Comparison of calibrated and uncalibrated arterial pressure-based cardiac output monitors during orthotopic liver transplantation

Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI(L)) and the FloTrac-Vigileo monitor (CI(V)). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI(TD)). CI(V)-CI(TD) bias ranged from -1.38 (95% confidence interval = -2.02 to -0.75 L/minute/m(2), P = 0.02) to -2.51 L/minute/m(2) (95% confidence interval = -3.36 to -1.65 L/minute/m(2), P < 0.001), and CI(L)-CI(TD) bias ranged from -0.65 (95% confidence interval = -1.29 to -0.01 L/minute/m(2), P = 0.047) to -1.48 L/minute/m(2) (95% confidence interval = -2.37 to -0.60 L/minute/m(2), P < 0.01). For both APCOs, bias to CI(TD) was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI(TD) was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI(TD). In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation.

Secondary collisions revisited: real-world crash data and relationship to crash test criteria

Objectives: Previous research conducted in the late 1980s suggested that vehicle impacts following an initial barrier collision increase severe occupant injury risk. Now over 25years old, the data are no longer representative of the currently installed barriers or the present US vehicle fleet. The purpose of this study is to provide a present-day assessment of secondary collisions and to determine if current full-scale barrier crash testing criteria provide an indication of secondary collision risk for real-world barrier crashes. Methods: To characterize secondary collisions, 1,363 (596,331 weighted) real-world barrier midsection impacts selected from 13years (1997-2009) of in-depth crash data available through the National Automotive Sampling System (NASS) / Crashworthiness Data System (CDS) were analyzed. Scene diagram and available scene photographs were used to determine roadside and barrier specific variables unavailable in NASS/CDS. Binary logistic regression models were developed for second event occurrence and resulting driver injury. To investigate current secondary collision crash test criteria, 24 full-scale crash test reports were obtained for common non-proprietary US barriers, and the risk of secondary collisions was determined using recommended evaluation criteria from National Cooperative Highway Research Program (NCHRP) Report 350. Results: Secondary collisions were found to occur in approximately two thirds of crashes where a barrier is the first object struck. Barrier lateral stiffness, post-impact vehicle trajectory, vehicle type, and pre-impact tracking conditions were found to be statistically significant contributors to secondary event occurrence. The presence of a second event was found to increase the likelihood of a serious driver injury by a factor of 7 compared to cases with no second event present. The NCHRP Report 350 exit angle criterion was found to underestimate the risk of secondary collisions in real-world barrier crashes. Conclusions: Consistent with previous research, collisions following a barrier impact are not an infrequent event and substantially increase driver injury risk. The results suggest that using exit-angle based crash test criteria alone to assess secondary collision risk is not sufficient to predict second collision occurrence for real-world barrier crashes.

The Little Metropolis: Religion, Politics, & Spolia

There have been numerous councils throughout the Catholic Church?s history. From the First Council of Nicaea in 325 CE to Vatican II in 1962, only a few centuries have passed without any major church doctrinal change. Following hand in hand with changes in doctrine came the bifurcation of the Christian Church into the Roman CatholicChurch and the Orthodox Church. The first split came in 325 CE with Arianism. Arius of Alexandria and his followers did not agree with the Catholic Church?s viewpoint that the son, Jesus, should be on equal footing with the Father and the Holy Spirit. Constantine the Great brought the Arianism debate to the First Council of Nicaea,which declared Arianism a heretical religion. The following Catholic council?s decisions separated the two Churches even more, eventually creating the formal separation of the Church during the East-West Schism in the middle of the 11th century. Although the twoChurches constantly tried to unite, the Churches hit speed bumps along the way. Eventually, the 1274 Second Council of Lyons officially united the two Churches, even if only for an ephemeral time. At first glance, it might not seem that much resulted from the 1274 Second Council of Lyons. Almost immediately after the council?s ruling, the two Churches split again. Little is known as to why the 1274 Second Council of Lyons ultimately failed in its unification attempt. In this thesis, I will examine the churches of the Little Metropolis at Athens, Merbaka in the Argolid, and Agioi Theodoroi in Athens. In detailing the architectural features of these buildings, I will reconstruct the church building program in association with the 1274 Second Council of Lyons. I will also compare these churchesusing historical sources to keep the sociological, religious, political, and historical context accurate.

