Monitoring of Urinary Calcium and Phosphorus Excretion in Preterm Infants - Comparison of two Methods

OBJECTIVES: Premature babies require supplementation with calcium and phosphorus to prevent metabolic bone disease of prematurity. To guide mineral supplementation, two methods of monitoring urinary excretion of calcium and phosphorus are used: urinary calcium or phosphorus concentration and calcium/creatinine or phosphorus/creatinine ratios. We compare these two methods in regards to their agreement on the need for mineral supplementation. METHODS: Retrospective chart review of 230 premature babies with birthweight <1500 g, undergoing screening of urinary spot samples from day 21 of life and fortnightly thereafter. Hypothetical cut-off values for urine calcium or phosphorus concentration (1 mmol/l) and urine calcium/creatinine ratio (0.5 mol/mol) or phosphorus/creatinine ratio (4 mol/mol) were applied to the sample results. The agreement on whether or not to supplement the respective minerals based on the results with the two methods was compared. Multivariate general linear models sought to identify patient characteristic to predict disagreeing results. RESULTS: 24.8% of cases disagreed on the indication for calcium supplementation, 8.8% for phosphorus. Total daily calcium intake was the only patient characteristic associated with discordant results. CONCLUSIONS: With the intention to supplement the respective mineral, comparison of urinary mineral concentration with mineral/creatinine ratio is moderate for Calcium and good for Phosphorus. The results do not allow to identify superiority of either method on the decision which babies require calcium and/or phosphorus supplements.

Monitoring cerebral oxygenation during balloon occlusion with multichannel NIRS

We report on oxygenation changes noninvasively recorded by multichannel continuous-wave near infrared spectroscopy (CW-NIRS) during endovascular neuroradiologic interventions requiring temporary balloon occlusion of arteries supplying the cerebral circulation. Digital subtraction angiography (DSA) provides reference data on the site, timing, and effectiveness of the flow stagnation as well as on the amount and direction of collateral circulation. This setting allows us to relate CW-NIRS findings to brain specific perfusion changes. We focused our analysis on the transition from normal perfusion to vessel occlusion, i.e., before hypoxia becomes clinically apparent. The localization of the maximal response correlated either with the core (occlusion of the middle cerebral artery) or with the watershed areas (occlusion of the internal carotid artery) of the respective vascular territories. In one patient with clinically and angiographically confirmed insufficient collateral flow during carotid artery occlusion, the total hemoglobin concentration became significantly asymmetric, with decreased values in the ipsilateral watershed area and contralaterally increased values. Multichannel CW-NIRS monitoring might serve as an objective and early predictive marker of critical perfusion changes during interventions-to prevent hypoxic damage of the brain. It also might provide valuable human reference data on oxygenation changes as they typically occur during acute stroke.

Monitoring of alcohol markers by capillary electrophoresis.

Work dealing with the monitoring of alcohol markers by CE performed during the past two decades led to the development of assays for carbohydrate-deficient transferrin (CDT), ethyl sulfate, ethyl glucuronide, and phosphatidylethanol in body fluids and first attempts for the detection of the urinary 5-hydroxytryptophol/5-hydroxyindoleacetic acid ratio and stable hemoglobin acetaldehyde adducts. Most notably are assays for CDT that have been commercialized and are being used in many laboratories under routine conditions. This paper provides insight into the development, specifications, and use of the currently known CE-based assays suitable to detect alcohol markers. The achievements reached so far indicate that CE is an attractive technology for monitoring alcohol markers. This is particularly seen with the CDT assays that do not require an elaborate sample pretreatment and thus could be fully automated for high-throughput analyses on multicapillary instruments.

