Can the impact of bed closure in intensive care units be reliably monitored?

OBJECTIVE: To assess the properties of various indicators aimed at monitoring the impact on the activity and patient outcome of a bed closure in a surgical intensive care unit (ICU). DESIGN: Comparison before and after the intervention. SETTING: A surgical ICU at a university hospital. PATIENTS: All patients admitted to the unit over two periods of 10 months. INTERVENTION: Closure of one bed out of 17. MEASUREMENTS AND RESULTS: Activity and outcome indicators in the ICU and the structures upstream from it (emergency department, operative theater, recovery room) and downstream from it (intermediate care units). After the bed closure, the monthly medians of admitted patients and ICU hospital days increased from 107 (interquartile range 94-112) to 113 (106-121, P=0.07) and from 360 (325-443) to 395 (345-436, P=0.48), respectively, along with the linear trend observed in our institution. All indicators of workload, patient severity, and outcome remained stable except for SAPS II score, emergency admissions, and ICU readmissions, which increased not only transiently but also on a mid-term basis (10 months), indicating that the process of patient care delivery was no longer predictable. CONCLUSIONS: Health care systems, including ICUs, are extraordinary flexible, and can adapt to multiple external constraints without altering commonly used activity and outcome indicators. It is therefore necessary to set up multiple indicators to be able to reliably monitor the impact of external interventions and intervene rapidly when the system is no longer under control.

Trace element distribution among rock-forming minerals from metamorphosed to partially molten basic igneous rocks in a contact aureole (Fuerteventura, Canaries)

Low pressure partial melting of basanitic and ankaramitic dykes gave rise to unusual, zebra-like migmatites, in the contact aureole of a layered pyroxenite-gabbro intrusion, in the root zone of an ocean island (Basal Complex, Fuerteventura, Canary Islands). These migmatites are characterised by a dense network of closely spaced, millimetre-wide leucocratic segregations. Their mineralogy consists of plagioclase (An(32-36)), diopside, biotite, oxides (magnetite, ilmenite), +/-amphibole, dominated by plagioclase in the leucosome and diopside in the melanosome. The melanosome is almost completely recrystallised, with the preservation of large, relict igneous diopside phenocrysts in dyke centres. Comparison of whole-rock and mineral major- and trace-element data allowed us to assess the redistribution of elements between different mineral phases and generations during contact metamorphism and partial melting. Dykes within and outside the thermal aureole behaved like closed chemical systems. Nevertheless, Zr, Hf, Y and REEs were internally redistributed, as deduced by comparing the trace element contents of the various diopside generations. Neocrystallised diopside - in the melanosome, leucosome and as epitaxial phenocryst rims - from the migmatite zone, are all enriched in Zr, Hf, Y and REEs compared to relict phenocrysts. This has been assigned to the liberation of trace elements on the breakdown of enriched primary minerals, kaersutite and sphene, on entering the thermal aureole. Major and trace element compositions of minerals in migmatite melanosomes and leucosomes are almost identical, pointing to a syn- or post-solidus reequilibration on the cooling of the migmatite terrain i.e. mineral-melt equilibria were reset to mineral-mineral equilibria. (C) 2007 Elsevier B.V. All rights reserved.

Validation des SCORES cliniques: notions théoriques et pratiques de base. [Validation of clinical scores: theoretical and practical basic notions].

Chaque jour, le médecin utilise dans sa pratique des scores cliniques. Ces scores sont souvent des aides à la décision médicale. Les étapes de validation des scores cliniques sont par contre souvent méconnues du médecin. Cette revue rappelle les bases théoriques de la validation d'un score clinique et propose des exercices pratiques. [Abstract] Physicians are using clinical scores on a regular basis. These scores are generally helpful in making medical decisions. However, the process of validation of clinical scores is often unknown to the physicians. This paper reviews the theory of validation of clinical scores and proposes practical exercises.

