Performance of noninvasive ventilation algorithms on ICU ventilators during pressure support: a clinical study.

To evaluate the impact of noninvasive ventilation (NIV) algorithms available on intensive care unit ventilators on the incidence of patient-ventilator asynchrony in patients receiving NIV for acute respiratory failure. Prospective multicenter randomized cross-over study. Intensive care units in three university hospitals. Patients consecutively admitted to the ICU and treated by NIV with an ICU ventilator were included. Airway pressure, flow and surface diaphragmatic electromyography were recorded continuously during two 30-min periods, with the NIV (NIV+) or without the NIV algorithm (NIV0). Asynchrony events, the asynchrony index (AI) and a specific asynchrony index influenced by leaks (AIleaks) were determined from tracing analysis. Sixty-five patients were included. With and without the NIV algorithm, respectively, auto-triggering was present in 14 (22%) and 10 (15%) patients, ineffective breaths in 15 (23%) and 5 (8%) (p = 0.004), late cycling in 11 (17%) and 5 (8%) (p = 0.003), premature cycling in 22 (34%) and 21 (32%), and double triggering in 3 (5%) and 6 (9%). The mean number of asynchronies influenced by leaks was significantly reduced by the NIV algorithm (p < 0.05). A significant correlation was found between the magnitude of leaks and AIleaks when the NIV algorithm was not activated (p = 0.03). The global AI remained unchanged, mainly because on some ventilators with the NIV algorithm premature cycling occurs. In acute respiratory failure, NIV algorithms provided by ICU ventilators can reduce the incidence of asynchronies because of leaks, thus confirming bench test results, but some of these algorithms can generate premature cycling.

Breeding objectives for a Nellore cattle rearing system

Abstract:The objective of this work was to define the traits that should be included as breeding objectives for Nellore cattle, according to simulations with a bio-economic model for rearing systems. The economic values (EVs) of the traits were calculated as the differences between the profits due to an increased performance of 1% in each trait, with the others traits remaining constant. To determine the impact of each selection on the revenue system, two scenarios were simulated based on the traits being selected. In the first scenario, the adopted selection criteria were: weaning weight (WW), weaning rate (WR), yearling weight (YW), and mature cow weight (MCW). In the second scenario, the cumulative productivity (CP) of dams was used as an indirect evaluation of the performance of calves, with all the other traits included, except WW. In the first scenario, an EV of R$ 1.44 kg-1 was obtained for WW. In the second scenario, an EV of R$ 2.91 kg-1 was obtained for CP. The trait with the highest EV in both scenarios was WR, which enhanced the profits by R$ 3.21 for each 1% increased performance. The meat price paid to the producer is the factor with the greatest impact on the EVs of all examined traits.

Moniensiöinen muuntaja taajuudenmuuttajakäytössä

Suuritehoisissa pumppu- ja puhallinkäytöissä käytetään usein suurnopeusmoottoria,jota syötetään välijännitteellä. Suurjännitetaajuudenmuuttajat ovat kalliita, eikä niitä ole aina edes mahdollista valmistaa. Tutkimuksen kohteena on rinnakkaisilla pienjännitetaajuudenmuuttajilla toteutettu sähkökäyttö, jossa pienjännite nostetaan moniensiöisellä muuntajalla suurjännitteeksi (6,6 kV) ja syötetään edelleen kuormana olevalle suurnopeusmoottorille. Opinnäytetyössä tutkitaan moniensiöisen muuntajan syöttöä rinnakkaisilla taajuudenmuuttajilla sekä niiden aiheuttamia häiriöitä toisilleen. Työssä tutkitaan myös harmonisten yliaaltojen vaikutuksia muuntajan häviöihin ja magnetointiominaisuuksiin. Taajuudenmuuttajan lähtöjännite ja -virta suodatetaan sinisuotimella, jonka parametreja simuloidaan Simulink- ohjelmistolla. Tavoite on löytää optimaaliset parametrit taajuudenmuuttajanlähtösuotimelle käyrämuotojen ja suotimeen jäävän tehon suhteen. Työssä tarkasteltiin sinisuodinta, johon jää 3 prosenttia syöttöjännitteestä. LC-suodin kompensoi sähkökäytön loistehon lähes kokonaan, joten taajuudenmuuttajien antotehon kannalta suotimet ovat perusteltuja. Taajuudenmuuttajan näennäisteho putoaa 22 prosenttia, joten taajuudenmuuttajat voidaan vastaavasti mitoittaa pienemmiksi.

