Inpatient diabetes care in a Swiss multi-site hospital: is there room for improvement?

Background and objective: Optimal care of diabetic patients (DPs) decreases the risk of complications. Close blood glucose monitoring can improve patient outcomes and shorten hospital stay. The objective of this pilot study was to evaluate the treatment of hospitalized DPs according to the current standards, including their diabetic treatment and drugs to prevent diabetes related complications [=guardian drugs: angiotensin converting enzyme inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARB), antiplatelet drugs, statins]. Guidelines of the American Diabetes Association (ADA) [1] were used as reference as they were the most recent and exhaustive for hospital care. Design: Observational pilot study: analysis of the medical records of all DPs seen by the clinical pharmacists during medical rounds in different hospital units. An assessment was made by assigning points for fulfilling the different criteria according to ADA and then by dividing the total by the maximum achievable points (scale 0-1; 1 = all criteria fulfilled). Setting: Different Internal Medicine and Geriatric Units of the (multi-site) Ho^pital du Valais. Main outcome measures: - Completeness of diabetes-related information: type of diabetes, medical history, weight, albuminuria status, renal function, blood pressure, (recent) lipid profile. - Management of blood glucose: Hb1Ac, glycemic control, plan for treating hyper-/hypoglycaemia. - Presence of guardian drugs if indicated. Results: Medical records of 42 patients in 10 different units were analysed (18 women, 24 men, mean age 75.4 ± 11 years). 41 had type 2 diabetes. - Completeness of diabetes-related information: 0.8 ± 0.1. Information often missing: insulin-dependence (43%) and lipid profile (86%). - Management of blood glucose: 0.5 ± 0.2. 15 patients had suboptimal glycemic balance (target glycaemia 7.2-11.2 mmol/ l, with values[11.2 or\3.8 mmol/l, or Hb1Ac[7%), 10 patients had a deregulated balance (more than 10 values[11.2 mmol/l or \3.8 mmol/l and even values[15 mmol/l). - Presence of guardian drugs if indicated: ACEI/ARB: 19 of 23 patients (82.6%), statin: 16 of 40 patients (40%), antiplatelet drug: 16 of 39 patients (41%). Conclusions: Blood glucose control was insufficient in many DPs and prescription of statins and antiplatelet drugs was often missing. If confirmed by a larger study, these two points need to be optimised. As it is not always possible and appropriate to make those changes during hospital stay, a further project should assess and optimise diabetes care across both inpatient and outpatient settings.

Sensitivity to Change of the Ultrasound synovitis SONAR Score in RA Patients: Results of the Scqm Cohort

Background/Purpose: Since the end of 2009, an ultrasound scoring call SONAR has been implemented for RA patients as a routine tool in the SCQM registry (Swiss Clinical Quality Management registry for rheumatic diseases). A cross-sectional evaluation of patients with active disease and clinical remission according to the DAS28ESR and the novel ACR/EULAR remission criteria from 2010 clearly indicated a good correlational external validity of synovial pathologies with clinical disease activity in RA (2012 EULAR meeting. Objective: of this study was to evaluate the sensitivity to change of B-mode and Power-Doppler scores in a longitudinal perspective along with the changes in DAS28ESR in two consecutive visits among the patients included in the SCQM registry Methods: All patients who had at least two SONAR scores and simultaneous DAS28ESR evaluations between December 2009 and June 2012 were included in this study. The data came from 20 different operators working mostly in hospitals but also in private practices, who had received a previous teaching over 3 days in a reference center. The SONAR score includes a semi-quantitative B mode and Power-Doppler evaluation of 22 joints from 0 to 3, maximum 66 points for each score. The selection of these 22 joints was done in analogy to a 28 joint count and further restricted to joint regions with published standard ultrasound images. Both elbows and wrist joints were dynamically scanned from the dorsal and the knee joints from a longitudinal suprapatellar view in flexion and in joint extension. The bilateral evaluation of the second to fifth metacarpophalangeal and proximal interphalangeal joints was done from a palmar view in full extension, and the Power-Doppler scoring from a dorsal view with hand and finger position in best relaxation. Results: From the 657 RA patients with at least one score performed, 128 RA patients with 2 or more consultations of DAS28ESR, and a complete SONAR data set could be included. The mean (SD) time between the two evaluations was 9.6 months (54). The mean (SD) DAS28ESR was: 3.5 (1.3) at the first visit and was significantly lower (mean 3.0, SD.2.0, p:_0.0001) at the second visit. The mean (SD) of the total B mode was 12 (9.5) at baseline and 9.6 (7.6) at follow-up (p_0.0004). The Power-Doppler score at entry was 2.9 (5.7) and 1.9 (3.6), at the second visit, p _0.0001. The Pearson r correlation between change in DAS28ESR and the B mode was 0.44 (95% CI: 0.29, 0.57, p_ 0.0001),and 0.35 (95% CI: 0.16, 0.50, p _ 0.0002) for the Power-Doppler score,. Clinical relevant change in DAS (_1.1) was associated with a change of total B mode score _3 in 23/32 patients and a change a Doppler score _0.5 in 19/26. Conclusion: This study confirms that the SONAR score is sensitive to change and provides a complementary method of assessing RA disease activity to the DAS that could be very useful in daily practice.