Red blood cell-derived microparticles isolated from blood units initiate and propagate thrombin generation.

BACKGROUND: Red blood cell-derived microparticles (RMPs) are small phospholipid vesicles shed from RBCs in blood units, where they accumulate during storage. Because microparticles are bioactive, it could be suggested that RMPs are mediators of posttransfusion complications or, on the contrary, constitute a potential hemostatic agent. STUDY DESIGN AND METHODS: This study was performed to establish the impact on coagulation of RMPs isolated from blood units. Using calibrated automated thrombography, we investigated whether RMPs affect thrombin generation (TG) in plasma. RESULTS: We found that RMPs were not only able to increase TG in plasma in the presence of a low exogenous tissue factor (TF) concentration, but also to initiate TG in plasma in absence of exogenous TF. TG induced by RMPs in the absence of exogenous TF was neither affected by the presence of blocking anti-TF nor by the absence of Factor (F)VII. It was significantly reduced in plasma deficient in FVIII or F IX and abolished in FII-, FV-, FX-, or FXI-deficient plasma. TG was also totally abolished when anti-XI 01A6 was added in the sample. Finally, neither Western blotting, flow cytometry, nor immunogold labeling allowed the detection of traces of TF antigen. In addition, RMPs did not comprise polyphosphate, an important modulator of coagulation. CONCLUSIONS: Taken together, our data show that RMPs have FXI-dependent procoagulant properties and are able to initiate and propagate TG. The anionic surface of RMPs might be the site of FXI-mediated TG amplification and intrinsic tenase and prothrombinase complex assembly.

Transcriptional regulatory patterns of the myelin basic protein and malic enzyme genes by the thyroid hormone receptors alpha1 and beta1.

While there is evidence that the two ubiquitously expressed thyroid hormone (T3) receptors, TRalpha1 and TRbeta1, have distinct functional specificities, the mechanism by which they discriminate potential target genes remains largely unexplained. In this study, we demonstrate that the thyroid hormone response elements (TRE) from the malic enzyme and myelin basic protein genes (METRE and MBPTRE) respectively, are not functionally equivalent. The METRE, which is a direct repeat motif with a 4-base pair gap between the two half-site hexamers binds thyroid hormone receptor as a heterodimer with 9-cis-retinoic acid receptor (RXR) and mediates a high T3-dependent activation in response to TRalpha1 or TRbeta1 in NIH3T3 cells. In contrast, the MBPTRE, which consists of an inverted palindrome formed by two hexamers spaced by 6 base pairs, confers an efficient transactivation by TRbeta1 but a poor transactivation by TRalpha1. While both receptors form heterodimers with RXR on MBPTRE, the poor transactivation by TRalpha1 correlates also with its ability to bind efficiently as a monomer. This monomer, which is only observed with TRalpha1 bound to MBPTRE, interacts neither with N-CoR nor with SRC-1, explaining its functional inefficacy. However, in Xenopus oocytes, in which RXR proteins are not detectable, the transactivation mediated by TRalpha1 and TRbeta1 is equivalent and independent of a RXR supply, raising the question of the identity of the thyroid hormone receptor partner in these cells. Thus, in mammalian cells, the binding characteristics of TRalpha1 to MBPTRE (i.e. high monomer binding efficiency and low transactivation activity) might explain the particular pattern of T3 responsiveness of MBP gene expression during central nervous system development.

Molecular epidemiology of Pseudomonas aeruginosa in intensive care units over a 10-year period (1998-2007).