Secondary Collisions Revisited: Real-World Crash Characteristics and Relationship to Crash Test Criteria

Previous research conducted in the late 1980’s suggested that vehicle impacts following an initial barrier collision increase severe occupant injury risk. Now over twenty-five years old, the data used in the previous research is no longer representative of the currently installed barriers or US vehicle fleet. The purpose of this study is to provide a present-day assessment of secondary collisions and to determine if full-scale barrier crash testing criteria provide an indication of secondary collision risk for real-world barrier crashes. The analysis included 1,383 (596,331 weighted) real-world barrier midsection impacts selected from thirteen years (1997-2009) of in-depth crash data available through the National Automotive Sampling System (NASS) / Crashworthiness Data System (CDS). For each suitable case, the scene diagram and available scene photographs were used to determine roadside and barrier specific variables not available in NASS/CDS. Binary logistic regression models were developed for second event occurrence and resulting driver injury. Barrier lateral stiffness, post-impact vehicle trajectory, vehicle type, and pre-impact tracking conditions were found to be statistically significant contributors toward secondary event occurrence. The presence of a second event was found to increase the likelihood of a serious driver injury by a factor of seven compared to cases with no second event present. Twenty-four full-scale crash test reports were obtained for common non-proprietary US barriers, and the risk of secondary collisions was determined using recommended evaluation criteria from NCHRP Report 350. It was found that the NCHRP Report 350 exit angle criterion alone was not sufficient to predict second collision occurrence for real-world barrier crashes.

Slovak Policy, 1956-1960

The project looked at crucial political events in Slovakia between 1956 and 1960. 1956 saw the first attempt by Slovak intellectuals to reform the communist regime by increasing the degree of democracy and 1960 was the culmination of the strengthening of the political persecution that began after 1957. The period was characterised by the partial replacement of the informal-political instruments of control over society by formal measures, and the gradual weakening of the role of terror in people's daily life. Marusiak studied the gradual accommodation of the communist regime by the people, analysing the social and political history against the background of political development and of specific aspects such as the conflict of youth and intellectuals with the regime, the collectivisation of agriculture and the liquidation of the rest of the private sector in the economy, public opinion and the changes in the political system, the relations between state and churches, and ethnic problems in Czechoslovakia. He concludes that there was a continuity between the aims and methods used by the communist regime before and after 1953 (or 1956) and that the communist regime in this period remained fundamentally totalitarian.

Opportunities for Local Development in Jiului Valley"

This was an exploratory study that aimed to gain a rough understanding of the possible ways of implementing community development. The study was carried out between October 1998 and August 1999 in Lupeni, in the Jiu Valley, which is a mining area facing major decline following the government's decision to restructure the mining industry. Against a background of the history of sociology and its insights into the development of the community concept and its theoretical, methodological and practical significance, an analysis was carried out on four levels relevant to the community development approach: social participation, citizens' level of dependency on the state, and membership and the sense of belonging to the local and national community. A needs analysis approach using questionnaires, in-depth interviews and the Delphi approach took into consideration all those actors who could play important roles in local development: local authorities, representatives of local organisations (schools, trade unions, local associations, churches), and local residents.

Hydrologic monitoring of an integrated low impact development (LID) underdrained stormwater management system

In 2005, Wetland Studies and Solutions, Inc. (WSSI) installed an extensive Low Impact Development (LID) stormwater management system on their new office site in Gainesville, Virginia. The 4-acre site is serviced by a network of LID components: permeable pavements (two proprietary and one gravel type), bioretention cell / rain garden, green roof, vegetated swale, rainwater harvesting and drip irrigation, and slow-release underground detention. The site consists of heavy clay soils, and the LID components are mostly integrated by a series of underdrain pipes. A comprehensive monitoring system has been designed and installed to measure hydrologic performance throughout the LID, underdrained network. The monitoring system measures flows into and out of each LID component independently while concurrently monitoring rainfall events. A sensitivity analysis and laboratory calibration has been performed on the flow measurement system. Field data has been evaluated to determine the hydrologic performance of the LID features. Finally, hydrologic models amenable to compact, underdrained LID sites have been reviewed and recommended for future modeling and design.

