Hemodialysis for cefepime intoxication: A case report

Introduction: We report a case of cefepime intoxication with acute severe neurologic symptoms, which was treated by temporary hemodialysis. Patients (or Materials) and Methods: Cefepime 2 g BID for endovascular prosthesis infection was prescribed to a frail, chronically ill 88-year-old woman with a serum creatinine of 199 μmol/L and an estimated creatinine clearance of 13 mL/min (Cockroft formula). Two days later, she was transferred to a neurocritical care unit because of acute aphasia, myoclonic jerks, and delirium with a Glasgow coma scale score of 12/15. The following day, in the absence of other causes, cefepime intoxication was hypothesized, and cefepime was withdrawn after a total of 7 doses = 14 g. Over the next 24 hours, two 3-hour hemodialysis (HD) sessions were performed under cefepime concentration monitoring. Results: Cefepime plasma levels were measured by liquid chromatography/ mass spectrometry. There is no validated reference range, but a study (Chapuis T et al, Critical Care, 2010) found a 50% risk of neurotoxicity with residual levels > 15 mg/L. In our patient, levels were 83.3 mg/L 10 hours after last dose, 24.1 mg/L immediately after the first HD session, 13.4 mg/L immediately before the second HD session, and 2.5 mg/L immediately after the second HD session. The patient made a full clinical recovery over the next 48 hours. The 70% to 80% fall in plasmatic levels observed during each HD session is in accordance with literature data (Schmaldienst S et al, Eur J Clin Pharmacol, 2000, and Manyor LM et al, Pharmacotherapy, 2008). According to kinetic simulation, cefepime dropped at a concentration < 15 mg/L 15 hours earlier with HD than it would have without. Conclusion: Neuropsychiatric adverse effects of beta-lactam antibiotics can be easily overlooked by clinicians. One should be especially cautious with their use in very old and frail patients in whom plasma creatinine poorly estimates renal function and cognitive impairment is highly prevalent. Temporary hemodialysis effectively clears cefepime, but its role in hastening clinical recovery may be limited.

2000 Transportation Scholars Conference: Compendium of Papers, 2000

Compendium of papers presented at the Transportation Scholars Conference in 2000.

Northern Landscapes : ʻʻImplementation of the European Landscape Convention In the North Calotte Area Municipalitiesʼʼ - Conference in Inari, Finland 7-9.9.2011

The conference promoting the objectives of the international European Landscape Convention (ELC) was held on 7-9 September 2011 in Inari. The primary aim of the conference was to increase awareness of the ELC and the prospects and requirements it brings to practical planning work, especially at the municipal level. The conference speakers included top experts from Sweden, Norway, Finland, France, Holland and Catalonia. This report is a collection of articles written by the experts in the ELC conference. The report is available in five languages: Finnish, Swedish, Norwegian, Northern Sámi and English. The common characteristics of the North Calotte area, such as the magnificent riverside scenery and the beautiful fell landscapes formed by the Sámi culture and reindeer management are broadly reflected in the environment. Alongside the traditional forms of land use, many other livelihoods and forms of land use now need to be accommodated in the area. Tourism, energy production, mining industry and new infrastructure create new and manifold challenges to the authorities in charge of land use in these areas. Municipalities need information and support for versatile planning in the future, so that the unique and valuable characteristics of the North can be preserved. Landscape protection and management in the landscape areas is executed through areal and land use planning, mainly through town planning and the creation of landscape management plans. The municipalities in the North Calotte region have their own partly divergent methods and practices, based on the various land use processes are executed. The municipalities and inhabitants have a great interest in preserving and protecting their living environment and maintaining and increasing the appeal of the area. Landscape is viewed as one of the most significant appealing factors that cannot be lost. The increasing land use in municipalities, for example due to energy production, mining industry and increasing tourism, create a need for more multidimensional planning. The reconciliation of the wishes of different interest groups, and traditional and new livelihoods will not be easy. Conflict is inevitable. This will lead to a greater need to engage local bodies to the planning processes right from the start of the projects. Close cooperation between different administrative branches, operators, local bodies and landscape research promote the objectives of the convention. To ensure that the work continues, a landscape co-operation group is planned to be established in the North Calotte area. It´s main task is to promote and develop landscape policy in the area.

