Variación de volumen sistólico como predictor de hipovolemia en pacientes pediátricos con choque séptico

El compromiso del sistema cardiovascular es frecuente en los pacientes en estado crítico, por tanto la monitorización hemodinámica es esencial para un tratamiento apropiado dirigido a objetivos terapéuticos en este grupo de pacientes. La monitorización hemodinámica del gasto cardíaco y la estimación del volumen intravascular son fundamentales para el manejo de los pacientes pediátricos en estado crítico, la medición del gasto cardíaco es uno de los principales elementos para evaluar la situación hemodinámica y la perfusión tisular de un paciente ayudando a dirigir el tratamiento y a monitorizar la respuesta clínica en pacientes con choque séptico. La hipovolemia es una causa común para la falla circulatoria en pacientes en condición crítica, el encontrar un método confiable para medición de precarga es importante para guiar la administración de líquidos. Tradicionalmente se han utilizado medidas de la volemia asociadas como la presión venosa central (PVC), frecuencia cardiaca (FC), presión arterial (PA) y el gasto urinario. Estos indicadores tienen grandes factores de distracción que hacen que su valor sea limitado y por tanto se tengan que buscar alternativas más confiables. En años recientes se han postulado parámetros dinámicos para la evaluación de la precarga, entre ellos uno de los mas ampliamente estudiado es la medición de la variabilidad de Volumen sistólico (VVS); Este valor se basa en el concepto de que durante la inspiración, la disminución del retorno venoso produce una disminución del Volumen sistólico, lo cual se manifiesta como una disminución en la onda de pulso; Por tanto en una situación de hipovolemia esta diferencia será mayor, dado que será más evidente la disminución del volumen al final de la diástole. En adultos este parámetro se ha convertido en una herramienta útil para evaluar estado de volumen de los pacientes que se encuentran en estado crítico y ha demostrado su utilidad para predecir respuesta a administración de fluidos en diferentes poblaciones de pacientes. En la actualidad no hay estudios en niños que comparen la medición de VVS contra dichas medidas tradicionales de volemia.

Developing a desertification indicator system for a small Mediterranean catchment: a case study from the Serra de Rodes, Alt Empordà, Catalunya, NE Spain

La desertificació és un problema de degradació de sòls de gran importància en regions àrides, semi-àrides i sub-humides, amb serioses conseqüències ambientals, socials i econòmiques com a resultat de l'impacte d'activitats humanes en combinació amb condicions físiques i medi ambientals desfavorables (UNEP, 1994). L'objectiu principal d'aquesta tesi va ser el desenvolupament d'una metodologia simple per tal de poder avaluar de forma precisa l'estat i l'evolució de la desertificació a escala local, a través de la creació d'un model anomenat sistema d'indicators de desertificació (DIS). En aquest mateix context, un dels dos objectius específics d'aquesta recerca es va centrar en l'estudi dels factors més importants de degradació de sòls a escala de parcel.la, comportant un extens treball de camp, analisi de laboratori i la corresponent interpretació i discussió dels resultats obtinguts. El segon objectiu específic es va basar en el desenvolupament i aplicació del DIS. L'àrea d'estudi seleccionada va ser la conca de la Serra de Rodes, un ambient típic Mediterràni inclòs en el Parc Natural del Cap de Creus, NE Espanya, el qual ha estat progressivament abandonat pels agricultors durant el segle passat. Actualment, els incendis forestals així com el canvi d'ús del sòl i especialment l'abandonament de terres són considerats els problemes ambientals més importants a l'àrea d'estudi (Dunjó et al., 2003). En primer lloc, es va realitzar l'estudi dels processos i causes de la degradació dels sòls a l'àrea d'interés. En base a aquest coneixement, es va dur a terme la identificació i selecció dels indicadors de desertificació més rellevants. Finalment, els indicadors de desertificació seleccionats a escala de conca, incloent l'erosió del sòl i l'escolament superficial, es van integrar en un model espaial de procés. Ja que el sòl és considerat el principal indicador dels processos d'erosió, segons la FAO/UNEP/UNESCO (1979), tant el paisatge original així com els dos escenaris d'ús del sòl desenvolupats, un centrat en el cas hipotétic del pas d'un incendi forestal, i l'altre un paisatge completament cultivat, poden ser ambients classificats sota baixa o moderada degradació. En comparació amb l'escenari original, els dos escenaris creats van revelar uns valors més elevats d'erosió i escolament superficial, i en particular l'escenari cultivat. Per tant, aquests dos hipotètic escenaris no semblen ser una alternativa sostenible vàlida als processos de degradació que es donen a l'àrea d'estudi. No obstant, un ampli ventall d'escenaris alternatius poden ser desenvolupats amb el DIS, tinguent en compte les polítiques d'especial interés per la regió de manera que puguin contribuir a determinar les conseqüències potencials de desertificació derivades d'aquestes polítiques aplicades en aquest escenari tan complexe espaialment. En conclusió, el model desenvolupat sembla ser un sistema força acurat per la identificació de riscs presents i futurs, així com per programar efectivament mesures per combatre la desertificació a escala de conca. No obstant, aquesta primera versió del model presenta varies limitacions i la necessitat de realitzar més recerca en cas de voler desenvolupar una versió futura i millor del DIS.