Paediatric bi-ventricular external assist device based on artificial muscles

Objective: Existing VADs are single-ventricle pumps needing anticoagulation. We developed a bi ventricular external assist device that reproduces the physiological heart muscle movement completely avoiding anticoagulants. Methods: The device has a carbon fibre skeleton fitting a 30-40 kg patient's heart, to which a Nitinol based artificial muscle is connected. The artificial muscle wraps both ventricles. The strength of the Nitinol fibres is amplified by a pivot articulation in contact with the ventricle wall. The fibres are electrically driven and a dedicated control unit has been developed. We assessed hemodynamic performances of this device using a previously described dedicated bench test. Volume ejected and pressure gradient has been measured with afterload ranging from 25 to 50mmHg. Results: With anafterload of 50mmHg the system has an ejection fraction (EF) of 10% on the right side and 8% on the left side. The system is able to generate a systolic ejection of 5,5 ml on the right side and 4,4 ml on the left side. With anafterload of 25mmHg the results are reduced of about 20%. The activation frequency is 80/minute resulting in a total volume displacement of 440 ml/minute on the right side and 352 ml/minute on the left side. Conclusions: The artificial muscle follows Starling's law as the ejected volume increases when afterload increases. These preliminary studies confirmed the possibility of improving the EF of a failing heart using artificial muscle for external cardiac compression. This device could be helpful in weaning CPB and/or for short-term cardio-circulatory support in paediatric population with cardiac failure.

Narration und Diagrammatik. Eine Vorüberlegung und sieben Thesen

[Narrative and the Diagrammatic. Preliminary Thoughts and Seven Theses.] This article proposes a view of narrative that does not depend on the traditional perspective of temporal sequence but emphasizes the spatial structure of literary narrative. Contrary to the prevalent treatment of space in narrative theory, the notion of spatiality in this context refers not to the space that is represented by the narrative (e.g. the setting and other spatial elements of the fictional world) but to the space that represents it: first, the graphic surface of the text; second, the (quasi-)spatial mental representation of its content that is produced in the process of reception. It is argued that these conditions form the primary ontological mode of narrative, whereas the temporal development of a story is an aesthetic illusion that has been specifically stimulated by the narrative conventions of approximately the past three centuries and must thus be considered a secondary effect. The diagrammatic, as a way of both depicting data and perceiving relations through spatial representation, thus forms a more adequate methodological approach to understanding narrative structure than approaches that are implicitly derived from the 'grammar' of narrative in the structuralist sense and its sequential logic.

Amoebal pathogens as emerging causal agents of pneumonia.

Despite using modern microbiological diagnostic approaches, the aetiological agents of pneumonia remain unidentified in about 50% of cases. Some bacteria that grow poorly or not at all in axenic media used in routine clinical bacteriology laboratory but which can develop inside amoebae may be the agents of these lower respiratory tract infections (RTIs) of unexplained aetiology. Such amoebae-resisting bacteria, which coevolved with amoebae to resist their microbicidal machinery, may have developed virulence traits that help them survive within human macrophages, i.e. the first line of innate immune defence in the lung. We review here the current evidence for the emerging pathogenic role of various amoebae-resisting microorganisms as agents of RTIs in humans. Specifically, we discuss the emerging pathogenic roles of Legionella-like amoebal pathogens, novel Chlamydiae (Parachlamydia acanthamoebae, Simkania negevensis), waterborne mycobacteria and Bradyrhizobiaceae (Bosea and Afipia spp.).