Kullan talteenotto takaisinuuttoliuoksista

Työssä tutkittiin kirjallisuuden ja laboratoriomittausten avulla vaihtoehtoja kullan pelkistämiseen ja talteenottoon kultauuton takaisinuuttoliuoksista. Tavoitteena oli löytää menetelmä, jolla saadaan puhdasta kiinteää lopputuotetta ilman kullan häviöitä. Käytettyjä pelkistimiä olivat D-(+)-glukoosi, natriumboorihydridi, L-askorbiinihappo, D-(-)-isoaskorbiinihappo ja aktiivihiili. Laboratoriokokeiden perusteella D-(-)-isoaskorbiinihappo sekä aktiivihiili olivat sopivimmat pelkistimet kokeissa käytetylle kultaliuokselle. Isoaskorbiinihapolla suoritettiin panoskokeita lasireaktorissa eri alku-pH:ssa sekä erilaisilla pelkistimen ja kullan moolisuhteilla. Tulosten perusteella havaittiin pH:n ja pelkistimen ylimäärän vaikuttavan merkittävästi lopputuotteen puhtauteen. Myös redox-potentiaalia säätämällä ja happopesulla pelkistyksen jälkeen voidaan vaikuttaa lopputuotteen puhtauteen. Aktiivihiilellä suoritettiin panoskokeita adsorptiotasapainojen (latausisotermi) ja kinetiikan tutkimiseksi. Hiileen on mahdollista saada kultaa 383 mg/g kuivaa hiiltä. Suurempi lataus voitaisiin saavuttaa käyttämällä hiiltä, jolla on pienempi partikkelikoko. Kolonnikokeita tehtiin eri virtausnopeuksilla. Kolonnikokeissa kullan dynaaminen adsorptiokapasiteetti hiileen odotetusti kasvoi virtausnopeuden laskiessa. Pienin käytetty virtausnopeus oli 2,40 BV/h, jolloin kapasiteetti oli 75,4 mg/g kuivaa hiiltä (c (Au feed) = 129 mg/L). Kullasta voidaan poistaa myös kolonnipelkistyksen jälkeen epäpuhtauksia happopesulla. Isoaskorbiinihapolla pelkistyksen kinetiikka on nopea ja sillä saatiin pelkistettyä puhdasta lopputuotetta. Sekä isoaskorbiinihappo, että aktiivihiili ovat potentiaalisia menetelmiä kullan talteenottoon.

