A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study.

PURPOSE: An optimal target for glucose control in ICU patients remains unclear. This prospective randomized controlled trial compared the effects on ICU mortality of intensive insulin therapy (IIT) with an intermediate glucose control. METHODS: Adult patients admitted to the 21 participating medico-surgical ICUs were randomized to group 1 (target BG 7.8-10.0 mmol/L) or to group 2 (target BG 4.4-6.1 mmol/L). RESULTS: While the required sample size was 1,750 per group, the trial was stopped early due to a high rate of unintended protocol violations. From 1,101 admissions, the outcomes of 542 patients assigned to group 1 and 536 of group 2 were analysed. The groups were well balanced. BG levels averaged in group 1 8.0 mmol/L (IQR 7.1-9.0) (median of all values) and 7.7 mmol/L (IQR 6.7-8.8) (median of morning BG) versus 6.5 mmol/L (IQR 6.0-7.2) and 6.1 mmol/L (IQR 5.5-6.8) for group 2 (p < 0.0001 for both comparisons). The percentage of patients treated with insulin averaged 66.2 and 96.3%, respectively. Proportion of time spent in target BG was similar, averaging 39.5% and 45.1% (median (IQR) 34.3 (18.5-50.0) and 39.3 (26.2-53.6)%) in the groups 1 and 2, respectively. The rate of hypoglycaemia was higher in the group 2 (8.7%) than in group 1 (2.7%, p < 0.0001). ICU mortality was similar in the two groups (15.3 vs. 17.2%). CONCLUSIONS: In this prematurely stopped and therefore underpowered study, there was a lack of clinical benefit of intensive insulin therapy (target 4.4-6.1 mmol/L), associated with an increased incidence of hypoglycaemia, as compared to a 7.8-10.0 mmol/L target. (ClinicalTrials.gov # NCT00107601, EUDRA-CT Number: 200400391440).

Application of control measures for infections caused by multi-resistant gram-negative bacteria in intensive care unit patients

Multi-resistant gram-negative rods are important pathogens in intensive care units (ICU), cause high rates of mortality, and need infection control measures to avoid spread to another patients. This study was undertaken prospectively with all of the patients hospitalized at ICU, Anesthesiology of the Hospital São Paulo, using the ICU component of the National Nosocomial Infection Surveillance System (NNIS) methodology, between March 1, 1997 and June 30, 1998. Hospital infections occurring during the first three months after the establishment of prevention and control measures (3/1/97 to 5/31/97) were compared to those of the last three months (3/1/98 to 5/31/98). In this period, 933 NNIS patients were studied, with 139 during the first period and 211 in the second period. The overall rates of infection by multi-resistant microorganisms in the first and second periods were, respectively, urinary tract infection: 3.28/1000 patients/day; 2.5/1000 patients/day; pneumonia: 2.10/1000 patients/day; 5.0/1000 patients/day; bloodstream infection: 1.09/1000 patients/day; 2.5/1000 patients/day. A comparison between overall infection rates of both periods (Wilcoxon test) showed no statistical significance (p = 0.067). The use of intervention measures effectively decreased the hospital bloodstream infection rate (p < 0.001), which shows that control measures in ICU can contribute to preventing hospital infections.

Studies about the atomic capabilities concept for linear control systems in physical multi-agent environments

This paper shows the impact of the atomic capabilities concept to include control-oriented knowledge of linear control systems in the decisions making structure of physical agents. These agents operate in a real environment managing physical objects (e.g. their physical bodies) in coordinated tasks. This approach is presented using an introspective reasoning approach and control theory based on the specific tasks of passing a ball and executing the offside manoeuvre between physical agents in the robotic soccer testbed. Experimental results and conclusions are presented, emphasising the advantages of our approach that improve the multi-agent performance in cooperative systems

Efficacy of prescribed injectable diacetylmorphine in the Andalusian trial: Bayesian analysis of responders and non-responders according to a multi domain outcome index.