Simple virtual reality display of fetal volume ultrasound

Three-dimensional (3D) ultrasound volume acquisition, analysis and display of fetal structures have enhanced their visualization and greatly improved the general understanding of their anatomy and pathology. The dynamic display of volume data generally depends on proprietary software, usually supplied with the ultrasound system, and on the operator's ability to maneuver the dataset digitally. We have used relatively simple tools and an established storage, display and manipulation format to generate non-linear virtual reality object movies of prenatal images (including moving sequences and 3D-rendered views) that can be navigated easily and interactively on any current computer. This approach permits a viewing or learning experience that is superior to watching a linear movie passively.

A STUDY ON THE FEASIBILITY OF UNIVERSAL CHIP CONTROL IN MACHINING

A novel solution to the long standing issue of chip entanglement and breakage in metal cutting is presented in this dissertation. Through this work, an attempt is made to achieve universal chip control in machining by using chip guidance and subsequent breakage by backward bending (tensile loading of the chip's rough top surface) to effectively control long continuous chips into small segments. One big limitation of using chip breaker geometries in disposable carbide inserts is that the application range is limited to a narrow band depending on cutting conditions. Even within a recommended operating range, chip breakers do not function effectively as designed due to the inherent variations of the cutting process. Moreover, for a particular process, matching the chip breaker geometry with the right cutting conditions to achieve effective chip control is a very iterative process. The existence of a large variety of proprietary chip breaker designs further exacerbates the problem of easily implementing a robust and comprehensive chip control technique. To address the need for a robust and universal chip control technique, a new method is proposed in this work. By using a single tool top form geometry coupled with a tooling system for inducing chip breaking by backward bending, the proposed method achieves comprehensive chip control over a wide range of cutting conditions. A geometry based model is developed to predict a variable edge inclination angle that guides the chip flow to a predetermined target location. Chip kinematics for the new tool geometry is examined via photographic evidence from experimental cutting trials. Both qualitative and quantitative methods are used to characterize the chip kinematics. Results from the chip characterization studies indicate that the chip flow and final form show a remarkable consistency across multiple levels of workpiece and tool configurations as well as cutting conditions. A new tooling system is then designed to comprehensively break the chip by backward bending. Test results with the new tooling system prove that by utilizing the chip guidance and backward bending mechanism, long continuous chips can be more consistently broken into smaller segments that are generally deemed acceptable or good chips. It is found that the proposed tool can be applied effectively over a wider range of cutting conditions than present chip breakers thus taking possibly the first step towards achieving universal chip control in machining.

Resource-allocation capabilities of commercial project management software. An experimental analysis

When project managers determine schedules for resource-constrained projects, they commonly use commercial project management software packages. Which resource-allocation methods are implemented in these packages is proprietary information. The resource-allocation problem is in general computationally difficult to solve to optimality. Hence, the question arises if and how various project management software packages differ in quality with respect to their resource-allocation capabilities. None of the few existing papers on this subject uses a sizeable data set and recent versions of common software packages. We experimentally analyze the resource-allocation capabilities of Acos Plus.1, AdeptTracker Professional, CS Project Professional, Microsoft Office Project 2007, Primavera P6, Sciforma PS8, and Turbo Project Professional. Our analysis is based on 1560 instances of the precedence- and resource-constrained project scheduling problem RCPSP. The experiment shows that using the resource-allocation feature of these packages may lead to a project duration increase of almost 115% above the best known feasible schedule. The increase gets larger with increasing resource scarcity and with increasing number of activities. We investigate the impact of different complexity scenarios and priority rules on the project duration obtained by the software packages. We provide a decision table to support managers in selecting a software package and a priority rule.