Monitoring present day changes in water vapour and the radiative energy balance using satellite data, reanalyses and models

A combination of satellite data, reanalysis products and climate models are combined to monitor changes in water vapour, clear-sky radiative cooling of the atmosphere and precipitation over the period 1979-2006. Climate models are able to simulate observed increases in column integrated water vapour (CWV) with surface temperature (Ts) over the ocean. Changes in the observing system lead to spurious variability in water vapour and clear-sky longwave radiation in reanalysis products. Nevertheless all products considered exhibit a robust increase in clear-sky longwave radiative cooling from the atmosphere to the surface; clear-sky longwave radiative cooling of the atmosphere is found to increase with Ts at the rate of ~4 Wm-2 K-1 over tropical ocean regions of mean descending vertical motion. Precipitation (P) is tightly coupled to atmospheric radiative cooling rates and this implies an increase in P with warming at a slower rate than the observed increases in CWV. Since convective precipitation depends on moisture convergence, the above implies enhanced precipitation over convective regions and reduced precipitation over convectively suppressed regimes. To quantify this response, observed and simulated changes in precipitation rate are analysed separately over regions of mean ascending and descending vertical motion over the tropics. The observed response is found to be substantially larger than the model simulations and climate change projections. It is currently not clear whether this is due to deficiencies in model parametrizations or errors in satellite retrievals.

Developing a system for assessing the costs associated with different procurement routes in the construction industry

In developing techniques for monitoring the costs associated with different procurement routes, the central task is disentangling the various project costs incurred by organizations taking part in construction projects. While all firms are familiar with the need to analyse their own costs, it is unusual to apply the same kind of analysis to projects. The purpose of this research is to examine the claims that new ways of working such as strategic alliancing and partnering bring positive business benefits. This requires that costs associated with marketing, estimating, pricing, negotiation of terms, monitoring of performance and enforcement of contract are collected for a cross-section of projects under differing arrangements, and from those in the supply chain from clients to consultants, contractors, sub-contractors and suppliers. Collaboration with industrial partners forms the basis for developing a research instrument, based on time sheets, which will be relevant for all those taking part in the work. The signs are that costs associated with tendering are highly variable, 1-15%, depending upon what precisely is taken into account. The research to date reveals that there are mechanisms for measuring the costs of transactions and these will generate useful data for subsequent analysis.