Web Presence Building and Performance Measuring in Business-to-Business Markets

Tutkimuksen tavoite oli selvittää yrityksen web toiminnan rakentamisen vaiheita sekä menestyksen mittaamista. Rakennusprosessia tutkittiin viisiportaisen askelmallin avulla. Mallin askeleet ovat; arviointi, strategian muotoilu, suunnitelma, pohjapiirros ja toteutus. Arviointi- ja toteutusvaiheiden täydentämiseksi sekä erityisesti myös internet toiminnan onnistumisen mittaamisen avuksi internet toiminnan hyödyt (CRM,kommunikointi-, myynti-, ja jakelukanava hyödyt markkinoinnin kannalta) käsiteltiin. Toiminnan menestyksen arvioinnin avuksi esiteltiin myös porrasmalli internet toimintaan. Porrasmalli määrittelee kauppakulissi-, dynaaminen-, transaktio- ja e-businessportaat. Tutkimuksessa löydettiin menestystekijöitä internet toimintojen menestykselle. Nämä tekijät ovat laadukas sisältö, kiinnostavuus, viihdyttävyys, informatiivisuus, ajankohtaisuus, personoitavuus, luottamus, interaktiivisuus, käytettävyys, kätevyys, lojaalisuus, suoriutuminen, responssiivisuus ja käyttäjätiedon kerääminen. Mittarit jaettiin tutkimuksessa aktiivisuus-, käyttäytymis- ja muunnosmittareihin. Lisäksi muita mittareita ja menestysindikaattoreita esiteltiin. Nämä menestyksen elementit ja mittarit koottiin yhteen uudessa internet toimintojen menestyksenarviointimallissa. Tutkielman empiirisessä osuudessa,esitettyjä teorioita peilattiin ABB:n (ABB:n sisällä erityisesti ABB Stotz-Kontakt) web toimintaan. Apuna olivat dokumenttianalyysi sekä haastattelut. Empiirinen osa havainnollisti teoriat käytännössä ja toi ilmi mahdollisuuden teorioiden laajentamiseen. Internet toimintojen rakentamismallia voidaan käyttää myös web toimintojen kehittämiseen ja porrasmalli sopii myös nykyisten internet toimintojen arvioimiseen. Mittareiden soveltaminen käytännössä toi kuitenkin ilmi tarpeen niiden kehittämiseen ja aiheen lisätutkimukseen. Niiden tulisi olla myös aiempaatiiviimmin liitetty kokonaisvaltaisen liiketoiminnan menestyksen mittaamiseen.

Impact des maladies rhumatismales sur la population âgée en Suisse et sa consommation de soins

