The Role of Biomarkers for Starting Antifungals in the Intensive Care Unit

Invasive candidiasis is associated with high mortality rates (35% to 60%), similar to the range reported for septic shock. The most common types include candidemia, frequently observed in immunocompromised patients, and noncandidemic systemic candidiasis, which constitutes the majority of cases in critically ill patients. However, they are difficult to prove and a definite diagnosis usually occurs late in the course of the disease, thus contributing to their bad prognosis. Early empirical treatment improves the prognosis and currently relies on the positive predictive value (PPV) of risk-assessment strategies (colonization index, Candida score, predictive rules) based on combinations of risk factors, but it may have also largely contributed to the overuse of antifungal agents in critically ill patients. In this context, non- culture-based diagnostic methods, including specific and nonspecific biomarkers, may significantly improve the diagnosis of invasive candidiasis. Candida DNA and mannan antigen/antimannan antibodies are of limited interest for the diagnosis of invasive candidiasis as they fail to identify noncandidemic systemic candidiasis, despite early positivity in candidemic patients. The utility of 1,3-beta-D-glucan (b-D-glucan), a panfungal cell wall antigen, has been demonstrated for the diagnosis of fungal infections in immunocompromised patients. Preliminary data suggest that it is also detectable early in critically ill patients developing noncandidemic systemic candidiasis. To take advantage of the high negative predictive value of risk-assessment strategies and the early increase in specific fungal biomarkers in high-risk patients, we propose a practical 2-step approach to improve the selection of patients susceptible to benefit from empirical antifungal treatment.

Mesure de l'impact de l'implication des proches aidants de patients hospitalises dans une unité de soins psychiatriques aigus sur eux-mêmes

Le but de cette étude est de mesurer ainsi que de qualifier l'impact de l'implication des proches aidants de patients hospitalisés dans des unités de soins psychiatriques aigus sur eux-mêmes. Le cadre conceptuel utilisé est celui du fardeau des familles de Schene (1990). Il différencie les parties objectives et subjectives du fardeau familial. La récolte de données a été réalisée à l'aide de l'Involvement Evaluation Questionnaire (IEQ). Les résultats de cette étude montrent que les proches aidants souffrent d'un niveau d'inquiétude élevé, 3.8 sur une échelle de Likert à 5 questions, ainsi que d'un niveau de tension à 2.44 sur une échelle de Likert à 5 questions. Des associations ont été trouvées. L'augmentation de la durée du trouble diminue l'inquiétude, avec une valeur ρ de 0.048. Le fait d'être habitué à la situation a également un impact en diminuant la tension, avec une valeur ρ de 0.002. Plus on est « habitué à la situation », avec une valeur ρ de -0.021, moins le proche est inquiet par rapport à la situation du patient. Ainsi que, plus le patient est jeune, plus le proche aidant ressent de tension, avec une valeur ρ de 0.008. Ces résultats, peu généralisables au vu du petit échantillon (n=24), pourraient toutefois impliquer une réflexion approfondie sur l'accueil, la place et le soutien des proches aidants de patients souffrants de troubles psychiatriques hospitalisés dans une unité de soins aigus de la part des infirmières.

Cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitário Cajuru

Objective To identify and analyze the prevalence of cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitário Cajuru. Materials and Methods Cross-sectional study analyzing 200 consecutive non contrast-enhanced cranial computed tomography reports of patients admitted to the emergency unit of Hospital Universitário Cajuru. Results Alterations were observed in 76.5% of the patients. Among them, the following findings were most frequently observed: extracranial soft tissue swelling (22%), bone fracture (16.5%), subarachnoid hemorrhage (15%), nonspecific hypodensity (14.5%), paranasal sinuses opacification (11.5%), diffuse cerebral edema (10.5%), subdural hematoma (9.5%), cerebral contusion (8.5%), hydrocephalus (8%), retractable hypodensity /gliosis/ encephalomalacia (8%). Conclusion The authors recognize that the most common findings in emergency departments reported in the literature are similar to the ones described in the present study. This information is important for professionals to recognize the main changes to be identified at cranial computed tomography, and for future planning and hospital screening aiming at achieving efficiency and improvement in services.

Le pool ou unité commune de personnel soignant

L'unité commune de personnel soignant ou pool infirmier du CHUV est un service de professionnels qualifiés, disponibles et capables de remplacer les défections du personnel régulier ou renforcer les effectifs lors de surcharge de travail occasionnel. [Table des matières] 1. Le pool: perspective historique: Origine du travail intérimaire; Le travail intérimaire en Suisse et son développement; Genèse du Pool; Développement du Pool. 2. Problématique du Pool : Perspective conceptuelle et théorique. L'hôpital, modèle d'organisation pris entre deux logiques; Marché-hiérarchie: théorie des coûts de transactions; La coordination collective des actions individuelles apport de l'économie des conventions. Concept de flexibilité. Connaissance tacite et explicite. 3. Le terrain d'observation. Annexes: Questionnaire des poolistes et résumé des commentaires; etc.

