Performance of mechanical ventilators at the patient's home: a multicentric quality control study

Background: Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV). Methods: A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the ventilator control panel, and the actual performance of the ventilator measured at home were compared; (2) the different ventilator alarms were tested; and (3) the effect of differences between the prescribed settings and the actual performance of the ventilator on non-programmed readmissions of the patient was determined. Results: Considerable differences were found between actual, set, and prescribed values of ventilator variables; these differences were similar in volume and pressure preset ventilators. The percentage of patients with a discrepancy between the prescribed and actual measured main ventilator variable (minute ventilation or inspiratory pressure) of more than 20% and 30% was 13% and 4%, respectively. The number of ventilators with built in alarms for power off, disconnection, or obstruction was 225, 280 and 157, respectively. These alarms did not work in two (0.9%), 52 (18.6%) and eight (5.1%) ventilators, respectively. The number of non-programmed hospital readmissions in the year before the study did not correlate with the index of ventilator error. Conclusions: This study illustrates the current limitations of the quality control of HMV and suggests that improvements should be made to ensure adequate ventilator settings and correct ventilator performance and ventilator alarm operation.

Fuel Adjustment, April 2011

Article 2120 of the Standard Specifications for Highway and Bridge Construction Series 2009 provides for a fuel adjustment factor to be applied to payments and partial payments for quantities of certain items of excavation work as the work is done, in accordance with the specification, when indicated in the contract documents. A Current Price Index (CPI), in dollars per gallon (liter), will be established by the DOT for each month. The CPI will be the price of No. 2 High Sulfur Diesel, as reported by Oil Price Information Service using the first weekday for the month and the average of all prices reported for Des Moines. The Base Price Index (BPI) for each contract will be the CPI in effect during the month previous to the month of the letting of that contract. If the contract has metric units, divide the Price Index ($/gal) by 3.785412 to obtain $/liter.

Care complexity, mood, and quality of life in liver pre-transplant patients.

RATIONALE: This study was intended to document the frequency of care complexity in liver transplant candidates, and its association with mood disturbance and poor health-related quality of life (HRQoL). METHODS: Consecutive patients fulfilling inclusion criteria, recruited in three European hospitals, were assessed with INTERMED, a reliable and valid method for the early assessment of bio-psychosocial health risks and needs. Blind to the results, they were also assessed with the Hospital Anxiety and Depression Scale (HADS). HRQoL was documented with the EuroQol and the SF36. Statistical analysis included multivariate and multilevel techniques. RESULTS: Among patients fulfilling inclusion criteria, 60 patients (75.9%) completed the protocol and 38.3% of them were identified as "complex" by INTERMED, but significant between-center differences were found. In support of the working hypothesis, INTERMED scores were significantly associated with all measures of both the SF36 and the EuroQol, and also with the HADS. A one point increase in the INTERMED score results in a reduction in 0.93 points in EuroQol and a 20% increase in HADS score. CONCLUSIONS: INTERMED-measured case complexity is frequent in liver transplant candidates but varies widely between centers. The use of this method captures in one instrument multiple domains of patient status, including mood disturbances and reduced HRQoL.

The dynamic adjustment of local government budgets : Does Spain behave differently?

[spa] El objetivo de este trabajo es analizar si los municipios españoles se ajustan en presencia de un shock presupuestario y (si es así) qué elementos del presupuesto son los que realizan el ajuste. La metodología utilizada para contestar estas preguntas es un mecanismo de corrección del error, VECM, que estimamos con un panel de datos de los municipios españoles durante el período 1988-2006. Nuestros resultados confirman que, en primer lugar, los municipios se ajustan en presencia de un shock fiscal (es decir, el déficit es estacionario en el largo plazo). En segundo lugar, obtenemos que cuando el shock afecta a los ingresos el ajuste lo soporta principalmente el municipio reduciendo el gasto, las transferencias tienen un papel muy reducido en este proceso de ajuste. Por el contrario, cuando el shock afecta al gasto, el ajuste es compartido en términos similares entre el municipio – incrementado los impuestos – y los gobiernos de niveles superiores – incrementando las transferencias. Estos resultados sugieren que la viabilidad de las finanzas pública locales es factible con diferentes entornos institucionales.

Quality coding by neural populations in the early olfactory pathway: analysis using information theory

In this article, we analyze the ability of the early olfactory system to detect and discriminate different odors by means of information theory measurements applied to olfactory bulb activity images. We have studied the role that the diversity and number of receptor neuron types play in encoding chemical information. Our results show that the olfactory receptors of the biological system are low correlated and present good coverage of the input space. The coding capacity of ensembles of olfactory receptors with the same receptive range is maximized when the receptors cover half of the odor input space - a configuration that corresponds to receptors that are not particularly selective. However, the ensemble's performance slightly increases when mixing uncorrelated receptors of different receptive ranges. Our results confirm that the low correlation between sensors could be more significant than the sensor selectivity for general purpose chemo-sensory systems, whether these are biological or biomimetic.

Cognition, mood and fatigue in patients in the early stage of multiple sclerosis.

