construction workers suffered fewer injuries, although these tended to be more severe. The injuries were evenly distributed through the working days of the week. A special effort should be made that current health and safety measures are understood and applied by foreign and older construction workers.

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To study the effects of a milking system that partially compensates for milk flow-dependent vacuum loss compared with a standard (high-line) milking unit in a tie-stall barn, milk flow and vacuum patterns were recorded in 10 cows during machine milking with 2 milking systems in a crossover design for 7 d each. Before and after each treatment period postmilking teat condition was recorded by ultrasound cross-sectioning. Additionally, 2 methods to measure teat tissue condition were compared: longitudinal teat ultrasound cross-sectioning and teat tissue density measurements with the spring-loaded caliper (cutimeter method). The partial compensation of milk flow-dependent vacuum loss caused an elevation of the peak flow rate (4.74+/-0.08 vs. 4.29+/-0.07 kg/min) and a shorter duration of plateau (1.57+/-0.06 vs. 1.96+/-0.07 min) compared with the standard milking system. Total milk yield, duration of incline and decline of milk flow, average milk flow, time until peak flow rate, main milking time, and total milking time did not differ between treatments (overall means: 13.75+/-0.17 kg; 0.65+/-0.01 min; 2.88+/-0.09 min; 2.82+/-0.05 kg/min; 1.65+/-0.03 min; 5.23+/-0.09 min, and 5.30+/-0.10 min, respectively). The vacuum drop in the short milk tube during periods of high milk flow was less in the compensating vacuum than in the standard milking system (11+/-1.1 vs. 15+/-0.7 kPa). Teat measures as determined by ultrasound remained unchanged over the entire experimental period with both milking systems. Postmilking teat tissue measures including their recovery within 20 min after the end of milking show a correlation (0.85 and 0.71, respectively) between the methods used (ultrasound and cutimeter method). In conclusion, a more constant vacuum at the teat tip (within the short milk tube) during periods of high milk flow affected milk flow patterns, mainly increasing peak flow rate. However, the reduced vacuum loss did not increase the overall speed of milking. In addition, effects of higher vacuum stability on teat condition and udder health were not obvious.

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Anaerobic digestion of food scraps has the potential to accomplish waste minimization, energy production, and compost or humus production. At Bucknell University, removal of food scraps from the waste stream could reduce municipal solid waste transportation costs and landfill tipping fees, and provide methane and humus for use on campus. To determine the suitability of food waste produced at Bucknell for high-solids anaerobic digestion (HSAD), a year-long characterization study was conducted. Physical and chemical properties, waste biodegradability, and annual production of biodegradable waste were assessed. Bucknell University food and landscape waste was digested at pilot-scale for over a year to test performance at low and high loading rates, ease of operation at 20% solids, benefits of codigestion of food and landscape waste, and toprovide digestate for studies to assess the curing needs of HSAD digestate. A laboratory-scale curing study was conducted to assess the curing duration required to reduce microbial activity, phytotoxicity, and odors to acceptable levels for subsequent use ofhumus. The characteristics of Bucknell University food and landscape waste were tested approximately weekly for one year, to determine chemical oxygen demand (COD), total solids (TS), volatile solids (VS), and biodegradability (from batch digestion studies). Fats, oil, and grease and total Kjeldahl nitrogen were also tested for some food waste samples. Based on the characterization and biodegradability studies, Bucknell University dining hall food waste is a good candidate for HSAD. During batch digestion studies Bucknell University food waste produced a mean of 288 mL CH4/g COD with a 95%confidence interval of 0.06 mL CH4/g COD. The addition of landscape waste for digestion increased methane production from both food and landscape waste; however, because the landscape waste biodegradability was extremely low the increase was small.Based on an informal waste audit, Bucknell could collect up to 100 tons of food waste from dining facilities each year. The pilot-scale high-solids anaerobic digestion study confirmed that digestion ofBucknell University food waste combined with landscape waste at a low organic loading rate (OLR) of 2 g COD/L reactor volume-day is feasible. During low OLR operation, stable reactor performance was demonstrated through monitoring of biogas production and composition, reactor total and volatile solids, total and soluble chemical oxygendemand, volatile fatty acid content, pH, and bicarbonate alkalinity. Low OLR HSAD of Bucknell University food waste and landscape waste combined produced 232 L CH4/kg COD and 229 L CH4/kg VS. When OLR was increased to high loading (15 g COD/L reactor volume-day) to assess maximum loading conditions, reactor performance became unstable due to ammonia accumulation and subsequent inhibition. The methaneproduction per unit COD also decreased (to 211 L CH4/kg COD fed), although methane production per unit VS increased (to 272 L CH4/kg VS fed). The degree of ammonia inhibition was investigated through respirometry in which reactor digestate was diluted and exposed to varying concentrations of ammonia. Treatments with low ammoniaconcentrations recovered quickly from ammonia inhibition within the reactor. The post-digestion curing process was studied at laboratory-scale, to provide a preliminary assessment of curing duration. Digestate was mixed with woodchips and incubated in an insulated container at 35 °C to simulate full-scale curing self-heatingconditions. Degree of digestate stabilization was determined through oxygen uptake rates, percent O2, temperature, volatile solids, and Solvita Maturity Index. Phytotoxicity was determined through observation of volatile fatty acid and ammonia concentrations.Stabilization of organics and elimination of phytotoxic compounds (after 10–15 days of curing) preceded significant reductions of volatile sulfur compounds (hydrogen sulfide, methanethiol, and dimethyl sulfide) after 15–20 days of curing. Bucknell University food waste has high biodegradability and is suitable for high-solids anaerobic digestion; however, it has a low C:N ratio which can result in ammonia accumulation under some operating conditions. The low biodegradability of Bucknell University landscape waste limits the amount of bioavailable carbon that it can contribute, making it unsuitable for use as a cosubstrate to increase the C:N ratio of food waste. Additional research is indicated to determine other cosubstrates with higher biodegradabilities that may allow successful HSAD of Bucknell University food waste at high OLRs. Some cosubstrates to investigate are office paper, field residues, or grease trap waste. A brief curing period of less than 3 weeks was sufficient to produce viable humus from digestate produced by low OLR HSAD of food and landscape waste.