BACKGROUND The objective of this research was to evaluate data from a randomized clinical trial that tested injectable diacetylmorphine (DAM) and oral methadone (MMT) for substitution treatment, using a multi-domain dichotomous index, with a Bayesian approach. METHODS Sixty two long-term, socially-excluded heroin injectors, not benefiting from available treatments were randomized to receive either DAM or MMT for 9 months in Granada, Spain. Completers were 44 and data at the end of the study period was obtained for 50. Participants were determined to be responders or non responders using a multi-domain outcome index accounting for their physical and mental health and psychosocial integration, used in a previous trial. Data was analyzed with Bayesian methods, using information from a similar study conducted in The Netherlands to select a priori distributions. On adding the data from the present study to update the a priori information, the distribution of the difference in response rates were obtained and used to build credibility intervals and relevant probability computations. RESULTS In the experimental group (n = 27), the rate of responders to treatment was 70.4% (95% CI 53.287.6), and in the control group (n = 23), it was 34.8% (95% CI 15.354.3). The probability of success in the experimental group using the a posteriori distributions was higher after a proper sensitivity analysis. Almost the whole distribution of the rates difference (the one for diacetylmorphine minus methadone) was located to the right of the zero, indicating the superiority of the experimental treatment. CONCLUSION The present analysis suggests a clinical superiority of injectable diacetylmorphine compared to oral methadone in the treatment of severely affected heroin injectors not benefiting sufficiently from the available treatments. TRIAL REGISTRATION Current Controlled Trials ISRCTN52023186.

The achievable region approach to the optimal control of stochastic systems

The achievable region approach seeks solutions to stochastic optimisation problems by: (i) characterising the space of all possible performances(the achievable region) of the system of interest, and (ii) optimisingthe overall system-wide performance objective over this space. This isradically different from conventional formulations based on dynamicprogramming. The approach is explained with reference to a simpletwo-class queueing system. Powerful new methodologies due to the authorsand co-workers are deployed to analyse a general multiclass queueingsystem with parallel servers and then to develop an approach to optimalload distribution across a network of interconnected stations. Finally,the approach is used for the first time to analyse a class of intensitycontrol problems.

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.

Using spatially distributed parameters and multi-response objective functions to solve parameterization of complex applications of semi-distributed hydrological models

Application of semi-distributed hydrological models to large, heterogeneous watersheds deals with several problems. On one hand, the spatial and temporal variability in catchment features should be adequately represented in the model parameterization, while maintaining the model complexity in an acceptable level to take advantage of state-of-the-art calibration techniques. On the other hand, model complexity enhances uncertainty in adjusted model parameter values, therefore increasing uncertainty in the water routing across the watershed. This is critical for water quality applications, where not only streamflow, but also a reliable estimation of the surface versus subsurface contributions to the runoff is needed. In this study, we show how a regularized inversion procedure combined with a multiobjective function calibration strategy successfully solves the parameterization of a complex application of a water quality-oriented hydrological model. The final value of several optimized parameters showed significant and consistentdifferences across geological and landscape features. Although the number of optimized parameters was significantly increased by the spatial and temporal discretization of adjustable parameters, the uncertainty in water routing results remained at reasonable values. In addition, a stepwise numerical analysis showed that the effects on calibration performance due to inclusion of different data types in the objective function could be inextricably linked. Thus caution should be taken when adding or removing data from an aggregated objective function.

Field Sales Management Control: Towards a Multi-Level Theory

The purpose of this dissertation is to increase the understanding and knowledge of field sales management control systems (i.e. sales managers monitoring, directing, evaluating and rewarding activities) and their potential consequences on salespeople. This topic is important because research conducted in the past has indicated that the choice of control system type can on the other hand have desirable consequences, such as high levels of motivation and performance, and on the other hand leadto harmful unintended consequences, such as opportunistic or unethical behaviors. Despite the fact that marketing and sales management control systems have been under rigorous research for over two decades, it still is at a very early stage of development, and several inconsistencies can be found in the research results. This dissertation argues that these inconsistencies are mainly derived from misspecification of the level of analysis in the past research. These different levels of analysis (i.e. strategic, tactical, and operational levels) involve very different decision-making situations regarding the control and motivation of sales force, which should be taken into consideration when conceptualizing the control. Moreover, the study of salesperson consequences of a field sales management control system is actually a cross-level phenomenon, which means that at least two levels of analysis are simultaneously involved. The results of this dissertation confirm the need to re-conceptualize the field sales management control system concept. It provides empirical evidence for the assertion that control should be conceptualized with more details atthe tactical/operational level of analysis than at the strategic levelof analysis. Moreover, the results show that some controls are more efficiently communicated to field salespeople than others. It is proposed that this difference is due to different purposes of control; some controls aredesigned for influencing salespersons' behavior (aim at motivating) whereas some controls are designed to aid decision-making (aim at providing information). According to the empirical results of this dissertation, the both types of controls have an impact to the sales force, but this impactis not as strong as expected. The results obtained in this dissertation shed some light to the nature of field sales management control systems, and their consequences on salespeopl