When to see a doctor for common health problems: distribution patterns of functional health literacy across migrant populations in Switzerland

BACKGROUND Knowing when to seek professional help for health problems is considered an important aspect of health literacy. However, little is known about the distribution of help-seeking knowledge in the general population or specific subpopulations. METHODS We analysed data from the "Health Monitoring of the Swiss Migrant Population 2010" and used a short survey tool to study the distribution of help-seeking knowledge. We sampled members of four migrant groups (from Portugal, Turkey, Serbia and Kosovo; n = 2,614). Our tool contained 12 items that addressed common physical and psychological health problems. A total sum score measured help-seeking knowledge. Two sub-scores analysed knowledge related to potential overuse (minor symptoms) or potential underuse (major symptoms). We applied linear regression to show variations in help-seeking knowledge by age, sex, region of origin and length of stay. RESULTS Controlling for self-rated health, we found that region of origin, higher education, female gender and younger age were significantly associated with higher knowledge scores. CONCLUSIONS We present empirical evidence of unequal distribution of help-seeking knowledge across four migrant populations in Switzerland. Our findings contribute to current conceptual developments in health literacy, and provide starting points for future research.

Monitoring disease activity and progression in Crohn's disease. A Swiss perspective on the IBD ahead 'optimised monitoring' recommendations.

BACKGROUND AND AIMS The structured IBD Ahead 'Optimised Monitoring' programme was designed to obtain the opinion, insight and advice of gastroenterologists on optimising the monitoring of Crohn's disease activity in four settings: (1) assessment at diagnosis, (2) monitoring in symptomatic patients, (3) monitoring in asymptomatic patients, and (4) the postoperative follow-up. For each of these settings, four monitoring methods were discussed: (a) symptom assessment, (b) endoscopy, (c) laboratory markers, and (d) imaging. Based on literature search and expert opinion compiled during an international consensus meeting, recommendations were given to answer the question 'which diagnostic method, when, and how often'. The International IBD Ahead Expert Panel advised to tailor this guidance to the healthcare system and the special prerequisites of each country. The IBD Ahead Swiss National Steering Committee proposes best-practice recommendations adapted for Switzerland. METHODS The IBD Ahead Steering Committee identified key questions and provided the Swiss Expert Panel with a structured literature research. The expert panel agreed on a set of statements. During an international expert meeting the consolidated outcome of the national meetings was merged into final statements agreed by the participating International and National Steering Committee members - the IBD Ahead 'Optimized Monitoring' Consensus. RESULTS A systematic assessment of symptoms, endoscopy findings, and laboratory markers with special emphasis on faecal calprotectin is deemed necessary even in symptom-free patients. The choice of recommended imaging methods is adapted to the specific situation in Switzerland and highlights the importance of ultrasonography and magnetic resonance imaging besides endoscopy. CONCLUSION The recommendations stress the importance of monitoring disease activity on a regular basis and by objective parameters, such as faecal calprotectin and endoscopy with detailed documentation of findings. Physicians should not rely on symptoms only and adapt the monitoring schedule and choice of options to individual situations.

Some advances in extensive bridge monitoring using low cost dynamic characterization

Dynamic measurements will become a standard for bridge monitoring in the near future. This fact will produce an important cost reduction for maintenance. US Administration has a long term intensive research program in order to diminish the estimated current maintenance cost of US$7 billion per year over 20 years. An optimal intervention maintenance program demands a historical dynamical record, as well as an updated mathematical model of the structure to be monitored. In case that a model of the structure is not actually available it is possible to produce it, however this possibility does not exist for missing measurement records from the past. Current acquisition systems to monitor structures can be made more efficient by introducing the following improvements, under development in the Spanish research Project “Low cost bridge health monitoring by ambient vibration tests using wireless sensors”: (a) a complete wireless system to acquire sensor data, (b) a wireless system that permits the localization and the hardware identification of the whole sensor system. The applied localization system has been object of a recent patent, and (c) automatization of the modal identification process, aimed to diminish human intervention. This system is assembled with cheap components and allows the simultaneous use of a large number of sensors at a low placement cost. The engineer’s intervention is limited to the selection of sensor positions, probably based on a preliminary FE analysis. In case of multiple setups, also the position of a number of fixed reference sensors has to be decided. The wireless localization system will obtain the exact coordinates of all these sensors positions. When the selection of optimal positions is difficult, for example because of the lack of a proper FE model, this can be compensated by using a higher number of measuring (also reference) points. The described low cost acquisition system allows the responsible bridge administration to obtain historical dynamic identification records at reasonable costs that will be used in future maintenance programs. Therefore, due to the importance of the baseline monitoring record of a new bridge, a monitoring test just after its construction should be highly recommended, if not compulsory.