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Soil erosion models and soil erosion risk maps are often used as indicators to assess potential soil erosion in order to assist policy decisions. This paper shows the scientific basis of the soil erosion risk map of Switzerland and its application in policy and practice. Linking a USLE/RUSLE-based model approach (AVErosion) founded on multiple flow algorithms and the unit contributing area concept with an extremely precise and high-resolution digital terrain model (2 m × 2 m grid) using GIS allows for a realistic assessment of the potential soil erosion risk, on single plots, i.e. uniform and comprehensive for the agricultural area of Switzerland (862,579 ha in the valley area and the lower mountain regions). The national or small-scale soil erosion prognosis has thus reached a level heretofore possible only in smaller catchment areas or single plots. Validation was carried out using soil loss data from soil erosion damage mappings in the field from long-term monitoring in different test areas. 45% of the evaluated agricultural area of Switzerland was classified as low potential erosion risk, 12% as moderate potential erosion risk, and 43% as high potential erosion risk. However, many of the areas classified as high potential erosion risk are located at the transition from valley to mountain zone, where many areas are used as permanent grassland, which drastically lowers their current erosion risk. The present soil erosion risk map serves on the one hand to identify and prioritise the high-erosion risk areas, and on the other hand to promote awareness amongst farmers and authorities. It was published on the internet and will be made available to the authorities in digital form. It is intended as a tool for simplifying and standardising enforcement of the legal framework for soil erosion prevention in Switzerland. The work therefore provides a successful example of cooperation between science, policy and practice.

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BACKGROUND: New equipment and techniques in winter sports, such as carving skis and snowboards, have brought up new trauma patterns into the spectrum of leisure trauma. The injuries resemble high-energy trauma known from road crashes. The aim of the present study was to assess the incidence of acute traumatic descending aortic rupture in recreational skiing-crashes. MATERIAL: Between January 1995 and December 2004, 22 patients were admitted to our hospital for aortic rupture. Four patients had skiing crashes (18.2%). Mean age was 31 years, all patients were male. In two cases, aortic rupture was associated with fractures of the upper and lower extremities. One patient additionally had a cerebral contusion with an initial Glasgow Coma Scale score of 13. In two patients, isolated aortic rupture was diagnosed. RESULTS: Two patients were treated by graft interposition, and one by endograft. One patient arrived under mechanical resuscitation without blood pressure. He died at admission. He had been observed for 5 hours in another hospital, complaining of severe intrascapular back pain, before transport to our trauma unit for unknown bleeding. In the other three cases, treatment was successful. CONCLUSION: Rescue services and paramedics should be aware of this new type of injury. Acute aortic rupture has to be considered as possible injury in high velocity skiing crashes.

