Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit

The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF) in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' chi2 test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis) were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS)/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044)), male gender (OR = 4.275 (1.340-13642)), shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229)), higher intra-operative hydration (OR = 1.002 (1.000-1004)), and plasma urea on admission (OR = 1.012 (0.980-1044)) remained significant (multivariate analysis). The mortality risk factors (univariate analysis) were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037). In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.

Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention

The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.

Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.

Effect of the implementation of the Hazard Analysis Critical Control Point (HACCP) prerequisite program in an institutional foodservice unit in Southern Brazil

The aims of this study were to investigate the hygienic practices in the food production of an institutional foodservice unit in Southern Brazil and to evaluate the effect of implementing good food handling practices and standard operational procedures using microbiological hygiene indicators. An initial survey of the general operating conditions classified the unit as regular in terms of compliance with State safety guidelines for food service establishments. An action plan that incorporated the correction of noncompliance issues and the training of food handlers in good food handling practices and standard operational procedures were then implemented. The results of the microbiological analysis of utensils, preparation surfaces, food handlers' hands, water, and ambient air were recorded before and after the implementation of the action plan. The results showed that the implementation of this type of practice leads to the production of safer foods.

Fusion of Data from Quadcopter’s Inertial Measurement Unit Using Complementary Filter

A quadcopter is a helicopter with four rotors, which is mechanically simple device, but requires complex electrical control for each motor. Control system needs accurate information about quadcopter’s attitude in order to achieve stable flight. The goal of this bachelor’s thesis was to research how this information could be obtained. Literature review revealed that most of the quadcopters, whose source-code is available, use a complementary filter or some derivative of it to fuse data from a gyroscope, an accelerometer and often also a magnetometer. These sensors combined are called an Inertial Measurement Unit. This thesis focuses on calculating angles from each sensor’s data and fusing these with a complementary filter. On the basis of literature review and measurements using a quadcopter, the proposed filter provides sufficiently accurate attitude data for flight control system. However, a simple complementary filter has one significant drawback – it works reliably only when the quadcopter is hovering or moving at a constant speed. The reason is that an accelerometer can’t be used to measure angles accurately if linear acceleration is present. This problem can be fixed using some derivative of a complementary filter like an adaptive complementary filter or a Kalman filter, which are not covered in this thesis.

Commitment in Finnish–Japanese strategic alliances

Finnish companies have usually formed a strategic alliance as entry mode when entering the Japanese market. However, these strategic alliances have not been studied in a general level and it remains unknown, what kind cooperation the Finnish companies are operating with their Japanese partners. Especially Finnish companies that aims to penetrate the Japanese market are eager to know more about this. The recent studies on topic have focused on a single industry or company and that is why more general level study was needed. The purpose of this study is to analyze types of Finnish–Japanese strategic alliances from the Finnish point of view. The analysis is conducted by answering the questions what strategic alliance types appear in the strategic alliances between Japanese and Finnish companies, and how commitment affects strategic alliance type. This study also examines how committed Finnish–Japanese strategic alliances are. In this study multiple case study was selected as research method. The data is collected by interviewing six representative of Finnish companies in Japan individually. Multiple case study was chosen for this study, because this study is interested in the topic in general level and this research method is suitable for this kind of research. From the interviews common attributes were pointed out and from them the big picture of the topic was created. Types of strategic alliances were determined by using previous literature on that topic. Two different types of strategic alliance were discovered: supplier alliance which is the most common one and learning alliance. The commitment of strategic alliance was measured visually by utilizing a figure that was modified for this study.The figure is originally based on earlier studies on strategic alliance types and their connection to ownership and commitment. By utilizing the figure it was noticed that commitment affects strategic alliance types: the more there is commitment involved, the more there is cooperation. Finnish–Japanese strategic alliances are not very committed despite they have existed for a long time. However, there is potential to be more committed. That is why Finnish companies should increase the commitment and attract the partners to develop the strategic alliances, because it would possible increase competitive advantage. This would be beneficial to all members within the strategic alliance.

Troponin I serum levels predict the need of dialysis in incident sepsis patients with acute kidney injury in the intensive care unit

Abstract Introduction: Sepsis, an extremely prevalent condition in the intensive care unit, is usually associated with organ dysfunction, which can affect heart and kidney. Objective: To determine whether the cardiac dysfunction and the Troponin I forecast the occurrence of acute renal failure in sepsis. Methods: Cardiac dysfunction was assessed by echocardiography and by the serum troponin I levels, and renal impairment by AKIN criteria and the need of dialysis. Twenty-nine patients with incident sepsis without previous cardiac or renal dysfunction were enrolled. Results and Discussion: Patients averaged 75.3 ± 17.3 years old and 55% were male. Median APACHE II severity score at ICU admission was 16 (9.7 - 24.2) and mortality rate in 30 days was 45%. On the fifth day, 59% had ventricular dysfunction. Troponin serum levels on day 1 in the affected patients were 1.02 ± 0.6 ng/mL compared with 0.23 ± 0.18 ng/mL in patients without heart dysfunction (p = 0.01). Eighteen out of 29 patients (62%) underwent renal replacement therapy (RRT) and the percent of patients with ventricular dysfunction who required dialysis was higher (94% vs. 16%, p = 0.0001). Values of troponin at day 1 were used to develop a ROC curve to determine their ability to predict the need of dialysis. The area under the curve was 0.89 and the cutoff value was 0.4 ng/mL. Conclusion: We found that an elevation in serum troponin levels, while guarding a relationship with ventricular dysfunction, can be a precious tool to predict the need for dialysis in sepsis patients.

Commitment in Finnish–Japanese strategic alliances

Finnish companies have usually formed a strategic alliance as entry mode when entering the Japanese market. However, these strategic alliances have not been studied in a general level and it remains unknown, what kind cooperation the Finnish companies are operating with their Japanese partners. Especially Finnish companies that aims to penetrate the Japanese market are eager to know more about this. The recent studies on topic have focused on a single industry or company and that is why more general level study was needed. The purpose of this study is to analyze types of Finnish–Japanese strategic alliances from the Finnish point of view. The analysis is conducted by answering the questions what strategic alliance types appear in the strategic alliances between Japanese and Finnish companies, and how commitment affects strategic alliance type. This study also examines how committed Finnish–Japanese strategic alliances are. In this study multiple case study was selected as research method. The data is collected by interviewing six representative of Finnish companies in Japan individually. Multiple case study was chosen for this study, because this study is interested in the topic in general level and this research method is suitable for this kind of research. From the interviews common attributes were pointed out and from them the big picture of the topic was created. Types of strategic alliances were determined by using previous literature on that topic. Two different types of strategic alliance were discovered: supplier alliance which is the most common one and learning alliance. The commitment of strategic alliance was measured visually by utilizing a figure that was modified for this study. The figure is originally based on earlier studies on strategic alliance types and their connection to ownership and commitment. By utilizing the figure it was noticed that commitment affects strategic alliance types: the more there is commitment involved, the more there is cooperation. Finnish–Japanese strategic alliances are not very committed despite they have existed for a long time. However, there is potential to be more committed. That is why Finnish companies should increase the commitment and attract the partners to develop the strategic alliances, because it would possible increase competitive advantage. This would be beneficial to all members within the strategic alliance.

Le Réveil des cochers-chauffeurs du Comité pour l'indépendance et l'unité des syndicats

1940/03.

Liste officielle ... des prisonniers de guerre français : d'après les renseignements fournis par l'autorité militaire allemande : nom, date et lieu de naissance, unité / Centre national d'information sur les prisonniers de guerre

1941/05/31 (N98).