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Sample records for continuous venovenous hemodiafiltration

  1. Sodium-reduced continuous venovenous hemodiafiltration (CVVHDF) for the prevention of central pontine myelinolysis (CPM) in hyponatremic patients scheduled for orthotopic liver transplantation.

    Science.gov (United States)

    Lenk, Marcus R; Kaspar, Michael

    2012-08-01

    Two patients in end-stage hepatic failure presented for orthotopic liver transplantation with longstanding severe hyponatremia (121 and 122 mmol/L). Both patients underwent liver transplantation with the concomitant use of continuous venovenous hemodiafiltration. Replacement and dialysate solutions were prepared individually to contain a sodium level that was individually considered safe with regard to the development of central pontine myelinolysis. The sodium increase in both patients was within the expected and planned limits despite a situation of mass transfusion. Both patients did well postoperatively and neither patient suffered neurological deficits. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning

    Science.gov (United States)

    Zakharov, Sergey; Pelclova, Daniela; Navratil, Tomas; Belacek, Jaromir; Kurcova, Ivana; Komzak, Ondrej; Salek, Tomas; Latta, Jiri; Turek, Radovan; Bocek, Robert; Kucera, Cyril; Hubacek, Jaroslav A; Fenclova, Zdenka; Petrik, Vit; Cermak, Martin; Hovda, Knut Erik

    2014-01-01

    During an outbreak of methanol poisonings in the Czech Republic in 2012, we were able to study methanol and formate elimination half-lives during intermittent hemodialysis (IHD) and continuous veno-venous hemodialysis/hemodiafiltration (CVVHD/HDF) and the relative impact of dialysate and blood flow rates on elimination. Data were obtained from 11 IHD and 13 CVVHD/HDF patients. Serum methanol and formate concentrations were measured by gas chromatography and an enzymatic method. The groups were relatively comparable, but the CVVHD/HDF group was significantly more acidotic (mean pH 6.9 vs. 7.1 IHD). The mean elimination half-life of methanol was 3.7 and formate 1.6 h with IHD, versus 8.1 and 3.6 h, respectively, with CVVHD/HDF (both significant). The 54% greater reduction in methanol and 56% reduction in formate elimination half-life during IHD resulted from the higher blood and dialysate flow rates. Increased blood and dialysate flow on the CVVHD/HDF also increased elimination significantly. Thus, IHD is superior to CVVHD/HDF for more rapid methanol and formate elimination, and if CVVHD/HDF is the only treatment available then elimination is greater with greater blood and dialysate flow rates. PMID:24621917

  3. Impact of computerized order entry and pre-mixed dialysis solutions for continuous veno-venous hemodiafiltration on selection of therapy for acute renal failure.

    Science.gov (United States)

    Saadulla, Lawand; Reeves, W Brian; Irey, Brittany; Ghahramani, Nasrollah

    2012-02-01

    To investigate the impacts of availability of pre-mixed solutions and computerized order entry on nephrologists' choice of the initial mode of renal replacement therapy in acute renal failure. We studied 898 patients with acute renal failure in 3 consecutive eras: era 1 (custom-mixed solution; n = 309), era 2 (pre-mixed commercial solution; n = 324), and era 3 (post-computerized order entry; n = 265). The proportion of patients treated with renal replacement therapy and the time from consult to initiation of continuous renal replacement therapy was similar in the 3 eras. Following introduction of the pre-mixed solution, the proportion of patients treated with continuous renal replacement therapy increased (20% vs. 33%; p mixed solution increases the likelihood of initiating continuous renal replacement therapy in acute renal failure, initiating it at a lower creatinine and for older patients, use of continuous veno-venous hemodialysis and higher prescribed continuous renal replacement therapy dose. Computerized order entry implementation is associated with an additional increase in the use of continuous veno-venous hemodialysis, higher total prescribed dialysis dose, and use of CRRT among an increasing number of patients not on mechanical ventilation. The effect of these changes on patient survival is not significant.

  4. Continuous venovenous haemodialysis

    DEFF Research Database (Denmark)

    Jensen, Dorte Møller; Bistrup, C; Pedersen, R S

    1996-01-01

    A simple three-pump-based system for the performance of continuous venovenous haemodialysis is described. The method employs access to the circulation via a double-lumen catheter, and by means of a standard extracorporeal peristaltic pump the blood is circulated through a haemofiltration filter....... Standard solutions for peritoneal dialysis are administered in a single-pass manner countercurrent to the blood flow. To control the dialysate flow through the filter, two separate pumps designed for intravenous infusion are used. Anticoagulation is achieved by means of continuous heparin infusion....... This three-pump system is effective in controlling the fluid balance and the level of azotemia. Furthermore, this system makes haemodialysis possible in spite of severe haemodynamic instability. The system is easy to use and inexpensive. 3 patients participated in the study....

  5. Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning

    Czech Academy of Sciences Publication Activity Database

    Zakharov, S.; Pelclová, D.; Navrátil, Tomáš; Běláček, J.; Kurcová, I.; Komzák, O.; Šálek, T.; Latta, J.; Turek, R.; Boček, R.; Kučera, C.; Hubáček, J. A.; Fenclová, Z.; Petřík, V.; Čermák, M.; Hovda, K. E.

    2014-01-01

    Roč. 86, č. 1 (2014), s. 199-207 ISSN 0085-2538 Institutional support: RVO:61388955 Keywords : Intermittent hemodialysis * hemodiafiltration * methanol poisonings Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 8.563, year: 2014

  6. Comparison of pre-filter and post-filter ionised calcium monitoring in continuous veno-venous hemodiafiltration (CVVHD-F with citrate anti-coagulation.

    Directory of Open Access Journals (Sweden)

    Matthew J Brain

    Full Text Available It is widespread practice during citrate anticoagulated renal replacement therapy to monitor circuit ionised calcium (iCa2+ to evaluate the effectiveness of anticoagulation. Whether the optimal site to sample the blood path is before or after the haemofilter is a common question.Using a prospectively collected observational dataset from intensive care patients receiving pre-dilution continuous veno-venous haemodiafiltration (CVVHD-F with integrated citrate anticoagulation we compared paired samples of pre and post filter iCa2+ where the target range was 0.3-0.5 mmol.L-1 as well as concurrently collected arterial iCa2+. Two nested mixed methods linear models were fitted to the data describing post vs pre filter iCa2+, and the relationship of pre, post and arterial samples.An 11 bed general intensive care unit.450 grouped samples from 152 time periods in seven patients on CRRT with citrate anticoagulation.The relationship of post to pre-filter iCa2+ was not 1:1 with post = 0.082 + 0.751 x pre-filter iCa2+ (95% CI intercept: 0.015-0.152, slope 0.558-0.942. Variation was greatest between patients rather than between circuits within the same patient or citrate dose. Compared to arterial iCa2+ there was no significant difference between pre and post-filter sampling sites (F-value 0.047, p = 0.827.These results demonstrate that there is minimal difference between pre and post filter samples for iCa2+ monitoring of circuit anticoagulation in citrate patients relative to the arterial iCa2+ in CVVHD-F however compared to pre-filter sampling, post filter sampling has a flatter response and greater variation.

  7. The effects of continuous venovenous hemofiltration on coagulation activation

    NARCIS (Netherlands)

    Bouman, Catherine S. C.; de Pont, Anne-Cornélie J. M.; Meijers, Joost C. M.; Bakhtiari, Kamran; Roem, Dorina; Zeerleder, Sacha; Wolbink, Gertjan; Korevaar, Johanna C.; Levi, Marcel; de Jonge, Evert

    2006-01-01

    INTRODUCTION: The mechanism of coagulation activation during continuous venovenous hemofiltration (CVVH) has not yet been elucidated. Insight into the mechanism(s) of hemostatic activation within the extracorporeal circuit could result in a more rational approach to anticoagulation. The aim of the

  8. Doripenem pharmacokinetics in critically ill patients receiving continuous hemodiafiltration (CHDF).

    Science.gov (United States)

    Hidaka, Seigo; Goto, Koji; Hagiwara, Satoshi; Iwasaka, Hideo; Noguchi, Takayuki

    2010-01-01

    Objectives of the prospective, open-label study were to investigate pharmacokinetics of doripenem and determine appropriate doripenem regimens during continuous hemodiafiltration (CHDF) in critically ill patients with renal failure (creatinine clearance times during one dosing interval were measured in order to calculate pharmacokinetic parameters and clearance via hemodiafiltration. Mean half-life (+/-standard deviation) of doripenem was 7.9+/-3.7 hours. Total body clearance of doripenem was 58.0+/-12.7 ml/min, including clearance of 13.5+/-1.6 ml/min via CHDF. An IV dose of 250 mg of doripenem every 12 hours during CHDF provided adequate plasma concentrations for critically ill patients with renal failure, without resulting in accumulation upon steady-state. Thus, under the conditions tested, CHDF appeared to have little effect on doripenem clearance. Therefore, the blood level of doripenem can be satisfactorily controlled by adjustment of doripenem dose and dosing interval, in accordance with residual renal function in patients receiving CHDF.

  9. Pharmacokinetics of linezolid during continuous hemodiafiltration: A case report.

    Science.gov (United States)

    Yamashina, Takuya; Tsuruyama, Moeko; Odawara, Miki; Tsuruta, Minako; Miyata, Hirochika; Kozono, Aki; Tsuji, Yasuhiro; Miyoshi, Takanori; Kawamata, Yosei; Hiraki, Yoichi

    2017-10-01

    The pharmacokinetics of linezolid clearance (CL LZD ) during continuous hemodiafiltration (CHDF) has not been comprehensively analyzed. Here, we examined CL LZD by CHDF in a patient with septic shock and disseminated intravascular coagulation due to methicillin-resistant Staphylococcus aureus. The extraction ratio of LZD by CHDF was 22.6%, and the protein-binding rate was 17.9% ± 7.7%. In addition, it was determined that the calculated total body clearance of LZD was 30.2 mL/min, plasma elimination half-life was 8.66 h, and the CL LZD by the dialyzer used for CHDF was 23.0 mL/min. From the obtained pharmacokinetics, the CL LZD of patients continuing CHDF was estimated to be approximately half of the reported CL LZD for healthy subjects. In addition, the LZD concentration of the sepsis patient who underwent CHDF remained higher than the minimum inhibitory concentration and was similar to the LZD concentrations reported in normal renal function patients. Although further studies are warranted, when LZD is administered to patients treated with CHDF, the present findings suggest that dose regulation is not required. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  10. Hemodiafiltration efficacy in treatment of methanol and ethylene glycol poisoning in a 2-year-old girl.

    Science.gov (United States)

    Szmigielska, Agnieszka; Szymanik-Grzelak, Hanna; Kuźma-Mroczkowska, Elżbieta; Roszkowska-Blaim, Maria

    2015-01-01

    Every year about 2.4 million people in USA are exposed to toxic substances. Many of them are children below 6 years of age. Majority of poisonings in children are incidental and related to household products including for example drugs, cleaning products or antifreeze products. Antifreeze solutions contain ethylene glycol and methanol. Treatment of these toxic substances involves ethanol administration, fomepizole, hemodialysis and correction of metabolic acidosis. The aim of the study was to check the efficacy of continuous venovenous hemodiagiltration in intoxication with ethylene glycol and methanol. One year and 7 months old girl after intoxication with ethylene glycol and methanol was treated with continuous venovenous hemodiafiltration instead of hemodialysis because of technical problems (circulatory instability). Intravenous ethanol infusion with hemodialtration resulted in rapid elimination of methanol from the body and significantly reduced blood ethylene glycol level. Continuous venovenous hemodiafiltration can be helpful in treatment of ethylene glycol and methanol intoxication.

  11. Systemic tobramycin concentrations during selective decontamination of the digestive tract in intensive care unit patients on continuous venovenous hemofiltration

    NARCIS (Netherlands)

    Mol, Meriel; van Kan, H. J. M.; Schultz, Marcus J.; de Jonge, Evert

    2008-01-01

    OBJECTIVE: To study whether selective decontamination of the digestive tract (SDD) results in detectable serum tobramycin concentrations in intensive care unit (ICU) patients with acute renal failure treated with continuous venovenous hemofiltration (CVVH). DESIGN AND SETTING: Prospective,

  12. [Suicide attempt by means of phenobarbital overdose. Effective treatment with continuous veno-venous hemodialysis].

    Science.gov (United States)

    Ruhe, M; Grautoff, S; Kähler, J; Pohle, T

    2016-03-01

    A 68-year-old woman tried to commit suicide using phenobarbital, which was initially prescribed for her dog that suffered from seizures. At admission she was unconscious and ventilated. Five days of intensive care therapy did not improve her state of consciousness. Subsequent continuous veno-venous hemodialysis accelerated the elimination of phenobarbital compared to endogenous elimination by a factor of five. The patient survived without sequelae. Detailed history taking and well-timed indication for dialysis were crucial.

  13. A case of severe thallium poisoning successfully treated with hemoperfusion and continuous veno-venous hemofiltration.

    Science.gov (United States)

    Huang, C; Zhang, X; Li, G; Jiang, Y; Wang, Q; Tian, R

    2014-05-01

    Thallium poisoning is a rare condition that is often misdiagnosed, delaying appropriate treatment. Left untreated, thallium toxicity can permanently damage the nervous and digestive systems or, in severe cases, lead to paralysis and death. It is most often treated by an oral administration of Prussian blue. Thallium has a long physiological half-life, and Prussian blue cannot sequester thallium outside the digestive tract. Therefore, the first priority in treating severe thallium poisoning is to lower blood levels as soon as possible. We report the case of a patient with supralethal blood levels of thallium treated successfully using combined hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVH). Three rounds of HP alone decreased blood thallium levels by 20.2%, 34.8%, and 32.2%, while each of the five subsequent rounds of CVVH reduced thallium blood levels by 63.5%, 64.2%, 42.1%, 18.6%, and 22.6%. The reversal of symptoms and prevention of lasting neurological damage indicates that HP, CVVH, 2,3-dimercaptopropane-1-sulfonate, neuroprotective agents along with supportive therapy were used successfully to treat a case of severe thallium poisoning.

  14. An Evaluation of Ciprofloxacin Pharmacokinetics in Critically Ill Patients undergoing Continuous Veno-venous Haemodiafiltration

    LENUS (Irish Health Repository)

    Spooner, Almath M

    2011-08-04

    Abstract Background The study aimed to investigate the pharmacokinetics of intravenous ciprofloxacin and the adequacy of 400 mg every 12 hours in critically ill Intensive Care Unit (ICU) patients on continuous veno-venous haemodiafiltration (CVVHDF) with particular reference to the effect of achieved flow rates on drug clearance. Methods This was an open prospective study conducted in the intensive care unit and research unit of a university teaching hospital. The study population was seven critically ill patients with sepsis requiring CVVHDF. Blood and ultrafiltrate samples were collected and assayed for ciprofloxacin by High Performance Liquid Chromatography (HPLC) to calculate the model independent pharmacokinetic parameters; total body clearance (TBC), half-life (t1\\/2) and volume of distribution (Vd). CVVHDF was performed at prescribed dialysate rates of 1 or 2 L\\/hr and ultrafiltration rate of 2 L\\/hr. The blood flow rate was 200 ml\\/min, achieved using a Gambro blood pump and Hospal AN69HF haemofilter. Results Seventeen profiles were obtained. CVVHDF resulted in a median ciprofloxacin t1\\/2 of 13.8 (range 5.15-39.4) hr, median TBC of 9.90 (range 3.10-13.2) L\\/hr, a median Vdss of 125 (range 79.5-554) L, a CVVHDF clearance of 2.47+\\/-0.29 L\\/hr and a clearance of creatinine (Clcr) of 2.66+\\/-0.25 L\\/hr. Thus CVVHDF, at an average flow rate of ~3.5 L\\/hr, was responsible for removing 26% of ciprofloxacin cleared. At the dose rate of 400 mg every 12 hr, the median estimated Cpmax\\/MIC and AUC0-24\\/MIC ratios were 10.3 and 161 respectively (for a MIC of 0.5 mg\\/L) and exceed the proposed criteria of >10 for Cpmax\\/MIC and > 100 for AUC0-24\\/MIC. There was a suggestion towards increased ciprofloxacin clearance by CVVHDF with increasing effluent flow rate. Conclusions Given the growing microbial resistance to ciprofloxacin our results suggest that a dose rate of 400 mg every 12 hr, may be necessary to achieve the desired pharmacokinetic

  15. Improvement of Oxygenation in Severe Acute Respiratory Distress Syndrome With High-Volume Continuous Veno-venous Hemofiltration.

    Science.gov (United States)

    Yang, Wenmin; Hong, Jie; Zeng, Qiyi; Tao, Jianping; Chen, Feiyan; Dang, Run; Liang, Yufeng; Wu, Zhiyuan; Yang, Yiyu

    2016-01-01

    The efficacy and therapeutic mechanisms of continuous renal replacement therapy (CRRT) for improvement of oxygenation in acute respiratory distress syndrome (ARDS) remain controversial. These questions were addressed by retrospective analysis of severe ARDS patients admitted to the pediatric intensive care unit of our hospital from 2009 to 2015 who received high-volume continuous veno-venous hemofiltration during mechanical ventilation. There was a significant improvement in partial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) 24 hours after CRRT onset compared with baseline (median change = 51.5; range = -19 to 450.5; P Improvement in oxygenation is likely related to both restoration of fluid balance and clearance of inflammatory mediators.

  16. Full protein alimentation and nitrogen equilibrium in a renal failure patient treated with continuous hemodiafiltration: a case report of 67 days of continuous hemodiafiltration.

    Science.gov (United States)

    Reynolds, H N; Borg, U; Frankenfield, D

    1992-01-01

    Standard care for patients with renal failure while in an intensive care unit involves traditional hemodialysis or peritoneal dialysis and protein restriction. We present a case of a patient with renal failure supported with continuous arteriovenous hemofiltration with dialysis (CAVH-D) who was given full protein alimentation. Total daily urea clearance was measured from the CAVH-D output. Protein load was 196 +/- 34 g/day while receiving total parenteral nutrition and 164 +/- 30 g/day while receiving enteral alimentation. Serum blood urea nitrogen was controlled between 40 and 75 mg/dL, except during septic episodes. Nitrogen balance was estimated based upon known alimentation protein load and measurable and estimated nitrogenous losses. The patient was potentially in nitrogen equilibrium during most of the dialysis period. The cumulative nitrogen balance was positive by 5.2 g after 67 days of dialysis. Volume of alimentation was 3.49 +/- 0.7 liters/day. With CAVH-D, the renal failure patient can receive full alimentation without volume or protein load limitations. Furthermore, nitrogen balances can be estimated easily while the patient is on CAVH-D.

  17. The dose of nafamostat mesilate during plasma exchange with continuous hemodiafiltration in the series-parallel circuit.

    Science.gov (United States)

    Nakae, Hajime; Igarashi, Toshiko; Tajimi, Kimitaka

    2006-06-01

    We studied nafamostat mesilate (NM) and interleukin (IL)-18 levels to determine whether the dose of NM is reduced during plasma exchange (PE) with continuous hemodiafiltration (CHDF) when the series-parallel circuit is used. The subjects of the current study included four patients with acute hepatic failure who underwent PE with CHDF. The four patients underwent a total 15 PE + CHDF procedures, and for each procedure, they were randomized to receive either a half-dose of NM or no NM in the CHDF circuit. Eight procedures were carried out with NM administration, and seven were carried out without NM administration. The dose of NM in the NM group was significantly higher than that in the non-NM group (P = 0.040). No significant differences were observed between the two groups in the inlet NM concentration, the outlet NM concentration, or the rate of IL-18 removal. No statistical correlation was observed between the IL-18 level and the NM dose, the inlet NM concentration, or the outlet NM concentration. There was no blood access difficulty such as catheter failure or clotting of the filter. Thus, it might be possible to carry out PE and CHDF with the series-parallel method without administration of NM in the CHDF circuit.

  18. A Retrospective Review of the Use of Regional Citrate Anticoagulation in Continuous Venovenous Hemofiltration for Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Anne Kit-Hung Leung

    2013-01-01

    Full Text Available Background. The emergence of a commercially prepared citrate solution has revolutionized the use of RCA in the intensive care unit (ICU. The aim of this study was to evaluate the safety profile of a commercially prepared citrate solution. Method. Predilution continuous venovenous hemofiltration (CVVH was performed using Prismocitrate 10/2 at 2500 mL/h and a blood flow rate of 150 mL/min. Calcium chloride solution was infused to maintain ionized calcium within 1.0–1.2 mmol/L. An 8.4% sodium bicarbonate solution was infused separately. Treatment was stopped when the predefined clinical target was reached or the filter clotted. Result. 58 sessions of citrate RCA were analyzed. The median circuit lifetime was 26.0 h (interquartile range IQR 21.2–44.3. The percentage of circuits lasting more than 12 h, 24 h, and 48 h was 94.6%, 58.9%, and 16.1%, respectively. There was no incidence of hypernatremia and median pH was 2.5, only four patients had evidence of citrate accumulation. Conclusion. The commercially prepared citrate solution could be used safely in critically ill patients who required CVVH with no major adverse events.

  19. Systemic tobramycin concentrations during selective decontamination of the digestive tract in intensive care unit patients on continuous venovenous hemofiltration.

    Science.gov (United States)

    Mol, Meriel; van Kan, Hendrikus J M; Schultz, Marcus J; de Jonge, Evert

    2008-05-01

    To study whether selective decontamination of the digestive tract (SDD) results in detectable serum tobramycin concentrations in intensive care unit (ICU) patients with acute renal failure treated with continuous venovenous hemofiltration (CVVH). Prospective, observational, single-center study in a mixed medical-surgical ICU. Adult ICU patients receiving SDD for at least 3 days and being treated with CVVH because of acute renal failure. Tobramycin serum concentrations were measured at the 3rd day after start of CVVH and every 3 days thereafter. Detectable serum concentrations of tobramycin were found in 12 (63%) of 19 patients and in 15 (58%) of the 26 samples. With a toxic tobramycin concentration defined as more than 2.0 mg/l, we found one patient with a toxic concentration of 3.0 mg/l. In three other patients tobramycin concentrations of >or=1.0 mg/l were found. In patients with acute renal failure treated with CVVH, administration of SDD with tobramycin can lead to detectable and potentially toxic serum tobramycin concentrations.

  20. Effectiveness of combining plasma exchange with continuous hemodiafiltration on acute Fatty liver of pregnancy complicated by multiple organ dysfunction.

    Science.gov (United States)

    Chu, Yu-Feng; Meng, Mei; Zeng, Juan; Zhou, Hai-Yan; Jiang, Jin-Jiao; Ren, Hong-Sheng; Zhang, Ji-Cheng; Zhu, Wen-Ying; Wang, Chun-Ting

    2012-06-01

    Acute fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic complications that induce significant maternal risk. The application of combining plasma exchange (PE) and continuous hemodiafiltration (CHDF) is a novel concept for patients with AFLP. Since 2002, we have utilized the combination of PE with CHDF as adjunctive medical therapy for 11 AFLP patients with multiple organ dysfunction. Before PE and CHDF initiation, four patients had signs and symptoms of encephalopathy, four required ventilatory support, and all 11 were developing liver failure, significant renal compromise, and coagulopathy. PE combined with CHDF for patients was initiated a mean of 2 days postpartum (range, days 0-3). Daily or every other day PE combined with CHDF was undertaken on two to eight occasions for each of the 11 patients. Ten patients responded with composite clinical and laboratory improvement and were discharged to the ward, then cured and discharged from hospital; one patient died of septic shock. Average duration of hospitalization was 17 days (range, days 9-38) from time of admission to discharge; the average duration of intensive care unit was 10 days (range, days 4-23). No significant PE- and CHDF-related complications occurred. These results indicate that combing PE and CHDF in a series-parallel circuit is an effective and safe treatment for patients with severe AFLP. This finding may have important implications for the development of an effective treatment for patients with AFLP suffering multiple organ dysfunction. © 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  1. How to calculate clearance of highly protein-bound drugs during continuous venovenous hemofiltration demonstrated with flucloxacillin.

