970 resultados para Ventilator weaning - Theses


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En aquest article s’ofereix un perfil del pensament de Rousseau a partir de la seva relació amb la filosofia estoica i la seva dependència respecte de les idees de Montaigne, alhora que es remarca —atenint-se a la Professió de fe del vicari savoià— la dimensió religiosa i espiritual de la seva cosmovisió. Sobre la base d’aquests supòsits es revisa l’impacte de les idees de Rousseau en el Romanticisme del segle xix, sense perdre de vista les crítiques que la seva pedagogia va merèixer dels ideòlegs del Noucentisme (Eugeni d’Ors, Joaquim Xirau). Finalment, es conclou que la presència de la pedagogia de Rousseau en el Moviment de Renovació Pedagògica, viscut durant les primeres dècades del segle xx a Catalunya, constitueix més un horitzó que no pas una realitat bastida sistemàticament i sòlidament.

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Assisting people to commit suicide has generated a passionate public debate. In exceptional situations, access to this support can be granted to the demanders in a hospital environment. So did the CHUV and the academic hospitals of Geneva draw up a procedure permitting, in principle, the access to an assistance to commit suicide. Two recent clinical situations experienced in the CHUV's Service of internal medicine have created a lot of discussions, doubts and revealed, sometimes, divergent positions. By the light of this clinical cases, we wished to share the perspective of the internist in charge of the ethician, of the chaplain, of the medical director, of the psychiatrist and of the palliative care responsible. Theses complex situations illustrate the deep ambivalence felt by the clinicians confronted to situations which require a multidisciplinary approach.

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The Iowa RCU has developed this selected bibliography of Iowa research in Vocational-Technical Education and related areas. Contract research as well as abstracts of masters theses and doctoral dissertations are included. For the most part, these abstracts have been gleaned from research at the three state universities and Drake University.

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This is a supplement to the selected bibliography of Iowa research in Vocational-Technical Education and related areas that the Iowa RCU developed. Contract research as well as abstracts of masters theses and doctoral dissertations are included.

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This is supplement no. 2 to the selected bibliography of Iowa research in Vocational-Technical Education and related areas that the Iowa RCU developed. Contract research as well as abstracts of masters theses and doctoral dissertations are included.

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Open surgery is still the main treatment of complex abdominal aortic aneurysm. Nevertheless, this approach is associated with major complications and high mortality rate. Therefore the fenestrated endograft has been used to treat the juxtarenal aneurysms. Unfortunately, no randomised controlled study is available to assess the efficacy of such devices. Moreover, the costs are still prohibitive to generalise this approach. Alternative treatments such as chimney or sandwich technique are being evaluated in order to avoid theses disadvantages. The aim of this paper is to present the endovascular approach to treat juxtarenal aneurysm and to emphasize that this option should be used only by highly specialized vascular centres.

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Este artículo pretende estudiar la relación entre periodistas y políticos en situacionescríticas. Los autores han analizado la información emitida por las cadenas de televisión:Televisión Española, Antena 3 y Tele 5 en los días 11, 12 y 13 de marzo de 2004, coincidiendocon el atentado de Madrid. De esta investigación, se concluye que los periodistasactuaron con poca capacidad crítica, en connivencia con los políticos, en la propagaciónde determinadas tesis poco o nada argumentadas y de ciertos tópicos y expresionesgratuitas.

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Through the City Energy Management Program, energy managers will directly work with up to 20 municipalities in Iowa to help identify opportunities to reduce energy costs in city-owned buildings, exterior lighting, and water/wastewater facilities. This assistance will be provided to the selected municipalities who will provide an in-kind match to achieve energy efficiency within their community. Power Point of theses resources.