The Control of the Edge Shrinkage in Board

Tämän diplomityön tavoitteena oli löytää prosessiparametrejä nestepakkauskartongin reuna-alueiden kuivatuskutistuman hallintaan ja saada tuotteen reuna-alueiden sileystaso paremmaksi. Tarkoituksena oli parantaa reuna-alueiden painettavuusominaisuuksia sekä saada koneen poikkisuunnassa laadultaan parempi tuote. Työn kirjallisuusosassa on tarkasteltu työn kannalta nestepakkauskartongin kriittisimpiä ominaisuuksia, sileyttä ja jäykkyyttä. Lisäksi kirjallisuusosassa on tarkasteltu kuitujen ominaisuuksia, sylinterikuivatusta ja kuivatuskutistumaa. Kokeellisessa osassa on etsitty esitutkimuksella prosessiparametrejä, jotka ovat aiheuttaneet poikkisuunnan sileyserojen kasvun kartonkikoneen investoinnin jälkeen. Suoria korrelaatioita prosessiparametrien ja kuivatuskutistuman välille ei löydetty. Kokeellisen osan tehdasmittakaavaisissa koeajoissa tutkittiin kahdeksan eri parametrin vaikutusta kuivatuskutistumaan, jotka perustuivat kirjallisuuteen. Tutkituista parametreistä huulisuihkun iskukulman muutoksella sekä konesuuntaisella kuivatusprofiililla ei ollut vaikutusta kuivatuskutistumaan. Runkokerroksen mäntysellun korvaaminen koivusellulla vähensi kuivatuskutistumaa ja lisäsi sileyttä, mutta tuotteen palstautumislujuus ei tällöin ollut riittävä. Retentiokemikaalien reseptimuutoksilla pinta- ja taustakerroksen välillä, kuivatusosan nollatason laskulla ja perälaatikkosakeuksien pienentämisellä oli vähän vaikutusta kuivatuskutistumaan. Vaikutus reuna-alueiden sileyteen oli kuitenkin vähemmän kuin 10 %. Diplomityön perusteella kuivatusosan nopeuseroilla ja kuivatusviirojen kireyksillä oli suurin vaikutusta kuivatuskutistumaan ja reuna-alueiden sileystasoon. Lisäämällä nopeuseroja ja kiristämällä kuivatusviiroja reuna-alueiden sileyttä pystyttiin parantamaan yli 20 %.

Control of Asian soybean rust with mancozeb, a multi-site fungicide

An experiment conducted in the field the action of mancozeb, a fungicide of multi-site action was tested, to control soybean rust caused by Phakopsora pachyrhizi. Its performance was compared to that of the mixture cyproconazole (DMI) + azoxystrobin (QoI). The soybean cultivar NA 7337 RR was used with a population of 400,000 plants/ha cultivated in 20m2 plots. Treatments consisted of mancozeb levels (1.5 and 2.0 kg/ha) applied four, six and eight times. The DMI + QoI mixture was applied three times at 0.3 L/ha + Nimbus. Rust severity was assessed six times in the plots and data were integrated as the area under the disease progress curve (AUDPC). The plots were harvested and grain yield was expressed as kg/ha. Data on AUDPC and yield were subjected to analysis of variance and means compared according to Turkey's test (p = 0.005). Treatments with mancozeb were superior to DMI + QoI mixture both for rust control and grain yield. Four applications of 2.0 k/ha mancozeb were more efficient than three applications of the mixture used as standard. Mancozeb has the potential to be added to fungicide mixtures in the establishment of soybean rust anti-resistance strategy.

