EZ-IO intraosseous device implementation in a pre-hospital emergency service : a prospective study and review of the literature

Introduction : La prise en charge des patients critiques nécessite dans la majorité des situations l'obtention rapide d'un accès vasculaire, afin d'administrer des médicaments, des solutés de remplissage, ou des produits sanguins. La mise en place d'un accès vasculaire peut s'avérer difficile chez ces patients. En cas d'échec de pose d'une voie veineuse périphérique, des abords vasculaires alternatifs existent. Il s'agit essentiellement de la pose d'une voie veineuse centrale, la réalisation d'une dénudation veineuse, ou la pose d'une voie intra-osseuse. Depuis le développement de dispositifs d'insertion « semi-automatique » à la fin des années 90, la voie intra-osseuse, traditionnellement réservée aux cas pédiatriques, est de plus en plus fréquemment utilisée chez les patients adultes. Le Service des Urgences du CHUV a introduit en 2009 les dispositifs d'insertion d'aiguilles intra-osseuses de type EZ-IO® (perceuse électrique), en salle de réanimation des urgences vitales (déchoquage), ainsi qu'au sein du secteur préhospitalier pour les interventions du SMUR de Lausanne et de l'hélicoptère REGA de la base de Lausanne. Par cette étude, nous voulions mettre en évidence les aspects épidémiologiques des patients ayant dû être perfusés par cet abord dans un contexte préhospitalier, ainsi que les circonstances cliniques ayant justifié un tel usage, le taux de succès, les éventuelles complications, les médicaments perfusés et la mortalité des patients ayant bénéficié de ce dispositif. Méthode: Chaque patient ayant bénéficié de la mise en place d'une voie intra-osseuse par EZ-IO® du 1er janvier 2009 au 31 décembre 2011 a été inclus. Les données récoltées étaient l'âge, le sexe, l'indication à la mise en place de l'intra-osseuse, la localisation, le taux de succès, les médicaments et fluides administrés, les complications, la mortalité à 48 heures et à la sortie de l'hôpital. Tous les articles mentionnant l'utilisation de ΙΈΖ-ΙΟ® dans des situations cliniques ont également été analysés par une revue de littérature structurée exhaustive, afin de comparer nos résultats avec les données de la littérature. Résultats : Cinquante-huit patients, représentant 60 intra-osseuses EZ-IO®, ont été inclus. Leur âge moyen (47 ans), le taux de succès (90%), les indications, la localisation de l'aiguille (98% au niveau du tibia proximal) et le taux de complications (0%) correspondent aux valeurs trouvées dans la littérature. Le taux de survie de nos patients est de 38% à 48 heures et de 29% à la sortie de l'hôpital. De nombreux médicaments ou solutés de perfusion ont été administrés; l'adrénaline restant le médicament le plus fréquemment administré par cette voie. Dans 7 cas, les patients ont bénéficié d'une induction d'anesthésie par voie intra-osseuse. La revue de littérature a permis de compiler 30 études distinctes, représentant un total de 1603 accès vasculaires de type EZ-IO®. Conclusion : La voie intra-osseuse s'avère fiable et rapide pour obtenir un accès vasculaire, avec un taux de complications très faible et permet l'administration d'un grand nombre de substances. D'autres études sont nécessaires pour évaluer l'impact de la voie intra osseuse, notamment en termes de mortalité, de complications tardives, ainsi que d'analyse coût/bénéfice de ce matériel.

Electronic control device exposure: a review of morbidity and mortality.

The use of electronic control devices has expanded worldwide during the last few years, the most widely used model being the Taser. However, the scientific knowledge about electronic control devices remains limited. We reviewed the medical literature to examine the potential implications of electronic devices in terms of morbidity and mortality, and to identify and evaluate all the existing experimental human studies. A single exposure of an electronic control device on healthy individuals can be assumed to be generally safe, according to 23 prospective human experimental studies and numerous volunteer exposures. In case series, however, electronic control devices could have deleterious effects when used in the field, in particular if persons receive multiple exposures, are intoxicated, show signs of "excited delirium," or present with medical comorbidities. As the use of electronic control devices continues to increase, the controversy about its safety, notably in potentially high-risk individuals, is still a matter of debate. The complications of electronic control device exposure are numerous but often recognizable, usually resulting from barbed dart injuries or from falls. Persons exposed to electronic control devices should therefore be fully examined, and traumatic lesions must be ruled out.