Poster presentation as a report of a self-designed laboratory experiment : a case study

Julkaisumaa: 203 CZ CZE Tšekki

The Future of the Clean Development Mechanism. Note on the report “A Call to Action” of the High-Level Panel on CDM Policy Dialogue. CEPS Special Report No. 71, 20 November 2012

The clean development mechanism (CDM) has been through a long and complex growing process since it was approved as part of the Kyoto Protocol. It was designed within the framework of the UNFCCC and the Kyoto Protocol, and reflected the political and economic realities of that time. To ensure its continued effectiveness in contributing to future global climate action and to reflect on how best to position the CDM to respond to future challenges, a high-level panel (HLP) was formed at the Durban climate change conference in 2011. Following extensive consultations, the panel published its report in September 2012. Through this Special Report, the CEPS Carbon Market Forum offers its reflections on findings and recommendations of the HLP, as well as, by extension, its own views on the future of the CDM. In the context of the latter, it explores the following questions: Is there a need for an instrument such as the CDM in the future? What ‘demand’ can it fill? In the roles identified under the first question, what can be done to adapt it and also continue to increase its efficacy?

Progress report on longitudinal and cross-sectional study of carbon disclosure strategies: evidence from UK listed companies

Global warming has attracted attention from all over the world and led to the concern about carbon emission. Kyoto Protocol, as the first major international regulatory emission trading scheme, was introduced in 1997 and outlined the strategies for reducing carbon emission (Ratnatunga et al., 2011). As the increased interest in carbon reduction the Protocol came into force in 2005, currently there are already 191 nations ratifying the Protocol(UNFCCC, 2012). Under the cap-and-trade schemes, each company has its carbon emission target. When company’s carbon emission exceeds the target the company will either face fines or buy emission allowance from other companies. Thus unlike most of the other social and environmental issues carbon emission could trigger cost for companies in introducing low-emission equipment and systems and also emission allowance cost when they emit more than their targets. Despite the importance of carbon emission to companies, carbon emission reporting is still operating under unregulated environment and companies are only required to disclose when it is material either in value or in substances (Miller, 2005, Deegan and Rankin, 1997). Even though there is still an increase in the volume of carbon emission disclosures in company’s financial reports and stand-alone social and environmental reports to show their concern of the environment and also their social responsibility (Peters and Romi, 2009), the motivations behind corporate carbon emission disclosures and whether carbon disclosures have impact on corporate environmental reputation and financial performance have not yet to explore. The problems with carbon emission lie on both the financial side and non-financial side of corporate governance. On one hand corporate needs to spend money in reducing carbon emission or paying penalties when they emit more than allowed. On the other hand as the public are more interested in environmental issues than before carbon emission could also impact on the image of corporate regarding to its environmental performance. The importance of carbon emission issue are beginning to be recognized by companies from different industries as one of the critical issues in supply chain management (Lee, 2011) and 80% of companies analysed are facing carbon risks resulting from emissions in the companies’ supply chain as shown in a study conducted by the Investor Responsibility Research Centre Institute for Corporate Responsibility (IRRCI) and over 80% of the companies analysed found that the majority of greenhouse gas (GHG) emission are from electricity and other direct suppliers (Trucost, 2009). The review of extant literature shows the increased importance of carbon emission issues and the gap in the study of carbon reporting and disclosures and also the study which links corporate environmental reputation and corporate financial performance with carbon reporting (Lohmann, 2009a, Ratnatunga and Balachandran, 2009, Bebbington and Larrinaga-Gonzalez, 2008). This study would focus on investigating the current status of UK carbon emission disclosures, the determinant factors of corporate carbon disclosure, and the relationship between carbon emission disclosures and corporate environmental reputation and financial performance of UK listed companies from 2004-2012 and explore the explanatory power of classical disclosure theories.