Wind turbine blade pitch control system

The present invention provides an improvement for a wind turbine (20) having at least one blade (21) mounted on a hub (22) for controlled rotation about a blade axis (yb-yb) to vary the pitch of the blade relative to an airstream. The hub is mounted on a nacelle (23) for rotation about a hub axis (xh-xh). The wind turbine includes a main pitch control system for selectively controlling the pitch of the blade, and/or a safety pitch control system for overriding the main blade pitch control system and for causing the blade to move toward a feathered position in the event of an overspeed or fault condition. The improvement includes: an energy storage device (26) mounted on the nacelle and associated with the blade; a pitch-axis controller (25) mounted on the nacelle and associated with the blade and with the energy storage device; an electro-mechanical actuator (28) mounted on the hub and associated with the blade; and at least one slip ring (29) operatively arranged to transmit power and/or data signals between the pitch-axis controller and the electro-mechanical actuator; whereby the mass on the rotating hub may be reduced.

The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.

Influence-matrix diagnostic of a data assimilation system

The influence matrix is used in ordinary least-squares applications for monitoring statistical multiple-regression analyses. Concepts related to the influence matrix provide diagnostics on the influence of individual data on the analysis - the analysis change that would occur by leaving one observation out, and the effective information content (degrees of freedom for signal) in any sub-set of the analysed data. In this paper, the corresponding concepts have been derived in the context of linear statistical data assimilation in numerical weather prediction. An approximate method to compute the diagonal elements of the influence matrix (the self-sensitivities) has been developed for a large-dimension variational data assimilation system (the four-dimensional variational system of the European Centre for Medium-Range Weather Forecasts). Results show that, in the boreal spring 2003 operational system, 15% of the global influence is due to the assimilated observations in any one analysis, and the complementary 85% is the influence of the prior (background) information, a short-range forecast containing information from earlier assimilated observations. About 25% of the observational information is currently provided by surface-based observing systems, and 75% by satellite systems. Low-influence data points usually occur in data-rich areas, while high-influence data points are in data-sparse areas or in dynamically active regions. Background-error correlations also play an important role: high correlation diminishes the observation influence and amplifies the importance of the surrounding real and pseudo observations (prior information in observation space). Incorrect specifications of background and observation-error covariance matrices can be identified, interpreted and better understood by the use of influence-matrix diagnostics for the variety of observation types and observed variables used in the data assimilation system. Copyright © 2004 Royal Meteorological Society

Failure of a control strategy for a hybrid air-conditioning and wind catchers/towers system at Bluewater shopping malls in Kent

Purpose – To evaluate the control strategy for a hybrid natural ventilation wind catchers and air-conditioning system and to assess the contribution of wind catchers to indoor air environments and energy savings if any. Design/methodology/approach – Most of the modeling techniques for assessing wind catchers performance are theoretical. Post-occupancy evaluation studies of buildings will provide an insight into the operation of these building components and help to inform facilities managers. A case study for POE was presented in this paper. Findings – The monitoring of the summer and winter month operations showed that the indoor air quality parameters were kept within the design target range. The design control strategy failed to record data regarding the operation, opening time and position of wind catchers system. Though the implemented control strategy was working effectively in monitoring the operation of mechanical ventilation systems, i.e. AHU, did not integrate the wind catchers with the mechanical ventilation system. Research limitations/implications – Owing to short-falls in the control strategy implemented in this project, it was found difficult to quantify and verify the contribution of the wind catchers to the internal conditions and, hence, energy savings. Practical implications – Controlling the operation of the wind catchers via the AHU will lead to isolation of the wind catchers in the event of malfunctioning of the AHU. Wind catchers will contribute to the ventilation of space, particularly in the summer months. Originality/value – This paper demonstrates the value of POE as indispensable tool for FM professionals. It further provides insight into the application of natural ventilation systems in building for healthier indoor environments at lower energy cost. The design of the control strategy for natural ventilation and air-conditioning should be considered at the design stage involving the FM personnel.

