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.

WCDMA HSPA performance counters for monitoring 3G-radio access network

The objective of this project was to gather all the counters which are used on HSPA performance monitoring. The main purpose was to create a compact packet of HSPA performance counters and radio network monitoring which Ericsson's employees can then use in their daily work. The study includes a short introduction to the architecture of the 3G-radio access network. The HSPA technology and HSPA performance are presented including a functional description of performance counters and KPIs, which are used for performance management and monitoring. The theory part of the study also covers an overview of performance management in OSS-RC. The final part of the study covers an overview of the performance management tools, in-troducing how the counters are represented in these interfaces. MOShell and OSS-RC are tools used in this study. Tools were selected because the MOShell is Ericsson's inter-nal management tool and OSS-RC is a tool designed for customers.

Recommendations for the use of multimodal monitoring in the neurointensive care unit.

PURPOSE OF REVIEW: Multimodal monitoring (MMM) is routinely applied in neurointensive care. Unfortunately, there is no robust evidence on which MMM-derived physiologic variables are the most clinically relevant, how and when they should be monitored, and whether MMM impacts outcome. The complexity is even higher because once the data are continuously collected, interpretation and integration of these complex physiologic events into targeted individualized care is still embryonic. RECENT FINDINGS: Recent clinical investigation mainly focused on intracranial pressure, perfusion of the brain, and oxygen availability along with electrophysiology. Moreover, a series of articles reviewing the available evidence on all the MMM tools, giving practical recommendations for bedside MMM, has been published, along with other consensus documents on the role of neuromonitoring and electroencephalography in this setting. SUMMARY: MMM allows comprehensive exploration of the complex pathophysiology of acute brain damage and, depending on the different configuration of the pathological condition we are treating, the application of targeted individualized care. Unfortunately, we still lack robust evidence on how to better integrate MMM-derived information at the bedside to improve patient management. Advanced informatics is promising and may provide us a supportive tool to interpret physiologic events and guide pathophysiological-based therapeutic decisions.

Automated monitoring of medical protocols: a secure and distributed architecture

The control of the right application of medical protocols is a key issue in hospital environments. For the automated monitoring of medical protocols, we need a domain-independent language for their representation and a fully, or semi, autonomous system that understands the protocols and supervises their application. In this paper we describe a specification language and a multi-agent system architecture for monitoring medical protocols. We model medical services in hospital environments as specialized domain agents and interpret a medical protocol as a negotiation process between agents. A medical service can be involved in multiple medical protocols, and so specialized domain agents are independent of negotiation processes and autonomous system agents perform monitoring tasks. We present the detailed architecture of the system agents and of an important domain agent, the database broker agent, that is responsible of obtaining relevant information about the clinical history of patients. We also describe how we tackle the problems of privacy, integrity and authentication during the process of exchanging information between agents.

End-tidal carbon dioxide monitoring using a naso-buccal sensor is not appropriate to monitor capnia during non-invasive ventilation.

BACKGROUND: In acute respiratory failure, arterial blood gas analysis (ABG) is used to diagnose hypercapnia. Once non-invasive ventilation (NIV) is initiated, ABG should at least be repeated within 1 h to assess PaCO2 response to treatment in order to help detect NIV failure. The main aim of this study was to assess whether measuring end-tidal CO2 (EtCO2) with a dedicated naso-buccal sensor during NIV could predict PaCO2 variation and/or PaCO2 absolute values. The additional aim was to assess whether active or passive prolonged expiratory maneuvers could improve the agreement between expiratory CO2 and PaCO2. METHODS: This is a prospective study in adult patients suffering from acute hypercapnic respiratory failure (PaCO2 ≥ 45 mmHg) treated with NIV. EtCO2 and expiratory CO2 values during active and passive expiratory maneuvers were measured using a dedicated naso-buccal sensor and compared to concomitant PaCO2 values. The agreement between two consecutive values of EtCO2 (delta EtCO2) and two consecutive values of PaCO2 (delta PaCO2) and between PaCO2 and concomitant expiratory CO2 values was assessed using the Bland and Altman method adjusted for the effects of repeated measurements. RESULTS: Fifty-four datasets from a population of 11 patients (8 COPD and 3 non-COPD patients), were included in the analysis. PaCO2 values ranged from 39 to 80 mmHg, and EtCO2 from 12 to 68 mmHg. In the observed agreement between delta EtCO2 and deltaPaCO2, bias was -0.3 mmHg, and limits of agreement were -17.8 and 17.2 mmHg. In agreement between PaCO2 and EtCO2, bias was 14.7 mmHg, and limits of agreement were -6.6 and 36.1 mmHg. Adding active and passive expiration maneuvers did not improve PaCO2 prediction. CONCLUSIONS: During NIV delivered for acute hypercapnic respiratory failure, measuring EtCO2 using a dedicating naso-buccal sensor was inaccurate to predict both PaCO2 and PaCO2 variations over time. Active and passive expiration maneuvers did not improve PaCO2 prediction. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01489150.