A survey on automatic recommenders in the context of institutional repositories

Peer-reviewed

Is It Possible to Predict the Manual Web Accessibility Result Using the Automatic Result?

The most adequate approach for benchmarking web accessibility is manual expert evaluation supplemented by automatic analysis tools. But manual evaluation has a high cost and is impractical to be applied on large websites. In reality, there is no choice but to rely on automated tools when reviewing large web sites for accessibility. The question is: to what extent the results from automatic evaluation of a web site and individual web pages can be used as an approximation for manual results? This paper presents the initial results of an investigation aimed at answering this question. He have performed both manual and automatic evaluations of the accessibility of web pages of two sites and we have compared the results. In our data set automatically retrieved results could most definitely be used as an approximation manual evaluation results.

Experimental Results and Evaluation of SmartBox Stimulation Device in a P2P E-learning System

In this paper, we present the experimental results and evaluation of the SmartBox stimulation device in P2P e-learning system which is based on JXTA-Overlay. We also show the design and implementation of the SmartBox environment that is used for stimulating the learners motivation to increase the learning efficiency. The SmartBox is integrated with our P2P system as a useful tool for monitoring and controlling learners¿ activity. We found by experimental results that the SmartBox is an effective way to increase the learner¿s concentration. We also investigated the relation between learner¿s body movement, concentration, and amount of study. From the experimental results, we conclude that the use of SmartBox is an effective way to stimulate the learners in order to continue studying while maintaining the concentration.

Automatic acquisition of Named Entities for Rule-Based Machine Translation

This paper proposes to enrich RBMTdictionaries with Named Entities(NEs) automatically acquired fromWikipedia. The method is appliedto the Apertium English-Spanishsystem and its performance comparedto that of Apertium with and withouthandtagged NEs. The system withautomatic NEs outperforms the onewithout NEs, while results vary whencompared to a system with handtaggedNEs (results are comparable forSpanish to English but slightly worstfor English to Spanish). Apart fromthat, adding automatic NEs contributesto decreasing the amount of unknownterms by more than 10%.

Automatic Decision-Oriented Mapping of Pollution Data

The paper deals with the development and application of the methodology for automatic mapping of pollution/contamination data. General Regression Neural Network (GRNN) is considered in detail and is proposed as an efficient tool to solve this problem. The automatic tuning of isotropic and an anisotropic GRNN model using cross-validation procedure is presented. Results are compared with k-nearest-neighbours interpolation algorithm using independent validation data set. Quality of mapping is controlled by the analysis of raw data and the residuals using variography. Maps of probabilities of exceeding a given decision level and ?thick? isoline visualization of the uncertainties are presented as examples of decision-oriented mapping. Real case study is based on mapping of radioactively contaminated territories.

On the Condition Monitoring of Induction machines

The research of condition monitoring of electric motors has been wide for several decades. The research and development at universities and in industry has provided means for the predictive condition monitoring. Many different devices and systems are developed and are widely used in industry, transportation and in civil engineering. In addition, many methods are developed and reported in scientific arenas in order to improve existing methods for the automatic analysis of faults. The methods, however, are not widely used as a part of condition monitoring systems. The main reasons are, firstly, that many methods are presented in scientific papers but their performance in different conditions is not evaluated, secondly, the methods include parameters that are so case specific that the implementation of a systemusing such methods would be far from straightforward. In this thesis, some of these methods are evaluated theoretically and tested with simulations and with a drive in a laboratory. A new automatic analysis method for the bearing fault detection is introduced. In the first part of this work the generation of the bearing fault originating signal is explained and its influence into the stator current is concerned with qualitative and quantitative estimation. The verification of the feasibility of the stator current measurement as a bearing fault indicatoris experimentally tested with the running 15 kW induction motor. The second part of this work concentrates on the bearing fault analysis using the vibration measurement signal. The performance of the micromachined silicon accelerometer chip in conjunction with the envelope spectrum analysis of the cyclic bearing faultis experimentally tested. Furthermore, different methods for the creation of feature extractors for the bearing fault classification are researched and an automatic fault classifier using multivariate statistical discrimination and fuzzy logic is introduced. It is often important that the on-line condition monitoring system is integrated with the industrial communications infrastructure. Two types of a sensor solutions are tested in the thesis: the first one is a sensor withcalculation capacity for example for the production of the envelope spectra; the other one can collect the measurement data in memory and another device can read the data via field bus. The data communications requirements highly depend onthe type of the sensor solution selected. If the data is already analysed in the sensor the data communications are needed only for the results but in the other case, all measurement data need to be transferred. The complexity of the classification method can be great if the data is analysed at the management level computer, but if the analysis is made in sensor itself, the analyses must be simple due to the restricted calculation and memory capacity.