Magnetic and processability studies on rubber ferrite composites based on natural rubber and mixed ferrite

Polycrystalline single phasic mixed ferrites belonging to the series Ni1−xZnxFe2O4 for various values of x have been prepared by conventional ceramic techniques. Pre-characterized nickel zinc ferrites were then incorporated into a natural rubber matrix according to a specific recipe for various loadings. The processability and cure parameters were then determined. The magnetic properties of the ceramic filler as well as the ferrite loaded rubber ferrite composites (RFC) were evaluated and compared. A general equation for predicting the magnetic properties was also formulated. The validity of these equations were then checked and correlated with the experimental data. The coercivity of the RFCs almost resemble that of the ceramic component in the RFC. Percolation threshold is not reached for a maximum loading of 120 phr (parts per hundred rubber by weight) of the filler. These studies indicate that flexible magnets can be made with appropriate magnetic properties namely saturation magnetisation (Ms) and magnetic field strength (Hc) by a judicious choice of x and a corresponding loading. These studies also suggest that there is no possible interaction between the filler and the matrix at least at the macroscopic level. The formulated equation will aid in synthesizing RFCs with predetermined magnetic

Processability, hardness, andmagnetic properties of rubber ferrite composites containingmanganese zinc ferrites

Rubber ferrite composites have the unique advantage of mouldability, which is not easily obtainable using ceramic magnetic materials. The incorporation of mixed ferrites in appropriate weight ratios into the rubber matrix not only modi es the dielectric properties of the composite but also imparts magnetic properties to it. Mixed ferrites belonging to the series of Mn(1 – x )Znx Fe2O4 have been synthesised with diVerent values of x in steps of 0·2, using conventional ceramic processing techniques. Rubber ferrite composites were prepared by the incorporation of these pre-characterised polycrystallineMn(1 – x )Znx Fe2O4 ceramics into a natural rubber matrix at diVerent loadings according to a speci c recipe. The processability of these elastomers was determined by investigating their cure characteristics. The magnetic properties of the ceramic llers as well as of the rubber ferrite composites were evaluated and the results were correlated. Studies of the magnetic properties of these rubber ferrite composites indicate that the magnetisation increases with loading of the ller without changing the coercive eld. The hardness of these composites shows a steady increase with the loading of the magnetic llers. The evaluation of hardness andmagnetic characteristics indicates that composites with optimummagnetisation and almost minimum stiVness can be achieved with a maximum loading of 120 phr of the ller at x=0·4. From the data on the magnetisation of the composites, a simple relationship connecting the magnetisation of the rubber ferrite composite and the ller was formulated. This can be used to synthesise rubber ferrite composites with predetermined magnetic properties

Magnetic and processability studies of nitrile rubber vulcanisates containing barium ferrite and carbon black

Fine particles of barium ferrite (BaFe12O19) belonging to the M-type hexagonal ferrites were prepared by the conventional ceramic techniques. They were incorporated into a nitrile rubber matrix according to a specific recipe for various loadings to produce rubber ferrite composites (RFC). The percolation threshold is not reached for a maximum loading of 130 phr (parts per hundred rubber). Here in this paper, the magnetic properties and processability of the nitrile rubber based RFCs containing barium ferrite (BaF) and HAF carbon black is reported. The magnetic properties of the ceramic ferrite and these rubber ferrite composites were evaluated and it was found that the coercivity values of RFCs were less than that of the ceramic BaF, but remained constant with the loading of both the ferrite filler and carbon black. However, other properties like saturation magnetization and magnetic remanence increased with the loading of ferrite filler.

A geometric interpretation for transmission real losses minimization through the optimal power flow and its influence on voltage collapse

This work presents an approach for geometric solution of an optimal power flow (OPF) problem for a two bus system (a slack and a PV busses). Additionally, the geometric relationship between the losses minimization and the increase of the reactive margin and, therefore, the maximum loading point, is shown. The algebraic equations for the calculation of the Lagrange multipliers and for the minimum losses value are obtained. These equations are used to validate the results obtained using an OPF program. (C) 2002 Elsevier B.V. B.V. All rights reserved.

