The hyperthermic patient

Concepts used in this chapter include: Thermoregulation:- Thermoregulation refers to the body’s sophisticated, multi-system regulation of core body temperature. This hierarchical system extends from highly thermo-sensitive neurons in the preoptic region of the brain proximate to the rostral hypothalamus, down to the brain stem and spinal cord. Coupled with receptors in the skin and spine, both central and peripheral information on body temperature is integrated to inform and activate the homeostatic mechanisms which maintain our core temperature at 37oC1. Hyperthermia:- An imbalance between the metabolic and external heat accumulated in the body and the loss of heat from the body2. Exertional heat stroke:- A disorder of excessive heat production coupled with insufficient heat dissipation which occurs in un-acclimated individuals who are engaging in over-exertion in hot and humid conditions. This phenomenon includes central nervous system dysfunction and critical dysfunction to all organ systems including renal, cardiovascular, musculoskeletal and hepatic functions. Non-exertional heat stroke:- In contrast to exertional heatstroke as a consequence of high heat production during strenuous exercise, non-exertional heatstroke results from prolonged exposure to high ambient temperature. The elderly, those with chronic health conditions and children are particularly susceptible.3 Rhabdomylosis:- An acute, sometimes fatal disease characterised by destruction of skeletal muscle. In exertional heat stroke, rhabdomylosis occurs in the context of strenuous exercise when mechanical and/or metabolic stress damages the skeletal muscle, causing elevated serum creatine kinease. Associated with this is the potential development of hyperkalemia, myoglobinuria and renal failure. Malignant hyperthermia:- Malignant hyperthermia is “an inherited subclinical myopathy characterised by a hypermetabolic reaction during anaesthesia. The reaction is related to skeletal muscle calcium dysregulation triggered by volatile inhaled anaesthetics and/or succinylcholine.”4 Presentation includes skeletal muscle rigidity, mixed metabolic and respiratory acidosis, tachycardia, hyperpyrexia, rhabdomylosis, hyperkalaemia, elevated serum creatine kinease, multi-organ failure, disseminated intravascular coagulation and death.5

The impact of heatwaves on emergency department visits in Brisbane, Australia : a time series study

Introduction The acute health effects of heatwaves in a subtropical climate and their impact on emergency departments (ED) are not well known. The purpose of this study is to examine overt heat-related presentations to EDs associated with heatwaves in Brisbane. Methods Data were obtained for the summer seasons (December to February) from 2000-2012. Heatwave events were defined as two or more successive days with daily maximum temperature >=34[degree sign]C (HWD1) or >=37[degree sign]C (HWD2). Poisson generalised additive model was used to assess the effect of heatwaves on heat-related visits (International Classification of Diseases (ICD) 10 codes T67 and X30; ICD 9 codes 992 and E900.0). Results Overall, 628 cases presented for heat-related illnesses. The presentations significantly increased on heatwave days based on HWD1 (relative risk (RR) = 4.9, 95% confidence interval (CI): 3.8, 6.3) and HWD2 (RR = 18.5, 95% CI: 12.0, 28.4). The RRs in different age groups ranged between 3-9.2 (HWD1) and 7.5-37.5 (HWD2). High acuity visits significantly increased based on HWD1 (RR = 4.7, 95% CI: 2.3, 9.6) and HWD2 (RR = 81.7, 95% CI: 21.5, 310.0). Average length of stay in ED significantly increased by >1 hour (HWD1) and >2 hours (HWD2). Conclusions Heatwaves significantly increase ED visits and workload even in a subtropical climate. The degree of impact is directly related to the extent of temperature increases and varies by socio-demographic characteristics of the patients. Heatwave action plans should be tailored according to the population needs and level of vulnerability. EDs should have plans to increase their surge capacity during heatwaves.

Register File Energy Optimization for Snooping Based Clustered VLIW Architectures

Frequent accesses to the register file make it one of the major sources of energy consumption in ILP architectures. The large number of functional units connected to a large unified register file in VLIW architectures make power dissipation in the register file even worse because of the need for a large number of ports. High power dissipation in a relatively smaller area occupied by a register file leads to a high power density in the register file and makes it one of the prime hot-spots. This makes it highly susceptible to the possibility of a catastrophic heatstroke. This in turn impacts the performance and cost because of the need for periodic cool down and sophisticated packaging and cooling techniques respectively. Clustered VLIW architectures partition the register file among clusters of functional units and reduce the number of ports required thereby reducing the power dissipation. However, we observe that the aggregate accesses to register files in clustered VLIW architectures (and associated energy consumption) become very high compared to the centralized VLIW architectures and this can be attributed to a large number of explicit inter-cluster communications. Snooping based clustered VLIW architectures provide very limited but very fast way of inter-cluster communication by allowing some of the functional units to directly read some of the operands from the register file of some of the other clusters. In this paper, we propose instruction scheduling algorithms that exploit the limited snooping capability to reduce the register file energy consumption on an average by 12% and 18% and improve the overall performance by 5% and 11% for a 2-clustered and a 4-clustered machine respectively, over an earlier state-of-the-art clustered scheduling algorithm when evaluated in the context of snooping based clustered VLIW architectures.

Conforto térmico em edificações

Pós-graduação em Engenharia Mecânica - FEG

Caracterização climática e comparação de métodos de estimativa de evapotranspiração de referência para regiões do Estado do Ceará

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Extreme temperature events analyzed with Fast Fourier Transform

Extreme weather and climate events have received increased attention in the last few years, due to the often large loss of agriculture business and exponentially increasing costs associated with them and insurance planning. This increased attention raises the question as to whether extreme weather and climate events are truly increasing, whether this is only a perceived increase exacerbated by enhanced media coverage, or both. There are a number of ways extreme climate events can be defined, such as extreme daily temperatures, extreme daily rainfall amounts, and large areas experiencing unusually warm monthly temperatures, among others. In this study, we will focus our attention in frost and heatstroke events measuring it as the number of days under 0 ºC and number of days with daily maximum over 30ºC monthly respectively. We have studied the trends in these extreme events applying a Fast Fourier Transform to the series to clarify the tendency. Lack of long-term climate data suitable for analysis of extremes is the single biggest obstacle to quantifying whether extreme events have changed over the twentieth century, including high temporal and spatial resolution observations of temperatures. However, several series have been grouped in different ways: chosen the longest series independently, by provinces, by main watersheds and altitude. On the other hand, synthetic series generated by Luna and Balairón (AEMet) were also analyzed. The results obtained by different pooling data are discussed concluding the difficulties to assess the extreme events tendencies and high regional variation in the trends.