Measurement with an automated oscillometric wrist device with position sensor leads to lower values than measurements obtained with an automated oscillometric arm device from the same manufacturer in elderly persons.

OBJECTIVE: Home blood pressure (BP) monitoring is recommended by several clinical guidelines and has been shown to be feasible in elderly persons. Wrist manometers have recently been proposed for such home BP measurement, but their accuracy has not been previously assessed in elderly patients. METHODS: Forty-eight participants (33 women and 15 men, mean age 81.3±8.0 years) had their BP measured with a wrist device with position sensor and an arm device in random order in a sitting position. RESULTS: Average BP measurements were consistently lower with the wrist than arm device for systolic BP (120.1±2.2 vs. 130.5±2.2 mmHg, P<0.001, means±SD) and diastolic BP (66.0±1.3 vs. 69.7±1.3 mmHg, P<0.001). Moreover, a 10 mmHg or greater difference between the arm and wrist device was observed in 54.2 and 18.8% of systolic and diastolic measures, respectively. CONCLUSION: Compared with the arm device, the wrist device with position sensor systematically underestimated systolic as well as diastolic BP. The magnitude of the difference is clinically significant and questions the use of the wrist device to monitor BP in elderly persons. This study points to the need to validate BP measuring devices in all age groups, including in elderly persons.

Accurate and early diagnosis of orthopedic device-related infection by microbial heat production and sonication.

Proper and rapid diagnosis of orthopedic device-related infection is important for successful treatment. Sonication has been shown to improve the diagnostic performance. We hypothesized that the combination of sonication with a novel method called microcalorimetry will further improve and accelerate the diagnosis of implant infection. We prospectively included 39 consecutive patients (mean age 59 years, 62% males) at our institution from whom 29 orthopedic prostheses and 10 osteosynthesis material were explanted. The explanted device was sonicated. The resulting sonication fluid was analyzed using microcalorimetry. Using standardized criteria to define orthopedic device-related infection, 12 cases (31%) were defined as infected. In all, positive periprosthetic tissue cultures were found. The sensitivity and specificity of microcalorimetry of sonication fluid were 100% and 97%, respectively. Mean time to detection, defined as time to reach a rising heat flow signal of 20 µW measured after equilibiration needed to get accurate measurement, was 10.9 h. In summary, microcalorimetry of sonication fluid is a reliable and a fast method in detecting the presence of microorganisms in orthopedic device-related infection. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1700-1703, 2013.

Characterization of board impurities with a Raman device

Erilaisia epäpuhtauksia kulkeutuu paperinvalmistusprosessiin ja monenlaisia saostumia muodostuu paperinvalmistuksen prosesseissa. Epäpuhtaudet voivat aiheuttaa prosessiongelmia sekä alentaa tuotteen laatua. Epäpuhtauksien alkuperän ja koostumuksen selvittäminen edellyttää usein erilaisten analyysimenetelmien käyttöä. Epäpuhtauksien luokittelu on useasti välttämätöntä ennen tarkempaa kemiallista analyysia. Paperinvalmistuksen epäpuhtauksien kvalitatiiviseen luokitteluun on yleisimmin käytetty mikroskopian, IR-spektroskopian ja analyyttisen pyrolyysin menetelmiä. Raman spektroskopia on harvinaisempi menetelmä paperiteollisuuden tutkimuksessa. Raman instrumenttien kehittyminen on ollut voimakasta viimeisen vuosikymmenen aikana. Raman spektroskopia onkin osoittanut mandollisuutensa polymeerien, lääketeollisuuden ja polttoaineteollisuuden tutkimuksissa. Tässä työssä tutkittiin erään elintarvikepakkauskartongin epäpuhtauksia Raman spektroskoopilla. Työn tavoitteena oli selvittää Raman analyysin käyttökelpoisuutta kartongin epäpuhtauksien online-luokittelussa. Tutkimukset suoritettiin Spectracoden RP-1 Raman instrumentilla. Tutkimukset osoittivat, että näytteen fluoresenssi ja näytteen hajoaminen asettavat rajoituksia epäpuhtauksien Raman analyysille. Epäpuhtauksien online-tunnistaminen toimii käytettäessä suuria lasertehoja ja säteilytysaikoja. Näytteiden laserherkkyys ja fluoresenssi rajoittavat kuitenkin suurien laiteparametrien käyttöä. Laiteparametrien pienentäminen johti mittauksien signaali-kohina suhteen alenemiseen, mikä puolestaan aiheutti online-tunnistuksen toimimattomuuden.