Data triangulation in the context of opioids monitoring via wastewater analyses.

BACKGROUND: The need to contextualise wastewater-based figures about illicit drug consumption by comparing them with other indicators has been stressed by numerous studies. The objective of the present study was to further investigate the possibility of combining wastewater data to conventional statistics to assess the reliability of the former method and obtain a more balanced picture of illicit drug consumption in the investigated area. METHODS: Wastewater samples were collected between October 2013 and July 2014 in the metropolitan area of Lausanne (226,000 inhabitants), Switzerland. Methadone, its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), the exclusive metabolite of heroin, 6-monoacetylmorphine (6-MAM), and morphine loads were used to estimate the amounts of methadone and heroin consumed. RESULTS: Methadone consumption estimated from EDDP was in agreement with the expectations. Heroin estimates based on 6-MAM loads were inconsistent. Estimates obtained from morphine loads, combined to prescription/sales data, were in agreement with figures derived from syringe distribution data and general population surveys. CONCLUSIONS: The results obtained for methadone allowed assessing the reliability of the selected sampling strategy, supporting its ability to capture the consumption of a small cohort (i.e., 743 patients). Using morphine as marker, in combination with prescription/sales data, estimates in accordance with other indicators about heroin use were obtained. Combining different sources of data allowed strengthening the results and suggested that the different indicators (i.e., administration route, average dosage and number of consumers) contribute to depict a realistic representation of the phenomenon in the investigated area. Heroin consumption was estimated to approximately 13gday(-1) (118gday(-1) at street level).

The Impact of Catechol-O-Methyltransferase and Dopamine D4 Receptor Genotypes on Neurophysiological Markers of Performance Monitoring

Dynamic adaptations of one"s behavior by means of performance monitoring are a central function of the human executive system, that underlies considerable interindividual variation. Converging evidence from electrophysiological and neuroimaging studies in both animals and humans hints atthe importance ofthe dopaminergic system forthe regulation of performance monitoring. Here, we studied the impact of two polymorphisms affecting dopaminergic functioning in the prefrontal cortex [catechol-O-methyltransferase (COMT) Val108/158Met and dopamine D4 receptor (DRD4) single-nucleotide polymorphism (SNP)-521] on neurophysiological correlates of performance monitoring. We applied a modified version of a standard flanker task with an embedded stop-signal task to tap into the different functions involved, particularly error monitoring, conflict detection and inhibitory processes. Participants homozygous for the DRD4 T allele produced an increased error-related negativity after both choice errors and failed inhibitions compared with C-homozygotes. This was associated with pronounced compensatory behavior reflected in higher post-error slowing. No group differences were seen in the incompatibility N2, suggesting distinct effects of the DRD4 polymorphism on error monitoring processes. Additionally, participants homozygous for the COMTVal allele, with a thereby diminished prefrontal dopaminergic level, revealed increased prefrontal processing related to inhibitory functions, reflected in the enhanced stop-signal-related components N2 and P3a. The results extend previous findings from mainly behavioral and neuroimaging data on the relationship between dopaminergic genes and executive functions and present possible underlying mechanisms for the previously suggested association between these dopaminergic polymorphisms and psychiatric disorders as schizophrenia or attention deficit hyperactivity disorder.

