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.

Analyzing and Computing the Sustainability Gains of Building Automation

Smart home implementation in residential buildings promises to optimize energy usage and save significant amount of energy simply due to a better understanding of user's energy usage profile. Apart from the energy optimisation prospects of this technology, it also aims to guarantee occupants significant amount of comfort and remote control over home appliances both at home locations and at remote places. However, smart home investment just like any other kind of investment requires an adequate measurement and justification of the economic gains it could proffer before its realization. These economic gains could differ for different occupants due to their inherent behaviours and tendencies. Thus it is pertinent to investigate the various behaviours and tendencies of occupants in different domain of interests and to measure the value of the energy savings accrued by smart home implementations in these domains of interest in order to justify such economic gains. This thesis investigates two domains of interests (the rented apartment and owned apartment) for primarily two behavioural tendencies (Finland and Germany) obtained from observation and corroborated by conducted interviews to measure the payback time and Return on Investment (ROI) of their smart home implementations. Also, similar measures are obtained for identified Australian use case. The research finding reveals that building automation for the Finnish behavioural tendencies seems to proffers a better ROI and payback time for smart home implementations.

Power Consumption Measurement and Scenario Based Energy Model in Wearable Computing Applications

The power is still today an issue in wearable computing applications. The aim of the present paper is to raise awareness of the power consumption of wearable computing devices in specific scenarios to be able in the future to design energy efficient wireless sensors for context recognition in wearable computing applications. The approach is based on a hardware study. The objective of this paper is to analyze and compare the total power consumption of three representative wearable computing devices in realistic scenarios such as Display, Speaker, Camera and microphone, Transfer by Wi-Fi, Monitoring outdoor physical activity and Pedometer. A scenario based energy model is also developed. The Samsung Galaxy Nexus I9250 smartphone, the Vuzix M100 Smart Glasses and the SimValley Smartwatch AW-420.RX are the three devices representative of their form factors. The power consumption is measured using PowerTutor, an android energy profiler application with logging option and using unknown parameters so it is adjusted with the USB meter. The result shows that the screen size is the main parameter influencing the power consumption. The power consumption for an identical scenario varies depending on the wearable devices meaning that others components, parameters or processes might impact on the power consumption and further study is needed to explain these variations. This paper also shows that different inputs (touchscreen is more efficient than buttons controls) and outputs (speaker sensor is more efficient than display sensor) impact the energy consumption in different way. This paper gives recommendations to reduce the energy consumption in healthcare wearable computing application using the energy model.

Cloud computing contribution to manufacturing industry

Manufacturing industry has been always facing challenge to improve the production efficiency, product quality, innovation ability and struggling to adopt cost-effective manufacturing system. In recent years cloud computing is emerging as one of the major enablers for the manufacturing industry. Combining the emerged cloud computing and other advanced manufacturing technologies such as Internet of Things, service-oriented architecture (SOA), networked manufacturing (NM) and manufacturing grid (MGrid), with existing manufacturing models and enterprise information technologies, a new paradigm called cloud manufacturing is proposed by the recent literature. This study presents concepts and ideas of cloud computing and cloud manufacturing. The concept, architecture, core enabling technologies, and typical characteristics of cloud manufacturing are discussed, as well as the difference and relationship between cloud computing and cloud manufacturing. The research is based on mixed qualitative and quantitative methods, and a case study. The case is a prototype of cloud manufacturing solution, which is software platform cooperated by ATR Soft Oy and SW Company China office. This study tries to understand the practical impacts and challenges that are derived from cloud manufacturing. The main conclusion of this study is that cloud manufacturing is an approach to achieve the transformation from traditional production-oriented manufacturing to next generation service-oriented manufacturing. Many manufacturing enterprises are already using a form of cloud computing in their existing network infrastructure to increase flexibility of its supply chain, reduce resources consumption, the study finds out the shift from cloud computing to cloud manufacturing is feasible. Meanwhile, the study points out the related theory, methodology and application of cloud manufacturing system are far from maturity, it is still an open field where many new technologies need to be studied.

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.

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.

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

1940/03.