Pseudomonas aeruginosa is one of the leading nosocomial pathogens in intensive care units (ICUs). The source of this microorganism can be either endogenous or exogenous. The proportion of cases as a result of transmission is still debated, and its elucidation is important for implementing appropriate control measures. To understand the relative importance of exogenous vs. endogenous sources of P. aeruginosa, molecular typing was performed on all available P. aeruginosa isolated from ICU clinical and environmental specimens in 1998, 2000, 2003, 2004 and 2007. Patient samples were classified according to their P. aeruginosa genotypes into three categories: (A) identical to isolate from faucet; (B) identical to at least one other patient sample and not found in faucet; and (C) unique genotype. Cases in categories A and B were considered as possibly exogenous, and cases in category C as possibly endogenous. A mean of 34 cases per 1000 admissions per year were found to be colonized or infected by P. aeruginosa. Higher levels of faucet contamination were correlated with a higher number of cases in category A. The number of cases in category B varied from 1.9 to 20 cases per 1000 admissions. This number exceeded 10/1000 admissions on three occasions and was correlated with an outbreak on one occasion. The number of cases considered as endogenous (category C) was stable and independent of the number of cases in categories A and B. The present study shows that repeated molecular typing can help identify variations in the epidemiology of P. aeruginosa in ICU patients and guide infection control measures.

Automaattisen pakkauskoneen käyttövarmuuden varmentaminen

Työn tavoitteena oli selvittää ja varmistaa uuden pakkauskoneen riittävä käyttövarmuus. Käyttövarmuuden selvittämistä varten tutustuttiin käyttövarmuuden käsitteisiin jatunnuslukuihin, sekä selvitettiin kunnossapidon merkitystä käyttövarmuuteen. Pakkauskoneen käyttövarmuutta analysoitiin vikapuumallin avulla. Analysointia varten laadittu vikapuumalli koostuu 391 perustapahtumasta ja yhteensä 629 tapahtumasta. Käyttövarmuusanalyysi suoritettiin kvalitatiivisesti ja kvantitatiivisesti. Analysointi painottuu kuitenkin kvantitatiiviseen simulointiin. Käyttövarmuusanalysoinnin apuna käytettiin simulointiohjelmaa. Käyttövarmuusvaatimukseksi asetettiin 99 % käytettävyys vuoden käyttöjakson aikana. Vikapuuanalyysin tuloksena saatiin arvio pakkauskoneen kokonaiskäytettävyydestä. Kokonaiskäytettävyydeksi muodostui 96,44 %, joka ei täytä käyttövarmuusvaatimusta. Yksittäisistä komponenttityypeistä epäluotettavimpia olivat liimalaitteiston ja paineilmajärjestelmän komponentit. Analysointityökalun avulla voitiin osoittaa käyttövarmuutta parantavien osatekijöiden vaikutukset saatuun kokonaiskäytettävyyteen. Käyttövarmuuteen voitiin vaikuttaa kunnossapidon avulla, lyhentämällä korjausaikaa ja varmentamalla komponentteja. Esitettyjen keinojen avulla käytettävyyttä on mahdollista nostaa n. 2,18 prosenttiyksikköä. Toimenpidesuositukset esitettiin saatujen tulosten ja työssä havainnoitujen asioiden perusteella. Käytettävyyden parantamiseksi ja varmistamiseksi suositetaan oikeanlaisia kunnossapitotoimenpiteitä, tehokkaan vikadiagnostiikan rakentamista sekä antureiden varmentamista. Käyttökunnonvalvonta suositetaan suoritettavaksi määräaikaistarkastuksina. Käyttökuntoa on aloitettava seuraamaan pidemmällä aikavälillä tapahtuvina häiriöraportointeina. Lisäksi tulevaisuudessa on vaadittava käyttövarmuustakuut toimittajilta laitehankintojen yhteydessä.

Assessing technology-based spin-offs from university support units

This paper takes a regional studies approach to assess spin-offs from a university-based technology transfer network. We first detect the regional objectives, inputs and outputs needed to assess spin-offs from support programmes. We then provide evidence on regional mechanisms for firm creation. We analyse spin-offs created at Catalan universities and find that many efficient spin-offs have formal technology transfer agreements, and emerge from technology-oriented universities. We also find that higher innovation levels and experience from the parent university are associated with higher efficiency, which is positively related to future fundamental profitability. Finally, we propose regional policy making and research directions.