    Science.gov (United States)

    Meyer, Brigitte; Ahmed el Gendy, Salwa; Delle Karth, Georg; Locker, Gottfried J; Heinz, Gottfried; Jaeger, Walter; Thalhammer, Florian

    2003-01-01

    Flucloxacillin is an important antimicrobial drug in the treatment of infections with Staphylococcus aureus and therefore is often used in staphylococcal infections. Furthermore, flucloxacillin has a high protein binding rate as for example ceftriaxone or teicoplanin--drugs which have formerly been characterized as not being dialyzable. The pharmacokinetic parameters of 4.0 g flucloxacillin every 8 h were examined in 10 intensive care patients during continuous venovenous hemofiltration (CVVH) using a polyamide capillary hemofilter. In addition, the difficulty of calculating the hemofiltration clearance of a highly protein-bound drug is described. Flucloxacillin serum levels were significantly lowered (56.9 +/- 24.0%) even though only 15% of the drug was detected in the ultrafiltrate. Elimination half-life, total body clearance and sieving coefficient were 4.9 +/- 0.7 h, 117.2 +/- 79.1 ml/min and 0.21 +/- 0.09, respectively. These discrepancies can be explained by the high protein binding of flucloxacillin, the adsorbing property of polyamide and the equation in order to calculate hemofiltration clearance. The unbound fraction of a 4.0 g flucloxacillin dosage facilitates time above the minimum inhibitory concentration (T > MIC) of 60% only for strains up to a minimum inhibitory concentration (MIC) of 0.5 mg/l. Based on the data of this study, we conclude that intensive care patients with staphylococcal infections on CVVH should be treated with 4.0 g flucloxacillin every 8 h which was safe and well tolerated. Moreover, further studies with highly protein-bound drugs are recommended to check the classical 'hemodialysis' equation as the standard equation in calculating the CVVH clearance of highly protein-bound drugs. Copyright 2003 S. Karger AG, Basel

  2. Carbamazepine and carbamazepine-10,11-epoxide clearance measurements during continuous venovenous hemofiltration in a massive overdose.

    Science.gov (United States)

    Smollin, Craig Geoffrey; Petrie, Matthew S; Kearney, Thomas

    2016-06-01

    Carbamazepine (CBZ) overdose can result in significant neurologic and cardiovascular toxicity, and is compounded by the presence of an active metabolite, carbamazepine-10,11-epoxide (CBZE). Existing publications describing continuous venovenous hemofiltration (CVVH) in CBZ overdose are limited in their ability to calculate accurate clearances. We report a case of CBZ overdose treated with CVVH with detailed measurement of CBZ, CBZE and their respective clearances calculated utilizing serial effluent measurements. This was coupled with serum level determinations comparing two analytical methodologies, time-of-flight mass spectroscopy and an immunoassay. A 41-year-old woman presented unresponsive after an overdose of CBZ. Initial CBZ serum levels were markedly elevated (57.8 μg/mL) and continued to rise. Due to continued hemodynamic instability, extracorporeal removal was initiated using CVVH. During the first 30 h of CVVH, interval serum samples and all ultrafiltrate bags were collected and analyzed. Serum and effluent levels of CBZ and CBZE were measured using an Agilent 6230 time-of-flight high-resolution mass spectrometer (TOF-MS). CBZ levels were also obtained utilizing the Microgenics CEDIA Carbamazepine Immunoassay (Thermo Fisher, Waltham, MA) for serum and effluent samples. Immunoassay analysis was performed using Siemens ADVIA 1800 instrument. The clearances achieved for CBZE (mean = 25.2, range 17.7-42.6 mL/min) exceeded that for CBZ (mean = 18.1, range 12.7-28.7 mL/min). CVVH removed a total of 1293 and 1261 mg of CBZ and CBZE, respectively. Serum levels of CBZ measured by immunoassay when compared with TOF-MS indicated cross reactivity of CBZE with the immunoassay. CVVH removed CBZE with higher clearances than CBZ. However, CVVH clearance rates for both CBZ and CBZE were lower than published clearances of CBZ and CBZE by intermittent hemodialysis. Our methodology allowed for a precise pharmacokinetic assessment of clearance based on

  3. Pharmacokinetics of Imipenem/Cilastatin Burn Intensive Care Unit Patients Undergoing High-Dose Continuous Venovenous Hemofiltration.

    Science.gov (United States)

    Boucher, Bradley A; Hudson, Joanna Q; Hill, David M; Swanson, Joseph M; Wood, G Christopher; Laizure, S Casey; Arnold-Ross, Angela; Hu, Zhe-Yi; Hickerson, William L

    2016-12-01

    High-dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently in patients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I/C), we evaluated the systemic and extracorporeal clearances (CLs) of I/C in patients with burns undergoing high-dose CVVH. Prospective clinical pharmacokinetic study. Ten adult patients with burns receiving I/C for a documented infection and requiring high-dose CVVH were studied. Blood and effluent samples for analysis of I/C concentrations were collected for up to 6 hours after the I/C infusion for calculation of I/C total CL (CL T otal ), CL by CVVH (CL HF ), half-life during CVVH, volume of distribution at steady state (Vd ss ), and the percentage of drug eliminated by CVVH. In this patient sample, the mean age was 50 ± 17 years, total body surface area burns was 23 ± 27%, and 80% were male. Nine patients were treated with high-dose CVVH for acute kidney injury and one patient for sepsis. The mean delivered CVVH dose was 52 ± 14 ml/kg/hour (range 32-74 ml/kg/hr). The imipenem CL HF was 3.27 ± 0.48 L/hour, which accounted for 23 ± 4% of the CL T otal (14.74 ± 4.75 L/hr). Cilastatin CL HF was 1.98 ± 0.56 L/hour, which accounted for 45 ± 19% of the CL T otal (5.16 + 2.44 L/hr). The imipenem and cilastatin half-lives were 1.77 ± 0.38 hours and 4.21 ± 2.31 hours, respectively. Imipenem and cilastatin Vd ss were 35.1 ± 10.3 and 32.8 ± 13.8 L, respectively. Efficient removal of I/C by high-dose CVVH, a high overall clearance, and a high volume of distribution in burn intensive care unit patients undergoing this CRRT method warrant aggressive dosing to treat serious infections effectively depending on the infection site and/or pathogen. © 2016 Pharmacotherapy Publications, Inc.

  4. Peramivir pharmacokinetics in a patient receiving continuous veno-venous hemodiafiltration during the 2009 H1N1 influenza A pandemic.

    Science.gov (United States)

    Bentley, Michael L; Hollistera, Alan S; Hansenb, Amanda C; Smith, Jean A; Cain, James S

    2014-12-01

    Peramivir is a neuraminidase inhibitor having activity against various influenza A and B subtypes. The main route of elimination is the kidney and a dose reduction is justified for multiple-day therapy when the creatinine clearance is calculate the saturation coefficient, plasma half-life, maximum and minimum plasma concentrations, and area under the plasma drug concentration-time curve (AUC) for peramivir. CVVHDF was performed using a Prisma pump and an AN69 filter. During peramivir sampling, the dialysate flow rate was 16.7 mL/min. The mean total ultrafiltrate produced was 14.2 mL/min. To calculate a saturation coefficient (SA), simultaneous sampling of blood and effluent was performed. Pre- and post-filter as well as effluent samples were obtained 4.5 and 8.5 hours following the 3rd dose of 480 mg. Plasma concentrations were also obtained at several time points and the AUC estimated from 0 to 24 hours (AUC0-24). The maximum plasma concentration (C30min) was 19,477 ng/mL, the minimum plasma concentration (Cmin) 2,750 ng/mL, and AUC0-24 196,166 ng x h/mL. The estimated plasma half-life was 8.2 hours with a log-linear decrease over the 24-hour period suggesting significant extracorporeal clearance. The calculated SA was 0.98, similar to an estimated SA of 1. Peramivir is readily cleared by CVVHDF having a calculated SA close to 1. The maximum and minimum plasma concentrations, AUC0-24, and plasma half-life was similar to those previously reported. These data will be useful in determining appropriate peramivir dosing regimens for severely ill influenza patients with acute renal impairment managed by CVVHDF.

  5. Use of the anion gap and intermittent hemodialysis following continuous hemodiafiltration in extremely high dose acute-on-chronic lithium poisoning: A case report.

    Science.gov (United States)

    Komaru, Yohei; Inokuchi, Ryota; Ueda, Yoshihiro; Nangaku, Masaomi; Doi, Kent

    2018-01-01

    A 35-year-old woman intentionally took 40,000 mg of lithium carbonate, and she was transferred to our hospital with nausea, vomiting, and diarrhea. She was diagnosed as having bipolar disorder 10 years ago and was receiving oral lithium therapy. Blood test results on arrival were remarkable for a negative anion gap of -2.1 and later, the serum lithium level turned out to be as high as 15.4 mEq/L. Intubation was required because of disrupted consciousness, and continuous hemodiafiltration (CHDF) was immediately started in the intensive care unit to obtain constant removal of lithium. After adding intermittent hemodialysis (IHD) twice during the daytime to accelerate the lithium clearance, CHDF became unnecessary on day 4, and she was extubated on day 6 with complete recovery of consciousness. Close monitoring of the patient data showed recovery of the decreased anion gap as indicator of the serum lithium level reduction. On day 36, she was discharged without any complication and sequela. The current case highlighted the effective use of CHDF between IHD sessions to prevent the rebound elevation of lithium and the role of the anion gap as a surrogate marker of serum lithium concentration during the treatment. © 2017 International Society for Hemodialysis.

  6. Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Jian-biao Meng

    2016-01-01

    Full Text Available Objective. To investigate the effects of 72-hour early-initiated continuous venovenous hemofiltration (ECVVH treatment in patients with septic-shock-induced acute respiratory distress syndrome (ARDS (not acute kidney injury, AKI with regard to serum E-selectin and measurements of lung function and hemodynamic stability. Methods. This prospective nonblinded single institutional randomized study involved 51 patients who were randomly assigned to receive or not receive ECVVH, an ECVVH group (n=24 and a non-ECVVH group (n=27. Besides standard therapies, patients in ECVVH group underwent CVVH for 72 h. Results. At 0 and 24 h after initiation of treatment, arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2 ratio, extravascular lung water index (EVLWI, and E-selectin level were not significantly different between groups (all P>0.05. Compared to non-ECVVH group, PaO2/FiO2 is significantly higher and EVLWI and E-selectin level are significantly lower in ECVVH group (all P<0.05 at 48 h and 72 h after initiation of treatment. The lengths of mechanical ventilation and stay in intensive care unit (ICU were shorter in ECVVH group (all P<0.05, but there was no difference in 28-day mortality between two groups. Conclusions. In patients with septic-shock-induced ARDS (not AKI, treatment with ECVVH in addition to standard therapies improves endothelial function, lung function, and hemodynamic stability and reduces the lengths of mechanical ventilation and stay in ICU.

  7. Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration.

    Science.gov (United States)

    Jacobs, Rita; Honore, Patrick M; Diltoer, Marc; Spapen, Herbert D

    2016-08-26

    Citrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium. The effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). The next group was treated with Prismocitrate 18/0 (PC18; 18 mmol citrate/L). Both groups received bicarbonate-buffered fluids in post-dilution. At similar citrate flow, the metabolic acidosis present at baseline in both groups was significantly attenuated in PC18 patients but persisted in PC10/2 patients after 24 h of treatment (median pH 7,42 vs 7,28; p = 0.0001). Acidosis in the PC10/2 group was associated with a decreased strong ion difference and an increased strong ion gap (respectively 43 vs. 51 mmol/L and 17 vs. 12 mmol/L, PC10/2 vs. PC18; both p = 0.001). Chloride flow was higher in PC10/2 than in PC18 subjects (25.9 vs 14.3 mmol/L blood; p < 0.05). Correction of acidosis was blunted in patients who received 10 mmol citrate/L as regional anticoagulation during CVVH. This could be explained by differences in chloride flow between the applied citrate solutions inducing hyperchloremic acidosis.

  8. Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure.

    Science.gov (United States)

    Bollmann, Marc-Daniel; Revelly, Jean-Pierre; Tappy, Luc; Berger, Mette M; Schaller, Marie-Denise; Cayeux, Marie-Christine; Martinez, Alexandre; Chioléro, René-Louis

    2004-06-01

    To compare the effects of sodium bicarbonate and lactate for continuous veno-venous hemodiafiltration (CVVHDF) in critically ill patients. Prospective crossed-over controlled trial in the surgical and medical ICUs of a university hospital. Eight patients with multiple organ dysfunction syndrome (MODS) requiring CVVHDF. Each patient received the two buffers in a randomized sequence over two consecutive days. The following variables were determined: acid-base parameters, lactate production and utilization ((13)C lactate infusion), glucose turnover (6,6(2)H(2)-glucose), gas exchange (indirect calorimetry). No side effect was observed during lactate administration. Baseline arterial acid-base variables were equal with the two buffers. Arterial lactate (2.9 versus 1.5 mmol/l), glycemia (+18%) and glucose turnover (+23%) were higher in the lactate period. Bicarbonate and glucose losses in CVVHDF were substantial, but not lactate elimination. Infusing (13)C lactate increased plasma lactate levels equally with the two buffers. Lactate clearance (7.8+/-0.8 vs 7.5+/-0.8 ml/kg per min in the bicarbonate and lactate periods) and endogenous production rates (14.0+/-2.6 vs 13.6+/-2.6 mmol/kg per min) were similar. (13)C lactate was used as a metabolic substrate, as shown by (13)CO(2) excretion. Glycemia and metabolic rate increased significantly and similarly during the two periods during lactate infusion. Lactate was rapidly cleared from the blood of critically ill patients without acute liver failure requiring CVVHDF, being transformed into glucose or oxidized. Lactate did not exert undesirable effects, except moderate hyperglycemia, and achieved comparable effects on acid-base balance to bicarbonate.

  9. Acute treatment of hyperammonemia by continuous renal replacement therapy in a newborn patient with ornithine transcarbamylase deficiency

    Directory of Open Access Journals (Sweden)

    Hyo Jeong Kim

    2011-10-01

    Full Text Available Ornithine transcarbamylase (OTC deficiency is well known as the most common inherited disorder of the urea cycle, and 1 of the most common causes of hyperammonemia in newborns. We experienced a case of a 3-day-old boy with OTC deficiency who appeared healthy in the first 2 days of life but developed lethargy and seizure soon afterwards. His serum ammonia level was measured as &gt;1700 μg/dL (range, 0 to 45 μg/dL. Continuous renal replacement therapy (CRRT in the mode of continuous venovenous hemodiafiltration was immediately applied to correct the raised ammonia level. No seizure occurred after the elevated ammonia level was reduced. Therefore, CRRT should be included as 1 of the treatment modalities for newborns with inborn errors of metabolism, especially hyperammonemia. Here, we report 1 case of successful treatment of hyperammonemia by CRRT in a neonate with OTC deficiency.

  10. Automatic Control of Veno-Venous Extracorporeal Lung Assist.

    Science.gov (United States)

    Kopp, Ruedger; Bensberg, Ralf; Stollenwerk, Andre; Arens, Jutta; Grottke, Oliver; Walter, Marian; Rossaint, Rolf

    2016-10-01

    Veno-venous extracorporeal lung assist (ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The "SmartECLA" system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value 49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min (P < 0.05), and reducing respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min (P < 0.05). The "SmartECLA" demonstrator allowed reliable automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. Impossible Airway Requiring Venovenous Bypass for Tracheostomy

    Directory of Open Access Journals (Sweden)

    Johnathan Gardes

    2012-01-01

    Full Text Available The elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient’s life.

  12. Evolution of Technology for Continuous Renal Replacement Therapy: Forty Years of Improvement.

    Science.gov (United States)

    Ronco, Claudio

    2018-01-01

    Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance. These problems were solved by the introduction of continuous arteriovenous hemodiafiltration and continuous arteriovenous hemodialysis, where uremic control could be achieved by increasing countercurrent dialysate flow rates to 1.5 or 2 L/h as necessary, or by venovenous techniques utilizing a double-lumen central venous catheter for vascular access. Thus, continuous venovenous hemofiltration replaced CAVH because of its improved performance and safety. From the initial adoptive technology, specific machines have been designed to permit safe and reliable performance of the therapy. These new machines have progressively undergone a series of technological steps that have resulted in the evolution of highly sophisticated equipment utilized today. A significant number of advances have taken place since the time continuous renal replacement therapy was initiated. In particular, there have been successful experiments with high-volume hemofiltration and high-permeability hemofiltration. The additional and combined use of sorbent has also been tested successfully. Progress has been made in the technology as well as the understanding of the pathophysiology of acute kidney injury. Today, new biomaterials and new devices are available and new frontiers are on the horizon. Although improvements have been made, a lot remains to be done. Critical care nephrology is expected to further evolve in the near future, especially in the area of information and

  13. Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit.

    Science.gov (United States)

    Yetimakman, Ayse Filiz; Tanyildiz, Murat; Kesici, Selman; Kockuzu, Esra; Bayrakci, Benan

    2017-06-01

    Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.

  14. Optimizing home dialysis: role of hemodiafiltration.

    Science.gov (United States)

    Vilar, Enric; Farrington, Ken; Bates, Chris; Mumford, Carol; Greenwood, Roger

    2011-01-01

    Over the last 40 years the technical obstacles which prevented a convective contribution to diffusive dialysis have been overcome. Hemodiafiltration represents a natural evolution of intermittent extracorporeal blood purification and the technology is now available to offer this as standard treatment in-center. The first randomized control trial of dialysis dose (National Cooperative Dialysis Study) showed that for three times weekly dialysis a critical level of urea clearance was necessary to ensure complication-free survival, the effect being noticeable by 3 months. Following this, observational studies suggested that higher doses improved longer term outcome. In a second large randomized controlled study (HEMO), higher small molecule clearance did not further improve outcome, but high-flux membranes, which permitted enhanced clearance of middle molecules, appeared to confer survival benefit in patients who had already been on dialysis > 3.7 years. Recently, outcomes from the Membrane Permeability Outcome study confirmed a survival benefit of high-flux membranes in high-risk patients. These studies indicate that in the medium term survival is critically dependent on achieving a minimum level of small solute removal. However, longer term survival (measured in years or decades) not only requires better small solute clearance but also enhanced clearance of middle molecules, the toxicity of which manifest over longer time scales. The rationale for convective treatment is strongest, therefore in those patients who have the greatest potential for long-term survival. Patients who opt for self-care at home to allow frequent dialysis generally are constituents of this group. Hemodiafiltration is likely to become standard therapy in-center and in the home. Copyright © 2011 S. Karger AG, Basel.

  15. Online Hemodiafiltration Reduces Bisphenol A Levels.

    Science.gov (United States)

    Quiroga, Borja; Bosch, Ricardo J; Fiallos, Ruth A; Sánchez-Heras, Marta; Olea-Herrero, Nuria; López-Aparicio, Pilar; Muñóz-Moreno, Carmen; Pérez-Alvarsan, Miguel Angel; De Arriba, Gabriel

    2017-02-01

    Several uremic toxins have been identified and related to higher rates of morbidity and mortality in dialysis patients. Bisphenol A (BPA) accumulates in patients with chronic kidney disease. The aim of this study is to demonstrate the usefulness of online hemodiafiltration (OL-HDF) in reducing BPA levels. Thirty stable hemodialysis patients were selected to participate in this paired study. During three periods of 3 weeks each, patients were switched from high-flux hemodialysis (HF-HD) to OL-HDF, and back to HF-HD. BPA levels were measured in the last session of each period (pre- and post-dialysis) using ELISA and HPLC. Twenty-two patients (mean age 73 ± 14 years; 86.4% males) were included. Measurements of BPA levels by HPLC and ELISA assays showed a weak but significant correlation (r = 0.218, P = 0.012). BPA levels decreased in the OL-HDF period of hemodialysis, in contrast to the HF-HD period when they remained stable (P = 0.002). In conclusion, OL-HDF reduced BPA levels in dialysis patients. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  16. Hemodiafiltration history, technology, and clinical results.

    Science.gov (United States)

    Ronco, Claudio; Cruz, Dinna

    2007-07-01

    Hemodiafiltration (HDF) is an extracorporeal renal-replacement technique using a highly permeable membrane, in which diffusion and convection are conveniently combined to enhance solute removal in a wide spectrum of molecular weights. In this modality, ultrafiltration exceeds the desired fluid loss in the patient, and replacement fluid must be administered to achieve the target fluid balance. Over the years, various HDF variants have emerged, including acetate-free biofiltration, high-volume HDF, internal HDF, paired-filtration dialysis, middilution HDF, double high-flux HDF, push-pull HDF, and online HDF. Recent technology has allowed online production of large volumes of microbiologically ultrapure fluid for reinfusion, greatly simplifying the practice of HDF. Several advantages of HDF over purely diffusive hemodialysis techniques have been described in the literature, including a greater clearance of urea, phosphate, beta(2)-microglobulin and other larger solutes, reduction in dialysis hypotension, and improved anemia management. Although randomized controlled trials have failed to show a survival benefit of HDF, recent data from large observational studies suggest a positive effect of HDF on survival. This article provides a brief review of the history of HDF, the various HDF techniques, and summary of their clinical effects.

  17. On-line hemodiafiltration at home.

    Science.gov (United States)

    Vega, Almudena; Abad, Soraya; Macías, Nicolás; Aragoncillo, Inés

    2018-04-01

    Survival with online hemodiafiltration (OL-HDF) is higher than with hemodialysis; frequent hemodialysis has also improved survival and quality of life. Home hemodialysis facilitates frequent therapy. We report our experience with 2 patients with stage 5 CKD who started home hemodialysis with OL-HDF in November 2016. After a training period at the hospital, they started home hemodialysis with OL-HDF after learning how to manage dialysis monitors and how to administer water treatment. We used the "5008-home" (FMC © ) monitor, and the Acqua C © (Fresenius Medical Care) for water treatment. Water conductivity was always checked before and during dialysis sessions and was always 2.5 to 3 mS/cm. Water cultures always fulfilled the criteria for ultrapurity. As far as we know, this is the first report on patients receiving OL-HDF at home. The technique proved to be safe and valid for renal replacement therapy and transfers the benefits of hospital convective therapy to the home setting. Future data will enable us to determine whether survival has also improved. © 2017 International Society for Hemodialysis.

  18. Why choose high volume online post-dilution hemodiafiltration?

    NARCIS (Netherlands)

    Basile, Carlo; Davenport, Andrew; Blankestijn, Peter J.

    The mortality rate of patients on maintenance dialysis remains alarmingly high, at approximately 15–20 % per year. Increasing dialyzer urea clearance has not been shown to improve survival and hence interest has shifted towards convective therapies, such as hemodiafiltration (HDF) which can remove

  19. Clinical and biochemical aspects of hemodialysis and hemodiafiltration

    NARCIS (Netherlands)

    den Hoedt, C.H.

    2012-01-01

    In hemodialysis (HD) clearance of uremic toxins occurs as a result of a concentration gradient between the blood and the dialysate, a process called diffusion. During hemodiafiltration (HDF), diffusion is combined with pressure driven fluid transport across the dialysis membrane, a process called

  20. Optimal therapeutic conditions for online hemodiafiltration.

    Science.gov (United States)

    Canaud, Bernard; Chenine, Leila; Renaud, Sophie; Leray, Hélène

    2011-01-01

    The safety of online hemodiafiltration (ol-HDF) relies on very strict rules of use. The use of ultrapure water to feed an ol-HDF machine is a basic requirement for ol-HDF. Technical aspects and microbial monitoring have been precisely described in the European Best Practice Guidelines. Specifically designed and certified ol-HDF machines are needed. All these machines share the production of substitution fluid by the cold sterilization process of fresh dialysate based on ultrafilters. Hygiene handling is a crucial measure to ensure permanent safety of the ol-HDF system. Frequent disinfection of the water treatment system and dialysis machine, destruction of biofilm by chemical agents and/or thermochemical disinfection, change of filters at regular intervals, and maintenance of a permanent circulation of water are among the basic measures required to ensure ultra-purity of water and dialysis fluid. Optimal performances of ol-HDF require the use of high blood flow (300-400 ml/min), highly permeable and adequately sized hemodiafilters, a high volume of substitution (5-6 l/h) and high dialysate flow (500 ml/min). The site and type of substitution (pre-, post-, mixed, and mid-dilution) should be customized to each patient according to its blood hemorheology and its filtration fraction limitation (transmembrane pressure). All attempts should be made to maximize the fluid volume exchange per session (convective dose) in any cases. The treatment schedule in terms of session duration and weekly frequency need to be adjusted individually to improve hemodynamic tolerance, to facilitate correction of fluid overload and to increase dialysis dose (for middle-sized solutes) in order to reduce circulating levels of major uremic toxins. ol-HDF is the more advanced form of renal replacement therapy offering high efficiency over a large spectrum of toxins, high biocompatibility profile and high flexible modality. ol-HDF may help to improve global care of chronic kidney disease

  1. Treatment of theophylline intoxication using continuous venovenous haemofiltration

    NARCIS (Netherlands)

    Koeijers, J.J.; Verhoeven, C.L.; Boersma, H.H.; van Mook, W.N.K.A

    2008-01-01

    Theophylline intoxication can cause serious complications such as seizures, cardiac arrhythmias and eventually cardiac arrest. Because of these potentially life-threatening clinical manifestations of theophylline intoxication, treatment methods that rapidly eliminate the drug are essential. These

  2. Colistin Pharmacokinetics in Burn Patients During Continuous Venovenous Hemofiltration

    Science.gov (United States)

    2015-01-01

    Bethesda, Maryland, USAc; University of the Incarnate Word, Feik School of Pharmacy, San Antonio, Texas, USAd; Uniformed Services University of the Health ...survey of renal replacement therapy prescribing prac- tice for acute kidney injury in Malaysian intensive care units. Nephrology (Carlton) 19:507–512

  3. Purity and stability of online-prepared hemodiafiltration fluid after storage.

    Science.gov (United States)

    Corradi, V; Cruz, D; Vázquez-Rangel, A; Furlan, F; Grillone, R; Bonaccorsi, A; Cazzavillan, S; de Cal, M; Frisone, P; Morea, A; Brendolan, A; Rassu, M; Ronco, C

    2013-01-01

    Previous studies have suggested that online hemodiafiltration (OL-HDF) fluid can be used as dialysate for continuous renal replacement therapies, and thus HDF costs can be reduced. The aims of this study were to determine the purity of OL-HDF fluid and to verify the stability of the electrolyte composition and acid-base balance during its storage. OL-HDF fluid was collected in 70 individual bags and stored for up to 7 days. The following tests were performed daily in 10 bags: natural visible precipitation (macrocrystallization), sample collection for chemical analysis and fluid culture, limulus amebocyte lysate endotoxin test, standard culture of NALGENE® filters after passing of the fluid, and molecular analysis of bacterial DNA. The values of pH and pCO(2) showed a significant change starting at 24 h (p values were beyond the measurable range. Coefficient of variation for pCO(2) was as high as 25.7%. Electrolyte composition (Na(+), K(+), Cl(-), Ca(2+) and glucose) showed a statistically significant difference over time (p bags in future studies. Copyright © 2013 S. Karger AG, Basel.