Rapport från 20th European Photovoltaic Solar Energy Conference and Exhibition : Barcelona 6-10 juni 2005

På uppdrag av STEM bevakade Eva Lindberg från Centrum för solenergi-forskning, SERC, Högskolan Dalarna, 20th European Photovoltaic Solar Energy Conference and Exhibition, Barcelona, 6-10 juni 2005. Ca 1700 personer fanns på deltagarlistan. På grund av konferensen omfattning kan endast ett litet urval av föredrag och utställare kommenteras i rapporten. Konferensprogrammet var indelat på följande områden:1. Grundläggande fakta, nya komponenter och material2. Kristallina kiselsolceller and materialteknologi3. Amorft och mikrokristallint kisel4. CIS, CdTe och andra (II-VI) ternära tunnfilmsceller5. PV-moduler och komponenter i PV-system6. PV-system i nätanslutna applikationer7. Globala aspekter på PV-solelektricitet8. PV-industrins resultatFoU om kristallina solceller dominerade stort, sedan tunnfilmsceller av främst amorft kisel. Intressant var att återvinning är föremål för FoU; dels återvinning av kiselsolceller när panelen tjänat ut; dels återvinning av Cu, Cd, Se och Te när tunnfilmscellerna tas ur bruk.237 företag fanns representerade i utställningen, varav 20 från Kina. Tyskland dominerade stort. Utställningen teman var följande: 1) Tillverkare av kiselplattor, solceller, PV-moduler, koncentratorer, solföljare (se bild nedan) 2) Tillverkare och återförsäljare av utrustning och material 3) Integrering och distribution av system 4) Mätningar och kontrollteknologi 5) Forskning och laboratorier 6) Service, teknik, konsulting 7) Myndigheter och föreningar 8) Media och förlag 9) Tillverkare av inverterare 10) Övrigt.

Distance teacher education – some experiences from Dalarna University, SwedenPaper presented at the 33rd Annual ATEE Conference Brussels, Belgium, 23rd – 27th August 2008

Distance teaching is now-a-days used in different shapes. However, it is something different from traditional campus organised education as it systematically uses Information Communication Technology (ICT) as a key element. When the distance teacher education started in Sweden many teacher educators doubted the wisdom of this. They expressed that the educational process to become a teacher would be deteriorated. For instance, they feared for high drop out rates and difficulties to examine in a proper way. The Swedish National Agency for Higher Education has recently edited a report that showed that this form of teacher education was well adapted to the labour market, but the possibilities for the teacher students to shape their education were relatively limited. However, we still know quite little about the effects of this way to educate teacher students. This paper explores the possibility of using distance teacher education.In a case study 20 students, who were the first to finish a complete a distance teacher education at Högskolan Dalarna, were asked in a questionnaire how they had apprehended their education. We also interviewed four of these students, as well as five teacher educators.One of our findings were that the distance teacher education reached new target groups, who not had been able to participate in university studies if it not had been offered in this form. Especially, this was valid for the middle-aged women, living a long distance away from a university, with social responsibilities for children or old parents. Other findings were that these students in general were target oriented and ambitious, wrote more than the campus students and developed that kind of skill better. Marratech, an ICT system for small groups, e-mail and chat were used for the communication. Marratech was considered to permit free and spontaneous communication, both of the teacher educators and the students. Initially the teacher educators were sceptical to distance teacher education, but afterwards they were surprised of how well it had worked. They declared that they had better and nearer contact with their students and more control over the students´ performance, but some parts of the teacher education were better suitable for campus education, for example, power of creating characters. Distance teacher education was considered time consuming and demanded much activity from the teacher educators as the students wanted rapid responses. This study indicates that distance teacher education works well for mature individuals with high motivation. However, it demands more time from the teacher educators, but it gives in general good results. Still, there are pedagogical challenges to overcome. Maybe we should reflect on a mix of distance teacher education and campus based teacher education, instead of separated ways of accomplishing teacher education?