Development and current use of parenteral nutrition in critical care - an opinion paper.

Critically ill patients depend on artificial nutrition for the maintenance of their metabolic functions and lean body mass, as well as for limiting underfeeding-related complications. Current guidelines recommend enteral nutrition (EN), possibly within the first 48 hours, as the best way to provide the nutrients and prevent infections. EN may be difficult to realize or may be contraindicated in some patients, such as those presenting anatomic intestinal continuity problems or splanchnic ischemia. A series of contradictory trials regarding the best route and timing for feeding have left the medical community with great uncertainty regarding the place of parenteral nutrition (PN) in critically ill patients. Many of the deleterious effects attributed to PN result from inadequate indications, or from overfeeding. The latter is due firstly to the easier delivery of nutrients by PN compared with EN increasing the risk of overfeeding, and secondly to the use of approximate energy targets, generally based on predictive equations: these equations are static and inaccurate in about 70% of patients. Such high uncertainty about requirements compromises attempts at conducting nutrition trials without indirect calorimetry support because the results cannot be trusted; indeed, both underfeeding and overfeeding are equally deleterious. An individualized therapy is required. A pragmatic approach to feeding is proposed: at first to attempt EN whenever and as early as possible, then to use indirect calorimetry if available, and to monitor delivery and response to feeding, and finally to consider the option of combining EN with PN in case of insufficient EN from day 4 onwards.

Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage.

BACKGROUND: Neuropsychological deficits (NPD) are common in patients with aneurysmal subarachnoid haemorrhage (aSAH). NPD are one of the major limiting factors for patients with an otherwise acceptable prognosis for sustained quality of life. There are only a few studies reporting outcome after aSAH, which used a standardized neuropsychological test battery as a primary or secondary outcome measure. Aim of this study was to determine the current practice of reporting NPD following aSAH in clinical studies. METHODS: A MEDLINE analysis was performed using the search term "subarachnoid haemorrhage outcome". The latest 1,000 articles were screened. We recorded study design, number of patients, and the presence of neuropsychological outcome report. Additionally, the time of testing after aSAH, the neuropsychological tests administered, as well as the percentage of patients with NPD were analyzed. RESULTS: A total of 324 publications between 2009 and 2012 were selected for further review. Of those, 21 studies (6.5%) reported neuropsychological outcome, in 2,001 of 346,666 patients (0.6%). The assessment of NPD differed broadly using both subjective and objective cognitive evaluation, and a large variety of tests were used. CONCLUSION: Neuropsychological outcome is underreported, and there is great variety in assessment in currently published clinical articles on aSAH. Prospective randomized trials treating aSAH may benefit from implementing more comprehensive and standardized neuropsychological outcome measures. This approach might identify otherwise unnoticed treatment effects in future interventional studies of aSAH patients.

Exploring the rate-limiting steps in visual phototransduction recovery by bottom-up kinetic modeling

Phototransduction in vertebrate photoreceptor cells represents a paradigm of signaling pathways mediated by G-protein-coupled receptors (GPCRs), which share common modules linking the initiation of the cascade to the final response of the cell. In this work, we focused on the recovery phase of the visual photoresponse, which is comprised of several interacting mechanisms. We employed current biochemical knowledge to investigate the response mechanisms of a comprehensive model of the visual phototransduction pathway. In particular, we have improved the model by implementing a more detailed representation of the recoverin (Rec)-mediated calcium feedback on rhodopsin kinase and including a dynamic arrestin (Arr) oligomerization mechanism. The model was successfully employed to investigate the rate limiting steps in the recovery of the rod photoreceptor cell after illumination. Simulation of experimental conditions in which the expression levels of rhodospin kinase (RK), of the regulator of the G-protein signaling (RGS), of Arr and of Rec were altered individually or in combination revealed severe kinetic constraints to the dynamics of the overall network. Our simulations confirm that RGS-mediated effector shutdown is the rate-limiting step in the recovery of the photoreceptor and show that the dynamic formation and dissociation of Arr homodimers and homotetramers at different light intensities significantly affect the timing of rhodopsin shutdown. The transition of Arr from its oligomeric storage forms to its monomeric form serves to temper its availability in the functional state. Our results may explain the puzzling evidence that overexpressing RK does not influence the saturation time of rod cells at bright light stimuli. The approach presented here could be extended to the study of other GPCR signaling pathways.