  4. Facing regulatory challenges of on-line hemodiafiltration.

    Science.gov (United States)

    Kümmerle, Wolfgang

    2011-01-01

    On-line hemodiafiltration (on-line HDF) is the result of a vision that triggered multifarious changes in very different areas. Driven by the idea to offer better medical treatment for renal patients, technological innovations were developed and established that also constituted new challenges in the field of regulatory affairs. The existing regulations predominantly addressed the quality and safety of those products needed to perform dialysis treatment which were supplied by industrial manufacturers. However, the complexity of treatment system required for the provision of on-line fluids demanded a holistic approach encompassing all components involved. Hence, focus was placed not only on single products, but much more on their interfacing, and the clinical infrastructure, in particular, had to undergo substantial changes. The overall understanding of the interaction between such factors, quite different in their nature, was crucial to overcome the arising regulatory obstacles. This essay describes the evolution of the on-line HDF procedure from the regulatory point of view. A simplified diagram demonstrates the path taken from the former regulatory understanding to the realization of necessary changes. That achievement was only possible through 'management of preview' and consequent promotion of technical and medical innovations as well as regulatory re-evaluations. Copyright © 2011 S. Karger AG, Basel.

  5. Hemodiafiltration Improves Plasma 25-Hepcidin Levels: A Prospective, Randomized, Blinded, Cross-Over Study Comparing Hemodialysis and Hemodiafiltration

    Directory of Open Access Journals (Sweden)

    Bergur V. Stefánsson

    2012-03-01

    Full Text Available Background/Aims: Data from studies comparing the effect of hemodiafiltration (HDF and conventional hemodialysis (HD on clinically important outcomes are insufficient to support superiority of HDF. None of these studies has been participant-blinded. Methods: We performed a prospective, randomized, and patient-blinded cross-over study. Twenty patients on chronic HD received either HD for 2 months followed by post-dilution HDF for 2 months or in opposite order. A range of clinical parameters, as well as markers of inflammation, oxidative stress and iron metabolism was measured. Results: The two treatments were similar with respect to dialysis-related complications, quality of life, and the biomarkers of oxidative stress and inflammation. Compared to HD, 25-hepcidin and β2-microglobulin were 38 and 32%, respectively, lower after 60 days of HDF (p Conclusion: In short term, HDF is not superior to HD regarding dialysis-related complications. The higher ESA consumption observed with HDF can be explained by blood clotting in tubing and dialyzers, as more anticoagulation was needed with post-dilution HDF. In a longer perspective, lowering serum hepcidin levels may improve pathological iron homeostasis.

  6. The effect of online hemodiafiltration on infections: Results from the CONvective TRAnsport STudy

    NARCIS (Netherlands)

    C.H. den Hoedt (Claire); M.P.C. Grooteman (Muriel); M.L. Bots (Michiel); P.J. Blankestijn (Peter); I. van der Tweel (I.); N.C. van der Weerd (Neelke); E.L. Penne (Lars); A.H.A. Mazairac (Albert); R. Lévesque (Renée); P.M. ter Wee (Piet); M.J. Nubé (Menso); M.A. van den Dorpel (Marinus)

    2015-01-01

    textabstractBackground: Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules.

  7. The Effect of Online Hemodiafiltration on Infections : Results from the CONvective TRAnsport STudy

    NARCIS (Netherlands)

    den Hoedt, Claire H.; Grooteman, Muriel P. C.; Bots, Michiel L.; Blankestijn, Peter J.; van der Tweel, Ingeborg; van der Weerd, Neelke C.; Penne, E. Lars; Mazairac, Albert H. A.; Levesque, Renee; ter Wee, Piet M.; Nube, Menso J.; van den Dorpel, Marinus A.

    2015-01-01

    Background Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there

  8. The Effect of Online Hemodiafiltration on Infections: Results from the CONvective TRAnsport STudy

    NARCIS (Netherlands)

    den Hoedt, Claire H.; Grooteman, Muriel P. C.; Bots, Michiel L.; Blankestijn, Peter J.; van der Tweel, Ingeborg; van der Weerd, Neelke C.; Penne, E. Lars; Mazairac, Albert H. A.; Levesque, Renée; ter Wee, Piet M.; Nubé, Menso J.; van den Dorpel, Marinus A.; Dorval, M.; Lévesque, R.; Koopman, M. G.; Konings, C. J. A. M.; Haanstra, W. P.; Kooistra, M.; van Jaarsveld, B.; Noordzij, T.; Feith, G. W.; Peltenburg, H. G.; van Buren, M.; Offerman, J. J. G.; Hoogeveen, E. K.; de Heer, F.; van de Ven, P. J.; Hovinga, T. K. Kremer; Bax, W. A.; Groeneveld, J. O.; Lavrijssen, A. T. J.; Schrander-van der Meer, A. M.; Reichert, L. J. M.; Huussen, J.; Rensma, P. L.; Schrama, Y.; van Hamersvelt, H. W.; Boer, W. H.; van Kuijk, W. H.; Vervloet, M. G.; Wauters, I. M. P. M. J.; Sekse, I.

    2015-01-01

    Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data

  9. The Effect of Online Hemodiafiltration on Infections: Results from the CONvective TRAnsport STudy

    NARCIS (Netherlands)

    Hoedt, C.H. den; Grooteman, M.P.C.; Bots, M.L.; Blankestijn, P.J.; Tweel, I. van der; Weerd, N.C. van der; Penne, E.L.; Mazairac, A.H.; Levesque, R.; Wee, P.M. Ter; Nube, M.J.; Dorpel, M.A. van den; Hamersvelt, H.W. van; et al.,

    2015-01-01

    BACKGROUND: Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there

  10. Treatment of hepatic encephalopathy by on-line hemodiafiltration: a case series study

    Directory of Open Access Journals (Sweden)

    Sugiyama Mitsugi

    2010-05-01

    Full Text Available Abstract Background It is thought that a good survival rate of patients with acute liver failure can be achieved by establishing an artificial liver support system that reliably compensates liver function until the liver regenerates or a patient undergoes transplantation. We introduced a new artificial liver support system, on-line hemodiafiltration, in patients with acute liver failure. Methods This case series study was conducted from May 2001 to October 2008 at the medical intensive care unit of a tertiary care academic medical center. Seventeen consecutive patients who admitted to our hospital presenting with acute liver failure were treated with artificial liver support including daily on-line hemodiafiltration and plasma exchange. Results After 4.9 ± 0.7 (mean ± SD on-line hemodiafiltration sessions, 16 of 17 (94.1% patients completely recovered from hepatic encephalopathy and maintained consciousness for 16.4 ± 3.4 (7-55 days until discontinuation of artificial liver support (a total of 14.4 ± 2.6 [6-47] on-line hemodiafiltration sessions. Significant correlation was observed between the degree of encephalopathy and number of sessions of on-line HDF required for recovery of consciousness. Of the 16 patients who recovered consciousness, 7 fully recovered and returned to society with no cognitive sequelae, 3 died of complications of acute liver failure except brain edema, and the remaining 6 were candidates for liver transplantation; 2 of them received living-related liver transplantation but 4 died without transplantation after discontinuation of therapy. Conclusions On-line hemodiafiltration was effective in patients with acute liver failure, and consciousness was maintained for the duration of artificial liver support, even in those in whom it was considered that hepatic function was completely abolished.

  11. A novel approach to the management of critically ill neonatal Ebstein's anomaly: Veno-venous extracorporeal membrane oxygenation to promote right ventricular recovery.

    Science.gov (United States)

    Bauser-Heaton, Holly; Nguyen, Charles; Tacy, Theresa; Axelrod, David

    2015-01-01

    This is the first report of the use of veno-venous extracorporeal membrane oxygenation in a neonate with severe Ebstein's anomaly. The report suggests the use of veno-venous extracorporeal membrane oxygenation in the immediate neonatal period may be a useful therapy in severe Ebstein's anomaly. By providing adequate oxygenation independent of the patient's native pulmonary blood flow, veno-venous extracorporeal membrane oxygenation allows the pulmonary vascular resistance to decrease and may promote right ventricular recovery.

  12. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support

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    Liane Brescovici Nunes

    2014-03-01

    Full Text Available OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1 optimization of extracorporeal membrane oxygenation blood flow; 2 identification of recirculation and cannula repositioning if necessary; 3 optimization of residual lung function and consideration of blood transfusion; 4 diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5 optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions.

  13. Effects of continuous renal replacement therapy on linezolid pharmacokinetic/pharmacodynamics: a systematic review.

    Science.gov (United States)

    Villa, Gianluca; Di Maggio, Paola; De Gaudio, A Raffaele; Novelli, Andrea; Antoniotti, Riccardo; Fiaccadori, Enrico; Adembri, Chiara

    2016-11-19

    Major alterations in linezolid pharmacokinetic/pharmacodynamic (PK/PD) parameters might be expected in critically ill septic patients with acute kidney injury (AKI) who are undergoing continuous renal replacement therapy (CRRT). The present review is aimed at describing extracorporeal removal of linezolid and the main PK-PD parameter changes observed in critically ill septic patients with AKI, who are on CRRT. Citations published on PubMed up to January 2016 were systematically reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. All authors assessed the methodological quality of the studies and consensus was used to ensure studies met inclusion criteria. In-vivo studies in adult patients with AKI treated with linezolid and on CRRT were considered eligible for the analysis only if operational settings of the CRRT machine, membrane type, linezolid blood concentrations and main PK-PD parameters were all clearly reported. Among 68 potentially relevant articles, only 9 were considered eligible for the analysis. Across these, 53 treatments were identified among the 49 patients included (46 treated with high-flux and 3 with high cut-off membranes). Continuous veno-venous hemofiltration (CVVH) was the most frequent treatment performed amongst the studies. The extracorporeal clearance values of linezolid across the different modalities were 1.2-2.3 L/h for CVVH, 0.9-2.2 L/h for hemodiafiltration and 2.3 L/h for hemodialysis, and large variability in PK/PD parameters was reported. The optimal area under the curve/minimum inhibitory concentration (AUC/MIC) ratio was reached for pathogens with an MIC of 4 mg/L in one study only. Wide variability in linezolid PK/PD parameters has been observed across critically ill septic patients with AKI treated with CRRT. Particular attention should be paid to linezolid therapy in order to avoid antibiotic failure in these patients. Strategies to improve the effectiveness of

  14. Using continuous renal replacement therapy to manage patients of shock and acute renal failure

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    Soni Sachin

    2009-01-01

    Full Text Available Background: The incidence of acute renal failure (ARF in the hospital setting is increasing. It portends excessive morbidity and mortality and a considerable burden on hospital resources. Extracorporeal therapies show promise in the management of patients with shock and ARF. It is said that the potential of such therapy goes beyond just providing renal support. The aim of our study was to analyze the clinical setting and outcomes of critically ill ARF patients managed with continuous renal replacement therapy (CRRT. Patients and Methods: Ours was a retrospective study of 50 patients treated between January 2004 and November 2005. These 50 patients were in clinical shock and had concomitant ARF. All of these patients underwent CVVHDF (continuous veno-venous hemodiafiltration in the intensive care unit. For the purpose of this study, shock was defined as systolic BP < 100 mm Hg in spite of administration of one or more inotropic agents. SOFA (Sequential Organ Failure Assessment score before initiation of dialysis support was recorded in all cases. CVVHDF was performed using the Diapact ® (Braun CRRT machine. The vascular access used was as follows: femoral in 32, internal jugular in 8, arteriovenous fistula (AVF in 4, and subclavian in 6 patients. We used 0.9% or 0.45% (half-normal saline as a prefilter replacement, with addition of 10% calcium gluconate, magnesium sulphate, sodium bicarbonate, and potassium chloride in separate units, while maintaining careful monitoring of electrolytes. Anticoagulation of the extracorporeal circuit was achieved with systemic heparin in 26 patients; frequent saline flushes were used in the other 24 patients. Results: Of the 50 patients studied, 29 were males and 21 females (1.4:1. The average age was 52.88 years (range: 20-75 years. Causes of ARF included sepsis in 24 (48%, hemodynamically mediated renal failure (HMRF in 18 (36%, and acute over chronic kidney disease in 8 (16% patients. The overall mortality was

  15. Using continuous renal replacement therapy to manage patients of shock and acute renal failure

    Science.gov (United States)

    Soni, Sachin S; Nagarik, Amit P; Adikey, Gopal Kishan; Raman, Anuradha

    2009-01-01

    Background: The incidence of acute renal failure (ARF) in the hospital setting is increasing. It portends excessive morbidity and mortality and a considerable burden on hospital resources. Extracorporeal therapies show promise in the management of patients with shock and ARF. It is said that the potential of such therapy goes beyond just providing renal support. The aim of our study was to analyze the clinical setting and outcomes of critically ill ARF patients managed with continuous renal replacement therapy (CRRT). Patients and Methods: Ours was a retrospective study of 50 patients treated between January 2004 and November 2005. These 50 patients were in clinical shock and had concomitant ARF. All of these patients underwent CVVHDF (continuous veno-venous hemodiafiltration) in the intensive care unit. For the purpose of this study, shock was defined as systolic BP magnesium sulphate, sodium bicarbonate, and potassium chloride in separate units, while maintaining careful monitoring of electrolytes. Anticoagulation of the extracorporeal circuit was achieved with systemic heparin in 26 patients; frequent saline flushes were used in the other 24 patients. Results: Of the 50 patients studied, 29 were males and 21 females (1.4:1). The average age was 52.88 years (range: 20–75 years). Causes of ARF included sepsis in 24 (48%), hemodynamically mediated renal failure (HMRF) in 18 (36%), and acute over chronic kidney disease in 8 (16%) patients. The overall mortality was 74%. The average SOFA score was 14.31. The variables influencing mortality on multivariate analysis were: age [odds ratio (OR):1.65; 95% CI: 1.35 to 1.92; P = 0.04], serum creatinine (OR:1.68; 95% CI: 1.44 to 1.86; P = 0.03), and serum bicarbonate (OR: 0.76; 95% CI: 0.55 to 0.94; P = 0.01). On univariate analysis the SOFA score was found to be a useful predictor of mortality. Conclusions: Despite advances in treating critically ill patients with newer extracorporeal therapies, mortality is dismally high

  16. Are There Any Downsides, Barriers, or Challenges in Delivering Hemodiafiltration in Everyday Clinical Practice?

    Science.gov (United States)

    Blankestijn, Peter J; Grooteman, Muriel; Nube, Menso

    2017-01-01

    There is considerable evidence to suggest that on-line hemodiafiltration (HDF) is superior to standard hemodialysis when comparing effects on clinical end points, especially when a certain minimum convection volume can be achieved. In this chapter we address the question of whether there are any downsides, challenges, or barriers in delivering on-line HDF in everyday clinical practice. We discuss the subject from a medical/practical point of view and briefly from a financial/economic perspective. © 2017 S. Karger AG, Basel.

  17. Role of residual kidney function and convective volume on change in beta2-microglobulin levels in hemodiafiltration patients

    NARCIS (Netherlands)

    Penne, E. Lars; van der Weerd, Neelke C.; Blankestijn, Peter J.; van den Dorpel, Marinus A.; Grooteman, Muriel P. C.; Nubé, Menso J.; ter Wee, Piet M.; Lévesque, Renée; Bots, Michiel L.

    2010-01-01

    Removal of beta2-microglobulin (beta2M) can be increased by adding convective transport to hemodialysis (HD). The aim of this study was to investigate the change in beta2M levels after 6-mo treatment with hemodiafiltration (HDF) and to evaluate the role of residual kidney function (RKF) and the

  18. Role of residual kidney function and convective volume on change in β2-microglobulin levels in hemodiafiltration patients

    NARCIS (Netherlands)

    E.L. Penne (Lars); N.C. van der Weerd (Neelke); P.J. Blankestijn (Peter); M.A. van den Dorpel (Marinus); M.P.C. Grooteman (Muriel); M.J. Nubé (Menso); P.M. ter Wee (Piet); R. Lévesque (Renée); M.L. Bots (Michiel)

    2010-01-01

    textabstractBackground and objectives: Removal of β2-microglobulin (β2M) can be increased by adding convective transport to hemodialysis (HD). The aim of this study was to investigate the change in β2M levels after 6-mo treatment with hemodiafiltration (HDF) and to evaluate the role of residual

  19. Haemodialysis followed by continuous veno-venous haemodiafiltration in lithium intoxication; a model and a case

    NARCIS (Netherlands)

    Meertens, John H J M; Jagernath, Danny R; Eleveld, Douglas J; Zijlstra, Jan G; Franssen, Casper F M

    2009-01-01

    For severe lithium intoxication haemodialysis is recommended to lower serum lithium levels rapidly. Frequently, serum lithium levels rebound after dialysis and repeated dialysis is needed. This is the first report of an adult patient with severe lithium intoxication who underwent haemodialysis (HD)

  20. THE ACHIEVABILITY OF TARGET CONVECTION VOLUMES IN ON-LINE HEMODIAFILTRATION

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    A. B. Sabodash

    2015-01-01

    Full Text Available Aim. To evaluate the achievability of recommended convection volumes in hemodiafiltration (HDF and impeding factors. Materials and methods. In short interventional one-center study among 67 stable prevalent dialysis patients we succeeded in achieving convection volume of more than 24 l/session in 60 patients (90%. Results. Substitution volume rose in the whole group from 21.1 ± 1.6 to 23.8 ± 1.2 l/session (p < 0.01. 12 patients, who didn`t achieve target volume had similar age, duration of renal replacement therapy and ultrafiltration rate as those who did. They differed from 55 patients who achieved target volume by substitution volume at first session in evaluation period (22.2 ± 1.7 vs. 23.6 ± 1.5 liters, р = 0.004, by transmembrane pressure (170 ± 40 vs. 146 ± 24 mmHg, р = 0.009 and by session duration (248 ± 15 vs. 262 ± 17 min, р = 0.0017. Blood flow rate also differed at the start of the study between the achievers and non-achievers: 353 ± 21 vs. 339 ± 19 ml/min, р = 0.035. The pressure in venous segment was lower in the achievers (154 ± 25 vs. 176 ± 36, р = 0.02 as well as transmembrane pressure (144 ± 24 vs. 164 ± 36, р = 0.014 which has been rising session by session in nonachievers. In non-achievers the membrane surface area was lower: 1.75 ± 0.2 vs. 1.91 ± 0.2 m2 (p = 0.02. In the multiple binary logistic regression model the session duration and membrane surface area were positive factors while the transmembrane pressure was negative one. Session prolonged by 15 min was associated with increase in relative chance to achieve target volume by 39% (95% CI 5–82%; р = 0.02. The membrane surface area enlarged by 0.1 m2 was linked with increase of chance by 4.2% (95% CI 0.2–8.4%; р = 0.04. The transmembrane pressure increased by 10 mmHg was associated with decreased chance to achieve target volume by 17% (95% CI 0–70%; р = 0.05. Conclusion. To achieve convection volume of 24 l/session one needs to afford

  1. Veno-venous extracorporeal membrane oxygenation using an innovative dual-lumen cannula following implantation of a total artificial heart.

    Science.gov (United States)

    Youdle, Jemma; Penn, Sarah; Maunz, Olaf; Simon, Andre

    2017-01-01

    We report our first clinical use of the new Protek Duo TM cannula for peripheral veno-venous extra-corporeal life support (ECLS). A 53-year-old male patient underwent implantation of a total artificial heart (TAH) for biventricular failure. However, due to the development of post-operative respiratory dysfunction, the patient required ECLS for six days.

  2. A novel approach to the management of critically ill neonatal Ebstein′s anomaly: Veno-venous extracorporeal membrane oxygenation to promote right ventricular recovery

    Directory of Open Access Journals (Sweden)

    Holly Bauser-Heaton

    2015-01-01

    Full Text Available This is the first report of the use of veno-venous extracorporeal membrane oxygenation in a neonate with severe Ebstein′s anomaly. The report suggests the use of veno-venous extracorporeal membrane oxygenation in the immediate neonatal period may be a useful therapy in severe Ebstein′s anomaly. By providing adequate oxygenation independent of the patient′s native pulmonary blood flow, veno-venous extracorporeal membrane oxygenation allows the pulmonary vascular resistance to decrease and may promote right ventricular recovery.

  3. A new veno-venous bypass type for ex-vivo liver resection in dogs.

    Science.gov (United States)

    Lei, Peng; Liu, Shi-Qi; Cui, Xiao-Hai; Lv, Yi; Zhao, Ge; Li, Jian-Hui

    2013-08-01

    Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex-vivo liver resection is an important treatment for unresectable liver tumors. This surgical procedure requires long operation time, during which blood flow must be carefully maintained to avoid venous congestion. An effective veno-venous bypass (VVB) may meet this requirement. The present study was to test our new designed VVB device which comprised one heparinized polyvinylchloride tube and three magnetic rings. The efficacy of this device was tested in five dogs. A VVB was established in 6-10 minutes. There was no leakage during the procedure. Hemodynamics was stable at anhepatic phase, which indicated that the bypass was successful. This newly-developed VVB device maintained circulation stability during ex-vivo liver resection in our dog model and thus, this VVB device significantly shortened the operation time.

  4. Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning

    Czech Academy of Sciences Publication Activity Database

    Zakharov, S.; Pelclová, D.; Navrátil, Tomáš; Běláček, J.; Latta, J.; Písař, M.; Rulíšek, J.; Lepš, J.; Zídek, P.; Kučera, C.; Boček, R.; Mazur, M.; Belik, Z.; Chalupa, J.; Talafa, V.; Kodras, K.; Nalos, D.; Sedlak, C.; Šenkyřík, M.; Šmíd, J.; Šálek, T.; Roberts, D. M.; Hovda, K. E.

    2017-01-01

    Roč. 55, č. 2 (2017), s. 123-132 ISSN 1556-3650 Institutional support: RVO:61388955 Keywords : Acidemia * continuous veno-venous hemodialysis * extended daily hemodialysis * intermittent hemodialysis * metabolic acidosis * methanol poisoning Subject RIV: CF - Physical ; Theoretical Chemistry OBOR OECD: Physical chemistry Impact factor: 3.677, year: 2016

  5. Mid-dilution hemodiafiltration: a comparison with pre- and postdilution modes using the same polyphenylene membrane.

    Science.gov (United States)

    Maduell, Francisco; Arias, Marta; Vera, Manel; Fontseré, Néstor; Blasco, Miquel; Barros, Xoana; Garro, Julia; Elena, Montserrat; Bergadá, Eduardo; Cases, Aleix; Bedini, Jose Luis; Campistol, Josep M

    2009-01-01

    As a change from Diapes to polyphenylene membrane in the mid-dilution filter has recently been developed, the aim of this study was to compare mid-dilution using this new dialyzer versus pre- and postdilution. The prospective study included 20 patients who underwent 4 hemodiafiltration (HDF) sessions: 1.7 m(2) polyphenylene and predilution infusion flow (Qi) 200 ml/min, 1.7 m(2) and postdilution Qi 100 ml/min, 1.9 and 2.2 m(2) mid-dilution both with Qi 200 ml/ min. The urea and creatinine reduction ratios were slightly higher in postdilution. The beta(2)-microglobulin (85.8%), myoglobin (73.6%), prolactin (67.8%) and retinol-binding protein (29.2%) reduction ratios with 1.9 m(2) mid-dilution, which was similar to 2.2 m(2) mid-dilution, were significantly higher than with the post- and predilution modes. Mid-dilution appears to be a good HDF alternative that allows a better removal of larger molecules than postdilution and, mainly, predilution. Mid-dilution using 1.9 or 2.2 m(2) dialyzers, at the same convective volume, showed a similar removal. Copyright 2009 S. Karger AG, Basel.