Developing a system for assessing the costs associated with different procurement routes in the construction industry

In developing techniques for monitoring the costs associated with different procurement routes, the central task is disentangling the various project costs incurred by organizations taking part in construction projects. While all firms are familiar with the need to analyse their own costs, it is unusual to apply the same kind of analysis to projects. The purpose of this research is to examine the claims that new, ways of working such as strategic alliancing and partnering bring positive business benefits. This requires that costs associated with marketing, estimating, pricing, negotiation of terms, monitoring of performance and enforcement of contract are collected for a cross-section of projects under differing arrangements, and from those in the supply, chain from clients to consultants, contractors, subcontractors and suppliers. Collaboration with industrial partners forms the basis for developing a research instrument, bused on time sheets, which will be relevant for all those taking part in the work. The signs are that costs associated with,with tendering are highly variable, 1-15%, depending upon what precisely, is taken into account. The research to date reveals that there are mechanisms for measuring the costs of transactions and these will generate useful data for subsequent analysis.

The effect of a perceptual cognitive task on exercise performance: the dual-task condition after brain injury

Objective: To examine the effect of additional cognitive demand on cycling performance in individuals with acquired brain injury (ABI). Design: Prospective observational study. Setting: Rivermead Rehabilitation Centre. Participants: Ten individuals with ABI ( 7 men, 3 women) ( traumatic brain injury 7, tumour 1, stroke 2) and 10 healthy controls ( 6 men, 4 women). Intervention: Individuals were asked to maintain a set cadence during a three-stage incremental cycling test in both single-task ( no additional task) and dual-task ( whilst performing an additional cognitive task) conditions. Results: The ABI group showed a slight slowing in cadence in stages 1 and 3 of the graded exercise test from the single-to the dual-task condition, although this was not significant ( p less than or equal to 0.05). The control group showed no slowing of cadence at any incremental stage. When directly comparing the ABI with the control group, the change in cadence observed in dual-task conditions was only significantly different in stage 3 ( p less than or equal to 0.05). Conclusions: Clinicians should be aware of the possibility that giving additional cognitive tasks ( such as monitoring exercise intensity) while individuals with acquired brain injury are performing exercises may detrimentally affect performance. The effect may be more marked when the individuals are performing exercise at higher intensities.

The SAFEE on-board threat detection system

Under the framework of the European Union Funded SAFEE project(1), this paper gives an overview of a novel monitoring and scene analysis system developed for use onboard aircraft in spatially constrained environments. The techniques discussed herein aim to warn on-board crew about pre-determined indicators of threat intent (such as running or shouting in the cabin), as elicited from industry and security experts. The subject matter experts believe that activities such as these are strong indicators of the beginnings of undesirable chains of events or scenarios, which should not be allowed to develop aboard aircraft. This project aimes to detect these scenarios and provide advice to the crew. These events may involve unruly passengers or be indicative of the precursors to terrorist threats. With a state of the art tracking system using homography intersections of motion images, and probability based Petri nets for scene understanding, the SAFEE behavioural analysis system automatically assesses the output from multiple intelligent sensors, and creates. recommendations that are presented to the crew using an integrated airborn user interface. Evaluation of the system is conducted within a full size aircraft mockup, and experimental results are presented, showing that the SAFEE system is well suited to monitoring people in confined environments, and that meaningful and instructive output regarding human actions can be derived from the sensor network within the cabin.

Using a RESTful messaging and registry system to support a range a distributed applications

Tycho was conceived in 2003 in response to a need by the GridRM [1] resource-monitoring project for a ldquolight-weightrdquo, scalable and easy to use wide-area distributed registry and messaging system. Since Tycho's first release in 2006 a number of modifications have been made to the system to make it easier to use and more flexible. Since its inception, Tycho has been utilised across a number of application domains including widearea resource monitoring, distributed queries across archival databases, providing services for the nodes of a Cray supercomputer, and as a system for transferring multi-terabyte scientific datasets across the Internet. This paper provides an overview of the initial Tycho system, describes a number of applications that utilise Tycho, discusses a number of new utilities, and how the Tycho infrastructure has evolved in response to experience of building applications with it.