Benefits of a low-cost one-phase current distortion detection device in appliance supply in low-voltage residential networks

In this bachelor’s thesis are examined the benefits of current distortion detection device application in customer premises low voltage networks. The purpose of this study was to find out if there are benefits for measuring current distortion in low-voltage residential networks. Concluding into who can benefit from measuring the power quality. The research focuses on benefits based on the standardization in Europe and United States of America. In this research, were also given examples of appliances in which current distortion detection device could be used. Along with possible illustration of user interface for the device. The research was conducted as an analysis of the benefits of current distortion detection device in residential low voltage networks. The research was based on literature review. The study was divided to three sections. The first explain the reasons for benefitting from usage of the device and the second portrays the low-cost device, which could detect one-phase current distortion, in theory. The last section discuss of the benefits of usage of current distortion detection device while focusing on the beneficiaries. Based on the result of this research, there are benefits from usage to the current distortion detection device. The main benefitting party of the current distortion detection device was found to be manufactures, as they are held responsible of limiting the current distortion on behalf of consumers. Manufactures could adjust equipment to respond better to the distortion by having access to on-going current distortion in network. The other benefitting party are system operators, who would better locate distortion issues in low-voltage residential network to start prevention of long-term problems caused by current distortion early on.

Avian mortalities due to transmission line collisions: a review of current estimates and field methods with an emphasis on applications to the Canadian electric network

Birds are vulnerable to collisions with human-made fixed structures. Despite ongoing development and increases in infrastructure, we have few estimates of the magnitude of collision mortality. We reviewed the existing literature on avian mortality associated with transmission lines and derived an initial estimate for Canada. Estimating mortality from collisions with power lines is challenging due to the lack of studies, especially from sites within Canada, and due to uncertainty about the magnitude of detection biases. Detection of bird collisions with transmission lines varies due to habitat type, species size, and scavenging rates. In addition, birds can be crippled by the impact and subsequently die, although crippling rates are poorly known and rarely incorporated into estimates. We used existing data to derive a range of estimates of avian mortality associated with collisions with transmission lines in Canada by incorporating detection, scavenging, and crippling biases. There are 231,966 km of transmission lines across Canada, mostly in the boreal forest. Mortality estimates ranged from 1 million to 229.5 million birds per year, depending on the bias corrections applied. We consider our most realistic estimate, taking into account variation in risk across Canada, to range from 2.5 million to 25.6 million birds killed per year. Data from multiple studies across Canada and the northern U.S. indicate that the most vulnerable bird groups are (1) waterfowl, (2) grebes, (3) shorebirds, and (4) cranes, which is consistent with other studies. Populations of several groups that are vulnerable to collisions are increasing across Canada (e.g., waterfowl, raptors), which suggests that collision mortality, at current levels, is not limiting population growth. However, there may be impacts on other declining species, such as shorebirds and some species at risk, including Alberta’s Trumpeter Swans (Cygnus buccinator) and western Canada’s endangered Whooping Cranes (Grus americana). Collisions may be more common during migration, which underscores the need to understand impacts across the annual cycle. We emphasize that these estimates are preliminary, especially considering the absence of Canadian studies.

Test results of a superconducting fault current limiter using YBCO coated conductor

A single-phase superconducting fault current limiter (SFCL) using a 0.9 m length of YBCO coated conductor (CC) tape was tested in 220 V-60 Hz line for fault current up to 1 kA, operating in 77 K. In this work are presented the IN experimental curves measured under DC and AC currents for the electrical characterization of the CC tape in order to design a low voltage current limiter. The experimental setup is described and the test results are presented for a unit conducting a steady nominal AC current of 50 A and also during the fault time (I to 5 cycles.) the performance of the CC-based SFCL providing the limiting resistance developed in the whole tape length after few milliseconds of the beginning of the fault was analyzed.