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The objective of this work was to evaluate the effect of insulin alone or in association with equine chorionic gonadotropin (eCG) on the fertility of postpartum beef cows subjected to synchronization. A total of 340 cows was subjected to fixed time artificial insemination. In the trial 1, the cows were subjected to temporary weaning (TW), while in the trial 2 the same protocol was tested without TW. The addition of an insulin injection to a progesterone/eCG-based protocol without TW increased the pregnancy rate of beef cows with body condition score (BCS) equal to or lower than 2.5. Insulin had no effect on cows submitted to TW or with BCS equal to or higher than 3.0.

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The objective of the study was to evaluate the tissue oxygenation and hemodynamic effects of NOS inhibition in clinical severe septic shock. Eight patients with septic shock refractory to volume loading and high level of adrenergic support were prospectively enrolled in the study. Increasing doses of NOS inhibitors [N(G)-nitro-L-arginine-methyl ester (L-NAME) or N(G)-monomethyl-L-arginine (L-NMMA)] were administered as i.v. bolus until a peak effect = 10 mmHg on mean blood pressure was obtained or until side effects occurred. If deemed clinically appropriate, a continuous infusion of L-NAME was instituted and adrenergic support weaning attempted. The bolus administration of NOS inhibitors transiently increased mean blood pressure by 10 mm Hg in all patients. Seven out of eight patients received an L-NAME infusion, associated over 24 h with a progressive decline in cardiac index (P < 0.001) and an increase in systemic vascular resistance (P < 0.01). Partial or total adrenergic support weaning was rapidly possible in 6/8 patients. Oxygen transport decreased (P < 0.001), but oxygen consumption remained unchanged in those patients in whom it could be measured by indirect calorimetry (5/8). Blood lactate and the difference between tonometric gastric and arterial PCO2 remained unchanged. There were 4/8 ICU survivors. We conclude that nitric oxide synthase inhibition in severe septic shock was followed with a progressive correction of the vasoplegic hemodynamic disturbances with finally normalization of cardiac output and systemic vascular resistances without any demonstrable deterioration in tissue oxygenation.

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Type 1 diabetes (T1D) is rarely a component of primary immune dysregulation disorders. We report two cases in which T1D was associated with thrombocytopenia. The first patient, a 13-year-old boy, presented with immune thrombocytopenia (ITP), thyroiditis, and, 3 wk later, T1D. Because of severe thrombocytopenia resistant to immunoglobulins, high-dose steroids, and cyclosporine treatment, anti-cluster of differentiation (CD20) therapy was introduced, with consequent normalization of thrombocytes and weaning off of steroids. Three and 5 months after anti-CD20 therapy, levothyroxin and insulin therapy, respectively, were stopped. Ten months after stopping insulin treatment, normal C-peptide and hemoglobin A1c (HbA1c) levels and markedly reduced anti-glutamic acid decarboxylase (GAD) antibodies were measured. A second anti-CD20 trial for relapse of ITP was initiated 2 yr after the first trial. Anti-GAD antibody levels decreased again, but HbA1c stayed elevated and glucose monitoring showed elevated postprandial glycemia, demanding insulin therapy. To our knowledge, this is the first case in which insulin treatment could be interrupted for 28 months after anti-CD20 treatment. In patient two, thrombocytopenia followed a diagnosis of T1D 6 yr previously. Treatment with anti-CD20 led to normalization of thrombocytes, but no effect on T1D was observed. Concerning the origin of the boys' conditions, several primary immune dysregulation disorders were considered. Thrombocytopenia associated with T1D is unusual and could represent a new entity. The diabetes manifestation in patient one was probably triggered by corticosteroid treatment; regardless, anti-CD20 therapy appeared to be efficacious early in the course of T1D, but not long after the initial diagnosis of T1D, as shown for patient two.

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Everything must be done to prevent and take care of lymphoedema as soon as possible to avoid its progression and its negative impact on patient's psychology and quality of life. The physical limitations and the socio-occupational incidence of lymphoedema must not be neglected. For theses reasons, it is important to promote the education of lymphology and its therapy. Since April 2008, the service of angiology of our university hospital (CHUV) has developed a multidisciplinary consultation for diagnosing and managing oedemas particularly primary and secondary lymphoedemas.