  6. What infusion flow should be used for mid-dilution hemodiafiltration?

    Science.gov (United States)

    Maduell, Francisco; Arias, Marta; Fontseré, Néstor; Vera, Manel; Masso, Elisabeth; Garro, Julia; Barros, Xoana; Martina, Maria N; Elena, Montserrat; Bergadá, Eduardo; Cases, Aleix; Bedini, Jose Luis; Campistol, Josep M

    2010-01-01

    There is still no consensus on the optimal infusion flow (Qi) in mid-dilution hemodiafiltration. The aim of this study was to compare mid-dilution with varying Qi. Prospective study in 25 patients who underwent seven hemodialysis sessions with a Qi of 0, 50, 100, 150, 200, 250 and 300 ml/min. All sessions were well tolerated except Qi 300 ml/min. No significant differences in urea, creatinine, alpha(1)-microglobulin or alpha(1)-acid glycoprotein reduction ratios were observed. beta(2)-Microglobulin, myoglobin and prolactin reduction ratios were higher with Qi 150, 200, 250 and 300 ml/min in comparison with Qi of 0, 50 and 100 ml/min. There were no differences in the removal of small or larger molecules when Qi was 150 ml/min or higher. Optimal Qi in mid-dilution appears to be in the range of 150-250 ml/min since good clinical outcomes, similar efficiency and no technical complications up to a Qi of 250 ml/min were observed.

  7. Effect of Taurine on Hemodiafiltration in Patients With Chronic Heart Failure.

    Science.gov (United States)

    Shiohira, Shunji; Komatsu, Mizuki; Okazaki, Masayuki; Naganuma, Toshiaki; Kawaguchi, Hiroshi; Nitta, Kosaku; Tsuchiya, Ken

    2016-02-01

    Taurine, an important factor in the living body, is essential for cardiovascular function and development and function of skeletal muscle, retina and central nervous system. In the present study, its effect on cardiovascular function was specifically taken into consideration. In hemodiafiltration (HDF) patients, the effect of taurine on patients with chronic heart failure (CHF), in whom dry weight was difficult to control, was evaluated. All patients who were subjected to regular HDF for 4 h three times per week at Joban hospital were included in this study. Patients with chronic heart failure, in whom dry weight was difficult to control (N = 4), were included in the evaluation of clinical status. X-ray and echocardiography were determined before and after taurine treatment. Almost all patients were taking nitric acid, warfarin, anti-platelet agents and vasopressors. Because vital signs were unstable in chronic heart failure, all cases withheld antihypertensive drugs during HDF. For unstable vital signs during HDF, pulmonary congestion was chronically recognized. After taurine was started, vital signs stabilized and lowering of dry weight was possible. In addition, X-ray and cardiac diastolic failure on echocardiography improved. Taurine was effective for CHF patients on HDF in whom dry weight was difficult to control in spite of various medications. © 2015 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  8. A technique for autologous priming of the veno-venous bypass circuit during liver transplantation.

    Science.gov (United States)

    Shackelford, Anthony G; Hodge, Ashley B; Chavin, Kenneth D; Baliga, Prabhakar K

    2011-06-01

    Orthotopic liver transplantations (OLT) have been associated with significant blood loss and hemodilution, necessitating significant homologous blood component replacement. Increasing administration of homologous blood products has been found to be inversely related to patient and graft survival. Various methods to reduce the amount of blood products patients receive during OLT, such as antifibrinolytic therapy, thromboelastography-guided transfusion, phlebotomy, reduced central venous pressures intraoperatively, and the use of the veno-venous bypass (VVB) circuit, have been explored.The asanguineous priming volume of the VVB circuit increases the likelihood of the patient receiving homologous blood products due to hemodilution. It was reasoned that autologous priming of the VVB circuit in OLT surgery was a plausible adjunctive blood conservation technique given its application to the extracorporeal circuit during cardiac surgery. We describe our technique of modifying the VVB circuit for autologous priming. This technique adds minimal risk and a small amount of cost to the procedure, requires slightly more communication among members of the surgical team, and with proper sequencing, adds no additional length to the surgical procedure. It is recommended that this technique be considered for addition to the arsenal of blood conservation techniques when VVB is used during OLT.

  9. Hemodiafiltration using pre-dilutional on-line citrate dialysate: A new technique for regional citrate anticoagulation: A feasibility study

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    Radhouane Bousselmi

    2015-01-01

    Full Text Available A prospective, observational, feasibility study was carried out on four patients with end-stage renal failure undergoing bicarbonate hemodialysis to study the feasibility of an on-line hemodiafiltration technique using a citrate dialysate with pre-dilutional infusion of citrate as a technique for regional citrate anticoagulation. All patients had contraindication to systemic heparin anticoagulation. The dialysis technique consisted of an on-line hemodiafiltration with a citrate dialysate without calcium using a Fresenius 4008S dialysis machine and Fresenius Polysulfone F60 dialyzers. The infusion solution was procured directly from the dialysate and was infused into the arterial line. To avoid the risk of hypocalcemia, calcium gluconate was infused to the venous return line. The study was carried out in two stages. During the first stage, the citrate infusion rate was 80 mL/min and the calcium infusion rate was 9 mmol/h. At the second stage, the rates were 100 mL/min and 11 mmol/h, respectively. The primary endpoint of this study was the incidence of thrombosis in the extracorporeal blood circuit and/or the dialyzer. A total of 78 sessions were conducted. All the sessions were well tolerated clinically and there were no major incidents in any of the four patients. At the first stage of the study, there were five incidences of small clots in the venous blood chamber, an incidence of extracorporeal blood circuit thrombosis of 12.5%. At the second stage of the study, no cases of extracorporeal blood circuit or dialyzer thrombosis were noted. Hemodiafiltration with on-line citrate dialysate infusion to the arterial line is safe and allows an effective regional anticoagulation of the extracorporeal blood circuit without the need for systemic anticoagulation.

  10. A brief clinical case of monitoring of oxygenator performance and patient-machine interdependency during prolonged veno-venous extracorporeal membrane oxygenation.

    Science.gov (United States)

    Belliato, Mirko; Degani, Antonella; Buffa, Antonino; Sciutti, Fabio; Pagani, Michele; Pellegrini, Carlo; Iotti, Giorgio Antonio

    2017-10-01

    Monitoring veno-venous extracorporeal membrane oxygenation (vvECMO) during 76 days of continuous support in a 42-years old patient with end-stage pulmonary disease, listed for double-lung transplantation. Applying a new monitor (Landing ® , Eurosets, Medolla, Italy) and describing how measured and calculated parameters can be used to understand the variable interdependency between artificial membrane lung (ML) and patient native lung (NL). During vvECMO, in order to understand how the respiratory function is shared between ML and NL, ideally we should obtain data about oxygen transfer and CO 2 removal, both by ML and NL. Measurements for NL can be made on the mechanical ventilator. Measurements for ML are typically made from gas analysis on blood samples drawn from the ECMO system before and after the oxygenator, and therefore are non-continuous. Differently, the Landing monitor provides a continuous measurement of the oxygen transfer from the ML, combined with hemoglobin level, saturation of drained blood and saturation of reinfused blood. Moreover, the Landing monitor provides hemodynamics data about circulation through the ECMO system, with blood flow, pre-oxygenator pressure and post-oxygenator pressure. Of note, measurements include the drain negative pressure, whose monitoring may be particularly useful to prevent hemolysis. Real-time monitoring of vvECMO provides data helpful to understand the complex picture of a patient with severely damaged lungs on one side and an artificial lung on the other side. Data from vvECMO monitoring may help to adapt the settings of both mechanical ventilator and vvECMO. Data about oxygen transfer by the oxygenator are important to evaluate the performance of the device and may help to avoid unnecessary replacements, thus reducing risks and costs.

  11. Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports.

    Science.gov (United States)

    Lother, Achim; Wengenmayer, Tobias; Benk, Christoph; Bode, Christoph; Staudacher, Dawid L

    2016-07-11

    Tracheostomy is recommended in case of prolonged mechanical ventilation. Therefore, most patients with an indication for venovenous extracorporeal membrane oxygenation (ECMO) will also have an indication for tracheostomy. We report 2 cases of fatal air embolism into the ECMO system as complication of percutaneous dilatational tracheostomy. Both patients had an AVALON ELITE® bi-caval cannula implanted draining blood from the vena cava superior and inferior. Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.

  12. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

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    Hirose Hitoshi

    2012-04-01

    Full Text Available Abstract Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for early identification of potential complications.

  13. Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

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    Ramponi F

    2016-09-01

    Full Text Available Francesco Ramponi,1,2 Claudio Ronco,1,3 Giacomo Mason,1 Enrico Rettore,4 Daniele Marcelli,5,6 Francesca Martino,1,3 Mauro Neri,1,7 Alejandro Martin-Malo,8 Bernard Canaud,5,9 Francesco Locatelli10 1International Renal Research Institute (IRRIV, San Bortolo Hospital, Vicenza, 2Department of Economics and Management, University of Padova, Padova, 3Department of Nephrology, San Bortolo Hospital, Vicenza, 4Department of Sociology and Social Research, University of Trento, FBK-IRVAPP & IZA, Trento, Italy; 5Europe, Middle East, Africa and Latin America Medical Board, Fresenius Medical Care,, Bad Homburg, Germany; 6Danube University, Krems, Austria; 7Department of Management and Engineering, University of Padova, Vicenza, Italy; 8Nephrology Unit, Reina Sofia University Hospital, Córdoba, Spain; 9School of Medicine, Montpellier University, Montpellier, France; 10Department of Nephrology, Manzoni Hospital, Lecco, Italy Background: Clinical studies suggest that hemodiafiltration (HDF may lead to better clinical outcomes than high-flux hemodialysis (HF-HD, but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.Methods: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1 estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2 simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3 application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different

  14. Calcium balance in pediatric online hemodiafiltration: Beware of sodium and bicarbonate in the dialysate.

    Science.gov (United States)

    Bacchetta, Justine; Sellier-Leclerc, Anne-Laure; Bertholet-Thomas, Aurélia; Carlier, Marie-Christine; Cartier, Régine; Cochat, Pierre; Ranchin, Bruno

    2015-11-01

    Online hemodiafiltration (oHDF) is increasingly used in children; we treated 28 children since 2009, adapting this technique to pediatric patients. In this service evaluation audit, we assessed plasma electrolytes to evaluate the evolution of total (tCa) and ionized (iCa) during a session, as well as dialysate calcium (dCa) concentrations. Using a 1.25 mmol Ca/L-dialysate, both tCa and iCa decreased during the session, with iCa falling below 1.1 mmol/L in 4/5 patients. In contrast, using a 1.5 mmol Ca/L-dialysate, iCa remained normal in all patients. Major discrepancies were observed between the expected and the measured dCa: 1.25 vs. 1.01 (0.83-1.04), and 1.5 vs. 1.47 (0.85-1.75) mmol/L, respectively (results presented as median [range]). These differences were explained by the modality of reconstituting dialysate: increasing bicarbonates and/or decreasing sodium requested in the dialysate decreases calcium extraction from the acid preparation. Proof of concept was given when requesting in an "ex-vivo" setting modifications in the requested sodium and bicarbonate in dialysate directly on the Fresenius machine. Nephrologists should be aware that "high bicarbonate and/or low sodium" requirements in oHDF decrease calcium in the dialysate. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  15. High-Flux Hemodialysis and High-Volume Hemodiafiltration Improve Serum Calcification Propensity.

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    Marijke Dekker

    Full Text Available Calciprotein particles (CPPs may play an important role in the calcification process. The calcification propensity of serum (T50 is highly predictive of all-cause mortality in chronic kidney disease patients. Whether T50 is therapeutically improvable, by high-flux hemodialysis (HD or hemodiafiltration (HDF, has not been studied yet.We designed a cross-sectional single center study, and included stable prevalent in-center dialysis patients on HD or HDF. Patients were divided into two groups based on dialysis modality, were on a thrice-weekly schedule, had a dialysis vintage of > 3 months and vascular access providing a blood flow rate > 300 ml/min. Calcification propensity of serum was measured by the time of transformation from primary to secondary CPP (T50 test, by time-resolved nephelometry.We included 64 patients, mean convective volume was 21.7L (SD 3.3L. In the pooled analysis, T50 levels increased in both the HD and HDF group with pre- and post-dialysis (mean (SD of 244(64 - 301(57 and 253(55 - 304(61 min respectively (P = 0.43(HD vs. HDF. The mean increase in T50 was 26.29% for HD and 21.97% for HDF patients (P = 0.61 (HD vs. HDF. The delta values (Δ of calcium, phosphate and serum albumin were equal in both groups. Baseline T50 was negatively correlated with phosphate, and positively correlated with serum magnesium and fetuin-A. The ΔT50 was mostly influenced by Δ phosphate (r = -0.342; P = 0.002 HD and r = -0.396; P<0.001 HDF in both groups.HD and HDF patients present with same baseline T50 calcification propensity values pre-dialysis. Calcification propensity is significantly improved during both HD and HDF sessions without significant differences between both modalities.

  16. The Effect of Online Hemodiafiltration on Infections: Results from the CONvective TRAnsport STudy.

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    Claire H den Hoedt

    Full Text Available Hemodialysis (HD patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data on infectious outcomes in HDF, we compared the effects of HDF with low-flux HD on the incidence and type of infections.We used data of the 714 HD patients (age 64 ±14, 62% men, 25% Diabetes Mellitus, 7% catheters participating in the CONvective TRAnsport STudy (CONTRAST, a randomized controlled trial evaluating the effect of HDF as compared to low-flux HD. The events were adjudicated by an independent event committee. The risk of infectious events was compared with Cox regression for repeated events and Cox proportional hazard models. The distributions of types of infection were compared between the groups.Thirty one percent of the patients suffered from one or more infections leading to hospitalization during the study (median follow-up 1.96 years. The risk for infections during the entire follow-up did not differ significantly between treatment arms (HDF 198 and HD 169 infections in 800 and 798 person-years respectively, hazard ratio HDF vs. HD 1.09 (0.88-1.34, P = 0.42. No difference was found in the occurrence of the first infectious event (either fatal, non-fatal or type specific. Of all infections, respiratory infections (25% in HDF, 28% in HD were most common, followed by skin/musculoskeletal infections (21% in HDF, 13% in HD.HDF as compared to HD did not result in a reduced risk of infections, larger studies are needed to confirm our findings.ClinicalTrials.gov NCT00205556.

  17. Association of intradialytic hypotension and convective volume in hemodiafiltration: results from a retrospective cohort study

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    Mora-Bravo Franklin G

    2012-09-01

    Full Text Available Abstract Background Hemodiafiltration (HDF, as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH as compared to diffusive techniques. The aim of this retrospective cohort study in dialysis patients receiving HDF in one urban dialysis facility in Mexico City was to investigate the occurrence of IDH during HDF treatments with varying convective volume prescriptions. Methods Subjects were stratified into equal groups of percentiles of convective volume prescription: Group 1 of 0 to 7.53 liters, group 2 of 7.54 to 14.8 liters, group 3 of 14.9 to 16.96 liters, group 4 of 16.97 to 18.9 liters, group 5 of 21 to 19.9 liters and group 6 of 21.1 to 30 liters. Logistic Regression with and without adjustment for confounding factors was used to evaluate factors associated with the occurrence of IDH. Results 2276 treatments of 154 patients were analyzed. IDH occurred during 239 HDF treatments (10.5% of all treatments. Group 1 showed 31 treatments (8.2% with IDH whereas group 6 showed IDH in only 15 sessions (4% of all treatments. Odds Ratio of IDH for Group 6 was 0.47 (95% CI 0.25 to 0.88 as compared to Group 1 after adjustment. Conclusions In summary the data of this retrospective cohort study shows an inverse correlation between the occurrence of IDH and convective volume prescription. Further research in prospective settings is needed to confirm these findings.

  18. Optimized convective transport with automated pressure control in on-line postdilution hemodiafiltration.

    Science.gov (United States)

    Joyeux, V; Sijpkens, Y; Haddj-Elmrabet, A; Bijvoet, A J; Nilsson, L-G

    2008-11-01

    In a stable patient population we evaluated on-line postdilution hemodiafiltration (HDF) on the incremental improvement in blood purification versus high-flux HD, using the same dialyzer and blood flow rate. For HDF we used a new way of controlling HDF treatments based on the concept of constant pressure control where the trans-membrane pressure is automatically set by the machine using a feedback loop on the achieved filtration (HDF UC). We enrolled 20 patients on on-line HDF treatment and during a 4-week study period recorded key treatment parameters in HDF UC. For one mid-week study treatment performed in HD and one midweek HDF UC treatment we sampled blood and spent dialysate to evaluate the removal of small- and middle-sized solutes. We achieved 18+/-3 liters of ultrafiltration in four-hour HDF UC treatments, corresponding to 27+/-3% of the treated blood volume. That percentage varied by patient hematocrit level. The ultrafiltration amounted to 49+/-4% of the estimated plasma water volume treated. We noted few machine alarms. For beta2m and factor D the effective reduction in plasma level by HDF (76+/-6% and 43+/-9%, respectively) was significantly greater than in HD, and a similar relation was seen in mass recovered in spent dialysate. Small solute removal was similar in HDF and HD. Albumin loss was low. The additional convective transport provided by on-line HDF significantly improved the removal of middle molecules when all other treatment settings were equal. Using the automated pressure control mode in HDF, the convective volume depended on the blood volume processed and the patient hematocrit level.

  19. Influence of dialysis membrane composition on plasma bisphenol A levels during online hemodiafiltration.

    Science.gov (United States)

    Mas, Sebastian; Bosch-Panadero, Enrique; Abaigar, Pedro; Camarero, Vanesa; Mahillo, Ignacio; Civantos, Esther; Sanchez-Ospina, Didier; Ruiz-Priego, Alberto; Egido, Jesus; Ortiz, Alberto; González-Parra, Emilio

    2018-01-01

    Bisphenol A (BPA) is an ubiquitous environmental toxin that is also found in dialyzers. Online hemodiafiltration (OL-HDF) more efficiently clears high molecular weight molecules, and this may improve BPA clearance. However, the BPA contents of dialysis membranes may be a source of BPA loading during OL-HDF. A prospective study assessed plasma BPA levels in OL-HDF patients using BPA-free (polynephron) or BPA-containing (polysulfone) dialyzers in a crossover design with two arms, after a run-in OL-HDF period of at least 6 months with the same membrane: 31 patients on polynephron at baseline were switched to polysulfone membranes for 3 months (polynephron-to-polysulfone) and 29 patients on polysulfone were switched to polynephron for 3 months (polysulfone-to-polynephron). After a run-in OL-HDF period of at least 6 months with the same membrane, baseline pre-dialysis BPA was lower in patients on polynephron (8.79±7.97 ng/ml) than in those on polysulfone (23.42±20.38 ng/mL, p<0.01), but still higher than in healthy controls (<2 ng/mL). After 3 months of polynephron-to-polysulfone switch, BPA was unchanged (8.98±7.88 to 11.14±15.98 ng/mL, ns) while it decreased on the polysulfone-to-polynephron group (23.42±20.38 to 11.41±12.38 ng/mL, p<0.01). OL-HDF for 3 months with BPA-free dialyzer membranes was associated to a significant decrease in predialysis BPA levels when compared to baseline BPA levels while on a BPA-containing membrane.

  20. Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: Results from a randomized controlled trial (CONTRAST)

    NARCIS (Netherlands)

    N.C. van der Weerd (Neelke); C.H. den Hoedt (Claire); P.J. Blankestijn (Peter); M.L. Bots (Michiel); M.A. van den Dorpel (Marinus); R. Lévesque (Renée); A.H.A. Mazairac (Albert); M.J. Nubé (Menso); E. Lars Penne; P.M. ter Wee (Piet); M.P.C. Grooteman (Muriel)

    2014-01-01

    textabstractResistance to erythropoiesis stimulating agents (ESA) is common in patients undergoing chronic hemodialysis (HD) treatment. ESA responsiveness might be improved by enhanced clearance of uremic toxins of middle molecular weight, as can be obtained by hemodiafiltration (HDF). In this

  1. Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: results from a randomized controlled trial (CONTRAST)

    NARCIS (Netherlands)

    Weerd, N.C. van der; Hoedt, C.H. den; Blankestijn, P.J.; Bots, M.L.; Dorpel, M.A. van den; Levesque, R.; Mazairac, A.H.; Nube, M.J.; Penne, E.L.; Wee, P.M. ter; Grooteman, M.P.; Hamersvelt, H.W. van; et al.,

    2014-01-01

    Resistance to erythropoiesis stimulating agents (ESA) is common in patients undergoing chronic hemodialysis (HD) treatment. ESA responsiveness might be improved by enhanced clearance of uremic toxins of middle molecular weight, as can be obtained by hemodiafiltration (HDF). In this analysis of the

  2. A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal.

    Science.gov (United States)

    Hermann, Alexander; Riss, Katharina; Schellongowski, Peter; Bojic, Andja; Wohlfarth, Philipp; Robak, Oliver; Sperr, Wolfgang R; Staudinger, Thomas

    2015-10-01

    Pump-driven veno-venous extracorporeal CO2-removal (ECCO2-R) increasingly takes root in hypercapnic lung failure to minimize ventilation invasiveness or to avoid intubation. A recently developed device (iLA activve(®), Novalung, Germany) allows effective decarboxylation via a 22 French double lumen cannula. To assess determinants of gas exchange, we prospectively evaluated the performance of ECCO2-R in ten patients receiving iLA activve(®) due to hypercapnic respiratory failure. Sweep gas flow was increased in steps from 1 to 14 L/min at constant blood flow (phase 1). Similarly, blood flow was gradually increased at constant sweep gas flow (phase 2). At each step gas transfer via the membrane as well as arterial blood gas samples were analyzed. During phase 1, we observed a significant increase in CO2 transfer together with a decrease in PaCO2 levels from a median of 66 mmHg (range 46-85) to 49 (31-65) mmHg from 1 to 14 L/min sweep gas flow (p gas flow rates. During phase 2, oxygen transfer significantly increased leading to an increase in PaO2 from 67 (49-87) at 0.5 L/min to 117 (66-305) mmHg at 2.0 L/min (p gas flow results in effective CO2-removal, which can be further reinforced by raising blood flow. The clinically relevant oxygenation effect in this setting could broaden the range of indications of the system and help to set up an individually tailored configuration.

  3. A novel option for reducing free light chains in myeloma kidney: supra-hemodiafiltration with endogenous reinfusion (HFR).

    Science.gov (United States)

    Pasquali, Sonia; Iannuzzella, Francesco; Corradini, Mattia; Mattei, Silvia; Bovino, Achiropita; Stefani, Alfredo; Palladino, Giuseppe; Caiazzo, Marialuisa

    2015-04-01

    In myeloma cast nephropathy, fast reduction of serum free light chain (FLC) levels correlates with renal recovery. Recently, extracorporeal treatments using filters with a high-molecular weight cut-off have been successfully used for FLC removal. However, using these new filters, high cost and elevated albumin leakage are common drawbacks. We studied a new and cheaper therapeutic approach with adsorbent resins to evaluate its efficacy. We treated four patients, affected by dialysis-dependent acute kidney injury (AKI) due to biopsy proven de novo FLC myeloma cast nephropathy. Each patient underwent bortezomib chemotherapy and extracorporeal treatment with the supra-hemodiafiltration with endogenous reinfusion (HFR) technique (Supra-HFR, Bellco Mirandola, Modena, Italy). Supra-HFR is a kind of hemodiafiltration that utilizes separated convection, diffusion and adsorption. The sorbent cartridge has a high affinity for FLC (both κ and λ) but is able to re-infuse albumin, avoiding the need for albumin perfusions. Supra HFR treatments (4 h each) were carried out for eight consecutive days and then every other day. All patients showed a significant reduction of serum FLC, whereas serum albumin concentration remained unchanged. Renal function recovered in three out of four patients. FLC removal with adsorbent resins represents an effective therapeutic strategy that does not require replacement with albumin .

