Is it worth treating fever in intensive care unit patients? Preliminary results from a randomized trial of the effect of external cooling.

BACKGROUND: Antipyresis is a common clinical practice in intensive care, although it is unknown if fever is harmful, beneficial, or a negligible adverse effect of infection and inflammation. METHODS: In a randomized study, rectal temperature and discomfort were assessed in 38 surgical intensive care unit patients without neurotrauma or severe hypoxemia and with fever (temperature >/=38.5 degrees C) and systemic inflammatory response syndrome. Eighteen patients received external cooling while 20 received no antipyretic treatment. RESULTS: Temperature and discomfort decreased similarly in both groups after 24 hours. No significant differences in recurrence of fever, incidence of infection, antibiotic therapy, intensive care unit and hospital length of stay, or mortality were noted between the groups. CONCLUSIONS: These results suggest that the systematic suppression of fever may not be useful in patients without severe cranial trauma or significant hypoxemia. Letting fever take its natural course does not seem to harm patients with systemic inflammatory response syndrome or influence the discomfort level and may save costs.

Optimization of Cooling Protocols for Hearts Destined for Transplantation

Design and analysis of conceptually different cooling systems for the human heart preservation are numerically investigated. A heart cooling container with required connections was designed for a normal size human heart. A three-dimensional, high resolution human heart geometric model obtained from CT-angio data was used for simulations. Nine different cooling designs are introduced in this research. The first cooling design (Case 1) used a cooling gelatin only outside of the heart. In the second cooling design (Case 2), the internal parts of the heart were cooled via pumping a cooling liquid inside both the heart’s pulmonary and systemic circulation systems. An unsteady conjugate heat transfer analysis is performed to simulate the temperature field variations within the heart during the cooling process. Case 3 simulated the currently used cooling method in which the coolant is stagnant. Case 4 was a combination of Case 1 and Case 2. A linear thermoelasticity analysis was performed to assess the stresses applied on the heart during the cooling process. In Cases 5 through 9, the coolant solution was used for both internal and external cooling. For external circulation in Case 5 and Case 6, two inlets and two outlets were designed on the walls of the cooling container. Case 5 used laminar flows for coolant circulations inside and outside of the heart. Effects of turbulent flow on cooling of the heart were studied in Case 6. In Case 7, an additional inlet was designed on the cooling container wall to create a jet impinging the hot region of the heart’s wall. Unsteady periodic inlet velocities were applied in Case 8 and Case 9. The average temperature of the heart in Case 5 was +5.0oC after 1500 s of cooling. Multi-objective constrained optimization was performed for Case 5. Inlet velocities for two internal and one external coolant circulations were the three design variables for optimization. Minimizing the average temperature of the heart, wall shear stress and total volumetric flow rates were the three objectives. The only constraint was to keep von Mises stress below the ultimate tensile stress of the heart’s tissue.

Internal cooling in rotational molding-A review

Rotational molding suffers from a relatively long cycle time, which hampers more widespread growth of the process. During each cycle, both the polymer and mold must be heated from room temperature to above polymer melting temperature and subsequently cooled to room temperature. The cooling time in this process is relatively long due to the poor thermal conductivity of plastics. Although rapid external cooling is possible, internal cooling rates are the major limitation. This causes the process to be uneconomical for large production runs of small parts. Various researchers have strived to minimize cycle times by applying various internal cooling procedures. This article presents a review of these methods, including computer simulations and practical investigations published to date. The effects of cooling rate on the morphology, shrinkage, warpage, and impact properties of rotationally molded polyolefins are also highlighted. In general, rapid and symmetrical cooling across the mold results in smaller spherulite size, increased mechanical properties and less potential warpage or distortion in moldings. POLYM. ENG. SCI., 2011. ©2011 Society of Plastics Engineers.