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BACKGROUND: Current bilevel positive-pressure ventilators for home noninvasive ventilation (NIV) provide physicians with software that records items important for patient monitoring, such as compliance, tidal volume (Vt), and leaks. However, to our knowledge, the validity of this information has not yet been independently assessed. METHODS: Testing was done for seven home ventilators on a bench model adapted to simulate NIV and generate unintentional leaks (ie, other than of the mask exhalation valve). Five levels of leaks were simulated using a computer-driven solenoid valve (0-60 L/min) at different levels of inspiratory pressure (15 and 25 cm H(2)O) and at a fixed expiratory pressure (5 cm H(2)O), for a total of 10 conditions. Bench data were compared with results retrieved from ventilator software for leaks and Vt. RESULTS: For assessing leaks, three of the devices tested were highly reliable, with a small bias (0.3-0.9 L/min), narrow limits of agreement (LA), and high correlations (R(2), 0.993-0.997) when comparing ventilator software and bench results; conversely, for four ventilators, bias ranged from -6.0 L/min to -25.9 L/min, exceeding -10 L/min for two devices, with wide LA and lower correlations (R(2), 0.70-0.98). Bias for leaks increased markedly with the importance of leaks in three devices. Vt was underestimated by all devices, and bias (range, 66-236 mL) increased with higher insufflation pressures. Only two devices had a bias < 100 mL, with all testing conditions considered. CONCLUSIONS: Physicians monitoring patients who use home ventilation must be aware of differences in the estimation of leaks and Vt by ventilator software. Also, leaks are reported in different ways according to the device used.

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In recent years, considerable research has focused on the biological effect of endocrine-disrupting chemicals. Bisphenol A (BPA) has been implicated as an endocrine-disrupting chemical (EDC) due to its ability to mimic the action of endogenous estrogenic hormones. The aim of this study was to assess the effect of perinatal exposure to BPA on cerebral structural development and metabolism after birth. BPA (1mg/l) was administered in the drinking water of pregnant dams from day 6 of gestation until pup weaning. At postnatal day 20, in vivo metabolite concentrations in the rat pup hippocampus were measured using high field proton magnetic resonance spectroscopy. Further, brain was assessed histologically for growth, gross morphology, glial and neuronal development and extent of myelination. Localized proton magnetic resonance spectroscopy ((1)H MRS) showed in the BPA-exposed rat a significant increase in glutamate concentration in the hippocampus as well as in the Glu/Asp ratio. Interestingly these two metabolites are metabolically linked together in the malate-aspartate metabolic shuttle. Quantitative histological analysis revealed that the density of NeuN-positive neurons in the hippocampus was decreased in the BPA-treated offspring when compared to controls. Conversely, the density of GFAP-positive astrocytes in the cingulum was increased in BPA-treated offspring. In conclusion, exposure to low-dose BPA during gestation and lactation leads to significant changes in the Glu/Asp ratio in the hippocampus, which may reflect impaired mitochondrial function and also result in neuronal and glial developmental alterations.

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Universities must motivate future professionals so that they are able to apply their experience over and beyond the scientific and technological context. These professionals should also be trained so that they are aware of the current position as regards the economy and limited energy resources, and they must be creative, knowledgeable and committed if they are to rethink the current model.The Departments of Architectural Technology II and Applied Physics, in collaboration with the Interdisciplinary Centre of Technology, Innovation and Education for Sustainability (CITIES), believed that students could be given the opportunity to specialise in the area of sustainable development by means of their final theses [2]. With this objective in mind, a line of theses called Energy Assessments was created as part of the Plan for Resource Consumption Efficiency (PECR). The line was based on a learning strategy that focused on the student.The teaching staff was able to observe that, in terms of cognitive aspects, the students improved their knowledge of environmental issues and the associated skills, and that they were more able to solve problems in the area of sustainability and had greater concerns about this subject matter after having completed their theses.