Structural health monitoringby using transmissibility

El control del estado en el que se encuentran las estructuras ha experimentado un gran auge desde hace varias décadas, debido a que los costes de rehabilitación de estructuras tales como los oleoductos, los puentes, los edificios y otras más son muy elevados. En las últimas dos décadas, se han desarrollado una gran cantidad de métodos que permiten identificar el estado real de una estructura, basándose en modelos físicos y datos de ensayos. El ensayo modal es el más común; mediante el análisis modal experimental de una estructura se pueden determinar parámetros como la frecuencia, los modos de vibración y la amortiguación y también la función de respuesta en frecuencia de la estructura. Mediante estos parámetros se pueden implementar diferentes indicadores de daño. Sin embargo, para estructuras complejas y grandes, la implementación de metodologías basadas en la función de respuesta en frecuencia requeriría realizar hipótesis sobre la fuerza utilizada para excitar la estructura. Dado que el análisis modal operacional utiliza solamente las señales de respuesta del sistema para extraer los parámetros dinámicos estructurales y, por tanto, para evaluar el estado de una estructura, el uso de la transmisibilidad sería posible. En este sentido, dentro del análisis modal operacional, la transmisibilidad ha concentrado mucha atención en el mundo científico en la última década. Aunque se han publicado muchos trabajos sobre el tema, en esta Tesis se proponen diferentes técnicas para evaluar el estado de una estructura basándose exclusivamente en la transmisibilidad. En primer lugar, se propone un indicador de daño basado en un nuevo parámetro, la coherencia de transmisibilidad; El indicador se ha valido mediante resultados numéricos y experimentales obtenidos sobre un pórtico de tres pisos. En segundo lugar, la distancia de Mahalanobis se aplica sobre la transmisibilidad como procedimiento para detectar variaciones estructurales provocadas por el daño. Este método se ha validado con éxito sobre una viga libre-libre ensayada experimentalmente. En tercer lugar, se ha implementado una red neuronal basada en medidas de transmisibilidad como metodología de predicción de daño sobre una viga simulada numéricamente. ABSTRACT Structural health monitoring has experienced a huge development from several decades ago since the cost of rehabilitation of structures such as oil pipes, bridges and tall buildings is very high. In the last two decades, a lot of methods able to identify the real stage of a structure have been developed basing on both models and experimental data. Modal testing is the most common; by carrying out the experimental modal analysis of a structure, some parameters, such as frequency, mode shapes and damping, as well as the frequency response function of the structure can be obtained. From these parameters, different damage indicators have been proposed. However, for complex and large structures, any frequency domain approach that relies on frequency response function estimation would be of difficult application since an assumption of the input excitations to the system should be carried out. Operational modal analysis uses only output signals to extract the structural dynamic parameters and, therefore, to identify the structural stage. In this sense, within operational modal analysis, transmissibility has attracted a lot of attention in the scientific field in the last decade. In this work new damage detection approaches based on transmissibility are developed. Firstly, a new theory of transmissibility coherence is developed and it is tested with a three-floor-structure both in simulation and in experimental data analysis; secondly, Mahalanobis distance is taken into use with the transmissibility, and a free-free beam is used to test the approach performance; thirdly, neural networks are used in transmissibility for structural health monitoring; a simulated beam is used to validate the proposed method.