QUESTION UNDER STUDY: Cognitive impairment occurs during multiple sclerosis (MS) and contributes to the burden of the disease, but its effect in the initial phase of MS still needs to be better understood. METHODS: We prospectively studied 127 early MS patients presenting with a clinically isolated syndrome (CIS) or definite MS, a mean disease duration of 2.6 years, and with minor disability (mean Expanded Disability Status Scale score 1.8). Patients were tested for long-term memory, executive functions, attention, fatigue, mood disorders, functional handicap and quality of life (QoL). Twenty-one CIS patients were excluded from study as the diagnosis of MS could not be confirmed. RESULTS: Over the 106 MS patients analysed, 31 (29.3%) were cognitively impaired (23.6% for memory, 10.4% for attention and 5.7% for executive functions). Cognitive deficits were already present in CIS patients in whom the diagnosis was not yet confirmed (20%). Impaired cognition was associated with anxiety (p = 0.05), depression(p = 0.004), fatigue (p = 0.03), handicap (p <0.001) and a lower QoL (p <0.001). After adjustment for QoL, handicap, depression, anxiety and fatigue were no longer associated with the presence of cognitive deficits. CONCLUSIONS: In this well-defined early MS group one third of the patients already exhibited cognitive deficits, which were usually apparent in an effortful learning situation and were generally mild. Mood disorders, fatigue, handicap and decreased QoL were all associated with the occurrence of cognitive deficits. QoL itself appeared to take all the other factors into account. Our results confirm the existence of an interplay between cognitive, affective and functional changes and fatigue in early MS.

Fuel Adjustment, May 2011

Article 2120 of the Standard Specifications for Highway and Bridge Construction Series 2009 provides for a fuel adjustment factor to be applied to payments and partial payments for quantities of certain items of excavation work as the work is done, in accordance with the specification, when indicated in the contract documents. A Current Price Index (CPI), in dollars per gallon (liter), will be established by the DOT for each month. The CPI will be the price of No. 2 High Sulfur Diesel, as reported by Oil Price Information Service using the first weekday for the month and the average of all prices reported for Des Moines. The Base Price Index (BPI) for each contract will be the CPI in effect during the month previous to the month of the letting of that contract. If the contract has metric units, divide the Price Index ($/gal) by 3.785412 to obtain $/liter.

Improvement of the quality factor of RF integrated inductors by layout optimization

A systematic method to improve the quality (Q) factor of RF integrated inductors is presented in this paper. The proposed method is based on the layout optimization to minimize the series resistance of the inductor coil, taking into account both ohmic losses, due to conduction currents, and magnetically induced losses, due to eddy currents. The technique is particularly useful when applied to inductors in which the fabrication process includes integration substrate removal. However, it is also applicable to inductors on low-loss substrates. The method optimizes the width of the metal strip for each turn of the inductor coil, leading to a variable strip-width layout. The optimization procedure has been successfully applied to the design of square spiral inductors in a silicon-based multichip-module technology, complemented with silicon micromachining postprocessing. The obtained experimental results corroborate the validity of the proposed method. A Q factor of about 17 have been obtained for a 35-nH inductor at 1.5 GHz, with Q values higher than 40 predicted for a 20-nH inductor working at 3.5 GHz. The latter is up to a 60% better than the best results for a single strip-width inductor working at the same frequency.

Impact de la chirurgie bariatrique sur la santé et la qualité de vie du patient obèse [Impact of bariatric surgery on health and quality life of obese patients]

The important weight loss due to bariatric surgery allows to improve and even correct, a great part of the comorbidities induced by obesity, as well as quality of life, and to reduce the coming out of cardiovascular and metabolic diseases in operated patients. The impact of surgical treatment on the patient's health and quality of life also allows to reduce direct and indirect costs of morbid obesity. However, its effects on mortality have not yet been clearly proved. The preoperative evaluation and the long term follow-up by a skilled team are essential to reduce potential complications, especially on the nutritional field and the risks of recovered weight linked to binge eating disorders.

Physical quality of an Oxisol cultivated with maize submited to cover crops in the pre-cropping period

The intensive use of land alters the distribution of the pore size which imparts consequences on the soil physical quality. The Least Limiting Water Range (LLWR) allows for the visualization of the effects of management systems upon either the improvement or the degradation of the soil physical quality. The objective of this study was to evaluate the physical quality of a Red Latosol (Oxisol) submited to cover crops in the period prior to the maize crop in a no-tillage and conventional tillage system, using porosity, soil bulk density and the LLWR as attributes. The treatments were: conventional tillage (CT) and a no-tillage system with the following cover crops: sunn hemp (Crotalaria juncea L.) (NS), pearl millet (Pennisetum americanum (L.) Leeke) (NP) and lablab (Dolichos lablab L.) (NL). The experimental design was randomized blocks in subdivided plots with six replications, with the plots being constituted by the treatments and the subplots by the layers analyzed. The no-tillage systems showed higher total porosity and soil organic matter at the 0-0.5 m layer for the CT. The CT did not differ from the NL or NS in relation to macroporosity. The NP showed the greater porosity, while CT and NS presented lower soil bulk density. No < 10 % airing porosity was found for the treatments evaluated, and value for water content where soil aeration is critical (θPA) was found above estimated water content at field capacity (θFC) for all densities. Critical soil bulk density was of 1.36 and 1.43 Mg m-3 for NP and CT, respectively. The LLWR in the no-tillage systems was limited in the upper part by the θFC, and in the bottom part, by the water content from which soil resistance to penetration is limiting (θPR). By means of LLWR it was observed that the soil presented good physical quality.