Outcome Prediction after Cardiac Arrest Treated with Hypothermia

Rationale: Clinical and electrophysiological prognostic markers of brain anoxia have been mostly evaluated in comatose survivors of out hospital cardiac arrest (OHCA) after standard resuscitation, but their predictive value in patients treated with mild induced hypothermia (IH) is unknown. The objective of this study was to identify a predictive score of independent clinical and electrophysiological variables in comatose OHCA survivors treated with IH, aiming at a maximal positive predictive value (PPV) and a high negative predictive value (NPV) for mortality. Methods: We prospectively studied consecutive adult comatose OHCA survivors from April 2006 to May 2009, treated with mild IH to 33-34_C for 24h at the intensive care unit of the Lausanne University Hospital, Switzerland. IH was applied using an external cooling method. As soon as subjects passively rewarmed (body temperature >35_C) they underwent EEG and SSEP recordings (off sedation), and were examined by experienced neurologists at least twice. Patients with status epilepticus were treated with AED for at least 24h. A multivariable logistic regression was performed to identify independent predictors of mortality at hospital discharge. These were used to formulate a predictive score. Results: 100 patients were studied; 61 died. Age, gender and OHCA etiology (cardiac vs. non-cardiac) did not differ among survivors and nonsurvivors. Cardiac arrest type (non-ventricular fibrillation vs. ventricular fibrillation), time to return of spontaneous circulation (ROSC) >25min, failure to recover all brainstem reflexes, extensor or no motor response to pain, myoclonus, presence of epileptiform discharges on EEG, EEG background unreactive to pain, and bilaterally absent N20 on SSEP, were all significantly associated with mortality. Absent N20 was the only variable showing no false positive results. Multivariable logistic regression identified four independent predictors (Table). These were used to construct the score, and its predictive values were calculated after a cut-off of 0-1 vs. 2-4 predictors. We found a PPV of 1.00 (95% CI: 0.93-1.00), a NPV of 0.81 (95% CI: 0.67-0.91) and an accuracy of 0.93 for mortality. Among 9 patients who were predicted to survive by the score but eventually died, only 1 had absent N20. Conclusions: Pending validation in a larger cohort, this simple score represents a promising tool to identify patients who will survive, and most subjects who will not, after OHCA and IH. Furthermore, while SSEP are 100% predictive of poor outcome but not available in most hospitals, this study identifies EEG background reactivity as an important predictor after OHCA. The score appears robust even without SSEP, suggesting that SSEP and other investigations (e.g., mismatch negativity, serum NSE) might be principally needed to enhance prognostication in the small subgroup of patients failing to improve despite a favorable score.

From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.

OBJECTIVES: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation. However, no studies have evaluated whether therapeutic hypothermia could be effectively implemented in intensive care practice and whether it would improve the outcome of all comatose patients with cardiac arrest, including those with shock or with cardiac arrest due to nonventricular fibrillation rhythms. DESIGN: Retrospective study. SETTING: Fourteen-bed medical intensive care unit in a university hospital. PATIENTS: Patients were 109 comatose patients with out-of-hospital cardiac arrest due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity). INTERVENTIONS: We analyzed 55 consecutive patients (June 2002 to December 2004) treated with therapeutic hypothermia (to a central target temperature of 33 degrees C, using external cooling). Fifty-four consecutive patients (June 1999 to May 2002) treated with standard resuscitation served as controls. Efficacy, safety, and outcome at hospital discharge were assessed. Good outcome was defined as Glasgow-Pittsburgh Cerebral Performance category 1 or 2. MEASUREMENTS AND MAIN RESULTS: In patients treated with therapeutic hypothermia, the median time to reach the target temperature was 5 hrs, with a progressive reduction over the 18 months of data collection. Therapeutic hypothermia had a major positive impact on the outcome of patients with cardiac arrest due to ventricular fibrillation (good outcome in 24 of 43 patients [55.8%] of the therapeutic hypothermia group vs. 11 of 43 patients [25.6%] of the standard resuscitation group, p = .004). The benefit of therapeutic hypothermia was also maintained in patients with shock (good outcome in five of 17 patients of the therapeutic hypothermia group vs. zero of 14 of the standard resuscitation group, p = .027). The outcome after cardiac arrest due to nonventricular fibrillation rhythms was poor and did not differ significantly between the two groups. Therapeutic hypothermia was of particular benefit in patients with short duration of cardiac arrest (<30 mins). CONCLUSIONS: Therapeutic hypothermia for the treatment of postcardiac arrest coma can be successfully implemented in intensive care practice with a major benefit on patient outcome, which appeared to be related to the type and the duration of initial cardiac arrest and seemed maintained in patients with shock.

Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study

OBJECTIVES: Current indications for therapeutic hypothermia (TH) are restricted to comatose patients with cardiac arrest (CA) due to ventricular fibrillation (VF) and without circulatory shock. Additional studies are needed to evaluate the benefit of this treatment in more heterogeneous groups of patients, including those with non-VF rhythms and/or shock and to identify early predictors of outcome in this setting. DESIGN: Prospective study, from December 2004 to October 2006. SETTING: 32-bed medico-surgical intensive care unit, university hospital. PATIENTS: Comatose patients with out-of-hospital CA. INTERVENTIONS: TH to 33 +/- 1 degrees C (external cooling, 24 hrs) was administered to patients resuscitated from CA due to VF and non-VF (including asystole or pulseless electrical activity), independently from the presence of shock. MEASUREMENTS AND MAIN RESULTS: We hypothesized that simple clinical criteria available on hospital admission (initial arrest rhythm, duration of CA, and presence of shock) might help to identify patients who eventually survive and might most benefit from TH. For this purpose, outcome was related to these predefined variables. Seventy-four patients (VF 38, non-VF 36) were included; 46% had circulatory shock. Median duration of CA (time from collapse to return of spontaneous circulation [ROSC]) was 25 mins. Overall survival was 39.2%. However, only 3.1% of patients with time to ROSC > 25 mins survived, as compared to 65.7% with time to ROSC < or = 25 mins. Using a logistic regression analysis, time from collapse to ROSC, but not initial arrest rhythm or presence of shock, independently predicted survival at hospital discharge. CONCLUSIONS: Time from collapse to ROSC is strongly associated with outcome following VF and non-VF cardiac arrest treated with therapeutic hypothermia and could therefore be helpful to identify patients who benefit most from active induced cooling.

SC HIOMON JA PAPERIKONEEN LÄMPÖTASAPAINON HALLINTA

Kivihiokkeen valmistus on energiaintensiivistä. Käytetystä energiasta muuttuu yli 90 prosenttia lämmöksi. Hiomolla käytetystä lämmöksi muuttuneesta tehosta voidaan paperikoneelle siirtää noin puolet. Mekaanisen massan valmistuksen ja paperikoneen vesikierrot erotetaan toisistaan häiriöaineiden kulkeutumisen estämiseksi. Vesikiertojen erottamisella katkaistaan myös lämmön siirtyminen hiomolta paperikoneelle massojen mukana. Käyttämällä lämmönsiirtimiä hiomon vesien jäähdytyksessä, voidaan hiomon hiomakoneiden suihkuvesivesilämpötilaa alentaa. Lämmönsiirto vaikuttaa paperikoneella annostelumassojen laimennusten kautta perälaatikkolämpötilaa kohottavasti. Työn tehtäväksi määritettiin kesäkuukausina esiintyvä hiomakoneiden suihkuveden raakavesijäähdytyksen tarpeen poistaminen ensisijaisesti niin, että ylimäärälämpö hyödynnetään tehtaalla. Työn muiksi tavoitteiksi muodostui annostelumassojen lämpötilan hallinta, etenkin muutokset, joilla voidaan nostaa hylkymassan annostelulämpötilaa. Työn kokeellinen osa tehtiin UPM Kymmene Oyj Kajaanin tehtailla syksyn 2004 aikana. Työssä tutkittiin WinGEMS simulointiohjelmalla tehtyjen mallien avulla lämmön siirtymistä hiomon ja paperikone 2:n välillä, sekä lämmönsiirtoa pois tasealueelta. Simulointimalli nykytilanteesta rakennettiin yksityiskohtaisesti nykyisen tuotantoprosessin kaltaiseksi ja siitä muokattiin eri vaihtoehtoja, joilla ratkaistiin tutkimukselle asetetut tehtävät. Kytkentämuutoksilla pystyttiin siirtämään hiomolta yli 85 % hiomakoneiden suihkuveden ylimäärälämmöstä ilman uusia laitehankintoja. Asentamalla lopuksi lämmönsiirrin hiomon puhdassuodoslinjaan, hiomakoneiden suihkuveden jäähdytystarve poistettiin kokonaan. Samalla alennettiin valkaisuun menevän massan lämpötilaa, jolloin peroksidivalkaisun kemikaalikulutus väheni yli 10 %. Lämmönsiirrinverkostosta tehtiin kesätilanteen pinch-analyysi, jolla selvitettiin prosessin lämmitys ja jäähdytystarpeet. Analyysin perusteella selvisi, että kytkennöissä ei rikota pinch sääntöjä ja, että prosessissa esiintyy kynnysongelma, jossa prosessi tarvitsee ainoastaan jäähdytystä.