  4. AN-69 membrane reactions are pH-dependent and preventable.

    Science.gov (United States)

    Brophy, P D; Mottes, T A; Kudelka, T L; McBryde, K D; Gardner, J J; Maxvold, N J; Bunchman, T E

    2001-07-01

    We report two pediatric patients who required blood priming for continuous venovenous hemodiafiltration. Both of these patients developed a significant hypotensive episode with initiation of continuous venovenous hemodiafiltration with immediate resolution on discontinuation. The most notable common characteristics of these patients were the use of the Multi-flo 60 (AN-69) dialyzer membrane and blood priming. No similar episodes were encountered when patients were primed with saline or albumin. The AN-69 membrane is exquisitely pH sensitive. The lower the pH concentration of the blood passing by the membrane, the greater the activation of bradykinin, a known hypotensive-inducing agent, by the dialyzer. On review of blood available from our blood bank, the following parameters became apparent. The pH of standard blood available from our blood bank ranged from 6.1 to 6.4. The blood obtained from our blood bank had significant hyperkalemia, hyponatremia, and hypocalcemia. No reactions were noted when patients were primed with normal saline, which has a pH of around 5.9. We speculate that the presence of endogenous blood substances, such as bradykinin, may have induced the hypotensive episodes. We describe two techniques we developed that should allow for the increased safe and effective use of the AN-69 membranes in continuous venovenous hemodiafiltration circuits. These observations indicate the requirement for careful and close attention to detail when delivering renal replacement therapy to anyone, but especially patients weighing less than 10 kg.

  5. Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: results from a randomized controlled trial (CONTRAST.

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    Neelke C van der Weerd

    Full Text Available Resistance to erythropoiesis stimulating agents (ESA is common in patients undergoing chronic hemodialysis (HD treatment. ESA responsiveness might be improved by enhanced clearance of uremic toxins of middle molecular weight, as can be obtained by hemodiafiltration (HDF. In this analysis of the randomized controlled CONvective TRAnsport STudy (CONTRAST; NCT00205556, the effect of online HDF on ESA resistance and iron parameters was studied. This was a pre-specified secondary endpoint of the main trial. A 12 months' analysis of 714 patients randomized to either treatment with online post-dilution HDF or continuation of low-flux HD was performed. Both groups were treated with ultrapure dialysis fluids. ESA resistance, measured every three months, was expressed as the ESA index (weight adjusted weekly ESA dose in daily defined doses [DDD]/hematocrit. The mean ESA index during 12 months was not different between patients treated with HDF or HD (mean difference HDF versus HD over time 0.029 DDD/kg/Hct/week [-0.024 to 0.081]; P = 0.29. Mean transferrin saturation ratio and ferritin levels during the study tended to be lower in patients treated with HDF (-2.52% [-4.72 to -0.31]; P = 0.02 and -49 ng/mL [-103 to 4]; P = 0.06 respectively, although there was a trend for those patients to receive slightly more iron supplementation (7.1 mg/week [-0.4 to 14.5]; P = 0.06. In conclusion, compared to low-flux HD with ultrapure dialysis fluid, treatment with online HDF did not result in a decrease in ESA resistance.ClinicalTrials.gov NCT00205556.

  6. Veno-venous bypass without systemic heparinization using a centrifugal pump: a blind comparison of a heparin bonded circuit versus a non heparin bonded circuit

    NARCIS (Netherlands)

    van der Hulst, V. P.; Henny, C. P.; Moulijn, A. C.; Engbers, G.; ten Cate, H.; Gründeman, P. F.; Klopper, P. J.

    1989-01-01

    Veno-venous bypass without the use of systemic heparinization has recently become of increasing interest for application during liver transplantation and surgery on the large abdominal veins. However, possible adverse effects on blood components as demonstrated by means of hematologic and hemostatic

  7. Hemodiafiltration Decreases Serum Levels of Inflammatory Mediators in Severe Leptospirosis: A Prospective Study.

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    Sérgio Aparecido Cleto

    Full Text Available Leptospirosis is a health problem worldwide. Its most severe form is a classic model of sepsis, provoking acute respiratory distress syndrome (ARDS and acute kidney injury (AKI, with associated mortality that remains unacceptably high. We previously demonstrated that early initiation of sustained low-efficiency dialysis (SLED followed by daily SLED significantly decreases mortality. However, the mode of clearance can also affect dialysis patient outcomes. Therefore, the objective of this study was to compare the effects of SLED with traditional (diffusive clearance, via hemodialysis, and SLED with convective clearance, via hemodiafiltration (SLEDf, in patients with severe leptospirosis.In this prospective study, conducted in the intensive care unit (ICU from 2009 through 2012, we compared two groups-SLED (n = 19 and SLEDf (n = 20-evaluating demographic, clinical, and biochemical parameters, as well as serum levels of interleukins, up to the third day after admission. All patients received dialysis early and daily thereafter.During the study period, 138 patients were admitted to our ICU with a diagnosis of leptospirosis; 39 (36 males/3 females met the criteria for ARDS and AKI. All patients were on mechanical ventilation and were comparable in terms of respiratory parameters. Mortality did not differ between the SLEDf and SLED groups. However, post-admission decreases in the serum levels of interleukin (IL-17, IL-7, and monocyte chemoattractant protein-1 were significantly greater in the SLEDf group. Direct bilirubin and the arterial oxygen tension/fraction of inspired oxygen ratio were significantly higher in the SLED group. We identified the following risk factors (sensitivities/specificities for mortality in severe leptospirosis: age ≥ 55 years (67%/91%; serum urea ≥ 204 mg/dl (100%/70%; creatinine ≥ 5.2 mg/dl (100%/58%; Acute Physiology and Chronic Health Evaluation II score ≥ 39.5 (67%/88%; Sequential Organ Failure Assessment score

  8. Early administration of venovenous extracorporeal life support for status asthmaticus during anaesthetic induction: case report and literature review

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    Chang Won Ho

    2018-03-01

    Full Text Available Here we report a case of a 40-year-old man who visited the emergency room with severe chest pain. He showed a Stanford type B aortic dissection on chest-computed tomography. Despite medical treatment and malperfusion of lower extremities, acute renal failure developed; hence thoracic endovascular aortic repair (TEVAR was considered under general anaesthesia. After endotracheal intubation, ventilation with low tidal volume required high inspiratory airway pressure. An arterial blood gas analysis showed PaCO2 of 61.8mmHg and PaO2 of 26.4mmHg, indicating a status asthmaticus of hypoxaemia and hypercarbia, which did not respond to bronchodilator or mechanical ventilation. Impending cardiac arrest was treated using venovenous extracorporeal life support, which was administered by percutaneous femoral cannulation. Surgical procedure was completed without any complications. Extracorporeal life support was weaned at one day after the operation. The patient was discharged without any complications.

  9. Venovenous Extracorporeal Membrane Oxygenation in an Adult Patient With Prader-Willi Syndrome: A Nutrition Case Report.

    Science.gov (United States)

    Pelekhaty, Stacy; Menaker, Jay

    2018-03-12

    Prader-Willi Syndrome (PWS) is a genetic condition that results in a constellation of symptoms and typically results in hyperphagia and obesity in adulthood. Critically ill adults with PWS present a unique challenge to the nutrition professional, particularly when they require support modalities such as extracorporeal membrane oxygenation (ECMO). The purpose of this case study is to review the nutrition care of a critically ill adult patient with PWS who required venovenous ECMO. The patient was successfully managed with a hypocaloric, high-protein approach, which did not result in the diagnosis of malnutrition during his hospitalization. The patient was ultimately transitioned off extracorporeal life support and discharged to a rehabilitation facility. © 2018 American Society for Parenteral and Enteral Nutrition.

  10. Evaluation of the perioperative period of orthotopic liver transplantation with veno-venous bypass and without it

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    D. A. Levit

    2017-01-01

    Full Text Available Orthotopic liver transplantation (OLT is the only treatment for many patients with end-stage chronic liver diseases. In patients with complete vena cava inferior (VCI cross-clamping veno-venous bypass (VVB is either used or not depending on the indications. The case management of the patient with complete VCI cross-clamping depends on the initial state of the recipient and the transplant team’s opinion.Aim. To compare the perioperative period of OLT depending on the method to conduct the main stage of the surgery: with the use of veno-venous bypass and without it with complete VCI cross-clamping.Materials and methods. In Group 1 (n = 20, OLT was performed without VVB with complete VCI cross-clamping; in Group 2 (n = 26, the surgery was conducted with veno-venous bypass. Patients in both groups were similar in age (46.15 ± 10.22 and 47.3 ± 9.29, respectively, in severity of the disease: Child-Pugh (10.15 ± 1.42 and 10.19 ± 2.45, MELD 16.47 ± 4.41 and 15.8 ± 4.95.Results. We determined and evaluated hemodynamic parameters, oxygen transport, the quantitative and qualitative infusion composition, urine output, characteristics of the postoperative period.Conclusion. Our data show that changes in hemodynamic and oxygen transport are associated with reperfusion syndrome and do not depend on the method of transplantation. At the same time, it reduces the blood loss, time of surgery, and the duration of postoperative mechanical ventilation and stay in the ICU after liver transplantation in patients without veno-venous bypass.

  11. Do the lungs contribute to propofol elimination in patients during orthotopic liver transplantation without veno-venous bypass?

    Institute of Scientific and Technical Information of China (English)

    Yi-Zhong Chen; Sheng-Mei Zhu; Hui-Liang He; Jian-Hong Xu; Su-Qin Huang; Qing-Lian Chen

    2006-01-01

    BACKGROUND: The clearance of propofol is very rapid, and its transformation takes place mainly in the liver. Some reports indicated extrahepatic clearance of the drug and that the lungs are the likely place where the process occurs. This study was undertaken to compare the plasma concentrations of propofol both in the pulmonary and radial arteries after constant infusion during the dissection, anhepatic and reperfusion phases of orthotopic liver transplantation (OLT) without veno-venous bypass, attempting to investigate extrahepatic clearance and to determine whether the human lungs take part in the elimination of propofol. METHODS: Fifteen patients undergoing OLT without veno-venous bypass were enrolled in the study, and propofol was infused via a forearm vein at a rate of 2 mg· kg-1·h-1. Blood samples were simultaneously collected from pulmonary and radial arteries at the end of the ifrst hepatic portal dissection (T0), at the clamping of the portal vein (T1), 30, and 60 minutes after the beginning of the anhepatic phase (T2, T3), and 30, 60, and 120 minutes after the unclamping of the new liver (T4, T5, T6). Plasma propofol concentrations were measured using a reversed-phase, high-performance liquid chromatographic method with lfuorescence detection. RESULTS: The concentrations of plasma propofol in the pulmonary and radial arteries at T2 and T3 rose signiifcantly compared with T0 and T1 (P CONCLUSIONS:Propofol is eliminated mainly by the liver, and also by extrahepatic organs. The lungs seem to be not a major site contributing to the extrahepatic metabolism of propofol in humans.

  12. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome.

    Science.gov (United States)

    Vaquer, Sergi; de Haro, Candelaria; Peruga, Paula; Oliva, Joan Carles; Artigas, Antonio

    2017-12-01

    Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8-44.1; I 2  = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1-45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R 2  = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = -0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8-56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8-39.6). Mortality due to complications was 6.9% (CI 95% = 4.1-11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7-23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1-21.7). Despite initial severity, significant portion of patients

  13. Radical improvement of signs and symptoms in systemic lupus erythematosus when treated with hemodiafiltration with endogenous reinfusion dialysis.

    Science.gov (United States)

    Solano, Francesco Giuseppe; Bellei, Elisa; Cuoghi, Aurora; Caiazzo, Marialuisa; Bruni, Francesco

    2015-01-01

    Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE). In the kidney, immune complexes and autoantibodies activate mesangial cells that secrete cytokines that can further amplify inflammatory processes. We present the case of a 42-year-old woman with lupus nephritis accompanied by periods of exacerbation of SLE, with necrotic-like skin lesions, psoriatic arthritis without skin psoriasis, purpura of the lower limb, petechial rash, joint pain, fever, eyelid edema with bilateral conjunctival hyperemia and itching. The patient underwent a dialytic treatment of hemodiafiltration with endogenous reinfusion. The technique uses the super-high-flux membrane Synclear 02 (SUPRA treatment) coupled with an adsorbent cartridge that has affinity for many toxins and mediators. Fever and joint pain were immediately reduced after treatment and, subsequently, there was a notable reduction of the skin damage. Prednisone and immunosuppressive drugs were gradually reduced until complete suspension. High-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometer was performed for identification of proteins captured by a resin bed during a dialysis session of the patient. This technique identified several biomarkers of kidney injuries, uremic toxins, fragments of immunoglobulins, antigens involved in antiphospholipid syndrome and a new marker (α-defensin) that correlated significantly with disease activity. The removal of these different proteins could possibly provide an explanation of the improvement in the patient's symptoms and the normalization of her SLE. SUPRA coupled with an adsorption may be a promising new technique for the treatment of lupus nephritis.

  14. Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations.

    Science.gov (United States)

    Karagiannidis, Christian; Kampe, Kristin Aufm; Sipmann, Fernando Suarez; Larsson, Anders; Hedenstierna, Goran; Windisch, Wolfram; Mueller, Thomas

    2014-06-17

    While non-invasive ventilation aimed at avoiding intubation has become the modality of choice to treat mild to moderate acute respiratory acidosis, many severely acidotic patients (pH respiratory acidosis was only feasible when blood flow rates of 750 to 1000 mL/minute (19Fr catheter) were used. Maximal CO2-elimination was 146.1 ± 22.6 mL/minute, while pH increased from 7.13 ± 0.08 to 7.41 ± 0.07 (blood flow of 1000 mL/minute; sweep gas flow 16 L/minute). Accordingly, a sweep gas flow of 8 L/minute resulted in a maximal CO2-elimination rate of 138.0 ± 16.9 mL/minute. The 14.5Fr catheter allowed a maximum CO2 elimination rate of 77.9 mL/minute, which did not result in the normalization of pH. Veno-venous ECCO2R may serve as a treatment option for severe respiratory acidosis. In this porcine model, ECCO2R was most effective when using blood flow rates ranging between 750 and 1000 mL/minute, while an increase in sweep gas flow from 8 to 16 L/minute had less impact on ECCO2R in this setting.

  15. Low-flow venovenous CO₂ removal in association with lung protective ventilation strategy in patients who develop severe progressive respiratory acidosis after lung transplantation.

    Science.gov (United States)

    Ruberto, F; Bergantino, B; Testa, M C; D'Arena, C; Zullino, V; Congi, P; Paglialunga, S G; Diso, D; Venuta, F; Pugliese, F

    2013-09-01

    Primary graft dysfunction (PGD) might occur after lung transplantation. In some severe cases, conventional therapies like ventilatory support, administration of inhaled nitric oxide (iNO), and intravenous prostacyclins are not sufficient to provide an adequate gas exchange. The aim of our study was to evaluate the use of a lung protective ventilation strategy associated with a low-flow venovenous CO2 removal treatment to reduce ventilator-associated injury in patients that develop severe PGD after lung transplantation. From January 2009 to January 2011, 3 patients developed PGD within 24 hours after lung transplantation. In addition to conventional medical treatment, including hemodynamic support, iNO and prostaglandin E1 (PGE1), we initiated a ventilatory protective strategy associated with low-flow venovenous CO2 removal treatment (LFVVECCO2R). Hemodynamic and respiratory parameters were assessed at baseline as well as after 3, 12, 24, and 48 hours. No adverse events were registered. Despite decreased baseline elevated pulmonary positive pressures, application of a protective ventilation strategy with LFVVECCO2R reduced PaCO2 and pulmonary infiltrates as well as increased pH values and PaO2/FiO2 ratios. Every patient showed simultaneous improvement of clinical and hemodynamic conditions. They were weaned from mechanical ventilation and extubated after 24 hours after the use of the low-flow venovenous CO2 removal device. The use of LFVVECCO2R together with a protective lung ventilation strategy during the perioperative period of lung transplantation may be a valid clinical strategy for patients with PGD and severe respiratory acidosis occured despite adequate mechanical ventilation. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Dialysate bicarbonate variation in maintenance hemodiafiltration patients: Impact on serum bicarbonate, intradialytic hypotension and interdialytic weight gain.

    Science.gov (United States)

    Viegas, Márcio; Cândido, Cristina; Felgueiras, Joana; Clemente, José; Barros, Sara; Farbota, Rostislav; Vera, Filipa; Matos, Antero; Sousa, Francisco

    2017-07-01

    The dialysate bicarbonate (DB) influences the acid-base balance in dialysis patients. Very low and high serum bicarbonate (SB) have been related with a higher mortality. Acid-base balance also has been associated with hemodynamic effects in these patients. The trial aim was to compare the effect of DB concentration variation on SB levels in maintenance hemodiafiltration (HDF) patients and the effect on intradialytic hypotension and interdialytic weight gain. A prospective study, with 9 months of follow-up, involving 93 patients, divided in two groups: group 1 and group 2 with a DB of 34 mmol/L and 30 mmol/L, respectively, with monitoring of pre and post HDF SB, intradialytic hypotension, and interdialytic weight gain. Pre dialysis SB was higher in group 1: median concentration of 22.7 mmol/L vs. 21.1 mmol/L (P < 0.001). Post dialysis SB levels were higher in group 1: median concentration of 28.0 mmol/L vs. 25.3 mmol/L (P < 0.001). Post dialysis SB in alkalotic range was only detected in group 1 (51.2% of the patients). No significant differences were detected in intradialytic hypotension rate [28.0 vs. 27.4 episodes per 1000 sessions in group 1 and 2, respectively, (P = 0.906)] or in average interdialytic weight gain [2.9% vs. 3.0% in group 1 and 2, respectively, (P = 0.710)]. DB of 30 mmol/L appears to be associated with SB levels closer to physiological levels than 34 mmol/L. The bicarbonate dialysate, in the tested concentrations, did not appear to have a significant impact on intradialytic hypotension and interdialytic weight gain in maintenance HDF patients. © 2016 International Society for Hemodialysis.

  17. The effect of on-line hemodiafiltration on improving the cardiovascular function parameters in children on regular dialysis

    Directory of Open Access Journals (Sweden)

    Fatina I Fadel

    2015-01-01

    Full Text Available The cardiovascular disease is an important cause of morbidity and accounts for almost 50% of deaths in patients undergoing maintenance dialysis. Many harmful molecules of the uremic milieu, such as the middle molecules, are difficult to remove by conventional hemodialysis (HD. On-line hemodiafiltration (OL-HDF can achieve a considerable clearance of middle molecules and, together with its sterile ultrapure infusate, may have favorable effects on inflammation and cardiovascular complications. We aimed in this study to assess the effect of OL-HDF on improving the chronic inflammatory state associated with chronic kidney disease and the possible impact of these changes on myocardial function in chronic HD children. Thirty pediatric patients [12 (40% males and 18 (60% females with a mean age of 11.3 ± 3.2 years] on conventional HD for at least six months were switched to OL-HDF for six months. Variables for comparison at the end of each period included the levels of serum C-reactive protein and Kt/V as well as electrocardiography and echocardiographic measurements, including left ventricular mass index (LVMI. On changing from HD to OL-HDF, there was a significant decrease in hs-CRP (from 7.9 ± 8.9 to 3.4 ± 3 μ g/mL (P = 0.01 and frequency of diastolic dysfunction (P = 0.04, while systolic function (FS and EF improved significantly (P = 0.007 and 0.05, respectively, while LVMI did not change. We conclude that OL-HDF was well tolerated in children with improvement of the systolic function of the myocardium and the overall frequency of diastolic dysfunction.

  18. Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO - Prevalence and Risk Factors.

    Science.gov (United States)

    Lehle, Karla; Philipp, Alois; Zeman, Florian; Lunz, Dirk; Lubnow, Matthias; Wendel, Hans-Peter; Göbölös, Laszlo; Schmid, Christof; Müller, Thomas

    2015-01-01

    The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO) and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009-2014) with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb) was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8), while acute oxygenator thrombosis (n = 15) did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0-4.5 L/min) through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142) mg/l] in comparison to non-survivors [148 (91, 256) mg/l, p≤0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality.

  19. Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO - Prevalence and Risk Factors.

    Directory of Open Access Journals (Sweden)

    Karla Lehle

    Full Text Available The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009-2014 with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8, while acute oxygenator thrombosis (n = 15 did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0-4.5 L/min through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142 mg/l] in comparison to non-survivors [148 (91, 256 mg/l, p≤0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality.

  20. Polysulfone hemodiafiltration membranes with enhanced anti-fouling and hemocompatibility modified by poly(vinyl pyrrolidone) via in situ cross-linked polymerization

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Lijing, E-mail: zhulijing@nimte.ac.cn; Song, Haiming; Wang, Jiarong; Xue, Lixin, E-mail: xuelx@nimte.ac.cn

    2017-05-01

    Poly(vinyl pyrrolidone) (PVP) and its copolymers have been widely employed for the modification of hemodiafiltration membranes due to their excellent hydrophilicity, antifouling and hemocompatibility. However, challenges still remain to simplify the modification procedure and to improve the utilization efficiency. In this paper, antifouling and hemocompatibility polysulfone (PSf) hemodiafiltration membranes were fabricated via in situ cross-linked polymerization of vinyl pyrrolidone (VP) and vinyltriethoxysilane (VTEOS) in PSf solutions and non-solvent induced phase separation (NIPS) technique. The prepared membranes were characterized by attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM), which suggested that VP and VTEOS have been cross-linked copolymerized in PSf membranes. The modified PSf membranes with high polymer content showed improved hydrophilicity, ultrafiltration and protein antifouling ability. In addition, the modified PSf membranes showed lower protein adsorption, inhibited platelet adhesion and deformation, prolonged the activated partial thromboplastin time (APTT), prothrombin time (PT), and decreased the content of fibrinogen (FIB) transferring to fibrin, indicating enhanced hemocompatibility. In a word, the present work provides a simple and effective one-step modification method to construct PSf membranes with improved hydrophilicity, antifouling and hemocompatibility. - Highlights: • PSf membranes were modified by in situ cross-linked polymerization. • The modified PSf membranes showed enhanced hydrophilicity. • The anti-fouling and hemocompatibility of PSf membranes were improved.

  1. Polysulfone hemodiafiltration membranes with enhanced anti-fouling and hemocompatibility modified by poly(vinyl pyrrolidone) via in situ cross-linked polymerization.

    Science.gov (United States)

    Zhu, Lijing; Song, Haiming; Wang, Jiarong; Xue, Lixin

    2017-05-01

    Poly(vinyl pyrrolidone) (PVP) and its copolymers have been widely employed for the modification of hemodiafiltration membranes due to their excellent hydrophilicity, antifouling and hemocompatibility. However, challenges still remain to simplify the modification procedure and to improve the utilization efficiency. In this paper, antifouling and hemocompatibility polysulfone (PSf) hemodiafiltration membranes were fabricated via in situ cross-linked polymerization of vinyl pyrrolidone (VP) and vinyltriethoxysilane (VTEOS) in PSf solutions and non-solvent induced phase separation (NIPS) technique. The prepared membranes were characterized by attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM), which suggested that VP and VTEOS have been cross-linked copolymerized in PSf membranes. The modified PSf membranes with high polymer content showed improved hydrophilicity, ultrafiltration and protein antifouling ability. In addition, the modified PSf membranes showed lower protein adsorption, inhibited platelet adhesion and deformation, prolonged the activated partial thromboplastin time (APTT), prothrombin time (PT), and decreased the content of fibrinogen (FIB) transferring to fibrin, indicating enhanced hemocompatibility. In a word, the present work provides a simple and effective one-step modification method to construct PSf membranes with improved hydrophilicity, antifouling and hemocompatibility. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Polysulfone hemodiafiltration membranes with enhanced anti-fouling and hemocompatibility modified by poly(vinyl pyrrolidone) via in situ cross-linked polymerization

    International Nuclear Information System (INIS)

    Zhu, Lijing; Song, Haiming; Wang, Jiarong; Xue, Lixin

    2017-01-01

    Poly(vinyl pyrrolidone) (PVP) and its copolymers have been widely employed for the modification of hemodiafiltration membranes due to their excellent hydrophilicity, antifouling and hemocompatibility. However, challenges still remain to simplify the modification procedure and to improve the utilization efficiency. In this paper, antifouling and hemocompatibility polysulfone (PSf) hemodiafiltration membranes were fabricated via in situ cross-linked polymerization of vinyl pyrrolidone (VP) and vinyltriethoxysilane (VTEOS) in PSf solutions and non-solvent induced phase separation (NIPS) technique. The prepared membranes were characterized by attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM), which suggested that VP and VTEOS have been cross-linked copolymerized in PSf membranes. The modified PSf membranes with high polymer content showed improved hydrophilicity, ultrafiltration and protein antifouling ability. In addition, the modified PSf membranes showed lower protein adsorption, inhibited platelet adhesion and deformation, prolonged the activated partial thromboplastin time (APTT), prothrombin time (PT), and decreased the content of fibrinogen (FIB) transferring to fibrin, indicating enhanced hemocompatibility. In a word, the present work provides a simple and effective one-step modification method to construct PSf membranes with improved hydrophilicity, antifouling and hemocompatibility. - Highlights: • PSf membranes were modified by in situ cross-linked polymerization. • The modified PSf membranes showed enhanced hydrophilicity. • The anti-fouling and hemocompatibility of PSf membranes were improved.