Les maladies rhumatismales sont fréquemment observées chez les personnes âgées et ont un impact considérable sur la qualité de vie des personnes en souffrant. Peu d'études suisses sur la situation épidémiologique et sur l'impact de ce type de maladies sur la consommation des services de santé existent. Cette thèse a pour but d'étudier les connaissances actuelles à partir de la littérature suisse et étrangère et d'établir un bilan en Suisse au moyen d'une enquête de population effectuée en 1997. Une revue systématique de littérature a été effectuée. En dépit d'une grande variété des approches méthodologiques rendant délicates les comparaisons géographiques et temporelles, la prévalence des maladies rhumatismales chez les personnes de 65 ans et plus semble être homogène entre pays et stable temporellement. particulièrement dès 1980. Celle-ci est élevée et augmente rapidement avec le très grand âge. De plus, les femmes sont plus fréquemment atteintes que les hommes. Notre revue montre que le recours aux soins ambulatoires (médecins, chiropraticiens, traitements ambulatoires des hôpitaux) lié aux maladies rhumatismales est important. L'impact de ces maladies sur les hospitalisations est, par contre, moins clairement établi. Les nouvelles générations de personnes en souffrant semblent avoir plus recours aux services de santé que les précédentes. Ces maladies sont aussi à l'origine d'une forte consommation d'anti-inflammatoires non-stéroïdiens avec comme conséquence une multitude de complications. En dépit de son efficacité et de son utilité, le recours à l'arthroplastie est sous- utilisé. Notre analyse se base sur une enquête réalisée auprès d'un échantillon représentatif des individus âgés de 15 ans et plus résidant de manière permanente en Suisse en 1997 : la prévalence des maladies rhumatismales en Suisse s'élève à 41 % chez les personnes âgées de 65 ans et plus, dont 48 % chez les femmes et 31 % chez les hommes. Ces prévalences sont inférieures à celles relevées dans la littérature probablement en raison de notre définition relativement restrictive des maladies rhumatismales. Ces dernières augmentent de 50 % le nombre attendu de consultations chez un médecin ou un chiropraticien et de 30 % le nombre attendu d'hospitalisations. Les personnes souffrantes ont. en outre, une probabilité de recours aux services de Soins à domicile 1,7 fois plus élevé que les autres. Aucun impact sur le nombre de traitements ambulatoires en milieu hospitalier n'a été trouvé. Nos résultats sont comparables à ceux relevés dans la littérature internationale et suisse, sauf pour les traitements ambulatoires des hôpitaux. En 1990, sur les 983'400 personnes de 65 ans et plus (recensement fédéral de la population de 1990), 403'200 personnes souffraient de maladies rhumatismales. Quelque 5'334'900 consultations chez un médecin ou un chiropraticien, 4'959'300 consultations chez un médecin et 216'800 hospitalisations étaient imputables aux personnes de 65 ans et plus toutes causes de consultations confondues, dont 1'008'000 consultations chez un médecin/chiropraticien, 927'300 chez un médecin et 98'500 hospitalisations imputables aux maladies rhumatismales. Selon ie scénario (( tendance )) des projections démographiques publiées par l'Office Fédéral de la Statistique. d'ici 2040, le nombre de personnes souffrant de maladies rhumatismales en Suisse risque d'augmenter de 80 % (en supposant que la prévalence reste stable), affectant 726'500 sur 1'772'000 personnes de 65 ans et plus. Cette augmentation est la conséquence de l'accroissement prévu de la population de 65 ans et plus dans la population générale. Le nombre global de consultatiordhospitalisations risque d'augmenter dans les mêmes proportions si le recours aux services de santé reste stable. En effet. en 2040, quelque 9'613'100 consultations chez un médecinichiropraticien, 8'936'200 consultations chez un médecin et 390'700 hospitalisations pourraient être imputables aux personnes de 65 ans et plus. dont 1'8 16'300 consultations chez un médecin/chiropraticien, 1'67 1'000 consultations chez un médecin et 1 90'600 hospitalisations en raison de maladies rhumatismales. Une légère diminution du nombre de personnes atteintes de maladies rhumatismales. ainsi que du recours aux services de santé engendré par ces maladies. est attendue dès 3040. Le nombre de personnes souffrant de maladies rhumatismales et le nombre de consultations/ hospitalisations associées risquant d'augmenter de façon considérable, il est nécessaire de freiner cette progression. Des mesures préventives primaires, secondaires ou tertiaires peuvent diminuer la prévalence des maladies rhumatismales et l'impact de celles-ci sur la consommation des services de santé.<br/><br/>Rheumatic diseases are frequently observed in elderly people and have an important impact on tlieir life qurlity. There are fe1.v Swiss stuciies on the epiciemio!ogica! situttien and on the impact of such diseases on the use of health services. This thesis aims at studying the current knowledge based on Swiss and international literature and at establishing the situation in Switzerland from a population survey conducted in 1997. A systeinatic literature review lias been carried out. Despite a large range of methods making a comparisoii diffcult, the prevalence of rheumatic diseases seems to be homogeneous in different countries and stable. especially since 1980. It is high and increases rapidly with age. Furthermore, \niorneil suffer more frequently thaii men. Our review shows that the use of ambulatory care linked to rheumatic diseases is important. On the contrary, the impact of such diseases on hospitalization is less clearly established. New generations seem to consult more. Rheumatic diseases are also at the origin of a strong consumptioii of non-steroidal anti- inflammatory drugs \vitIl potential severe consequences. Despite its effectiveness and efficiency, arthroplasty is underused. Our analysis is based 011 a survey of Swiss permanent residents aged 15 or more in 1997. Based on Our analysis, the prevalence of rheumatic diseases in Switzerland is 41 % for elderly people (48 96 for women and 31 % for men). Theses prevalences are smaller than those found in the literature because of our relatively strict definition of rheumatic diseases. The latter diseases increase of about 50 o/o the expected number of consultations (chiropractor included or not) and of about 30 960 the expected number of hospitalizations. The affected persons have a probability of home care use 1.7 times higlier than the others. No impact on the number of outpatient care provided by hospitals has been found. Our results are comparable to those found in the international and Swiss literature, except for hospital outpatient care. In 1990, of 983,400 perçons aged 65 and older, 403,200 persons suffered from rheumatic diseases. 5,334,900 consultations by a physician or a chiropractor, 4,959,300 consultations by a physician and 2 16,800 hospitalizations were attributed to the elderly whatever, the reason of consultation, of which 1,008,000 consultations by a physicianlchiropractor, 927,300 by a physician, and 98,500 hospitalizations are due to rheumatic diseases. According to the "tendance" scenario of demographic projections published by the Swiss Federal Office of Statistics, until 2040 the number of persons suffering from rheumatic diseases will increase of 80 % if the prevalence stays stable, affecting 736,500 of 1,772,000 perçons of 65 and older. This increase is due to the increase of the percentage of persons 65 and older in the population. The global number of consultationshospitalizations will increase similarly if the use of health services stays stable. In 2040, 9,613,l 00 consultations by a physiciaidchiropractor, 8,936,200 Consultations by a physician and 390,700 hospitalizations could be attributed to the persons aged 65 and older, of which 1,816,300 consultations by a physician, 1,671,000 consultations by a physician/chiropractor and 109,600 hospitalizations will be due to the rheumatic diseases. However a small decrease of the number of affected perçons and of the subsequent use of health services is expected after 2040. The number of affected elderly people and the volume of conçultations/hospitalizations are expected to increase and it ir necessx-y to slow down this progression. Preventive interventions, primary, secondary or tertiary, can decrease the prevalence of rheumatic diseases and the impaci on the consumption of health services.