The Impact of Western Social Workers in Romania - a Fine Line between Empowerment and Disempowerment

Ideally the social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance their well-being (IFSW 2004). The social work practice, however, often proves to be different. Social workers are always in the danger to make decisions for their clients or define problems according to their own interpretation and world view. In quite a number of cases, the consequence of such a social work practice is that the clients feel disempowered rather than empowered. This dilemma is multiplying when western social workers get involved in developing countries. The potential that intervention, with the intention to empower and liberate the people, turns into disempowerment is tremendously higher because of the differences in tradition, culture and society, on the one side and the power imbalance between the ‘West’ and the ‘Rest’ on the other side. Especially in developing countries, where the vast majority of people live in poverty, many Western social workers come with a lot of sympathy and the idea to help the poor and to change the world. An example is Romania. After the collapse of communism in 1989, Romania was an economically, politically and socially devastated country. The pictures of the orphanages shocked the western world. As a result many Non-Governmental Organisations (NGOs), churches and individuals were bringing humanitarian goods to Romania in order to alleviate the misery of the Romanian people and especially the children. Since then, important changes in all areas of life have occurred, mostly with foreign financial aid and support. At the political level, democratic institutions were established, a liberal market economy was launched and laws were adapted to western standards regarding the accession into the European Union and the NATO. The western world has left its marks also at the grassroots level in form of NGOs or social service agencies established through western grants and individuals. Above and beyond, the presence of western goods and investment in Romania is omnipresent. This reflects a newly-gained freedom and prosperity - Romania profits certainly from these changes. But this is only one side of the medal, as the effect of westernisation contradicts with the Romanian reality and overruns many deep-rooted traditions, thus the majority of people. Moreover, only a small percentage of the population has access to this western world. Western concepts, procedures or interpretations are often highly differing from the Romanian tradition, history and culture. Nevertheless, western ideas seem to dominate the transition in many areas of daily life in Romania. A closer look reveals that many changes take place due to pressure of western governments and are conditioned to financial support. The dialectic relationship between the need for foreign aid and the implementation becomes very obvious in Romania and often leads, despite the substantial benefits, to unpredictable and rather negative side-effects, at a political, social, cultural, ecological and/or economic level. This reality is a huge dilemma for all those involved, as there is a fine line between empowering and disempowering action. It is beyond the scope of this journal to discuss the dilemma posed by Western involvement at all levels; therefore this article focuses on the impact of Western social workers in Romania. The first part consists of a short introduction to social work in Romania, followed by the discussion about the dilemma posed by the structure of project of international social work and the organisation of private social service agencies. Thirdly the experiences of Romanian staff with Western social workers are presented and then discussed with regard to turning disempowering tendencies of Western social workers into empowerment.

Street Children and Mobile Youth Work in Africa - the 8th ISMO Symposium October 2003

The International Society for Mobile Youth Work (ISMO) and the National Council of Churches in Kenya (NCCK) organised from the 27th to 30th October 2003 at the Jumuia Conference and Country Home in Limuru/Kenya with 198 participants from 35 countries around the world the 8th International Symposium on Mobile Youth Work with special focus on children at risk (street children and youth) in Africa. For this purpose there were invited field workers, scientists and stakeholders engaged as advocates for the rights and well being of endangered children and youths. The participants came mainly from African countries and of course especially from Kenya, but also from Asia, Latin America and from Europe.

Fortbildung online: Entwicklung, Erprobung und Evaluation eines tutoriell betreuten Online-Selbstlernangebots für Lehrkräfte

The quality of schools mainly depends on the competence of teachers. Further professional development courses as third and longest period of teacher training play an essential role in maintaining professional skills. In almost every federal state teaching personnel are required to take part in further training courses. A range of courses offered by the State, the churches, and by independent institutions are available.

DiepRuR

Aufbau einer föderativen Dienstlandschaft in der Ruhr-Region auf Basis von SAML mit dem Ziel eine organisationsübergreifende Nutzung von webbasierten IT-Diensten zu ermöglichen