  3. Elevated removal of middle molecules without significant albumin loss with mixed-dilution hemodiafiltration for patients unable to provide sufficient blood flow rates.

    Science.gov (United States)

    Potier, Jacky; Le Roy, Frank; Faucon, Jean Paul; Besselièvre, Thibault; Renaudineau, Eric; Farquet, Christian; Soihan, Pascale; Touzard, Dominique; Djema, Asia; Ilinca, Toma

    2013-01-01

    We examined the hypothesis that mixed-dilution online hemodiafiltration (MIXED) rather than predilution online hemodiafiltration (PRE) could enable patients with low blood flow rate (Qb) to benefit from advantages of convective therapies. Thirty-eight patients were included in a prospective, randomized, crossover and multicenter study conducted with a view to comparing the equilibrated Kt/V, reduction ratio (RR) of phosphates, β2-microglobulin (β2-M) and myoglobin (myo) between PRE and MIXED, each at two Qb values of 250 and 300 ml/min during 4 h sessions with a FX1000HDF dialyzer. Albumin losses (Alb) were also measured in 12 patients. MIXED was always found to be more efficient compared to PRE notably for middle molecules (MM). RRβ2-M: MIX250: 81.3 ± 3.6 vs. PRE250: 75.2 ± 5.9; MIX300: 82.7 ± 3.6 vs. PRE300: 78.1 ± 5.4; RRmyo: MIX250: 70.2 ± 3.6 vs. PRE250: 42.6 ± 2.6; MIX300: 70.6 ± 3.6 vs. PRE300: 45.7 ± 3.6 and with Alb <3.0 g/session. MIXED allows patients unable to provide sufficiently high Qb to achieve high levels of MM removal. © 2013 S. Karger AG, Basel.

  4. Hemodiafiltration Versus Hemodialysis and Survival in Patients With ESRD: The French Renal Epidemiology and Information Network (REIN) Registry.

    Science.gov (United States)

    Mercadal, Lucile; Franck, Jeanna-Eve; Metzger, Marie; Urena Torres, Pablo; de Cornelissen, François; Edet, Stéphane; Béchade, Clémence; Vigneau, Cécile; Drüeke, Tilman; Jacquelinet, Christian; Stengel, Bénédicte

    2016-08-01

    Recent randomized trials report that mortality is lower with high-convection-volume hemodiafiltration (HDF) than with hemodialysis (HD). We used data from the French national Renal Epidemiology and Information Network (REIN) registry to investigate trends in HDF use and its relationship with mortality in the total population of incident dialysis patients. The study included those who initiated HD therapy from January 1, 2008, through December 31, 2011, and were dialyzed for more than 3 months; follow-up extended to the end of 2012. HDF use at the patient and facility level. All-cause and cardiovascular mortality, using Cox models to estimate HRs of HDF as time-dependent covariate at the patient level, with age as time scale and fully adjusted for comorbid conditions and laboratory data at baseline, catheter use, and facility type as time-dependent covariates. Analyses completed by Cox models for HRs of the facility-level exposure to HDF updated yearly. Of 28,407 HD patients, 5,526 used HDF for a median of 1.2 (IQR, 0.9-1.9) years; 2,254 of them used HDF exclusively. HRs for all-cause and cardiovascular mortality associated with HDF use were 0.84 (95% CI, 0.77-0.91) and 0.73 (95% CI, 0.61-0.88), respectively. In patients treated exclusively with HDF, these HRs were 0.77 (95% CI, 0.67-0.87) and 0.66 (95% CI, 0.50-0.86). At the facility level, increasing the percentage of patients using HDF from 0% to 100% was associated with HRs for all-cause and cardiovascular mortality of 0.87 (95% CI, 0.77-0.99) and 0.72 (95% CI, 0.54-0.96), respectively. Observational study. Whether analyzed as a patient- or facility-level predictor, HDF treatment was associated with better survival. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  5. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives

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    Ayan Sen

    2016-01-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration.

  6. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives.

    Science.gov (United States)

    Sen, Ayan; Callisen, Hannelisa E; Alwardt, Cory M; Larson, Joel S; Lowell, Amelia A; Libricz, Stacy L; Tarwade, Pritee; Patel, Bhavesh M; Ramakrishna, Harish

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration.

  7. Seeking an optimal renal replacement therapy for the chronic kidney disease epidemic: the case for on-line hemodiafiltration.

    Science.gov (United States)

    Gatti, Emanuele; Ronco, Claudio

    2011-01-01

    the overall costs incurred by payers of renal care. In short, optimal care needs to be provided with shrinking resources and without compromising the medical appropriateness of the therapy. Additionally, we believe ensuring improved quality of life is just as important as prolonging patient survival. Therefore, a balanced compromise between optimal and affordable technology is required in order to reach the targets of achieving good medical care and meeting the expectations of patients, their families, healthcare providers, and society as a whole. Under these premises, and focusing on the aforementioned targets, we believe that on-line hemodiafiltration (HDF) represents the most advanced and clinically appropriate RRT modality available to best cope with the CKD epidemic. Together with the guidance and recommendations of those taking care of CKD patients on dialysis therapy, the contribution of industry is indispensable for the availability of highly reliable and affordable solutions to the impending dilemma. As representatives of the academic-medical community and of industry, we present a joint case for the application of on-line HDF towards meeting the challenge of large-scale provision of dialysis under an increasingly restrictive financial climate. Copyright © 2011 S. Karger AG, Basel.

  8. THE SUCCESSFUL TREATMENT OF A PERIPHERAL VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION FOR SEVERE ACUTE RESPIRATORY FAILURE IN THE EARLY PERIOD AFTER ADULT LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2014-01-01

    Full Text Available Aim: of our clinical study was to present own experience of veno-venous extracorporeal membrane oxygenation (VV ECMO for the treatment of an adult patient (female, 28 yrs, 150 cm, 35 kg with acute respiratory distress syndrome (ARDS in the early period after liver transplantation against satisfactory liver graft function. Materials and methods. Double-lumen cannula 22 F was placed percutaneously in the right internal jugular vein. The ext- racorporeal contour reduced in length and the polymethylpeptene oxygenator (priming volume 175 ml were also. Results. In 1 hour after the beginning of VV ECMO, we registered the noted improvement of arterial blood gas and acid-base balance (regress of respiratory acidosis, improvement of arterial oxygenation which allowed us to use the «protective» mode of mechanical ventilation. Improvement of gas exchange and regress of clinical and radiological manifestations of ARDS allowed for VV ECMO weaning and decannulation on day 7. The patient was discharged from ICU and then from our Centre to a homestay respectively on the 9th and 16th day after VV ECMO weaning with the satisfactory liver graft and lungs function. Conclusion. VV ECMO can be successfully applied to correct the life-threatening acute respiratory failure in the early period after liver transplantation. 

  9. A case of rhabdomyolysis after kidney transplantation successfully managed with intensive continuous dialysis.

    Science.gov (United States)

    Shahbazov, Rauf; Fox, Michael; Alejo, Jennifer L; Anjum, Malik A; Azari, Feredun; Doyle, Alden; Agarwal, Avinash; Brayman, Kenneth L

    2018-04-01

    Rhabdomyolysis is characterized by muscle cell death which can result in acute kidney injury from pigment nephropathy. We present a patient who developed rhabdomyolysis immediately after deceased donor kidney transplantation surgery and was managed with continuous renal replacement therapy that resulted in successful salvage of the kidney allograft. Patients who develop acute kidney failure requiring renal replacement therapy generally have a poor prognosis. It is worth noting that while continuous veno-venous hemofiltration (CVVHF) offers greater volume support and continuous clearance compared to hemodialysis (HD), recent studies have demonstrated no clinically significant improvement in clinical outcome between the two. Perhaps CVVHF is a better modality compared to HD in this setting to prevent further insult from pigment nephropathy to an allograft. A combination of early diagnosis and intensive continuous renal replacement therapy can be used for allograft salvage in a patient with rhabdomyolysis in the immediate post-kidney transplant period.

  10. Estudio comparativo de biocompatibilidad entre la hemodiafiltración en línea y la hemodiafiltración con reinfusión endógena Biocompatibility comparative study between online hemodiafiltration and hemodiafiltration with endogenous reinfusion

    Directory of Open Access Journals (Sweden)

    José Luis Cobo Sánchez

    2012-12-01

    Full Text Available Objetivo: Comparar la biocompatibilidad entre la hemodiafiltración en línea (HDF y la hemodiafiltración con reinfusión endógena (HFR. Material y método: Estudio comparativo observacional en una población de 15 pacientes en hemodiálisis crónica elegidos al azar entre los pacientes de nuestra unidad. Se compararon cambios en el perfil hematológico, nivel de PCR y constantes vitales, pre y post hemodiálisis, tras someterse a ambas técnicas de hemodiafiltración. Se comparó las diferencias entre los parámetros estudiados pre y post hemodiálisis en cada técnica. Resultados: Los niveles de plaquetas descendieron más en la HDF (HDF -1,33 vs HFR -19,73 x10³/mm³, p=0,005. El nivel de leucocitos disminuyó en la HDF y aumentó en la HFR (HDF -0,46 vs HFR +0,8 x10³/mm³; p=0,006. Respecto a la fórmula leucocitaria hubo resultados dispares: segmentados HDF -1,7 vs HFR +5,4%, pAim: To compare biocompatibility between online hemodiafiltration (HDF and hemodiafiltration with endogenous reinfusion. Methods: Observational comparative study in a population of 15 chronic hemodialysis patients randomly selected among the patients in our unit. We compared changes in hematological profile, CRP level and vital signs, pre and post hemodialysis, after undergoing both hemodiafiltration techniques. Comparing the differences between the parameters studied before and after each hemodialysis technique. Results: Platelet levels decreased more in the HDF (HDF -1,33 vs HFR -19,73 x10³/mm³, p=0,005. Leukocyte levels decreased in the HDF and increased with HFR (HDF -0,46 vs HFR +0,8 x10³/mm³; p=0,006. Regarding the leukocyte formula had mixed results: segmented HDF -1,7 vs HFR +5,4%, p<0,001; lymphocytes HDF +1,96 vs HFR -3,62%, p<0,001. With the HFR decreased CRP levels less (HDF -0,05 vs HFR -0,001 mg/dl; p= NS. Regarding vital signs, systolic blood pressure decreased more in the HFR than HDF (HDF -9,93 vs HFR -10,33 mmHg; p<0,001, conversely that the

  11. Comparison of survival between dialysis patients with incident high-flux hemodialysis versus on-line hemodiafiltration: A single center experience in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Mohamed Said Abdelsalam

    2018-01-01

    Full Text Available Conventional hemodialysis (HD is the most common treatment modality used for renal replacement therapy. The concept of HD is based on the diffusion of solutes across a semipermeable membrane. Hemofiltration (HF is based on convective transport of solutes; hemodiafiltration (HDF is based on combined convective and diffusive therapies. Data about survival benefit of on-line HDF (OL-HDF over high-flux HD (HF-HD is conflicting. We conducted this study to investigate if there is a survival difference between the two treatment modalities. This study is a retrospective, single-center study in which 78 patients were screened; 18 were excluded and 60 patients were analyzed. The study patients were aged 47.5 ± 20.7 years, 33 patients (55% were on HF-HD, and 27 patients (45% were on OL-HDF. A total of 24 patients (40% of both groups were diabetic and, the mean duration on dialysis was 43.5 ±21.3 months in the HF-HD group and 41.2 ± 22.0 months in the OL-HDF group. The mean substitution volume for OL-HDF was 22.3 ± 2.5 L. Survival was 73% [95%, confidence interval (CI 60–84] in the HF-HD group and 65% (95%, CI 54–75 in the OL-HDF group by the end of the study period. The unadjusted hazard ratio (HR with 95% CI comparing HF-HD to high-volume postdilution OL-HDF was 0.78 (0.10–5.6; P = 0.810. Kaplan–Meier analysis for patient survival over five years showed no significant difference between the two modalities. Prospective controlled trials with a larger number of patients will be needed to assess the long-term clinical outcome of postdilution OL-HDF over HF-HD.

  12. Venovenous Bypass Is Associated With a Lower Incidence of Acute Kidney Injury After Liver Transplantation in Patients With Compromised Pretransplant Renal Function.

    Science.gov (United States)

    Sun, Kai; Hong, Fu; Wang, Yun; Agopian, Vatche G; Yan, Min; Busuttil, Ronald W; Steadman, Randolph H; Xia, Victor W

    2017-11-01

    Although the hemodynamic benefits of venovenous bypass (VVB) during liver transplantation (LT) are well appreciated, the impact of VVB on posttransplant renal function is uncertain. The aim of this study was to determine if VVB was associated with a lower incidence of posttransplant acute kidney injury (AKI). Medical records of adult (≥18 years) patients who underwent primary LT between 2004 and 2014 at a tertiary hospital were reviewed. Patients who required pretransplant renal replacement therapy and intraoperative piggyback technique were excluded. Patients were divided into 2 groups, VVB and non-VVB. AKI, determined by the Acute Kidney Injury Network criteria, was compared between the 2 groups. Propensity match was used to control selection bias that occurred before VVB and multivariable logistic regression was used to control confounding factors during and after VVB. Of 1037 adult patients who met the study inclusion criteria, 247 (23.8%) received VVB. A total of 442 patients (221 patients in each group) were matched. Aftermatch patients were further divided according to a predicted probability AKI model using preoperative creatinine (Cr), VVB, and intraoperative variables into 2 subgroups: normal and compromised pretransplant renal functions. In patients with compromised pretransplant renal function (Cr ≥1.2 mg/dL), the incidence of AKI was significantly lower in the VVB group compared with the non-VVB group (37.2% vs 50.8%; P = .033). VVB was an independent risk factor negatively associated with AKI (odds ratio, 0.1; 95% confidence interval, 0.1-0.4; P = .001). Renal replacement in 30 days and 1-year recipient mortality were not significantly different between the 2 groups. The incidence of posttransplant AKI was not significantly different between the 2 groups in patients with normal pretransplant renal function (Cr the role of intraoperative VVB in posttransplant AKI are warranted.

  13. pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure.

    Science.gov (United States)

    McNamee, J J; Gillies, M A; Barrett, N A; Agus, A M; Beale, R; Bentley, A; Bodenham, A; Brett, S J; Brodie, D; Finney, S J; Gordon, A J; Griffiths, M; Harrison, D; Jackson, C; McDowell, C; McNally, C; Perkins, G D; Tunnicliffe, W; Vuylsteke, A; Walsh, T S; Wise, M P; Young, D; McAuley, D F

    2017-05-01

    One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO 2 R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO 2 R in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCO 2 R and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCO 2 R in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.

  14. Comparison of toxin removal outcomes in online hemodiafiltration and intra-dialytic exercise in high-flux hemodialysis: A prospective randomized open-label clinical study protocol

    Directory of Open Access Journals (Sweden)

    Maheshwari Vaibhav

    2012-11-01

    Full Text Available Abstract Background Maintenance hemodialysis (HD patients universally suffer from excess toxin load. Hemodiafiltration (HDF has shown its potential in better removal of small as well as large sized toxins, but its efficacy is restricted by inter-compartmental clearance. Intra-dialytic exercise on the other hand is also found to be effective for removal of toxins; the augmented removal is apparently obtained by better perfusion of skeletal muscles and decreased inter-compartmental resistance. The aim of this trial is to compare the toxin removal outcome associated with intra-dialytic exercise in HD and with post-dilution HDF. Methods/design The main hypothesis of this study is that intra-dialytic exercise enhances toxin removal by decreasing the inter-compartmental resistance, a major impediment for toxin removal. To compare the HDF and HD with exercise, the toxin rebound for urea, creatinine, phosphate, and β2-microglobulin will be calculated after 2 hours of dialysis. Spent dialysate will also be collected to calculate the removed toxin mass. To quantify the decrease in inter-compartmental resistance, the recently developed regional blood flow model will be employed. The study will be single center, randomized, self-control, open-label prospective clinical research where 15 study subjects will undergo three dialysis protocols (a high flux HD, (b post-dilution HDF, (c high flux HD with exercise. Multiple blood samples during each study session will be collected to estimate the unknown model parameters. Discussion This will be the first study to investigate the exercise induced physiological change(s responsible for enhanced toxin removal, and compare the toxin removal outcome both for small and middle sized toxins in HD with exercise and HDF. Successful completion of this clinical research will give important insights into exercise effect on factors responsible for enhanced toxin removal. The knowledge will give confidence for implementing

  15. Feasibility of perflutren microsphere contrast transthoracic echocardiography in the visualization of ventricular endocardium during venovenous extracorporeal membrane oxygenation in a validated ovine model.

    Science.gov (United States)

    Platts, David G; Diab, Sara; Dunster, Kimble R; Shekar, Kiran; Burstow, Darryl J; Sim, Beatrice; Tunbridge, Matthew; McDonald, Charles; Chemonges, Saul; Chan, Jonathan; Fraser, John F

    2015-03-01

    Transthoracic echocardiography (TTE) during extra corporeal membrane oxygenation (ECMO) is important but can be technically challenging. Contrast-specific TTE can improve imaging in suboptimal studies. These contrast microspheres are hydrodynamically labile structures. This study assessed the feasibility of contrast echocardiography (CE) during venovenous (VV) ECMO in a validated ovine model. Twenty-four sheep were commenced on VV ECMO. Parasternal long-axis (Plax) and short-axis (Psax) views were obtained pre- and postcontrast while on VV ECMO. Endocardial definition scores (EDS) per segment were graded: 1 = good, 2 = suboptimal 3 = not seen. Endocardial border definition score index (EBDSI) was calculated for each view. Endocardial length (EL) in the Plax view for the left ventricle (LV) and right ventricle (RV) was measured. Summation EDS data for the LV and RV for unenhanced TTE (UE) versus CE TTE imaging: EDS 1 = 289 versus 346, EDS 2 = 38 versus 10, EDS 3 = 33 versus 4, respectively. Wilcoxon matched-pairs rank-sign tests showed a significant ranking difference (improvement) pre- and postcontrast for the LV (P < 0.0001), RV (P < 0.0001) and combined ventricular data (P < 0.0001). EBDSI for CE TTE was significantly lower than UE TTE for the LV (1.05 ± 0.17 vs. 1.22 ± 0.38, P = 0.0004) and RV (1.06 ± 0.22 vs. 1.42 ± 0.47, P = 0.0.0006) respectively. Visualized EL was significantly longer in CE versus UE for both the LV (58.6 ± 11.0 mm vs. 47.4 ± 11.7 mm, P < 0.0001) and the RV (52.3 ± 8.6 mm vs. 36.0 ± 13.1 mm, P < 0.0001), respectively. Despite exposure to destructive hydrodynamic forces, CE is a feasible technique in an ovine ECMO model. CE results in significantly improved EDS and increased EL. © 2014, Wiley Periodicals, Inc.

  16. Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange--retrospective analysis of 265 cases.

    Directory of Open Access Journals (Sweden)

    Matthias Lubnow

    Full Text Available OBJECTIVES: Technical complications are a known hazard in veno-venous extracorporeal membrane oxygenation (vvECMO. Identifying these complications and predictive factors indicating a developing system-exchange was the goal of the study. METHODS: Retrospective study on prospectively collected data of technical complications including 265 adult patients (Regensburg ECMO Registry, 2009-2013 with acute respiratory failure treated with vvECMO. Alterations in blood flow resistance, gas transfer capability, hemolysis, coagulation and hemostasis parameters were evaluated in conjunction with a system-exchange in all patients with at least one exchange (n = 83. RESULTS: Values presented as median (interquartile range. Patient age was 50(36-60 years, the SOFA score 11(8-14.3 and the Murray lung injury Score 3.33(3.3-3.7. Cumulative ECMO support time 3411 days, 9(6-15 days per patient. Mechanical failure of the blood pump (n = 5, MO (n = 2 or cannula (n = 1 accounted for 10% of the exchanges. Acute clot formation within the pump head (visible clots, increase in plasma free hemoglobin (frHb, serum lactate dehydrogenase (LDH, n = 13 and MO (increase in pressure drop across the MO, n = 16 required an urgent system-exchange, of which nearly 50% could be foreseen by measuring the parameters mentioned below. Reasons for an elective system-exchange were worsening of gas transfer capability (n = 10 and device-related coagulation disorders (n = 32, either local fibrinolysis in the MO due to clot formation (increased D-dimers [DD], decreased platelet count; n = 24, or device-induced hyperfibrinolysis (increased DD, decreased fibrinogen [FG], decreased platelet count, diffuse bleeding tendency; n = 8, which could be reversed after system-exchange. Four MOs were exchanged due to suspicion of infection. CONCLUSIONS: The majority of ECMO system-exchanges could be predicted by regular inspection of the complete ECMO circuit, evaluation of gas exchange, pressure drop

  17. Suicidal intoxication with potassium chlorate successfully treated with renal replacement therapy and extracorporeal liver support.

    Science.gov (United States)

    Sein Anand, Jacek; Barwina, Małgorzata; Zajac, Maciej; Kaletha, Krystian

    2012-01-01

    We present a case of a 22-year-old male who, in a suicide attempt, ingested approximately 200 g of potassium chlorate. Upon admission to the hospital, he presented in full respiratory failure with cyanosis. Methylene blue antidote was given but found to be ineffective. The patient was intubated and mechanical ventilation was initiated. Because of renal failure with anuria, intermittent haemodialysis (iHD) followed by continuous venovenous hemodiafiltration (CVVHDF) was performed. His hospital stay was also complicated by hemolysis, disseminated intravascular coagulation, and atrial fibrillation. Transfusions of packed red blood cells, platelets, and fresh frozen plasma were necessary to correct the deficits. He also developed liver failure and required two sessions of molecular adsorbent recirculating system (MARS) therapy. On day 14 of his hospitalization, he regained consciousness, as well as full respiratory and circulatory function. There are no controlled studies addressing management of potassium chlorate poisoning. We suggest that early renal replacement therapy should be strongly considered.

  18. [Mobile single-pass batch hemodialysis system in intensive care medicine. Reduction of costs and workload in renal replacement therapy].

    Science.gov (United States)

    Hopf, H-B; Hochscherf, M; Jehmlich, M; Leischik, M; Ritter, J

    2007-07-01

    This paper describes the introduction of a single-pass batch hemodialysis system for renal replacement therapy in a 14 bed intensive care unit. The goals were to reduce the workload of intensive care unit physicians using an alternative and simpler method compared to continuous veno-venous hemodiafiltration (CVVHDF) and to reduce the costs of hemofiltrate solutions (80,650 EUR per year in our clinic in 2005). We describe and evaluate the process of implementation of the system as well as the achieved and prospective savings. We conclude that a close cooperation of all participants (physicians, nurses, economists, technicians) of a hospital can achieve substantial benefits for patients and employees as well as reduce the economic burden of a hospital.

  19. Continuous auditing & continuous monitoring : Continuous value?

    NARCIS (Netherlands)

    van Hillo, Rutger; Weigand, Hans; Espana, S; Ralyte, J; Souveyet, C

    2016-01-01

    Advancements in information technology, new laws and regulations and rapidly changing business conditions have led to a need for more timely and ongoing assurance with effectively working controls. Continuous Auditing (CA) and Continuous Monitoring (CM) technologies have made this possible by

  20. Effect of increased convective clearance by on-line hemodiafiltration on all cause and cardiovascular mortality in chronic hemodialysis patients – the Dutch CONvective TRAnsport STudy (CONTRAST: rationale and design of a randomised controlled trial [ISRCTN38365125

    Directory of Open Access Journals (Sweden)

    Nubé Menso J

    2005-05-01

    Full Text Available Abstract Background The high incidence of cardiovascular disease in patients with end stage renal disease (ESRD is related to the accumulation of uremic toxins in the middle and large-middle molecular weight range. As online hemodiafiltration (HDF removes these molecules more effectively than standard hemodialysis (HD, it has been suggested that online HDF improves survival and cardiovascular outcome. Thus far, no conclusive data of HDF on target organ damage and cardiovascular morbidity and mortality are available. Therefore, the CONvective TRAnsport STudy (CONTRAST has been initiated. Methods CONTRAST is a Dutch multi-center randomised controlled trial. In this trial, approximately 800 chronic hemodialysis patients will be randomised between online HDF and low-flux HD, and followed for three years. The primary endpoint is all cause mortality. The main secondary outcome variables are fatal and non-fatal cardiovascular events. Conclusion The study is designed to provide conclusive evidence whether online HDF leads to a lower mortality and less cardiovascular events as compared to standard HD.