Compact thermal storage: a-state-of-the-art review of experimental results

Thermal energy storage (TES) can increase the thermal energy effieresa, of a process by reusing the waste heat from industrial process, solar energy or other sources. There are different ways to store thermal energy: by sensible heat, by latest heat, by sorption process or by chemical reaction. This thesrs provides a-state-of-the-art review of the experimental performance of TES systems based on solid gas sorption process and chemical reactions. The importance of theses processes is that provides a heat loss free storage system with a high energy density.

The effect of age at the first mating and herd size on the lifetime productivity of sows

The effect of age at the first mating and herd size were evaluated in the reference Spanish Databank (BDporc) of 37 698 sows born between 1991 and 1995 and with individual lifetime records. The data included dates of births at entrance and culling, first mating, repetitive mating and conception, first farrowing and weaning records. Individual records were validated before the analysis by screening them through a tolerance “filter” in order to eliminate the extreme values from the analysis. The total database of the sows was classified in 7 classes according to age at the first mating (< 210, 210–220, 221–230, 231–240, 241–250, 251–270, and > 270 days) and in 6 classes of herd size (< 200, 200–300, 301–400, 401–600, 601–800, and > 800 sows). The total number of litters and number of weaned piglets obtained from each sow during the lifetime production were significantly (P < 0.05) greater for gilts between 221 and 240 d of age at the first mating. There was a significant (P < 0.001) effect of the herd size on the reproductive performance of the sow, and the best performance was obtained with herds with 401 to 600 sows compared to < 200 or > 800 sow-herds. Furthermore, a significant (P < 0.001) interaction between age at the first mating and herd size was detected and can be associated with a particular pattern for the herd size class 401–600 sows with the best performances obtained for the sows first mated at less than 200 days. For the other herd sizes, the results indicated that sows mated for the first time at the right age, 221–240 days, are more productive, both in the number and size of the parities throughout lifetime production.