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INTRODUCTION: It has been shown that early central venous oxygen saturation (ScvO2)-guided optimization of hemodynamics can improve outcome in septic patients. The early ScvO2 profile of other patient groups is unknown. The aim of this study was to characterize unplanned admissions in a multidisciplinary intensive care unit (ICU) with respect to ScvO2 and outcome. METHODS: Ninety-eight consecutive unplanned admissions to a multidisciplinary ICU (median age 63 [range 19 to 83] years, median Simplified Acute Physiology Score [SAPS II] 43 [range 11 to 92]) with a clinical indication for a central venous catheter were included in the study. ScvO2 was assessed at ICU arrival and six hours later but was not used to guide treatment. Length of stay in ICU (LOSICU) and in hospital (LOShospital) and 28-day mortality were recorded. RESULTS: ScvO2 was 70% +/- 12% (mean +/- standard deviation) at admission and 71% +/- 10% six hours later (p = 0.484). Overall 28-day mortality was 18%, LOSICU was 3 (1 to 28) days, and LOShospital was 19 (1 to 28) days. Patients with an ScvO2 of less than 60% at admission had higher mortality than patients with an ScvO2 of more than 60% (29% versus 17%, p < 0.05). Changes in ScvO2 during the first six hours were not predictive of LOSICU, LOShospital, or mortality. CONCLUSION: Low ScvO2 in unplanned admissions and high SAPS II are associated with increased mortality. Standard ICU treatment increased ScvO2 in patients with a low admission ScvO2, but the increase was not associated with LOSICU or LOShospital.

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Project-based education and portfolio assessments are at the forefront of educational research. This research follows the implementation of a project-based unit in a high school physics class. Students played the role of an engineering firm who designed, built and tested file folder bridges. The purpose was to determine if projectbased learning could improve student attitude toward science and related careers like engineering. Teams of students presented their work in a portfolio for a final assessment of the process of designing, building and testing their bridges.

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Building energy meter network, based on per-appliance monitoring system, willbe an important part of the Advanced Metering Infrastructure. Two key issues exist for designing such networks. One is the network structure to be used. The other is the implementation of the network structure on a large amount of small low power devices, and the maintenance of high quality communication when the devices have electric connection with high voltage AC line. The recent advancement of low-power wireless communication makes itself the right candidate for house and building energy network. Among all kinds of wireless solutions, the low speed but highly reliable 802.15.4 radio has been chosen in this design. While many network-layer solutions have been provided on top of 802.15.4, an IPv6 based method is used in this design. 6LOWPAN is the particular protocol which adapts IP on low power personal network radio. In order to extend the network into building area without, a specific network layer routing mechanism-RPL, is included in this design. The fundamental unit of the building energy monitoring system is a smart wall plug. It is consisted of an electricity energy meter, a RF communication module and a low power CPU. The real challenge for designing such a device is its network firmware. In this design, IPv6 is implemented through Contiki operation system. Customize hardware driver and meter application program have been developed on top of the Contiki OS. Some experiments have been done, in order to prove the network ability of this system.

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PURPOSE: To assess family satisfaction in the ICU and to identify parameters for improvement. METHODS: Multicenter study in Swiss ICUs. Families were given a questionnaire covering overall satisfaction, satisfaction with care and satisfaction with information/decision-making. Demographic, medical and institutional data were gathered from patients, visitors and ICUs. RESULTS: A total of 996 questionnaires from family members were analyzed. Individual questions were assessed, and summary measures (range 0-100) were calculated, with higher scores indicating greater satisfaction. Summary score was 78 +/- 14 (mean +/- SD) for overall satisfaction, 79 +/- 14 for care and 77 +/- 15 for information/decision-making. In multivariable multilevel linear regression analyses, higher severity of illness was associated with higher satisfaction, while a higher patient:nurse ratio and written admission/discharge criteria were associated with lower overall satisfaction. Using performance-importance plots, items with high impact on overall satisfaction but low satisfaction were identified. They included: emotional support, providing understandable, complete, consistent information and coordination of care. CONCLUSIONS: Overall, proxies were satisfied with care and with information/decision-making. Still, several factors, such as emotional support, coordination of care and communication, are associated with poor satisfaction, suggesting the need for improvement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-009-1611-4) contains supplementary material, which is available to authorized users.

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OBJECTIVE: To investigate a large outbreak of scabies in an intensive care unit of a university hospital and an affiliated rehabilitation center, and to establish effective control measures to prevent further transmission. DESIGN: Outbreak investigation. SETTING: The intensive care unit of a 750-bed university hospital and an affiliated 92-bed rehabilitation center. METHODS: All exposed individuals were screened by a senior staff dermatologist. Scabies was diagnosed on the basis of (1) identification of mites by skin scraping, (2) identification of mites by dermoscopy, or (3) clinical examination of patients without history of prior treatment for typical burrows. During a follow-up period of 6 months, the attack rate was calculated as the number of symptomatic individuals divided by the total number of exposed individuals. INTERVENTIONS: All exposed healthcare workers (HCWs) and their household members underwent preemptive treatment. Initially, the most effective registered drug in Switzerland (ie, topical lindane) was prescribed, but this prescription was switched to topical permethrin or systemic ivermectin as a result of the progression of the outbreak. Individuals with any signs or symptoms of scabies underwent dermatological examination. RESULTS: Within 7 months, 19 cases of scabies were diagnosed, 6 in children with a mean age of 3.1 years after exposure to the index patient with HIV and crusted scabies. A total of 1,640 exposed individuals underwent preemptive treatment. The highest attack rate of 26%-32% was observed among HCWs involved in the care of the index patient. A too-restricted definition of individuals at risk, noncompliance with treatment, and the limited effectiveness of lindane likely led to treatment failure, relapse, and reinfestation within families. CONCLUSIONS: Crusted scabies resulted in high attack rates among HCWs and household contacts. Timely institution of hygienic precautions with close monitoring and widespread, simultaneous scabicide treatment of all exposed individuals are essential for control of an outbreak.