  1. Bypass during Liver Transplantation: Anachronism or Revival? Liver Transplantation Using a Combined Venovenous/Portal Venous Bypass—Experiences with 163 Liver Transplants in a Newly Established Liver Transplantation Program

    Directory of Open Access Journals (Sweden)

    Anne Mossdorf

    2015-01-01

    Full Text Available Introduction. The venovenous/portal venous (VVP bypass technique has generally become obsolete in liver transplantation (LT today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass.

  2. Continuous Problem of Function Continuity

    Science.gov (United States)

    Jayakody, Gaya; Zazkis, Rina

    2015-01-01

    We examine different definitions presented in textbooks and other mathematical sources for "continuity of a function at a point" and "continuous function" in the context of introductory level Calculus. We then identify problematic issues related to definitions of continuity and discontinuity: inconsistency and absence of…

  3. Business continuity

    International Nuclear Information System (INIS)

    Breunhoelder, Gert

    2002-01-01

    This presentation deals with the following keypoints: Information Technology (IT) Business Continuity and Recovery essential for any business; lessons learned after Sept. 11 event; Detailed planning, redundancy and testing being the key elements for probability estimation of disasters

  4. Continuous tokamaks

    International Nuclear Information System (INIS)

    Peng, Y.K.M.

    1978-04-01

    A tokamak configuration is proposed that permits the rapid replacement of a plasma discharge in a ''burn'' chamber by another one in a time scale much shorter than the elementary thermal time constant of the chamber first wall. With respect to the chamber, the effective duty cycle factor can thus be made arbitrarily close to unity minimizing the cyclic thermal stress in the first wall. At least one plasma discharge always exists in the new tokamak configuration, hence, a continuous tokamak. By incorporating adiabatic toroidal compression, configurations of continuous tokamak compressors are introduced. To operate continuous tokamaks, it is necessary to introduce the concept of mixed poloidal field coils, which spatially groups all the poloidal field coils into three sets, all contributing simultaneously to inducing the plasma current and maintaining the proper plasma shape and position. Preliminary numerical calculations of axisymmetric MHD equilibria in continuous tokamaks indicate the feasibility of their continued plasma operation. Advanced concepts of continuous tokamaks to reduce the topological complexity and to allow the burn plasma aspect ratio to decrease for increased beta are then suggested

  5. Continuous Dropout.

    Science.gov (United States)

    Shen, Xu; Tian, Xinmei; Liu, Tongliang; Xu, Fang; Tao, Dacheng

    2017-10-03

    Dropout has been proven to be an effective algorithm for training robust deep networks because of its ability to prevent overfitting by avoiding the co-adaptation of feature detectors. Current explanations of dropout include bagging, naive Bayes, regularization, and sex in evolution. According to the activation patterns of neurons in the human brain, when faced with different situations, the firing rates of neurons are random and continuous, not binary as current dropout does. Inspired by this phenomenon, we extend the traditional binary dropout to continuous dropout. On the one hand, continuous dropout is considerably closer to the activation characteristics of neurons in the human brain than traditional binary dropout. On the other hand, we demonstrate that continuous dropout has the property of avoiding the co-adaptation of feature detectors, which suggests that we can extract more independent feature detectors for model averaging in the test stage. We introduce the proposed continuous dropout to a feedforward neural network and comprehensively compare it with binary dropout, adaptive dropout, and DropConnect on Modified National Institute of Standards and Technology, Canadian Institute for Advanced Research-10, Street View House Numbers, NORB, and ImageNet large scale visual recognition competition-12. Thorough experiments demonstrate that our method performs better in preventing the co-adaptation of feature detectors and improves test performance.

  6. Continuity theory

    CERN Document Server

    Nel, Louis

    2016-01-01

    This book presents a detailed, self-contained theory of continuous mappings. It is mainly addressed to students who have already studied these mappings in the setting of metric spaces, as well as multidimensional differential calculus. The needed background facts about sets, metric spaces and linear algebra are developed in detail, so as to provide a seamless transition between students' previous studies and new material. In view of its many novel features, this book will be of interest also to mature readers who have studied continuous mappings from the subject's classical texts and wish to become acquainted with a new approach. The theory of continuous mappings serves as infrastructure for more specialized mathematical theories like differential equations, integral equations, operator theory, dynamical systems, global analysis, topological groups, topological rings and many more. In light of the centrality of the topic, a book of this kind fits a variety of applications, especially those that contribute to ...

  7. Continuation calculus

    NARCIS (Netherlands)

    Geron, B.; Geuvers, J.H.; de'Liguoro, U.; Saurin, A.

    2013-01-01

    Programs with control are usually modeled using lambda calculus extended with control operators. Instead of modifying lambda calculus, we consider a different model of computation. We introduce continuation calculus, or CC, a deterministic model of computation that is evaluated using only head

  8. Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso Predictors of acute kidney injury in patients undergoing a conventional orthotopic liver transplant without veno-venous bypass

    Directory of Open Access Journals (Sweden)

    Olival Cirilo L. da Fonseca-Neto

    2011-06-01

    Full Text Available RADICAL: Injúria renal aguda é uma das complicações mais comuns do transplante ortotópico de fígado. A ausência de critério universal para sua definição nestas condições dificulta as comparações entre os estudos. A técnica convencional para o transplante consiste na excisão total da veia cava inferior retro-hepática durante a hepatectomia nativa. Controvérsias sobre o efeito da técnica convencional sem desvio venovenoso na função renal continuam. OBJETIVO: Estimar a incidência e os fatores de risco de injúria renal aguda entre os receptores de transplante ortotópico de fígado convencional sem desvio venovenoso. MÉTODOS: Foram avaliados 375 pacientes submetidos a transplante ortotópico de fígado. Foram analisadas as variáveis pré, intra e pós-operatórias em 153 pacientes submetidos a transplante ortotópico de fígado convencional sem desvio venovenoso. O critério para a injúria renal aguda foi valor da creatinina sérica > 1,5 mg/dl ou débito urinário BACKGROUND: Acute kidney injury is one of the most common complications of orthotopic liver transplantation. The absence of universal criteria for definition of these conditions make comparisons difficult between studies. The conventional technique for transplantation is the total excision of the inferior vena cava during liver retro-native hepatectomy. Controversies about the effect of the conventional technique without venovenous bypass on renal function remain. AIM: To estimate the incidence and risk of acute kidney injury factors among recipients of orthotopic liver transplantation without conventional venovenous bypass. METHODS: Was studied 375 patients undergoing orthotopic liver transplantation. Variables were analyzed in preoperative, intraoperative and postoperative complications in 153 patients undergoing orthotopic liver transplantation without conventional venovenous bypass. The criterion for acute kidney injury was serum creatinine > 1.5 mg/dl or

  9. Continuation calculus

    Directory of Open Access Journals (Sweden)

    Bram Geron

    2013-09-01

    Full Text Available Programs with control are usually modeled using lambda calculus extended with control operators. Instead of modifying lambda calculus, we consider a different model of computation. We introduce continuation calculus, or CC, a deterministic model of computation that is evaluated using only head reduction, and argue that it is suitable for modeling programs with control. It is demonstrated how to define programs, specify them, and prove them correct. This is shown in detail by presenting in CC a list multiplication program that prematurely returns when it encounters a zero. The correctness proof includes termination of the program. In continuation calculus we can model both call-by-name and call-by-value. In addition, call-by-name functions can be applied to call-by-value results, and conversely.

  10. Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Kunka, Megan E; Cady, Elizabeth A; Woo, Heejung C; Thompson Bastin, Melissa L

    2015-01-01

    Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours), which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient's actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.

  11. Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Megan E. Kunka

    2015-01-01

    Full Text Available Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours, which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient’s actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.

  12. Between strong continuity and almost continuity

    Directory of Open Access Journals (Sweden)

    J.K. Kohli

    2010-04-01

    Full Text Available As embodied in the title of the paper strong and weak variants of continuity that lie strictly between strong continuity of Levine and almost continuity due to Singal and Singal are considered. Basic properties of almost completely continuous functions (≡ R-maps and δ-continuous functions are studied. Direct and inverse transfer of topological properties under almost completely continuous functions and δ-continuous functions are investigated and their place in the hier- archy of variants of continuity that already exist in the literature is out- lined. The class of almost completely continuous functions lies strictly between the class of completely continuous functions studied by Arya and Gupta (Kyungpook Math. J. 14 (1974, 131-143 and δ-continuous functions defined by Noiri (J. Korean Math. Soc. 16, (1980, 161-166. The class of almost completely continuous functions properly contains each of the classes of (1 completely continuous functions, and (2 al- most perfectly continuous (≡ regular set connected functions defined by Dontchev, Ganster and Reilly (Indian J. Math. 41 (1999, 139-146 and further studied by Singh (Quaestiones Mathematicae 33(2(2010, 1–11 which in turn include all δ-perfectly continuous functions initi- ated by Kohli and Singh (Demonstratio Math. 42(1, (2009, 221-231 and so include all perfectly continuous functions introduced by Noiri (Indian J. Pure Appl. Math. 15(3 (1984, 241-250.

  13. Continuous renal replacement therapy for acute renal failure in patients with cancer: a well-tolerated adjunct treatment

    Directory of Open Access Journals (Sweden)

    Rebecca Fischler

    2016-08-01

    Full Text Available Abstract Introduction – Acute renal failure (ARF has a poor prognosis in patients with cancer requiring intensive care unit (ICU admission. Our aim is finding prognostic factors for hospital mortality in patients with cancer with ARF requiring renal replacement therapy (RRT. Methods – In this retrospective study, all patients with cancer with ARF treated with continuous venovenous filtration (CVVHDF in the ICU of the Institut Jules Bordet, between January 1st 2003 and December 31st 2012, were included in the study.Results – 103 patients are assessed: men/women 69/34, median age 62 years, solid/haematologic tumours 68/35, median SAPS II 56. Mortality rate was 63%. Seven patients required chronic renal dialysis. After multivariate analysis, two variables were statistically associated with hospital mortality : more than one organ failure (including kidney (OR 5.918 ; 95% CI 2.184 – 16.038 ; p<0,001 and low albumin level (OR 3.341; 95% CI 1.229 – 9.077; p=0,02. Only minor complications related to CVVHDF have been documented.Conclusions – Despite the poor prognosis associated with ARF, CVVHDF is an effective and tolerable renal replacement technique in patients with cancer admitted to the ICU. Multiple organ failure and hypoalbuminemia, two independent prognostic factors for hospital mortality have to be considered when deciding for introducing RRT.

  14. Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Han Soo Park

    2017-03-01

    Full Text Available Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF. A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED. She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment.

  15. Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Nagarik Amit

    2010-01-01

    Full Text Available Systemic heparinization during continuous renal replacement therapy (CRRT is associated with disadvantage of risk of bleeding. This study analyses the efficacy of frequent saline flushes compared with heparin anticoagulation to maintain filter life. From January 2004 to November 2007, 65 critically ill patients with acute renal failure underwent CRRT. Continuous venovenous hemodialfiltration (CVVHDF was performed using Diapact Braun CRRT machine. 1.7% P.D. fluid was used as dialysate. 0.9% NS with addition of 10% Ca Gluconate, Magnesium Sulphate, Soda bicarbonate and Potassium Chloride added sequentially in separate units were used for replacement, carefully monitoring their levels. Anticoagulation of extracorporeal circuit was achieved with unfractionated heparin (250-500 units alternate hour in 35 patients targeting aPTT of 45-55 seconds. No anticoagulation was used in 30 patients with baseline APTT > 55 seconds and extracorporeal circuit was maintained with saline flushes at 30 min interval. 65 pa-tients including 42 males. Co-morbidities were comparable in both groups. HMARF was signifi-cantly more common in heparin group while Sepsis was comparable in both the groups. CRRT parameters were similar in both groups. Average filter life in heparin group was 26 ± 6.4 hours while it was 24.5 ± 6.36 hours in heparin free group ( P=NS. Patients receiving heparin had 16 bleeding episodes (0.45/patient while only four bleeding episodes occurred in heparin free group (0.13/patient, P< 0.05. Mortality was 71% in heparin group and 67% in heparin free group. Frequent saline flushes is an effective mode of maintainance of extracorporeal circuit in CRRT when aPTT is already on the higher side, with significantly decreased bleeding episodes.

  16. Completely continuous and weakly completely continuous abstract ...

    Indian Academy of Sciences (India)

    An algebra A is called right completely continuous (right weakly completely continuous) ... Moreover, some applications of these results in group algebras are .... A linear subspace S(G) of L1(G) is said to be a Segal algebra, if it satisfies the.

  17. Providing Continuous Assurance

    NARCIS (Netherlands)

    Kocken, Jonne; Hulstijn, Joris

    2017-01-01

    It has been claimed that continuous assurance can be attained by combining continuous monitoring by management, with continuous auditing of data streams and the effectiveness of internal controls by an external auditor. However, we find that in existing literature the final step to continuous

  18. [Successful continuous renal replacement therapy in a neonate with early-onset group B streptococcal sepsis and multi-organ dysfunction syndrome].

    Science.gov (United States)

    von Schnakenburg, C; Hufnagel, M; Superti-Furga, A; Rieger-Fackeldey, E; Berner, R

    2009-01-01

    Group B streptococcal early-onset sepsis (GBS EOS) in neonates has a mortality rate of approximately 5%, particularly in the presence of multi-organ dysfunction. Fluid management is crucial in these patients, and continuous venovenous haemofiltration (CVVH) should be considered a therapeutic option even in newborn babies. After an uneventful pregnancy within hours after birth, a female term infant presented with dyspnoea, irritability and cyanosis. The systemic inflammatory response syndrome (SIRS) progressed to multi-organ dysfunction with acute respiratory distress syndrome (ARDS), impaired myocardial contractility, pulmonary hypertension and fluid overload. The maximum PRISM score was 51. The child required maximal respiratory and inotropic support with high volume intravenous fluid administration. However, only by using of CVVH from day 5 to 14, we successfully resolved progressive pulmonary and cardiovascular dysfunction. The child improved directly after initiation of fluid removal, was extubated on day 17 and discharged without obvious sequelae on day 57. All microbiology studies revealed GBS. Perinatal GBS-infections remain a major life-threatening event for newborn babies. CVVH should be considered an option for reversing fluid overload even in neonates with overwhelming SIRS. Alternatively, extracorporeal membrane oxygenation (ECMO) is discussed.

  19. Association between mortality and replacement solution bicarbonate concentration in continuous renal replacement therapy: A propensity-matched cohort study.

    Directory of Open Access Journals (Sweden)

    Kianoush Kashani

    Full Text Available Given the known deleterious effects seen with bicarbonate supplementation for acidemia, we hypothesized that utilizing high bicarbonate concentration replacement solution in continuous venovenous hemofiltration (CVVH would be independently associated with higher mortality.In a propensity score-matched historical cohort study conducted at a single tertiary care center from December 9, 2006, through December 31, 2009, a total of 287consecutive adult critically ill patients with Stage III acute kidney injury (AKI requiring CVVH were enrolled. We excluded patients on maintenance dialysis, those who received other modalities of continuous renal replacement therapies, and patients that received a mixed of 22 and 32 mEq/L bicarbonate solution pre- and post-filter. The primary outcome was in-hospital and 90-day mortality rates.Among enrollees, 68 were used 32 mEq/L bicarbonate solution, and 219 received 22mEq/L bicarbonate solution for CVVH. Patients on 32 mEq/L bicarbonate solution were more often non-surgical, had lower pH and bicarbonate level but had higher blood potassium and phosphorus levels in comparison with those on 22 mEq/L bicarbonate solution. After adjustment for the baseline characteristics, the use of 32 bicarbonate solution was significantly associated with increased in-hospital (HR = 1.94; 95% CI 1.02-3.79 and 90-day mortality (HR = 1.50; 95% CI 1.03-2.14. There was a significant increase in the hospital (p = .03 and 90-day (p = .04 mortality between the 22 vs. 32 mEq/L bicarbonate solution groups following propensity matching.Our data showed there is a strong association between using high bicarbonate solution and mortality independent of severity of illness and comorbid conditions. These findings need to be evaluated further in prospective studies.

  20. Business Continuity Management Plan

    Science.gov (United States)

    2014-12-01

    NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT BUSINESS CONTINUITY MANAGEMENT PLAN December 2014......maximum 200 words) Navy Supply Systems Command (NAVSUP) lacks a business process framework for the development of Business Continuity Management

  1. Smarandache Continued Fractions

    OpenAIRE

    Ibstedt, H.

    2001-01-01

    The theory of general continued fractions is developed to the extent required in order to calculate Smarandache continued fractions to a given number of decimal places. Proof is given for the fact that Smarandache general continued fractions built with positive integer Smarandache sequences baving only a finite number of terms equal to 1 is convergent. A few numerical results are given.

  2. Plants under continuous light

    NARCIS (Netherlands)

    Velez Ramirez, A.I.; Ieperen, van W.; Vreugdenhill, D.; Millenaar, F.F.

    2011-01-01

    Continuous light is an essential tool for understanding the plant circadian clock. Additionally, continuous light might increase greenhouse food production. However, using continuous light in research and practice has its challenges. For instance, most of the circadian clock-oriented experiments

  3. Clinical observation on the treatment of acute liver failure by combined non-biological artificial liver.

    Science.gov (United States)

    Li, Maoqin; Sun, Jingxi; Li, Jiaqiong; Shi, Zaixiang; Xu, Jiyuan; Lu, Bo; Cheng, Shuli; Xu, Yanjun; Wang, Xiaomeng; Zhang, Xianjiang

    2016-12-01

    The clinical efficacy and safety of different combinations of non-bio artificial liver in the treatment of acute liver failure was examined. A total of 61 cases were selected under blood purification treatment from the patients with severe acute liver failure admitted to the severe disease department of the hospital from December, 2010 to December, 2015. Three types of artificial liver combinations were observed, i.e., plasma exchange plus hemoperfusion plus continuous venovenous hemodiafiltration (PE+HP+CVVHDF), PE+CVVHDF and HP+CVVHDF. The heart rate (HR), mean arterial pressure (MAP), respiratory index (PaO 2 /FiO 2 ), liver and kidney function indicator, as well as platelet and coagulation function were compared. A comparison before and after the treatment using the three methods, showed improvement in the HRs, MAPs, PaO 2 /FiO 2 , total bilirubins (TBIL) and alanine aminotransferases (ALT) (Prate of 62.3% (38/61), and a viral survival rate of 35.0% (7/20); with the non-viral survival rate being 75.6% (31/41). In conclusion, following the treatment of three types of artificial livers, the function was improved to varying degrees, with the PE+HP+CVVHDF and the PE+CVVHDF method being better. By contrast, after the treatment of non-viral liver failure, the survival rate was significantly higher than the patients with viral liver failure.

  4. Cutting Out Continuations

    DEFF Research Database (Denmark)

    Bahr, Patrick; Hutton, Graham

    2016-01-01

    In the field of program transformation, one often transforms programs into continuation-passing style to make their flow of control explicit, and then immediately removes the resulting continuations using defunctionalisation to make the programs first-order. In this article, we show how these two...... transformations can be fused together into a single transformation step that cuts out the need to first introduce and then eliminate continuations. Our approach is calculational, uses standard equational reasoning techniques, and is widely applicable....

  5. Archives: Continuing Medical Education

    African Journals Online (AJOL)

    Items 51 - 88 of 88 ... Archives: Continuing Medical Education. Journal Home > Archives: Continuing Medical Education. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 51 - 88 of 88 ...

  6. Generalized analytic continuation

    CERN Document Server

    Ross, William T

    2002-01-01

    The theory of generalized analytic continuation studies continuations of meromorphic functions in situations where traditional theory says there is a natural boundary. This broader theory touches on a remarkable array of topics in classical analysis, as described in the book. This book addresses the following questions: (1) When can we say, in some reasonable way, that component functions of a meromorphic function on a disconnected domain, are "continuations" of each other? (2) What role do such "continuations" play in certain aspects of approximation theory and operator theory? The authors use the strong analogy with the summability of divergent series to motivate the subject. In this vein, for instance, theorems can be described as being "Abelian" or "Tauberian". The introductory overview carefully explains the history and context of the theory. The authors begin with a review of the works of Poincaré, Borel, Wolff, Walsh, and Gončar, on continuation properties of "Borel series" and other meromorphic func...

  7. Trieste will continue

    International Nuclear Information System (INIS)

    1968-01-01

    Trieste will continue to be the home of the International Centre for Theoretical Physics for the foreseeable future. An agreement signed in Vienna during December between the Italian Government and the Agency brought this assurance. (author)

  8. Nocturnal continuous glucose monitoring

    DEFF Research Database (Denmark)

    Bay, Christiane; Kristensen, Peter Lommer; Pedersen-Bjergaard, Ulrik

    2013-01-01

    Abstract Background: A reliable method to detect biochemical nocturnal hypoglycemia is highly needed, especially in patients with recurrent severe hypoglycemia. We evaluated reliability of nocturnal continuous glucose monitoring (CGM) in patients with type 1 diabetes at high risk of severe...

  9. Continual improvement plan

    Science.gov (United States)

    1994-01-01

    NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

  10. Continuing Medical Education

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 25, No 9 (2007) >. Log in or Register to get access to full text downloads.

  11. Branching trajectory continual integral

    International Nuclear Information System (INIS)

    Maslov, V.P.; Chebotarev, A.M.

    1980-01-01

    Heuristic definition of the Feynman continual integral over branching trajectories is suggested which makes it possible to obtain in the closed form the solution of the Cauchy problem for the model Hartree equation. A number of properties of the solution is derived from an integral representation. In particular, the quasiclassical asymptotics, exact solution in the gaussian case and perturbation theory series are described. The existence theorem for the simpliest continual integral over branching trajectories is proved [ru

  12. Continuous Markovian Logics

    DEFF Research Database (Denmark)

    Mardare, Radu Iulian; Cardelli, Luca; Larsen, Kim Guldstrand

    2012-01-01

    Continuous Markovian Logic (CML) is a multimodal logic that expresses quantitative and qualitative properties of continuous-time labelled Markov processes with arbitrary (analytic) state-spaces, henceforth called continuous Markov processes (CMPs). The modalities of CML evaluate the rates...... of the exponentially distributed random variables that characterize the duration of the labeled transitions of a CMP. In this paper we present weak and strong complete axiomatizations for CML and prove a series of metaproperties, including the finite model property and the construction of canonical models. CML...... characterizes stochastic bisimilarity and it supports the definition of a quantified extension of the satisfiability relation that measures the "compatibility" between a model and a property. In this context, the metaproperties allows us to prove two robustness theorems for the logic stating that one can...

  13. Continuing bonds and place.

    Science.gov (United States)

    Jonsson, Annika; Walter, Tony

    2017-08-01

    Where do people feel closest to those they have lost? This article explores how continuing bonds with a deceased person can be rooted in a particular place or places. Some conceptual resources are sketched, namely continuing bonds, place attachment, ancestral places, home, reminder theory, and loss of place. The authors use these concepts to analyze interview material with seven Swedes and five Britons who often thought warmly of the deceased as residing in a particular place and often performing characteristic actions. The destruction of such a place, by contrast, could create a troubling, haunting absence, complicating the deceased's absent-presence.

  14. Introduction to Continuous Optimization

    DEFF Research Database (Denmark)

    Andreasson, Niclas; Evgrafov, Anton; Patriksson, Michael

    optimal solutions for continuous optimization models. The main part of the mathematical material therefore concerns the analysis and linear algebra that underlie the workings of convexity and duality, and necessary/sufficient local/global optimality conditions for continuous optimization problems. Natural...... algorithms are then developed from these optimality conditions, and their most important convergence characteristics are analyzed. The book answers many more questions of the form “Why?” and “Why not?” than “How?”. We use only elementary mathematics in the development of the book, yet are rigorous throughout...

  15. Continuous Platform Development

    DEFF Research Database (Denmark)

    Nielsen, Ole Fiil

    low risks and investments but also with relatively fuzzy results. When looking for new platform projects, it is important to make sure that the company and market is ready for the introduction of platforms, and to make sure that people from marketing and sales, product development, and downstream......, but continuous product family evolution challenges this strategy. The concept of continuous platform development is based on the fact that platform development should not be a one-time experience but rather an ongoing process of developing new platforms and updating existing ones, so that product family...