Selection response of growth rate in rabbits for meat production

Genetic and environmental trends in 2 lines of rabbit (B and R) selected on individual weight gain (WG) from weaning (4 wk) to slaughter (11 wk) were estimated using mixed model methodology. Line B was derived from the California breed and line R was a synthetic of stock of different origin. The data were collected from a single herd and comprised 7 718 individuals in line B and 9 391 in line R, the lines having 12 and 9 generations of selection respectively. Realized responses in the 2 lines were 2.7% and 2.2% of the initial mean per year respectively and showed that selection on WG was effective but was less than expected. Selection on slaughter weight (SW) and effects of selection on other economic traits are discussed. It is concluded that selection on either WG or SW is a simple method for improving growth rate in rabbit sire line stocks.

Estimación de los efectos del manejo reproductivo y su influencia en la selección del tamaño de la camada en porcino

Con datos procedentes de poblaciones de campo (37.920 partos porducidos en granjas de selección y 95.240 partos producidos en granjas de producción) se ha analizado la influencia de la edad al primer parto, de la duración de la lactación, de la duración del intervalo destete-cubrición fértil y del tipo de cubrición fértil sobre el número de lechones nacidos vivos por parto (NV). Además, utilizando datos simulados se ha evaluado el interés de considerar estos factores de manejo en el modelo de evaluación genética para NV. Los factores de manejo analizados influyen de forma significativa (P < 0,05) sobre NV, en magnitud y sentido similar en las poblaciones de selección y de producción. Mediante simulación se comprueba que omitir la influencia de los factores de manejo anteriores en el modelo de evaluación genética no interfiere en la respuesta a la selección, aunque puede conducir a la obtención de predictores sesgados del valor genético.

Relación entre el nivel de grasa e ingestión y la excreción urinaria de nitrógeno y energía, en gazapos en crecimiento-cebo

Se determinó la excreción urinaria de nitrógeno (NU, %) y de energía (EU, kcal/100g), en la última semana de vida, de 36 conejos alimentados, desde el destete (a los 28 d) hasta el sacrificio a los dos meses de edad, con tres piensos conteniendo 0, 3 y 6 % de grasa añadida (G0, G3 y G6); y administrados a dos niveles de ingestión: ad libitum (IL) y restringido (IR) al 70 % de IL. El NU y la EU estuvieron influidos positivamente tanto por el nivel de ingestión (P<0,001) como por el % de grasa ingerida (P<0,05). En estos resultados puede estar involucrado el metabolismo tan elevado de las lipoproteínas transportadoras de lípidos, implicadas en el metabolismo de las grasas, ya sean de origen alimentario o de la lipogénesis de novo. La relación entre la EU y el NU aporta valores muy superiores a los que podría corresponder a las materias orgánicas nitrogenadas, por lo que se podría pensar, como posible causa, en la intervención de materia orgánica no nitrogenada. Asimismo, la cuantificación de la EM del pienso se ve afectada por el incremento del valor calórico de la orina, con el nivel de ingestión y/o el 6 % de grasa añadida. Con ello se evidencia la desigualdad entre ED y EM de la grasa en las raciones que las incluya. Asimismo, el hecho de que la movilización grasa —bien sea de origen alimentario o de la lipogénesis— altere la excreción nitrogenada y/o energética a través de la orina, pone de manifiesto la importancia de su consideración, especialmente cuando dicha pérdida puede afectar a los rendimientos de algunas producciones animales.

Monitoring of brain and systemic oxygenation in neurocritical care patients.

Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.

Tandem-GMA Welding of Low Alloy Structural Steel

The Tandem-GMAW method is the latest development as the consequences of improvements in the welding methods. The twin-wire and then the Tandem-method with the separate power sources has got a remarkable place in the welding of many types of materials with different joint types. The biggest advantage of Tandem welding method is the flexibility of choosing both the electrodes of different types from each other according to the type of the parent material. This is possible because of the feasibility of setting the separate welding parameters for both the wires. In this thesis work the effect of the variation in three parameters on the weld bead in Tandem-GMA welding method is studied. Theses three parameters are the wire feed rate in the slave wire, the wire feed rate in the master wire and the voltage difference in both the wires. The results are then compared to study the behaviour of the weld bead with the change in these parameters.