Development of tender information process by business intelligence in a global company unit

The purpose of this Thesis was to study what is the present situation of Business Intelligence of the company unit. This means how efficiently unit uses possibilities of modern information management systems. The aim was to resolve how operative informa-tion management of unit’s tender process could be improved by modern information technology applications. This makes it possible that tender processes could be faster and more efficiency. At the beginning it was essential to acquaint oneself with written literature of Business Intelligence. Based on Business Intelligence theory is was relatively easy but challenging to search and discern how tender business could be improved by methods of Busi-ness Intelligence. The empirical phase of this study was executed as qualitative research method. This phase includes theme and natural interviews on the company. Problems and challenges of tender process were clarified in a part an empirical phase. Group of challenges were founded when studying information management of company unit. Based on theory and interviews, group of improvements were listed which company could possible do in the future when developing its operative processes.

Capillary thermal desorption unit for near real-time analysis of VOCs at sub-trace levels. Application to the analysis of environmental air contamination and breath samples

A capillary microtrap thermal desorption module is developed for near real-time analysis of volatile organic compounds (VOCs) at sub-ppbv levels in air samples. The device allows the direct injection of the thermally desorbed VOCs into a chromatographic column. It does not use a second cryotrap to focalize the adsorbed compounds before entering the separation column so reducing the formation of artifacts. The connection of the microtrap to a GC–MS allows the quantitative determination of VOCs in less than 40 min with detection limits of between 5 and 10 pptv (25 °C and 760 mmHg), which correspond to 19–43 ng m−3, using sampling volumes of 775 cm3. The microtrap is applied to the analysis of environmental air contamination in different laboratories of our faculty. The results obtained indicate that most volatile compounds are easily diffused through the air and that they also may contaminate the surrounding areas when the habitual safety precautions (e.g., working under fume hoods) are used during the manipulation of solvents. The application of the microtrap to the analysis of VOCs in breath samples suggest that 2,5-dimethylfuran may be a strong indicator of a person's smoking status

Developing an Improved System for Allocating Support Unit Costs to Business Units

The objective of this study is to develop an improved support unit cost allocation system for a medium-sized technology company, and to examine which options for overhead cost accounting exist. The study begins with presenting the terminology and methods associated with overhead cost accounting and responsibility accounting. Also the most common challenges and resulting benefits of overhead cost allocation system development are brought up. As one research method two case studies were conducted for benchmarking purposes. These external cases are compared with the principal company’s cost allocation system and reflected against the theoretical background. In the empirical section interviews were used as the primary source of information alongside self studying principal company’s old cost allocation method. Interviews revealed the main weaknesses of the old system and proposals for a new one, which were utilized in setting targets for developing the new system. As a result of the development process an improved support unit cost allocation system was realized for year 2009. The new system is able to handle support unit costs in more detail enhancing the transparency and fairness of resulting cost allocations. Parts of support unit costs are now seen as business units’ own costs rather than group-level overhead. Also recommendations for further development are made after analyzing how well the targets were reached.

Real unit labour costs in Eurozone countries: drivers and clusters

We examine the trajectories of the real unit labour costs (RULCs) in a selection of Eurozone economies. Strong asymmetries in the convergence process of the RULCs and its components —real wages, capital intensity, and technology— are uncovered through decomposition and cluster analyses. In the last three decades, the PIIGS (Portugal, Ireland, Italy, Greece, and Spain) succeeded in reducing their RULCs by more than their northern partners. With the exception of Ireland, however, technological progress was weak; it was through capital intensification that periphery economies gained efficiency and competitiveness. Cluster heterogeneity, and lack of robustness in cluster composition, is a reflection of the difficulties in achieving real convergence and, by extension, nominal convergence. We conclude by outlining technology as the key convergence factor, and call for a renewed attention to real convergence indicators to strengthen the process of European integration.

Structural development of the harvester head saw unit

The main goal of the thesis was to further develop harvester head saw device to the Finnish forest machine manufacturer. The work was done from the basis of the manufacturer´s current production model and the earlier study from this same subject called: “Development of chain saw for harvester” Tero Kaatrasalo, 2004. The work was focused to improving the serviceability and reliability of the saw device, but design also included adding few beforehand determined new features into the saw unit. This was done to give some added value for the end customer. The work includes analysis of the earlier saw devices and ideations of the improvements for the structure.