Pinch-menetelmän soveltaminen sellutehtaassa

Työn tarkoituksena oli tutkia pinch-menetelmän soveltuvuutta toiminnassa olevassa UPM-Kymmene Oyj:n kaukaan sellutehtaassa ja kartoittaa pinch-analyysin avulla keittämön sekä haihduttamon lämpöenergiatarpeet sekä ylijäämät kesä ja talvitilanteissa vuodelle 1999. Kesätilanteeksi on katsottu riittävän elokuu ja talvitilanteeksi helmikuu. Työn alussa on lyhyesti käyty läpi pinch-tekniikkaan liittyvää teoriaa ja tutustutaan yleisesti työssä käytettyyn Pro_pi2 laskentaohjelmaan. Laskennan tulokset on muodostettu käsittelemällä tiedonkeruujärjestelmistä haettu virtaavien nesteiden tulo- ja kohdelämpötiloista sekä massavirroista muodostuva data Pro_pi2 laskentaohjelmalla. Tulokset on esitetty kappaleessa 5, jossa kesä ja talvitilanteista saatuja tuloksia on verrattu keskenään. Mielenkiinnon vuoksi mukaan vertailuun on otettu vuoden 1999 tietojen lisäksi myös tiedot vuoden 2000 talvelle. Pinch-menetelmään perustuvan Pro_pi2 laskentaohjelman todettiin soveltuvan ennemminkin lämmön talteenottojärjestelmän sekä tehtaan energiakäytön esisuunnitteluun kuin jo olemassa olevan tehtaan tutkimiseen.

Ydinreaktorin painesäiliön ulkoisen jäähdytyksen lämmönsiirtokokeita

The purpose of this work was to design and carry out thermal-hydraulic experiments dealing with overcooling transients of a VVER-440-type nuclear reactor pressure vessel. Sudden overcooling accident could have negative effect on the mechanical strength of the pressure vessel. If part of the pressure vessel is compromised, the intense pressure inside a pressurized water reactor could cause the wall to fracture. Information on the heat transfer along the outside of the pressure vessel wall is necessary for stress analysis. Basic knowledge of the overcooling accident and heat transfer types on the outside of the pressure vessel is presented as background information. Test facility was designed and built based to study and measure heat transfer during specific overcooling scenarios. Two test series were conducted with the first one concentrating on the very beginning of the transient and the second one concentrating on steady state heat transfer. Heat transfer coefficients are calculated from the test data using an inverse method, which yields better results in fast transients than direct calculation from the measurement results. The results show that heat transfer rate varies considerably during the transient, being very high in the beginning and dropping to steady state in a few minutes. The test results show that appropriate correlations can be used in future analysis.

Experimental analysis of novel telecom source materials and devices

Incumbent telecommunication lasers emitting at 1.5 µm are fabricated on InP substrates and consist of multiple strained quantum well layers of the ternary alloy InGaAs, with barriers of InGaAsP or InGaAlAs. These lasers have been seen to exhibit very strong temperature dependence of the threshold current. This strong temperature dependence leads to a situation where external cooling equipment is required to stabilise the optical output power of these lasers. This results in a significant increase in the energy bill associated with telecommunications, as well as a large increase in equipment budgets. If the exponential growth trend of end user bandwidth demand associated with the internet continues, these inefficient lasers could see the telecommunications industry become the dominant consumer of world energy. For this reason there is strong interest in developing new, much more efficient telecommunication lasers. One avenue being investigated is the development of quantum dot lasers on InP. The confinement experienced in these low dimensional structures leads to a strong perturbation of the density of states at the band edge, and has been predicted to result in reduced temperature dependence of the threshold current in these devices. The growth of these structures is difficult due to the large lattice mismatch between InP and InAs; however, recently quantum dots elongated in one dimension, known as quantum dashes, have been demonstrated. Chapter 4 of this thesis provides an experimental analysis of one of these quantum dash lasers emitting at 1.5 µm along with a numerical investigation of threshold dynamics present in this device. Another avenue being explored to increase the efficiency of telecommunications lasers is bandstructure engineering of GaAs-based materials to emit at 1.5 µm. The cause of the strong temperature sensitivity in InP-based quantum well structures has been shown to be CHSH Auger recombination. Calculations have shown and experiments have verified that the addition of bismuth to GaAs strongly reduces the bandgap and increases the spin orbit splitting energy of the alloy GaAs1−xBix. This leads to a bandstructure condition at x = 10 % where not only is 1.5 µm emission achieved on GaAs-based material, but also the bandstructure of the material can naturally suppress the costly CHSH Auger recombination which plagues InP-based quantum-well-based material. It has been predicted that telecommunications lasers based on this material system should operate in the absence of external cooling equipment and offer electrical and optical benefits over the incumbent lasers. Chapters 5, 6, and 7 provide a first analysis of several aspects of this material system relevant to the development of high bismuth content telecommunication lasers.