Paediatric bi-ventricular external assist device based on artificial muscles

Objective: Existing VADs are single-ventricle pumps needing anticoagulation. We developed a bi ventricular external assist device that reproduces the physiological heart muscle movement completely avoiding anticoagulants. Methods: The device has a carbon fibre skeleton fitting a 30-40 kg patient's heart, to which a Nitinol based artificial muscle is connected. The artificial muscle wraps both ventricles. The strength of the Nitinol fibres is amplified by a pivot articulation in contact with the ventricle wall. The fibres are electrically driven and a dedicated control unit has been developed. We assessed hemodynamic performances of this device using a previously described dedicated bench test. Volume ejected and pressure gradient has been measured with afterload ranging from 25 to 50mmHg. Results: With anafterload of 50mmHg the system has an ejection fraction (EF) of 10% on the right side and 8% on the left side. The system is able to generate a systolic ejection of 5,5 ml on the right side and 4,4 ml on the left side. With anafterload of 25mmHg the results are reduced of about 20%. The activation frequency is 80/minute resulting in a total volume displacement of 440 ml/minute on the right side and 352 ml/minute on the left side. Conclusions: The artificial muscle follows Starling's law as the ejected volume increases when afterload increases. These preliminary studies confirmed the possibility of improving the EF of a failing heart using artificial muscle for external cardiac compression. This device could be helpful in weaning CPB and/or for short-term cardio-circulatory support in paediatric population with cardiac failure.

Hallintasovellus M2M-tiedonsiirtoon GPRS-verkossa

Pääosa matkapuhelinjärjestelmien liikenteestä on toistaiseksi puhetta. Dataliikenteen osuus on kuitenkin jatkuvasti kasvamassa uusien tekniikoiden myötävaikutuksella. Langattoman dataliikenteen kehittämiselle tuo myös lisäpainetta internetin nopeasti yleistynyt käyttö. Eräs lupaavimmista sovellusalueista on konekommunikaatio, M2M, minkä läpilyöntiä on ennustettu jo vuosia. Viime vuosina markkinoille tulleet M2M-laitteet tarjoavat aiemmista laitteista poiketen myös mahdollisuuden sovellusten suorittamiseen itse laitteessa ja niiden päivittämisen langattomasti. Työssä vertaillaan kolmea markkinoilla olevaa konekommunikaatioon soveltuvaa laitetta ja tarkastellaan niiden ominaisuuksia ja sovellusten päivitettävyyttä GPRS-verkkoa käyttäen. Tarkastelussa havaitaan, että teleoperaattoreiden asettamat rajoitukset ja käytössä olevat päivitysmenetelmät aiheuttavat tiettyjä ongelmia päivitysten käytettävyydelle. Työn tuloksena kehitettiin hallintasovellusohjelmisto, mikä mahdollisti etäällä sijaitsevien M2M-laitteiden sovellusten päivittämisen helppokäyttöisen käyttöliittymän avulla. Hallintasovellusta käyttäen useita, maantieteellisesti hajallaan olevia laitteita oli mahdollista päivittää samanaikaisesti automatisoidusti. Hallintasovellus osoittautui käyttökelpoiseksi työkaluksi M2Mlaitteiden sovellusten hallintaan jo, kun laitemäärä kasvoi muutamista kappaleista muutamaan kymmeneen.