Continuation fast decoupled power flow with secant predictor

The conventional Newton and fast decoupled power flow methods are considered inadequate for obtaining the maximum loading point of power systems due to ill-conditioning problems at and near this critical point. At this point, the Jacobian matrix of the Newton method becomes singular. In addition, it is widely accepted that the P-V and Q-theta decoupling assumptions made for the fast decoupled power flow formulation no longer hold. However, in this paper, it is presented a new fast decoupled power flow that becomes adequate for the computation of the maximum loading point by simply using the reactive power injection of a selected PV bus as a continuation parameter. Besides, fast decoupled methods using V and 0 as parameters and a secant predictor are also presented. These new versions are compared to each other with the purpose of pointing out their features, as well as the influence of reactive power and transformer tap limits. The results obtained for the IEEE systems (14 and 118 buses) show that the characteristics of the conventional method are enhanced and the region of convergence around the singular solution is enlarged.

Alternative parameters for the continuation power flow method

The conventional Newton's method has been considered inadequate to obtain the maximum loading point (MLP) of power systems. It is due to the Jacobian matrix singularity at this point. However, the MLP can be efficiently computed through parameterization techniques of continuation methods. This paper presents and tests new parameterization schemes, namely the total power losses (real and reactive), the power at the slack bus (real or reactive), the reactive power at generation buses, the reactive power at shunts (capacitor or reactor), the transmission lines power losses (real and reactive), and transmission lines power (real and reactive). Besides their clear physical meaning, which makes easier the development and application of continuation methods for power systems analysis, the main advantage of some of the proposed parameters is that its not necessary to change the parameter in the vicinity of the MLP. Studies on the new parameterization schemes performed on the IEEE 118 buses system show that the ill-conditioning problems at and near the MLP are eliminated. So, the characteristics of the conventional Newton's method are not only preserved but also improved. (C) 2003 Elsevier B.V. B.V. All rights reserved.

Método da continuação aplicado na análise de contingência de linhas de transmissão

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Técnicas de parametrização global para o fluxo de carga continuado

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Técnica de parametrização geométrica para o fluxo de carga continuado baseado nas variáveis tensão nodal e fator de carregamento

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fluxo de carga continuado utilizando estratégia de parametrização geométrica baseada em parâmetros físicos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

An Improved Parameterization Technique for the Continuation Power Flow

Continuation methods have been long used in P-V curve tracing due to their efficiency in the resolution of ill-conditioned cases, with close to singular Jacobian matrices, such as the maximum loading point of power systems. Several parameterization techniques have been proposed to avoid matrix singularity and successfully solve those cases. This paper presents a simple geometric parameterization technique to overcome the singularity of the Jacobian matrix by the addition of a line equations located at the plane determined by a bus voltage magnitude and the loading factor. This technique enlarges the set of voltage variables that can be used to whole P-V curve tracing, without ill-conditioning problems and no need of parameter changes. Simulation results, obtained for large realistic Brazilian and American power systems, show that the robustness and efficiency of the conventional power flow are not only preserved but also improved.

Effect of axial loads on implanted-supported partial fixed prostheses by strain gauge analysis

Objectives: The present study used strain gauge analysis to perform an in vitro evaluation of the effect of axial loading on 3 elements of implant-supported partial fixed prostheses, varying the type of prosthetic cylinder and the loading points. Material and methods: Three internal hexagon implants were linearly embedded in a polyurethane block. Microunit abutments were connected to the implants applying a torque of 20 Ncm, and prefabricated Co-Cr cylinders and plastic prosthetic cylinders were screwed onto the abutments, which received standard patterns cast in Co-Cr alloy (n=5). Four strain gauges (SG) were bonded onto the surface of the block tangentially to the implants, SG 01 mesially to implant 1, SG 02 and SG 03 mesially and distally to implant 2, respectively, and SG 04 distally to implant 3. Each metallic structure was screwed onto the abutments with a 10 Ncm torque and an axial load of 30 kg was applied at five predetermined points (A, B, C, D, E). The data obtained from the strain gauge analyses were analyzed statistically by RM ANOVA and Tukey's test, with a level of significance of p<0.05. Results: There was a significant difference for the loading point (p=0.0001), with point B generating the smallest microdeformation (239.49 mu epsilon) and point D the highest (442.77 mu epsilon). No significant difference was found for the cylinder type (p=0.748). Conclusions: It was concluded that the type of cylinder did not affect in the magnitude of microdeformation, but the axial loading location influenced this magnitude.