A systemic approach for optimal cooling tower operation

The thermal performance of a cooling tower and its cooling water system is critical for industrial plants, and small deviations from the design conditions may cause severe instability in the operation and economics of the process. External disturbances such as variation in the thermal demand of the process or oscillations in atmospheric conditions may be suppressed in multiple ways. Nevertheless, such alternatives are hardly ever implemented in the industrial operation due to the poor coordination between the utility and process sectors. The complexity of the operation increases because of the strong interaction among the process variables. In the present work, an integrated model for the minimization of the operating costs of a cooling water system is developed. The system is composed of a cooling tower as well as a network of heat exchangers. After the model is verified, several cases are studied with the objective of determining the optimal operation. It is observed that the most important operational resources to mitigate disturbances in the thermal demand of the process are, in this order: the increase in recycle water flow rate, the increase in air flow rate and finally the forced removal of a portion of the water flow rate that enters the cooling tower with the corresponding make-up flow rate. (C) 2009 Elsevier Ltd. All rights reserved.

Frequency stabilised grating feedback laser diode for atom cooling applications

The free running linewidth of an external cavity grating feedback diode laser is on the order of a few megahertz and is limited by the mechanical and acoustic vibrations of the external cavity. Such frequency fluctuations can be removed by electronic feedback. We present a hybrid stabilisation technique that uses both a Fabry-Perot confocal cavity and an atomic resonance to achieve excellent short and long term frequency stability. The system has been shown to reduce the laser linewidth of an external cavity diode laser by an order of magnitude to 140 kHz, while limiting frequency excursions to 60 kHz relative to an absolute reference over periods of several hours. The scheme also presents a simple way to frequency offset two lasers many gigahertz apart which should find a use in atom cooling experiments, where hyperfine ground-state frequency separations are often required.

Water treatments in semi-closed cooling circuits and their impact on the quality of effluents discharged by CERN

Dissertação apresentada à Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia do Ambiente, Gestão de Sistemas Ambientais

Water treatments in semi-closed cooling circuits and their impact on the quality of effluents discharged by CERN

Mestrado integrado em Engenharia do Ambiente, perfil: Gestão de Sistemas Ambientais

The Palaeozoic metamorphic evolution of the Alpine External Massifs

The pre-Mesozoic metamorphic pattern of the External Massifs, composed of subunits of different metamorphic histories, resulted from the telescoping of Variscan, Ordovician and older metamorphic and structural textures and formations. During an early period, the future External Massifs were part of a peri-Gondwanian microplate evolving as an active margin. Precambrian to lower Palaeozoic igneous and sedimentary protoliths were reworked during an Ordovician subduction cycle (eclogites, granulites) preceding Ordovician anatexis and intrusion of Ordovician granitoids. Little is known about the time period when the microcontinent containing the future External Massifs followed a migration path leading to collision with Laurussia. Corresponding rock-series have not been identified. This might be because they have been eroded or transformed by migmatisation or because they remain hidden in the monocyclic areas. Besides the transformations which originated during the Ordovician subduction cycle, strong metamorphic transformations resulted from Variscan collision when many areas underwent amphibolite facies transformations and migmatisation. The different subunits composing the External Massifs and their corresponding P-T evolution are the expression of different levels in a nappe pile, which may have formed before Visean erosion and cooling. The presence of durbachitic magmatic rocks may be the expression of a large scale Early Variscan upwelling line which formed after Variscan lithospheric subduction. Late Variscan wrench fault tectonics and crustal thinning accompanied by high thermal gradients triggered several pulses of granite intrusions.