Fault current test of a bifilar Bi-2212 bulk coil

A bifilar Bi-2212 bulk coil with parallel shunt resistor was tested under fault current condition using a 3 MVA single-phase transformer in a 220 V-60 Hz line achieving fault current peak of 8 kA. The fault current tests are performed from steady state peak current of 200 A by applying controlled short circuits up to 8 kA varying the time period from one to six cycles. The test results show the function of the shunt resistor providing homogeneous quench behavior of the HTS coil besides its intrinsic stabilizing role. The limiting current ratio achieves a factor 4.2 during 5 cycles without any degradation.

Test results of fault current limiter using YBCO tapes with shunt protection

A Fault Current Limiter (FCL) based on high temperature superconducting elements with four tapes in parallel were designed and tested in 220 V line for a fault current peak between 1 kA to 4 kA. The elements employed second generation (2G) HTS tapes of YBCO coated conductor with stainless steel reinforcement. The tapes were electrically connected in parallel with effective length of 0.4 m per element (16 elements connected in series) constituting a single-phase unit. The FCL performance was evaluated through over-current tests and its recovery characteristics under load current were analyzed using optimized value of the shunt protection. The projected limiting ratio achieved a factor higher than 4 during fault of 5 cycles without degradation. Construction details and further test results will be shown in the paper. © 2010 IOP Publishing Ltd.

Development and test of resistive superconducting fault current limiter; acting time and its recovery conditions

Resistive-type of superconducting fault current limiters (RSFCL) have been developed for medium voltage class aiming to operate at 1 MVA power capacity and short time recovery (< 2 s). A RSFCL in form of superconducting modular device was designed and constructed using 50 m-length of YBCO coated conductor tapes for operation under 1 kV / 1 kA and acting time of 0.1 s. In order to increase the acting time the RSFCL was combined with an air-core reactor in parallel to increase the fault limiting time up to 1 s. The tests determined the electrical and thermal characteristics of the combined resistive/ inductive protection unit. The combined fault current limiter reached a limiting current of 583 A, corresponding to a limiting factor of 3.3 times within an acting time of up to 1 s.

In vivo assessment of HCN channel current (I(h)) in human motor axons

The "Trond" protocol of nerve excitability tests has been used widely to assess axonal function in peripheral nerve. In this study, the routine Trond protocol was expanded to refine assessment of cAMP-dependent, hyperpolarization-activated current (I(h)) activity. I(h) activity is generated by hyperpolarization-activated, cyclic nucleotide-modulated (HCN) channels in response to hyperpolarization. It limits activity-dependent hyperpolarization, contributes to neuronal automaticity, and is implicated in chronic pain states. Published data regarding I(h) activity in motor nerve are scant. We used additional strong, prolonged hyperpolarizing conditioning stimuli in the threshold electrotonus component of the Trond protocol to demonstrate the time-course of activation of I(h) in motor axons. Fifteen healthy volunteers were tested on four occasions during 1 week. I(h) action was revealed in the threshold electrotonus by the limiting and often reversal, after about 100 ms, of the threshold increase caused by strong hyperpolarizing currents. Statistical analysis by repeated-measures analysis of variance enabled confidence limits to be established for variation between subjects and within subjects. The results demonstrate that, of all the excitability parameters, those dependent on I(h) were the most characteristic of an individual, because variance between subjects was more than four times the variance within subjects. This study demonstrates a reliable method for in vivo assessment of I(h,) and also serves to document the normal variability in nerve excitability properties within subjects.

Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage

BACKGROUND Neuropsychological deficits (NPD) are common in patients with aneurysmal subarachnoid haemorrhage (aSAH). NPD are one of the major limiting factors for patients with an otherwise acceptable prognosis for sustained quality of life. There are only a few studies reporting outcome after aSAH, which used a standardized neuropsychological test battery as a primary or secondary outcome measure. Aim of this study was to determine the current practice of reporting NPD following aSAH in clinical studies. METHODS A MEDLINE analysis was performed using the search term "subarachnoid haemorrhage outcome". The latest 1,000 articles were screened. We recorded study design, number of patients, and the presence of neuropsychological outcome report. Additionally, the time of testing after aSAH, the neuropsychological tests administered, as well as the percentage of patients with NPD were analyzed. RESULTS A total of 324 publications between 2009 and 2012 were selected for further review. Of those, 21 studies (6.5%) reported neuropsychological outcome, in 2,001 of 346,666 patients (0.6%). The assessment of NPD differed broadly using both subjective and objective cognitive evaluation, and a large variety of tests were used. CONCLUSION Neuropsychological outcome is underreported, and there is great variety in assessment in currently published clinical articles on aSAH. Prospective randomized trials treating aSAH may benefit from implementing more comprehensive and standardized neuropsychological outcome measures. This approach might identify otherwise unnoticed treatment effects in future interventional studies of aSAH patients.

Limiting efficiencies of GaAs solar cells

The limiting efficiencies of GaAs solar cells when used under concentrated sunlight are calculated. The benefits to be expected from applying techniques which restrict the angle of acceptance of the cell are determined. It is concluded that when the acceptance angle is restricted the emission of the luminescent photons and therefore the associated current loss are reduced. A limiting efficiency close to 39% results for concentration ratios of about 1000 suns AM1.5 direct. For lower concentration ratios, the limiting efficiency decreases if Auger recombination is also taken into account

On-site measurement of limiting subcell in multijunction solar devices

It is well known that the response of any photovoltaic solar cell is dependent on the spectral characteristics of the incident radiation. This dependency is crucial in the output characteristics of a multijunction (MJ) cell where the spectral composition of the radiation determines the overall photocurrent produced, as either the top or the middle subcell will be limiting its response. The current mismatching between top and middle subcell is translated into energy losses, affecting the yield of the system. For research and commercial purposes it is interesting to measure accurately the incident solar radiation on a MJ cell, in terms of its spectral composition. This measurement will allows us to determine the photocurrent generated in each band of the multijunction device. Nowadays, the only way of measuring the photocurrent generated by each subcell is done with isotype cells or with spectroradiometers but there is no device capable of directly measuring each subcell photocurrent. In this paper it is described a device based on a commercial multijunction solar cell that is capable of measuring the direct irradiance for the top and middle bands thus it offers information of the limiting subcell (top or middle) in outdoors conditions.

Inhibitory Control is a Rate-Limiting Factor to Preschoolers' Use of Irregular Inflection

We investigated whether children’s inhibitory control is associated with their ability to produce irregular verb forms as well as learn from corrective feedback following their use of an over-regularized form. Forty-eight 3.5 to 4.5 year old children were tested on the irregular past tense and provided with adult corrective input via models of correct use or recasts of errors following ungrammatical responses. Inhibitory control was assessed with a three-item battery of tasks that required suppressing a prepotent response in favor of a non-canonical one. Results showed that inhibitory control was predictive of children’s initial production of irregular forms and not associated with their post-feedback production of irregulars. These findings show that children’s executive functioning skills may be a rate-limiting factor on their ability to produce correct forms, but might not interact with their ability to learn from input in this domain. Findings are discussed in terms of current theories of past-tense acquisition and learning from input more broadly.

Current concepts of tumour metastasis

Background: Tumour metastasis remains the principal cause of treatment failure and poor prognosis in patients with cancer. Recent advances in our understanding of the biology of metastasis are providing novel potential targets for anti-cancer therapies. Aim: This paper reviews the current concepts in tumour metastasis. Methods: A review of Medline publications relating to the molecular biology and therapy of human tumour metastasis was conducted. Results and Discussion: Early metastasis models were based upon the premise of uninterrupted tumour growth, with the inevitable formation of distant metastases and eventual death of the patient. However, current research suggests that metastasis is an inefficient process governed by several rate-limiting steps, and that failure to negotiate these steps can lead to tumour dormancy. Successful metastatic tumour growth depends upon appropriate tumour-host microenvironment interactions and, ultimately, the development of vascularised metastases post-extravasation in the target organ. An understanding of the molecular mechanisms involved in this dynamic process will aid in the identification of therapeutic targets that may allow earlier diagnosis and more specific therapies for patients with metastasis.