ISO standars on test methods for water radioactivity monitoring

Water is vital to humans and each of us needs at least 1.5 L of safe water a day to drink. Beginning as long ago as 1958 the World Health Organization (WHO) has published guidelines to help ensure water is safe to drink. Focused from the start on monitoring radionuclides in water, and continually cooperating with WHO, the International Standardization Organization (ISO) has been publishing standards on radioactivity test methods since 1978. As reliable, comparable and"fit for purpose" results are an essential requirement for any public health decision based on radioactivity measurements, international standards of tested and validated radionuclide test methods are an important tool for production of such measurements. This paper presents the ISO standards already published that could be used as normative references by testing laboratories in charge of radioactivity monitoring of drinking water as well as those currently under drafting and the prospect of standardized fast test methods in response to a nuclear accident.

Venttiilien kunnossapidon optimointi

Tässä työssä tarkastellaan venttiilien kunnossapitoa ja erityisesti niiden kunnonvalvontaa. Työssä on kerrottu perusteita venttiileiden kunnonvalvonnan suorittamiseksi, venttiili- ja toimilaitevikojen perussyistä ja niiden havaitsemisesta. Työn pääpaino on kuitenkin kunnonvalvontamenetelmissä ja niiden käytössä. Mittauksia venttiilivuodon havaitsemiseksi suoritettiin akustisen emission, ultraäänen ja lämpötilan pistemittauksen avulla. Venttiilien yleistä kuntoa määritettiin värähtelyn, venymäliuskojen ja laitoksella jo toimivan moottoritoimilaitteen virtamittauksen avulla. Työssä on annettu suuntaviivat tulosten tulkitsemiselle, mutta yksityiskohtainen ja tarkempi tulosten tulkinnan määrittäminen jätetään laitoksen henkilökunnasta sille henkilölle joka mittauksia tulee tekemään tai jonka työnkuvaan muuten kuuluu kyseisten tulosten tulkitseminen.

Teollisuusyrityksen ekstranet –ratkaisut asiakaspalvelutoiminnan kehittämiseksi

Työssä tarkastellaan sähköisen liiketoiminnan ja asiakaspalvelutoiminnan työvälineenä käytettävän ekstranet–verkon sovellus- ja hyötypotentiaalia teollisuusyrityksissä. Lisäksi selvityksen kohteena ovat ekstranet –palvelu-kanavien strateginen suunnittelu ja kehitys yrityksissä sekä niiden liike-toiminnalliset vaikutukset. Tarkastelun kohteena on esimerkkiyrityksen ekstranet–palvelujärjestelmä ja siinä toimivat sovellukset toiminta-ominaisuuksineen. Lähitarkastelussa on yrityksen yhden ekstranet –moduulin konseptin kehittäminen, joka liittyy uuden sovelluksen pilottikehitys-hankkeeseen, jossa asiakkaalle on tarkoitus tarjota teknistä tukea ns. etädiagnostiikan avulla. Etäseurannan kohteena tässä moduulissa ovat asiakkaan liimausprosessin parametrit, jotka kuvaavat toimittajan liima-aineiden käyttäytymistä asiakkaan prosessissa. Parametritietojen siirtämisen relevanttiutta sekä asiakkaan prosessin problematiikkaa on selvitetty haastattelemalla yrityksen tuotekehityksen ja teknisen asiakaspalvelun avainhenkilöitä. Välittämällä asiakkaan prosessia koskevia tietoja ekstranetiin ja hyväksikäyttämällä niitä päästään merkittäviin molemminpuolisiin tehokkuus- ja kilpailuetuihin sekä kasvavaan asiakasuskollisuuteen. Työn tuloksena on esitetty kehitettävän sovelluksen konsepti, joka voi määritellä ennakkotiedot sitä rakentavalle ASP-toimittajalle sekä toimia vakiomallina sovelluksen käyttökohteita laajennettaessa.