Multi-axis solutions in packaging machines in Europe

The objective of this thesis was to examine the potential of multi-axis solutions in packaging machines produced in Europe. The definition of a multi-axis solution in this study is a construction that uses a common DC bus power supply for different amplifiers running the axes and the intelligence is centralized into one unit. The cost structure of a packaging machine was gained from an automation research, which divided the machines according to automation categories. The automation categories were then further divided into different sub-components by evaluating the ratio of multi-axis solutions compared to other automation components in packaging machines. A global motion control study was used for further information. With the help of the ratio, an estimation of the potential of multi-axis solutions in each country and packaging machine sector was completed. In addition to the research, a specific questionnaire was sent to five companies to gain information about the present situation and possible trends in packaging machinery. The greatest potential markets are in Germany and Italy, which are also the largest producers of packaging machinery in Europe. The greatest growth in the next few years will be seen in Turkey where the annual growth rate equals the general machinery production rate in Asia. The greatest market potential of the Nordic countries is found in Sweden in 35th position on the list. According to the interviews, motion control products in packaging machines will retain their current power levels, as well as the number of axes in the future. Integrated machine safety features together with a universal programming language are the desired attributes of the future. Unlike generally in industry, the energy saving objectives are and will remain insignificant in the packaging industry.

Modeling and control of multibody system with flexible appendages

The objective of this work is to describe the design and the implementation of an experiment to study the dynamics and the active control of a slewing multi-link flexible structure. The experimental apparatus was designed to be representative of a flexible space structure such as a satellite with multiple flexible appendages. In this study we describe the design procedures, the analog and digital instrumentation, the analytical modeling together with model validation studies carried out through experimental modal testing and parametric system identification studies in the frequency domain. Preliminary results of a simple positional control where the sensor and the actuator are positioned physically at the same point is also described.

Control of multi-actuator system by an electrically driven hydraulic pump-motor

The awareness and concern of our environment together with legislation have set more and more tightening demands for energy efficiency of non-road mobile machinery (NRMM). Integrated electro-hydraulic energy converter (IEHEC) has been developed in Lappeenranta University of Technology (LUT). The elimination of resistance flow, and the recuperation of energy makes it very efficient alternative. The difficulties of IEHEC machine to step to the market has been the requirement of one IEHEC machine per one actuator. The idea is to switch IEHEC between two actuators of log crane using fast on/off valves. The control system architecture is introduced. The system has been simulated in co-simulation using two different software. The simulated responses of pump-controlled system is compared to the responses of the conventional valve-controlled system.

Design and Control of an Anthropomorphic Robotic Finger with Multi-point Tactile Sensation

The goal of this research is to develop the prototype of a tactile sensing platform for anthropomorphic manipulation research. We investigate this problem through the fabrication and simple control of a planar 2-DOF robotic finger inspired by anatomic consistency, self-containment, and adaptability. The robot is equipped with a tactile sensor array based on optical transducer technology whereby localized changes in light intensity within an illuminated foam substrate correspond to the distribution and magnitude of forces applied to the sensor surface plane. The integration of tactile perception is a key component in realizing robotic systems which organically interact with the world. Such natural behavior is characterized by compliant performance that can initiate internal, and respond to external, force application in a dynamic environment. However, most of the current manipulators that support some form of haptic feedback either solely derive proprioceptive sensation or only limit tactile sensors to the mechanical fingertips. These constraints are due to the technological challenges involved in high resolution, multi-point tactile perception. In this work, however, we take the opposite approach, emphasizing the role of full-finger tactile feedback in the refinement of manual capabilities. To this end, we propose and implement a control framework for sensorimotor coordination analogous to infant-level grasping and fixturing reflexes. This thesis details the mechanisms used to achieve these sensory, actuation, and control objectives, along with the design philosophies and biological influences behind them. The results of behavioral experiments with a simple tactilely-modulated control scheme are also described. The hope is to integrate the modular finger into an %engineered analog of the human hand with a complete haptic system.

Studies about the atomic capabilities concept for linear control systems in physical multi-agent environments

This paper shows the impact of the atomic capabilities concept to include control-oriented knowledge of linear control systems in the decisions making structure of physical agents. These agents operate in a real environment managing physical objects (e.g. their physical bodies) in coordinated tasks. This approach is presented using an introspective reasoning approach and control theory based on the specific tasks of passing a ball and executing the offside manoeuvre between physical agents in the robotic soccer testbed. Experimental results and conclusions are presented, emphasising the advantages of our approach that improve the multi-agent performance in cooperative systems