Non-intrusive monitoring of atmospheric CO2 in analogue models of terrestrial carbon cycle

1. Closed Ecological Systems (CES) are small manmade ecosystems which do not have any material exchange with the surrounding environment. Recent ecological and technological advances enable successful establishment and maintenance of CES, making them a suitable tool for detecting and measuring subtle feedbacks and mechanisms. 2. As a part of an analogue (physical) C cycle modelling experiment, we developed a non-intrusive methodology to control the internal environment and to monitor atmospheric CO2 concentration inside 16 replicated CES. Whilst maintaining an air-tight seal of all CES, this approach allowed for access to the CO2 measuring equipment for periodic re-calibration and repairs. 3. To ensure reliable cross-comparison of CO2 observations between individual CES units and to minimise the cost of the system, only one CO2 sampling unit was used. An ADC BioScientific OP-2 (open-path) analyser mounted on a swinging arm was passing over a set of 16 measuring cells. Each cell was connected to an individual CES with air continuously circulating between them. 4. Using this setup, we were able to continuously measure several environmental variables and CO2 concentration within each closed system, allowing us to study minute effects of changing temperature on C fluxes within each CES. The CES and the measuring cells showed minimal air leakage during an experimental run lasting, on average, 3 months. The CO2 analyser assembly performed reliably for over 2 years, however an early iteration of the present design proved to be sensitive to positioning errors. 5. We indicate how the methodology can be further improved and suggest possible avenues where future CES based research could be applied.

Hyperresolution global land surface modeling: meeting a grand challenge for monitoring Earth's terrestrial water

Monitoring Earth's terrestrial water conditions is critically important to many hydrological applications such as global food production; assessing water resources sustainability; and flood, drought, and climate change prediction. These needs have motivated the development of pilot monitoring and prediction systems for terrestrial hydrologic and vegetative states, but to date only at the rather coarse spatial resolutions (∼10–100 km) over continental to global domains. Adequately addressing critical water cycle science questions and applications requires systems that are implemented globally at much higher resolutions, on the order of 1 km, resolutions referred to as hyperresolution in the context of global land surface models. This opinion paper sets forth the needs and benefits for a system that would monitor and predict the Earth's terrestrial water, energy, and biogeochemical cycles. We discuss six major challenges in developing a system: improved representation of surface‐subsurface interactions due to fine‐scale topography and vegetation; improved representation of land‐atmospheric interactions and resulting spatial information on soil moisture and evapotranspiration; inclusion of water quality as part of the biogeochemical cycle; representation of human impacts from water management; utilizing massively parallel computer systems and recent computational advances in solving hyperresolution models that will have up to 109 unknowns; and developing the required in situ and remote sensing global data sets. We deem the development of a global hyperresolution model for monitoring the terrestrial water, energy, and biogeochemical cycles a “grand challenge” to the community, and we call upon the international hydrologic community and the hydrological science support infrastructure to endorse the effort.

Comparing the UK Met Office climate prediction system DePreSys with idealized predictability in the HadCM3 model

The initial condition effect on climate prediction skill over a 2-year hindcast time-scale has been assessed from ensemble HadCM3 climate model runs using anomaly initialization over the period 1990–2001, and making comparisons with runs without initialization (equivalent to climatological conditions), and to anomaly persistence. It is shown that the assimilation improves the prediction skill in the first year globally, and in a number of limited areas out into the second year. Skill in hindcasting surface air temperature anomalies is most marked over ocean areas, and is coincident with areas of high sea surface temperature and ocean heat content skill. Skill improvement over land areas is much more limited but is still detectable in some cases. We found little difference in the skill of hindcasts using three different sets of ocean initial conditions, and we obtained the best results by combining these to form a grand ensemble hindcast set. Results are also compared with the idealized predictability studies of Collins (Clim. Dynam. 2002; 19: 671–692), which used the same model. The maximum lead time for which initialization gives enhanced skill over runs without initialization varies in different regions but is very similar to lead times found in the idealized studies, therefore strongly supporting the process representation in the model as well as its use for operational predictions. The limited 12-year period of the study, however, means that the regional details of model skill should probably be further assessed under a wider range of observational conditions.