Structural health monitoringby using transmissibility

El control del estado en el que se encuentran las estructuras ha experimentado un gran auge desde hace varias décadas, debido a que los costes de rehabilitación de estructuras tales como los oleoductos, los puentes, los edificios y otras más son muy elevados. En las últimas dos décadas, se han desarrollado una gran cantidad de métodos que permiten identificar el estado real de una estructura, basándose en modelos físicos y datos de ensayos. El ensayo modal es el más común; mediante el análisis modal experimental de una estructura se pueden determinar parámetros como la frecuencia, los modos de vibración y la amortiguación y también la función de respuesta en frecuencia de la estructura. Mediante estos parámetros se pueden implementar diferentes indicadores de daño. Sin embargo, para estructuras complejas y grandes, la implementación de metodologías basadas en la función de respuesta en frecuencia requeriría realizar hipótesis sobre la fuerza utilizada para excitar la estructura. Dado que el análisis modal operacional utiliza solamente las señales de respuesta del sistema para extraer los parámetros dinámicos estructurales y, por tanto, para evaluar el estado de una estructura, el uso de la transmisibilidad sería posible. En este sentido, dentro del análisis modal operacional, la transmisibilidad ha concentrado mucha atención en el mundo científico en la última década. Aunque se han publicado muchos trabajos sobre el tema, en esta Tesis se proponen diferentes técnicas para evaluar el estado de una estructura basándose exclusivamente en la transmisibilidad. En primer lugar, se propone un indicador de daño basado en un nuevo parámetro, la coherencia de transmisibilidad; El indicador se ha valido mediante resultados numéricos y experimentales obtenidos sobre un pórtico de tres pisos. En segundo lugar, la distancia de Mahalanobis se aplica sobre la transmisibilidad como procedimiento para detectar variaciones estructurales provocadas por el daño. Este método se ha validado con éxito sobre una viga libre-libre ensayada experimentalmente. En tercer lugar, se ha implementado una red neuronal basada en medidas de transmisibilidad como metodología de predicción de daño sobre una viga simulada numéricamente. ABSTRACT Structural health monitoring has experienced a huge development from several decades ago since the cost of rehabilitation of structures such as oil pipes, bridges and tall buildings is very high. In the last two decades, a lot of methods able to identify the real stage of a structure have been developed basing on both models and experimental data. Modal testing is the most common; by carrying out the experimental modal analysis of a structure, some parameters, such as frequency, mode shapes and damping, as well as the frequency response function of the structure can be obtained. From these parameters, different damage indicators have been proposed. However, for complex and large structures, any frequency domain approach that relies on frequency response function estimation would be of difficult application since an assumption of the input excitations to the system should be carried out. Operational modal analysis uses only output signals to extract the structural dynamic parameters and, therefore, to identify the structural stage. In this sense, within operational modal analysis, transmissibility has attracted a lot of attention in the scientific field in the last decade. In this work new damage detection approaches based on transmissibility are developed. Firstly, a new theory of transmissibility coherence is developed and it is tested with a three-floor-structure both in simulation and in experimental data analysis; secondly, Mahalanobis distance is taken into use with the transmissibility, and a free-free beam is used to test the approach performance; thirdly, neural networks are used in transmissibility for structural health monitoring; a simulated beam is used to validate the proposed method.

Beef CHAPA : cow/calf health & productivity audit.

"March 1996"--Cover of [pt. 6]

Monitoring PAHs in the Brisbane River and Moreton Bay, Australia, using semipermeable membrane devices and EROD activity in yellowfin bream, Acanthopagrus australis

Two water quality monitoring strategies designed to sample hydrophobic organic contaminants have been applied and evaluated across an expected concentration gradient in PAHs in the Moreton region. Semipermeable membrane devices (SPMDs) that sequester contaminants via passive diffusion across a membrane were used to evaluate the concentration of PAHs at four and five sites in spring and summer 2001/2002, respectively. In addition, induction of hepatic cytochrome P4501, EROD activity, in yellowfin bream, Acanthopagrus australis, captured in the vicinity of SPMD sampling sites following deployment in summer was used as a biomarker of exposure to PAHs and related chemicals. SPMDs identified a clear and reproducible gradient in PAH contamination with levels increasing from east to west in Moreton Bay and upstream in the Brisbane River. The highest PAH concentrations expressed as B(a)P-toxicity equivalents (TEQs) were found in urban areas, which were also furthest upstream and experienced the least flushing. Cytochrome P4501 induction in A. australis was similar at all sites. The absence of clear trends in EROD activity may be attributable to factors not measured in this study or variable residency time of A. australis in contaminated areas. It is also possible that fish in the Moreton region are displaying enzymatic adaptation, which has been reported previously for fish subjected to chronic exposure to organic contaminants. These potential interferences complicate interpretation of EROD activity from feral biota. It is, therefore, suggested that future monitoring combine the two methods by applying passive sampler extracts to in vitro EROD assays. (C) 2004 Elsevier Ltd. All rights reserved.

Lessons from monitoring the performance of highway bridges

Peer reviewed