City of Goose Lake, June 30, 2003

City Audit Report

Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study.

BACKGROUND: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AIMS: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. METHODS: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. RESULTS: The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). CONCLUSIONS: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.

Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM.

OBJECTIVES: Recommendations for EEG monitoring in the ICU are lacking. The Neurointensive Care Section of the ESICM assembled a multidisciplinary group to establish consensus recommendations on the use of EEG in the ICU. METHODS: A systematic review was performed and 42 studies were included. Data were extracted using the PICO approach, including: (a) population, i.e. ICU patients with at least one of the following: traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, stroke, coma after cardiac arrest, septic and metabolic encephalopathy, encephalitis, and status epilepticus; (b) intervention, i.e. EEG monitoring of at least 30 min duration; (c) control, i.e. intermittent vs. continuous EEG, as no studies compared patients with a specific clinical condition, with and without EEG monitoring; (d) outcome endpoints, i.e. seizure detection, ischemia detection, and prognostication. After selection, evidence was classified and recommendations developed using the GRADE system. RECOMMENDATIONS: The panel recommends EEG in generalized convulsive status epilepticus and to rule out nonconvulsive seizures in brain-injured patients and in comatose ICU patients without primary brain injury who have unexplained and persistent altered consciousness. We suggest EEG to detect ischemia in comatose patients with subarachnoid hemorrhage and to improve prognostication of coma after cardiac arrest. We recommend continuous over intermittent EEG for refractory status epilepticus and suggest it for patients with status epilepticus and suspected ongoing seizures and for comatose patients with unexplained and persistent altered consciousness. CONCLUSIONS: EEG monitoring is an important diagnostic tool for specific indications. Further data are necessary to understand its potential for ischemia assessment and coma prognostication.

A combined ear sensor for pulse oximetry and carbon dioxide tension monitoring: accuracy in critically ill children.

IMPLICATIONS: A new combined ear sensor was tested for accuracy in 20 critically ill children. It provides noninvasive and continuous monitoring of arterial oxygen saturation, arterial carbon dioxide tension, and pulse rate. The sensor proved to be clinically accurate in the tested range.

City of Spirit Lake, Auditor of State's Report on Reaudit, For the Period, July 1, 2001 through June 30, 2003

City Audit Report - Reaudit

City of Carter Lake, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings, June 30, 2004

City Audit Report

Sediment penetration depths of epi- and infaunal ostracods from Lake Geneva (Switzerland)

Many (palaeo-)environmental parameters can be deduced from ecological and chemical analyses of ostracods. However, the specific ecology of each taxon has a great impact on its reaction to changing environmental conditions. As a consequence, each taxon records these changes differently. The mean penetration depth (MPD) and relative individual abundances have been documented along sediment depth profiles for the dominant sub-littoral to profundal species of ostracods in western Lake Geneva, Switzerland, and this data can be used to estimate their preferential habitat in terms of sediment depths. Isocypris beauchampi, Limnocytherina sanctipatricii, Cypria ophtalmica forma lacustris at 13-m water depths, Limnocythere inopinata, and a winter generation of Herpetocypris reptans have the shallowest habitat preferences at the study sites (MPDs of 0.45, 0.48, 0.49, 0.60, and 0.81 cm, respectively). These results suggest that these populations may be regarded as being preferentially epifaunal forms. Populations of Cytherissa lacustris (MPDs of 0.61, 0.73, and 0.82 cm at 13-, 33-, and 70-m water depths, respectively), Cypria ophtalmica forma lacustris at 70 m (MPD = 0.96 cm), Fabaeformiscandona caudata (MPD = 0.99 cm), and a summer generation of Herpetocypris reptans (MPD = 1.03 cm) were identified as being infaunal. Candona neglecta is the species that was found the deepest in the sediment of Lake Geneva, with MPDs of 0.65, 1.22, and 1.30 cm at 13-, 33-, and 70-m water depths, respectively. Information on the sediment texture and oxygen concentrations inferred from the analyses of sediment pore water suggest that the oxygen content of the sediment pore water is not the only dominant parameter controlling the differences in ostracod sediment penetration depths observed among the different sites, but that they might also be influenced by the sediment 'softness,' which itself depends on grain size, water content, and the abundance of organic matter in sediment.

Evaluation of bedbath in critically ill patients: impact of water temperature on the pulse oximetry variation

This is a participant study, quasi-experimental, of a before and after type. A quantitative approach of biophysiological measures was used, represented by the saturation of oxygen measured by pulse oximeter (SpO2), and recorded on three occasions: before, during and after the bedbath in critically ill patients hospitalized at the ICU of a University Hospital in Brazil. Objective: to compare the SpO2 in various stages of the bath, with and without control of water temperature. Data collection was performed between December 2007 and April 2008 on a convenience sample consisting of 30 patients aged over 18 who had classification in TISS-28 from level II. Results show that water temperature control means a lower variation of SpO2 (p<0.05). No marked differences in variation of saturation between men and women or between age groups were established. In conclusion, heated and constant water temperature during the bedbath is able to minimize the fall of SpO2 that occurs while handling patients during procedures.

City of Goose Lake, Capitalization Grants for Drinking Water, State Revolving Funds, Independent Auditor's Reports, Schedule of Expenditures of Federal Awards, Schedule of Findings and Questioned Costs, Year Ended June 30, 2005

City Audit Report

City of Carter Lake, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings, June 30, 2005

City Audit Report

How does the body-scale model affect back-calculated growth: the example of arctic charr Salvelinus alpinus (L.) of Lake Geneva (Switzerland)

When back-calculating fish length from scale measurements, the choice of the body-scale relationship is a fundamental step. Using data from the arctic charrSalvelinus alpinus (L.) of Lake Geneva (Switzerland) we show the need for a curvilinear model, on both statistical and biological grounds. From several 2-parameters models, the log-linear relationship appears to provide the best fit. A 3-parameters, Bertalanffy model did not improve the fit. We show moreover that using the proportional model would lead to important misinterpretations of the data.