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OBJECTIVES: Respiratory syncytial virus (RSV) infections are a leading cause of hospital admissions in small children. A substantial proportion of these patients require medical and nursing care, which can only be provided in intermediate (IMC) or intensive care units (ICU). This article reports on all children aged < 3 years who required admission to IMC and/or ICU between October 1, 2001 and September 30, 2005 in Switzerland. PATIENTS AND METHODS: We prospectively collected data on all children aged < 3 years who were admitted to an IMC or ICU for an RSV-related illness. Using a detailed questionnaire, we collected information on risk factors, therapy requirements, length of stay in the IMC/ICU and hospital, and outcome. RESULTS: Of the 577 cases reported during the study period, 90 were excluded because the patients did not fulfill the inclusion criteria; data were incomplete in another 25 cases (5%). Therefore, a total of 462 verified cases were eligible for analysis. At the time of hospital admission, only 31 patients (11%) were older than 12 months. Since RSV infection was not the main reason for IMC/ICU admission in 52% of these patients, we chose to exclude this subgroup from further analyses. Among the 431 infants aged < 12 months, the majority (77%) were former near term or full term (NT/FT) infants with a gestational age > or = 35 weeks without additional risk factors who were hospitalized at a median age of 1.5 months. Gestational age (GA) < 32 weeks, moderate to severe bronchopulmonary dysplasia (BPD), and congenital heart disease (CHD) were all associated with a significant risk increase for IMC/ICU admission (relative risk 14, 56, and 10, for GA < or = 32 weeks, BPD, and CHD, respectively). Compared with NT/FT infants, high-risk infants were hospitalized at an older age (except for infants with CHD), required more invasive and longer respiratory support, and had longer stays in the IMC/ICU and hospital. CONCLUSIONS: In Switzerland, RSV infections lead to the IMC/ICU admission of approximately 1%-2% of each annual birth cohort. Although prematurity, BPD, and CHD are significant risk factors, non-pharmacological preventive strategies should not be restricted to these high-risk patients but also target young NT/FT infants since they constitute 77% of infants requiring IMC/ICU admission.

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BACKGROUND: Sedation protocols, including the use of sedation scales and regular sedation stops, help to reduce the length of mechanical ventilation and intensive care unit stay. Because clinical assessment of depth of sedation is labor-intensive, performed only intermittently, and interferes with sedation and sleep, processed electrophysiological signals from the brain have gained interest as surrogates. We hypothesized that auditory event-related potentials (ERPs), Bispectral Index (BIS), and Entropy can discriminate among clinically relevant sedation levels. METHODS: We studied 10 patients after elective thoracic or abdominal surgery with general anesthesia. Electroencephalogram, BIS, state entropy (SE), response entropy (RE), and ERPs were recorded immediately after surgery in the intensive care unit at Richmond Agitation-Sedation Scale (RASS) scores of -5 (very deep sedation), -4 (deep sedation), -3 to -1 (moderate sedation), and 0 (awake) during decreasing target-controlled sedation with propofol and remifentanil. Reference measurements for baseline levels were performed before or several days after the operation. RESULTS: At baseline, RASS -5, RASS -4, RASS -3 to -1, and RASS 0, BIS was 94 [4] (median, IQR), 47 [15], 68 [9], 75 [10], and 88 [6]; SE was 87 [3], 46 [10], 60 [22], 74 [21], and 87 [5]; and RE was 97 [4], 48 [9], 71 [25], 81 [18], and 96 [3], respectively (all P < 0.05, Friedman Test). Both BIS and Entropy had high variabilities. When ERP N100 amplitudes were considered alone, ERPs did not differ significantly among sedation levels. Nevertheless, discriminant ERP analysis including two parameters of principal component analysis revealed a prediction probability PK value of 0.89 for differentiating deep sedation, moderate sedation, and awake state. The corresponding PK for RE, SE, and BIS was 0.88, 0.89, and 0.85, respectively. CONCLUSIONS: Neither ERPs nor BIS or Entropy can replace clinical sedation assessment with standard scoring systems. Discrimination among very deep, deep to moderate, and no sedation after general anesthesia can be provided by ERPs and processed electroencephalograms, with similar P(K)s. The high inter- and intraindividual variability of Entropy and BIS precludes defining a target range of values to predict the sedation level in critically ill patients using these parameters. The variability of ERPs is unknown.