Test automation in Basic Acceptance Testing of S60 platform

Perushyväksymistestaus on oleellinen osa S60 alustan julkaisukandidaatin maturiteetin seurannassa. Perushyväksymistestausta tehdään myös ohjelmiston julkistamiskelpoisuuden varmistamiseksi. Testaustulokset halutaan aina mahdollisimman nopeasti. Lisäksi testaustiimin työmäärä on hiljalleen kasvanut, koska projekteja onenemmän ja korjauksia sisältäviä ja räätälöityjä settejä testataan enemmän. Tässä diplomityössä tutkitaan lyhentäisikö testisetin osan automatisointi testien ajoaikaa ja helpottaisiko se testaajien työtaakkaa. Tarkastelu toteutetaan automatisoimalla osa testisetistä ja kokemuksia esitellään tässä lopputyössä.

Modernisation of bar mill automation

Työn tavoitteena on tankovalssaamon perusautomaation modernisointi Ovako Bar Oy Ab:n Imatran terästehtaalla. Vanha automaatiojärjestelmä on toteutettu 80-luvun puoli-välin tekniikalla käyttämällä Siemens Sicomp MMC 216 moniprosessori-tietokonetta, Siemens Simatic S5 logiikkayksiköitä sekä Siemens Simadyn D DC-käyttöjä. Modernisoinnin tarkoituksena on korvata vanha automaatiojärjestelmä Siemens PCS7 -järjestelmällä siten, että tankovalssaamon automaatiojärjestelmä voidaan liittää osaksi jo aiemmin modernisoituja, nykyisin PCS7 automaatiojärjestelmällä toteutettuja ratkaisu-ja. Valssaamon mekaniikka ei mahdollista tuotannon kasvattamista pelkästään uuden automaatiojärjestelmän avulla, joten modernisointi keskittyy parantamaan järjestelmän luotettavuutta ja helpottamaan ylläpitoa. Projekti päätettiin jakaa kolmeen osaan, jotka voidaan toteuttaa erillisinä osaprojekteina. Tärkein osaprojekti on MMC järjestelmän uusinta. Muut osaprojektit ovat DC-käyttöjen sekä ohjelmoitavien logiikkojen modernisointi. Osaprojektit valittiin siten, että mikä tahansa niistä voidaan toteuttaaerillisenä projektinaan, mikäli kaikkia osia ei voida mo-dernisoida samanaikaisesti budjetin asettamien rajoitusten vuoksi.

El mercat del vi espanyol als Estats Units

L’objecte d’estudi d’aquest projecte final, és el mercat del vi espanyol als Estats Units. Es tracta d’un mercat relativament jove degut a que la cultura del vi per un nord-americà amb una renda mitja es nova. Encara així, els Estats Units es el tercer país amb major consum per volum del món. Per tal de poder entendre millor aquest mercat, s’estudiaran les diferents característiques del país, les regions on es produeix el vi i la seva distribució i els diferents agents que s’impliquen en aquest procés en el país. Un cop analitzat els aspectes econòmics i les característiques més importants d’Estats Units, es realitzarà una anàlisi de l’oferta i de la demanda del sector del vi en aquest país per poder realitzar una comparativa més endavant amb el mercat del vi espanyol i de la perspectiva que es té a Estats Units sobre aquest tipus de vi. Un aspecte molt important que s’ha observat es la dificultat d’accés al mercat del vi a Estats Units. Per això, s’ha dedicat un capítol sencer a analitzar els diferents controls i regulacions que s’han de tenir en compte alhora d’importar vi a aquest país americà. Per últim, es realitza un anàlisi del mercat del vi espanyol i la perspectiva que es té dels vins espanyols a Estats Units. En aquest capítol s’analitzarà sobre tot la producció, el consum i les exportacions espanyoles i s’explicarà amb detall el concepte de denominacions d’origen.