Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Background
Fluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.

Methods
We will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.

Discussion
While fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.

Systematic review registration
PROSPERO CRD42013005608. (http://​www.​crd.​york.​ac.​uk/​PROSPERO/​)

A new Nawaz–Enscore–Ham-based heuristic for permutation flow-shop problem with bicriteria of makespan and machine idle-time

A new heuristic based on Nawaz–Enscore–Ham (NEH) algorithm is proposed for solving permutation flowshop scheduling problem in this paper. A new priority rule is proposed by accounting for the average, mean absolute deviation, skewness and kurtosis, in order to fully describe the distribution style of processing times. A new tie-breaking rule is also introduced for achieving effective job insertion for the objective of minimizing both makespan and machine idle-time. Statistical tests illustrate better solution quality of the proposed algorithm, comparing to existing benchmark heuristics.

Whose sins do the Brethren confess? The problem of sin as the problem of expiation

Among Brethren fisher families in Gamrie, northeast Scotland, professional clergy and written liturgy are held to be blasphemous denials of the true workings of the Holy Spirit. God, I was told, chooses to speak through all born-again (male) persons, unrestricted by the vain repetitions of lettered clerics and their prayer books. In this context, confession of one’s own sin is a private and pointedly interior affair. In Gamrie, not only did every man seek to be his own skipper, but also his own priest. Yet, much of Brethren worship is given over to ritualised acts of confession. So whose sins do the Brethren confess, and to what end? This article argues that among the Brethren of Gamrie, such acts involve confessing not one’s own sin, but the sins of a ‘sick’ and ‘fallen’ world. More than this, by attending to the sociological (as opposed to theological) processes of confessing the sins of another, we see a collapse in the distinction between confiteor and credo that has so dogged anthropological studies of Christianity. In Brethren prayer and bible study, as well as in everyday gossip, the “I confess” of the confiteor and the “I believe” of credo co-constitute one another in and through evidences of the ‘lostness’ of ‘this present age’. But how, if at all, does this solve ‘the problem of sin’? This article suggests that, with the ritual gaze of confession turned radically outward, Brethren announcements of global wickedness enact (in a deliberate tautology) both a totalising call for repentance from sin, and a millenarian creed of the imminent apocalypse. Here, the problem of ritual can be understood as the problem of (partially failed) expiation.

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided. Mortality remains at approximately 30%.

Convex Quadratic Programming Approach to the Maximum Matching Problem

The problem of determining a maximum matching or whether there exists a perfect matching, is very common in a large variety of applications and as been extensively studied in graph theory. In this paper we start to introduce a characterisation of a family of graphs for which its stability number is determined by convex quadratic programming. The main results connected with the recognition of this family of graphs are also introduced. It follows a necessary and sufficient condition which characterise a graph with a perfect matching and an algorithmic strategy, based on the determination of the stability number of line graphs, by convex quadratic programming, applied to the determination of a perfect matching. A numerical example for the recognition of graphs with a perfect matching is described. Finally, the above algorithmic strategy is extended to the determination of a maximum matching of an arbitrary graph and some related results are presented.

Implicit optimality criterion for convex SIP problem with box constrained index set

We consider a convex problem of Semi-Infinite Programming (SIP) with multidimensional index set. In study of this problem we apply the approach suggested in [20] for convex SIP problems with one-dimensional index sets and based on the notions of immobile indices and their immobility orders. For the problem under consideration we formulate optimality conditions that are explicit and have the form of criterion. We compare this criterion with other known optimality conditions for SIP and show its efficiency in the convex case.

Optimization models for a short sea fuel oil distribution problem

O transporte marítimo e o principal meio de transporte de mercadorias em todo o mundo. Combustíveis e produtos petrolíferos representam grande parte das mercadorias transportadas por via marítima. Sendo Cabo Verde um arquipelago o transporte por mar desempenha um papel de grande relevância na economia do país. Consideramos o problema da distribuicao de combustíveis em Cabo Verde, onde uma companhia e responsavel por coordenar a distribuicao de produtos petrolíferos com a gestão dos respetivos níveis armazenados em cada porto, de modo a satisfazer a procura dos varios produtos. O objetivo consiste em determinar políticas de distribuicão de combustíveis que minimizam o custo total de distribuiçao (transporte e operacões) enquanto os n íveis de armazenamento sao mantidos nos n íveis desejados. Por conveniencia, de acordo com o planeamento temporal, o prob¬lema e divido em dois sub-problemas interligados. Um de curto prazo e outro de medio prazo. Para o problema de curto prazo sao discutidos modelos matemáticos de programacao inteira mista, que consideram simultaneamente uma medicao temporal cont ínua e uma discreta de modo a modelar multiplas janelas temporais e taxas de consumo que variam diariamente. Os modelos sao fortalecidos com a inclusão de desigualdades validas. O problema e então resolvido usando um "software" comercial. Para o problema de medio prazo sao inicialmente discutidos e comparados varios modelos de programacao inteira mista para um horizonte temporal curto assumindo agora uma taxa de consumo constante, e sao introduzidas novas desigualdades validas. Com base no modelo escolhido sao compara¬das estrategias heurísticas que combinam três heur ísticas bem conhecidas: "Rolling Horizon", "Feasibility Pump" e "Local Branching", de modo a gerar boas soluçoes admissíveis para planeamentos com horizontes temporais de varios meses. Finalmente, de modo a lidar com situaçoes imprevistas, mas impor¬tantes no transporte marítimo, como as mas condicões meteorológicas e congestionamento dos portos, apresentamos um modelo estocastico para um problema de curto prazo, onde os tempos de viagens e os tempos de espera nos portos sao aleatórios. O problema e formulado como um modelo em duas etapas, onde na primeira etapa sao tomadas as decisões relativas as rotas do navio e quantidades a carregar e descarregar e na segunda etapa (designada por sub-problema) sao consideradas as decisoes (com recurso) relativas ao escalonamento das operacões. O problema e resolvido por um metodo de decomposto que usa um algoritmo eficiente para separar as desigualdades violadas no sub-problema.

More than just a problem with faces: Altered body perception in a group of congenital prosopagnosics

It has been estimated that one out of forty people in the general population suffer from congenital prosopagnosia (CP), a neurodevelopmental disorder characterized by difficulty identifying people by their faces. CP involves impairment in recognising faces, although the perception of non-face stimuli may also be impaired. Given that social interaction does not only depend on face processing, but also the processing of bodies, it is of theoretical importance to ascertain whether CP is also characterised by body perception impairments. Here, we tested eleven CPs and eleven matched control participants on the Body Identity Recognition Task (BIRT), a forced-choice match-to-sample task, using stimuli that require processing of body, not clothing, specific features. Results indicated that the group of CPs was as accurate as controls on the BIRT, which is in line with the lack of body perception complaints by CPs. However the CPs were slower than controls, and when accuracy and response times were combined into inverse efficiency scores (IES), the group of CPs were impaired, suggesting that the CPs could be using more effortful cognitive mechanisms to be as accurate as controls. In conclusion, our findings demonstrate CP may not generally be limited to face processing difficulties, but may also extend to body perception

Methods to improve creativity and innovation: the effectiveness of creative problem solving

This chapter focuses on the development of organizational creativity, using the CPS methodology, aiming at demonstrating its effectiveness in using the individual and team divergent thinking improvement in identifying organizational problems. A study was undertaken using problem solving teams in seven companies, in which each individual was submitted to a pre-post test in attitudes towards divergent thinking and asked to express the evaluation of the method. All the information reported in the sessions was recorded. The results indicate a change in attitude favourable to divergent thinking, the provision of a professional, efficient method of organizing knowledge in such a way that can help individuals to find original solutions to problems, and an important way to lead teams to creativity and innovation, according with companies different orientations.

Creativity and problem solving in the development of organizational innovation

This research focuses on creativity and innovation management in organizations. We present a model of intervention that aims at establishing a culture of organizational innovation through the internal development of individual and team creativity focusing on problem solving. The model relies on management’s commitment and in the organization’s talented people (creative leaders and employees) as a result of their ability in defining a better organization. The design follows Min Basadur’s problem solving approach consisting of problem finding, fact finding, problem definition, solution finding and decision implementation. These steps are carried out using specific techniques and procedures that will link creative people and management in order to initiate the process until problems are defined. For each defined problem, project teams will develop possible solutions and implement these decisions. Thus, a system of transformation of the individual and team creativity into organizational innovation can be established.

Implementing and testing branch-and-bound algorithm for the quadratic 0-1 problem on transputers

Discrete optimization problems are very difficult to solve, even if the dimention is small. For most of them the problem of finding an ε-approximate solution is already NP-hard. The branch-and-bound algorithms are the most used algorithms for solving exactly this sort of problems.

A computational study of a parallel Branch and Bound algorithm for the quadratic 0-1 programming problem on transputers

Discrete optimization problems are very difficult to solve, even if the dimantion is small. For most of them the problem of finding an ε-approximate solution is already NP-hard.

An efficient parallel implementation of a least squares problem

Least squares solutions are a very important problem, which appear in a broad range of disciplines (for instance, control systems, statistics, signal processing). Our interest in this kind of problems lies in their use of training neural network controllers.