  16. Expenditure survey on continued veno-venous hemodialysis procedure in the intensive care unit Levantamiento del costo del procedimiento de hemodiálisis vena-venosa continua en unidades de terapia intensiva Levantamento do custo do procedimento de hemodiálise veno-venosa contínua em unidades de terapia intensiva

    Directory of Open Access Journals (Sweden)

    Lígia Maria dal Secco

    2007-12-01

    Full Text Available This study aimed to characterize patients submitted to dialytic treatment with CVVHD in ICUs; monitor procedure time duration; estimate nurses' labor wages and; estimate the direct procedures mean costs. The study was developed in a public teaching hospital located in São Paulo, Brazil. A total of 93 procedures performed in 50 patients composed the sample. The results showed the predominance of male patients (62%; mean age was 60.8 years old; ICU hospitalization time was 19.2 days; 86% of the patients died; 76% of the patients presented acute renal insufficiency and, mean procedure time per patient was 1.9. The mean procedure duration was 26.6 hours. The mean cost of nurses' wages were R$ 592.04 which represented 28.7% of the total cost. The mean total expenditure was R$ 2,065.36 ranging from R$ 733.65 to R$ 6,994.18.El objetivo de este estudio fue identificar características sócio-demográficas de los pacientes sometidos al tratamiento de Hemodiálisis Vena-Venosa Continua (CVVHD en Unidades de Terapia Intensiva (UTIs; identificar el tiempo de duración de los procedimientos; calcular el costo del tiempo de los enfermeros y evaluar el costo promedio directo de los procedimentos. El estudio fue realizado en un hospital escuela público en la ciudad de São Paulo. La muestra fue constituida por 93 procedimientos realizados en 50 pacientes. Los resultados mostraron la predominancia del sexo masculino (62%; la edad promedia fue de 60,8 años; el tiempo promedio de permanencia en la UTI fue de 19,2 días; el 86% evolucionó a óbito y el promedio del número de los procedimientos por paciente fue de 1,9 días. La insuficiencia renal aguda (IRA está presente en el 76% de los pacientes. La duración promedia fue de 26,6 horas. El costo del tiempo del enfermero fue en promedio R$ 592,04 y representó el 28,7% del costo total. El costo total promedio del procedimiento fue de R$ 2.065,36, con variación de R$ 733,65 a R$ 6.994,18.Os objetivos deste estudo foram: caracterizar a clientela submetida ao tratamento dialítico de Hemodiálise Veno-Venosa Contínua (CVVHD em Unidades de Terapia Intensiva (UTIs, levantar o tempo de duração dos procedimentos, calcular o custo da mão-de-obra dos enfermeiros, estimar o custo médio direto dos procedimentos. O estudo foi desenvolvido em um hospital escola público no município de São Paulo. A amostra foi constituída por 93 procedimentos realizados em 50 pacientes. Os resultados mostraram predominância do sexo masculino (62%, a idade média foi de 60,8 anos, o tempo médio de permanência na UTI foi de 19,2 dias, 86% evoluíram a óbito e a média do número de procedimentos por paciente foi de 1,9. A insuficiência renal aguda (IRA estava presente em 76% dos pacientes. A duração média do procedimento foi de 26,6 horas. O custo da mão-de-obra direta do enfermeiro foi em média R$ 592,04, representando 28,7% do custo total. O custo total médio do procedimento foi de R$ 2.065,36, variando de R$ 733,65 a R$ 6.994,18.

  17. The acid-base effects of continuous hemofiltration with lactate or bicarbonate buffered replacement fluids.

    Science.gov (United States)

    Tan, H K; Uchino, S; Bellomo, R

    2003-06-01

    To evaluate, quantify and compare the effects of continuous veno-venous hemofiltration (CVVH) with lactate or bicarbonate-buffered replacement fluids on acid-base balance. Randomized double crossover study. Intensive Care Unit of Tertiary Medical Center. Eight patients with severe acute renal failure. Random allocation to either 2 hours of isovolemic lactate-buffered (treatment A) CVVH or 2 hours of bicarbonate-buffered (treatment B) CVVH with cross over and with same procedure repeated the following day (double cross over). Timed collections of arterial blood and ultrafiltrate (UF), measurement of blood and UF gases and lactate concentrations and calculation of buffer-base mass balance. At baseline, both groups of patients had a similar, slight metabolic alkalosis (pH: 7.45 vs. 7.45; BE 3.9 mEq/L for treatment A and 4.0 for treatment B) and a serum bicarbonate of 28.1 mmol/L for treatment A vs. 28.3 mmol/L for treatment B; all NS. This alkalosis was present despite slight hyperlactatemia in both groups (A: 2.4 mmol/L vs. B 2.8 mmol/; NS). Within 60 minutes of treatment, however, treatment A led to a significantly higher lactate concentration (3.9 vs 2.5 mmol/L; p = 0.0011), a significantly lower BE (2.3 vs 4.1 mEq/L; p = 0.0019) and a significantly lower bicarbonate concentration (26.7 vs. 28.3 mmol/L; p = 0.0038) in the presence of an unchanged PaCO2. These differences persisted during the study period. The UF of patients receiving treatment A contained more lactate (10.2 vs 2.9 mmol/L; p buffer-base balance of +20.4 mEq/h compared to -2.6 mEq/h for treatment B; p buffered replacement fluids induces iatrogenic hyperlactatemia. Such hyperlactatemia is associated with an acidifying effect despite a positive buffer-base balance.

  18. Studies on continuous fermentation

    Energy Technology Data Exchange (ETDEWEB)

    Ueda, K

    1958-01-01

    Continuous fermentation of molasses with a combined system of agitated vessel and flow pipe is studied. A new apparatus was designed. The rate of the fermentation was faster with this apparatus than with the former apparatus which was composed of two vessels.

  19. Continuous Reinforced Concrete Beams

    DEFF Research Database (Denmark)

    Hoang, Cao Linh; Nielsen, Mogens Peter

    1996-01-01

    This report deals with stress and stiffness estimates of continuous reinforced concrete beams with different stiffnesses for negative and positive moments e.g. corresponding to different reinforcement areas in top and bottom. Such conditions are often met in practice.The moment distribution...

  20. Continuous Adductor Canal Blocks

    DEFF Research Database (Denmark)

    Monahan, Amanda M; Sztain, Jacklynn F; Khatibi, Bahareh

    2016-01-01

    on cutaneous knee sensation in volunteers. METHODS: Bilateral adductor canal catheters were inserted in 24 volunteers followed by ropivacaine 0.2% administration for 8 hours. One limb of each subject was assigned randomly to a continuous infusion (8 mL/h) or automated hourly boluses (8 m...

  1. Continuous Personal Improvement.

    Science.gov (United States)

    Emiliani, M. L.

    1998-01-01

    Suggests that continuous improvement tools used in the workplace can be applied to self-improvement. Explains the use of such techniques as one-piece flow, kanban, visual controls, and total productive maintenance. Points out misapplications of these tools and describes the use of fishbone diagrams to diagnose problems. (SK)

  2. Continuity and Change.

    Science.gov (United States)

    Istance, David

    1985-01-01

    Examines issues related to continuity in education and educational change. Indicates that although schools must be responsive to changing social and economic conditions (and contribute to them), they must also be protected against fluctuating swings of educational fashion and safeguard their long-term mission, even when buffeted by short-term…

  3. Promoting Continuing Education Programs.

    Science.gov (United States)

    Hendrickson, Gayle A.

    This handbook is intended for use by institutions in marketing their continuing education programs. A section on "Devising Your Strategy" looks at identifying a target audience, determining the marketing approach, and developing a marketing plan and promotional techniques. A discussion of media options looks at the advantages and…

  4. Continuous quality improvement

    NARCIS (Netherlands)

    Rohlin, Madeleine; Schaub, Rob M.H.; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

    2002-01-01

    Versch. in: Eur J Dent Educ; 6 (Suppl. 3): 67–77 Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of

  5. Continuous digital health

    NARCIS (Netherlands)

    Van Halteren, Aart; Gay, Vaĺerie

    2015-01-01

    A transformation is underway regarding how we deal with our health, not only because mobile Internet technology has made it possible to have continuous access to personal health information, but also because breaking the trend of ever-growing healthcare costs is increasingly necessary. Connectivity,

  6. Continuous quality improvement

    International Nuclear Information System (INIS)

    Bourne, P.B.

    1985-01-01

    This paper describes the various statistical tools used at the Hanford Engineering Development Laboratory to achieve continuous quality improvement in the development of Breeder Reactor Technology and in reactor operations. The role of the quality assurance professionals in this process, including quantifiable measurements using actual examples, is provided. The commitment to quality improvement through top management involvement is dramatically illustrated

  7. Continuous feedback fluid queues

    NARCIS (Netherlands)

    Scheinhardt, Willem R.W.; van Foreest, N.D.; Mandjes, M.R.H.

    2003-01-01

    We investigate a fluid buffer which is modulated by a stochastic background process, while the momentary behavior of the background process depends on the current buffer level in a continuous way. Loosely speaking the feedback is such that the background process behaves `as a Markov process' with

  8. Continuing Medical Education

    African Journals Online (AJOL)

    A review article willintroduce readers to the educational subject matter, along with one-page summarises (in print) of additional articles that may be accessed in full online. We will continue to offer topical and up-to-date CME material. Readers are encouraged to register with samj.org.za to receive future notifications of new ...

  9. Continuous Fiber Ceramic Composites

    Energy Technology Data Exchange (ETDEWEB)

    Fareed, Ali [Honeywell Advanced Composites Inc. (HACI), Newark, DE (United States); Craig, Phillip A. [Honeywell Advanced Composites Inc. (HACI), Newark, DE (United States)

    2002-09-01

    Fiber-reinforced ceramic composites demonstrate the high-temperature stability of ceramics--with an increased fracture toughness resulting from the fiber reinforcement of the composite. The material optimization performed under the continuous fiber ceramic composites (CFCC) included a series of systematic optimizations. The overall goals were to define the processing window, to increase the robustinous of the process, to increase process yield while reducing costs, and to define the complexity of parts that could be fabricated.

  10. Deconstructing continuous flash suppression

    OpenAIRE

    Yang, Eunice; Blake, Randolph

    2012-01-01

    In this paper, we asked to what extent the depth of interocular suppression engendered by continuous flash suppression (CFS) varies depending on spatiotemporal properties of the suppressed stimulus and CFS suppressor. An answer to this question could have implications for interpreting the results in which CFS influences the processing of different categories of stimuli to different extents. In a series of experiments, we measured the selectivity and depth of suppression (i.e., elevation in co...

  11. Safety Campaign Continues

    CERN Multimedia

    2002-01-01

    If you see this poster, stop and read it! This is the third poster produced by TIS Division as part of its information campaign on health and safety in the workplace. It provides statistics on occupational accidents at CERN. You will see that, as in the rest of Europe, falls, slips and trips continue to be the main cause of accident. So, eyes open and take care! For more information : http://safety.cern.ch/

  12. Robust continuous clustering.

    Science.gov (United States)

    Shah, Sohil Atul; Koltun, Vladlen

    2017-09-12

    Clustering is a fundamental procedure in the analysis of scientific data. It is used ubiquitously across the sciences. Despite decades of research, existing clustering algorithms have limited effectiveness in high dimensions and often require tuning parameters for different domains and datasets. We present a clustering algorithm that achieves high accuracy across multiple domains and scales efficiently to high dimensions and large datasets. The presented algorithm optimizes a smooth continuous objective, which is based on robust statistics and allows heavily mixed clusters to be untangled. The continuous nature of the objective also allows clustering to be integrated as a module in end-to-end feature learning pipelines. We demonstrate this by extending the algorithm to perform joint clustering and dimensionality reduction by efficiently optimizing a continuous global objective. The presented approach is evaluated on large datasets of faces, hand-written digits, objects, newswire articles, sensor readings from the Space Shuttle, and protein expression levels. Our method achieves high accuracy across all datasets, outperforming the best prior algorithm by a factor of 3 in average rank.

  13. Continuous multivariate exponential extension

    International Nuclear Information System (INIS)

    Block, H.W.

    1975-01-01

    The Freund-Weinman multivariate exponential extension is generalized to the case of nonidentically distributed marginal distributions. A fatal shock model is given for the resulting distribution. Results in the bivariate case and the concept of constant multivariate hazard rate lead to a continuous distribution related to the multivariate exponential distribution (MVE) of Marshall and Olkin. This distribution is shown to be a special case of the extended Freund-Weinman distribution. A generalization of the bivariate model of Proschan and Sullo leads to a distribution which contains both the extended Freund-Weinman distribution and the MVE

  14. Continuity and consensus

    DEFF Research Database (Denmark)

    Abrahamson, Peter

    2010-01-01

    maternal leave. These changes can be explained as adjustments to post-industrial conditions within a political culture relying on class compromises and a broad consensus informed by expert advice coming from civil servants and ad hoc policy commissions. The paper concludes that changes in Danish family...... policy reflect changing conditions for employment and the minding of children and that there has been a high degree of continuity and consensus about the change, as indicated by the strong increase in female labour market involvement....

  15. Continuous Integration in CFMGR

    CERN Document Server

    Frohlingsdorf, David

    2017-01-01

    Cfmgr is a managing tool for network devices. At the moment there is no way to automatically check the working behaviour of the tool, meaning that a lot of effort is spend into manually testing the tool after an update. During my stay at CERN I developed a black-box testing framework for Cfmgr according to Continuous Integration practices and successfully deployed the framework using Jenkins and Docker. This report discusses in detail how the framework works and how it can be configured, and equally gives a broad problem description and outlines future work directions.

  16. Continuous-infusion adriamycin

    International Nuclear Information System (INIS)

    Benjamin, R.S.; Chawla, S.P.; Ewer, M.S.; Hortobagyi, G.N.

    1986-01-01

    This chapter discusses the diminished cardiotoxicity as well as diminished nausea and vomiting with continuous infusions of adriamycin to patients undergoing radiation therapy, particularly with infusions of 48 hours or longer, and best with 96-hour infusions, the longest duration that has been studied systematically. In breast cancer, data show that more adriamycin is better, but only for a selected subgroup of patients: those with complete remission. The diminished cardiotoxicity makes the use of adriamycin more attractive in the adjuvant situation, where increased safety will decrease the chances of long-term complications and make retreatment easy for cured patients who develop second malignancies

  17. Continuous Shearlet Tight Frames

    KAUST Repository

    Grohs, Philipp

    2010-10-22

    Based on the shearlet transform we present a general construction of continuous tight frames for L2(ℝ2) from any sufficiently smooth function with anisotropic moments. This includes for example compactly supported systems, piecewise polynomial systems, or both. From our earlier results in Grohs (Technical report, KAUST, 2009) it follows that these systems enjoy the same desirable approximation properties for directional data as the previous bandlimited and very specific constructions due to Kutyniok and Labate (Trans. Am. Math. Soc. 361:2719-2754, 2009). We also show that the representation formulas we derive are in a sense optimal for the shearlet transform. © 2010 Springer Science+Business Media, LLC.

  18. Landsat Data Continuity Mission

    Science.gov (United States)

    ,

    2012-01-01

    The Landsat Data Continuity Mission (LDCM) is a partnership formed between the National Aeronautics and Space Administration (NASA) and the U.S. Geological Survey (USGS) to place the next Landsat satellite in orbit in January 2013. The Landsat era that began in 1972 will become a nearly 41-year global land record with the successful launch and operation of the LDCM. The LDCM will continue the acquisition, archiving, and distribution of multispectral imagery affording global, synoptic, and repetitive coverage of the Earth's land surfaces at a scale where natural and human-induced changes can be detected, differentiated, characterized, and monitored over time. The mission objectives of the LDCM are to (1) collect and archive medium resolution (30-meter spatial resolution) multispectral image data affording seasonal coverage of the global landmasses for a period of no less than 5 years; (2) ensure that LDCM data are sufficiently consistent with data from the earlier Landsat missions in terms of acquisition geometry, calibration, coverage characteristics, spectral characteristics, output product quality, and data availability to permit studies of landcover and land-use change over time; and (3) distribute LDCM data products to the general public on a nondiscriminatory basis at no cost to the user.

  19. Integrated, Continuous Emulsion Creamer.

    Science.gov (United States)

    Cochrane, Wesley G; Hackler, Amber L; Cavett, Valerie J; Price, Alexander K; Paegel, Brian M

    2017-12-19

    Automated and reproducible sample handling is a key requirement for high-throughput compound screening and currently demands heavy reliance on expensive robotics in screening centers. Integrated droplet microfluidic screening processors are poised to replace robotic automation by miniaturizing biochemical reactions to the droplet scale. These processors must generate, incubate, and sort droplets for continuous droplet screening, passively handling millions of droplets with complete uniformity, especially during the key step of sample incubation. Here, we disclose an integrated microfluidic emulsion creamer that packs ("creams") assay droplets by draining away excess oil through microfabricated drain channels. The drained oil coflows with creamed emulsion and then reintroduces the oil to disperse the droplets at the circuit terminus for analysis. Creamed emulsion assay incubation time dispersion was 1.7%, 3-fold less than other reported incubators. The integrated, continuous emulsion creamer (ICEcreamer) was used to miniaturize and optimize measurements of various enzymatic activities (phosphodiesterase, kinase, bacterial translation) under multiple- and single-turnover conditions. Combining the ICEcreamer with current integrated microfluidic DNA-encoded library bead processors eliminates potentially cumbersome instrumentation engineering challenges and is compatible with assays of diverse target class activities commonly investigated in drug discovery.

  20. Continuously adjustable Pulfrich spectacles

    Science.gov (United States)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  1. Continuous alcoholic fermentation

    Energy Technology Data Exchange (ETDEWEB)

    Smidrkal, M; Nejedly, A

    1956-01-01

    Results are given of investigations on the continuous production of ethanol on a laboratory and on a semi-commercial scale. The suggested devices are particularly described. Under constant conditions the production cycle required 12 to 17 days, the acidity being 4.0 to 415 ml. 0.1 N NaOH/100 ml and the concentration of fermented wort 10.5 to 11%. The maximum production from 1 h of fermentation space during 24 h was 8.67 l of absolute alcohol when the efflux was divided into several basins; when the efflux of sweet wort was collected into one basin only, the maximum production was 7.20 l of absolute alcohol. The amount of alcohol produced was 62.20 l/100 kg sugar.

  2. Spaces of continuous functions

    CERN Document Server

    Groenewegen, G L M

    2016-01-01

    The space C(X) of all continuous functions on a compact space X carries the structure of a normed vector space, an algebra and a lattice. On the one hand we study the relations between these structures and the topology of X, on the other hand we discuss a number of classical results according to which an algebra or a vector lattice can be represented as a C(X). Various applications of these theorems are given. Some attention is devoted to related theorems, e.g. the Stone Theorem for Boolean algebras and the Riesz Representation Theorem. The book is functional analytic in character. It does not presuppose much knowledge of functional analysis; it contains introductions into subjects such as the weak topology, vector lattices and (some) integration theory.

  3. [Detection of risks for the safety of the patients in the implementation of continuous techniques of extracorporeal depuration (CTED)].

    Science.gov (United States)

    Molano Álvarez, E; Guirao Moya, A; Esteban Sánchez, M E; Sanz Cruz, P; García Delgado, E; Sánchez-Izquierdo Riera, J Á

    2011-01-01

    Continuous techniques of extracorporeal depuration (CTED) manage high volumes of fluid exchange and extensive control of its safety is required. To detect the risks of CTED and to determine its frequency per patient. An observational, retrospective study was performed. Inclusion criteria were patients admitted from January 2009 to December 2009, with CTED in the Polyvalent Intensive Care Unit (ICU) of the Hospital 12 de Octubre. We previously identified 10 risks that were detectable in the clinical records. We analyzed demographic and treatment variables. The quantitative variables were expressed as mean±SD and the qualitative ones as absolute and relative frequencies. SPSS 15.0(®). A total of 54 patients (11.7%), with ages 59.78±14.8, 42 men (77.8%) were included. In 81.4%, the indication was acute kidney failure; 80.3% were treated with hemodiafiltration. Mean hours of CTED were 112.9±139.9 and the medium of 2 filters per patient (recommended intakes 0-31). Risk/patient rate was: 100% of patients without monitoring of the Mg and P, and 3.7% (n=2) urea; in 16 (29.6%), there was coagulation of the circuit prior to 24 hours and in 25 (46.3%) the blood could not be returned; in 14 (29.3%), written regime was always lacking on the order for treatment. The dose was not reflected on the patient's chart in 2 (3.7%); in 3 patients (5.6%) with coagulation disorder, anticoagulants were prescribed in the circuit. In 1 (1.9%) bleeding was observed and in 10 (18.5%) there was mild hypothermia (35-32°C). A standardized monitoring of the Mg and P is required. The therapy should be prescribed in the medical treatment. The technique needs to be improved in order to prolong its duration and avoid blood losses. Copyright © 2010 Elsevier España, S.L. y SEEIUC. All rights reserved.

  4. Continuous spinal anesthesia.

    Science.gov (United States)

    Moore, James M

    2009-01-01

    Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a

  5. Continuous composite riser

    Energy Technology Data Exchange (ETDEWEB)

    Slagsvold, L. [ABB Offshore Systems (Norway)

    2002-12-01

    The industry is now looking at developing reserves in waters depths of up to 3000 m (10000 ft). When moving into deeper waters the un-bonded flexible riser becomes very heavy and introduces large hang-off forces on the vessel. We are therefore investigating riser concepts incorporating new materials and with a simpler cross section that can be used for floating production. Advanced composite materials have properties such as, low weight, high strength, good durability and very good fatigue performance. Composite materials are slowly being exploited in the oil industry; they are being prototype tested for drilling risers and small diameter lines. Part of the process for the industry to accept larger diameter production risers made out of composite materials is to understand both the advantages and limitations. A new continuous composite riser system is being developed which capitalizes on the technical benefits of this material while addressing the known constraints. The fully bonded riser is being developed for ultra deep waters and its' characteristics include high temperature (160 deg C), high pressure (500 barg min), light weight, chemical resistant, good insulation, excellent fatigue characteristics and installation by reeling. The concept is based on the use of a thermoplastic liner together with a thermoplastic carbon fibre composite. This paper summarises the ongoing development, which has a goal to manufacture and qualify an 8'' riser, and includes all the steps in a production process from material qualification to the winding process and analytical modelling. (author)

  6. Continuous cell recycle fermentation

    Energy Technology Data Exchange (ETDEWEB)

    Warren, R K; Hill, G A; MacDonald, D G

    1991-10-01

    A cell recycle fermentor using a cross-flow membrane filter has been operated for extended periods. Productivities as high as 70 g/l/h were obtained at a cell concentration of 120 g/l and a product concentration of 70 g/l. The experimental results were then fitted to previously derived biokinetic models (Warren et al., 1990) for a continuous stirred tank fermentor. A good fit for growth rate was found and the cell yield was shown to decrease with product concentration. The product yield, however, was found to remain nearly constant at all cell, substrate and product concentrations. These biokinetics, along with a previous model for the membrane filter (Warren et al., 1991) were then used in a simulalation to estimate the costs of producing ethanol in a large scale system. This simulation was optimized using a variant of the steepest descent method from which a fermentor inlet substrate concentration of 150 g/l and a net cost of $CAN 253.5/1000 L ethanol were projected. From a sensitivity analysis, the yield parameters were found to have the greatest effect on ethanol net cost of the fermentor parameters, while the operating costs and the profit was found to be most sensitive to the wheat raw material cost and to the dried grains by-product value. 55 refs., 11 tabs., 7figs.

  7. Deconstructing continuous flash suppression.

    Science.gov (United States)

    Yang, Eunice; Blake, Randolph

    2012-03-08

    In this paper, we asked to what extent the depth of interocular suppression engendered by continuous flash suppression (CFS) varies depending on spatiotemporal properties of the suppressed stimulus and CFS suppressor. An answer to this question could have implications for interpreting the results in which CFS influences the processing of different categories of stimuli to different extents. In a series of experiments, we measured the selectivity and depth of suppression (i.e., elevation in contrast detection thresholds) as a function of the visual features of the stimulus being suppressed and the stimulus evoking suppression, namely, the popular "Mondrian" CFS stimulus (N. Tsuchiya & C. Koch, 2005). First, we found that CFS differentially suppresses the spatial components of the suppressed stimulus: Observers' sensitivity for stimuli of relatively low spatial frequency or cardinally oriented features was more strongly impaired in comparison to high spatial frequency or obliquely oriented stimuli. Second, we discovered that this feature-selective bias primarily arises from the spatiotemporal structure of the CFS stimulus, particularly within information residing in the low spatial frequency range and within the smooth rather than abrupt luminance changes over time. These results imply that this CFS stimulus operates by selectively attenuating certain classes of low-level signals while leaving others to be potentially encoded during suppression. These findings underscore the importance of considering the contribution of low-level features in stimulus-driven effects that are reported under CFS.

  8. Optimisation of dialysate flow in on-line hemodiafiltration

    Directory of Open Access Journals (Sweden)

    Francisco Maduell

    2015-09-01

    Conclusion: Qd variations in OL-HDF do not change convective volume. A higher Qd was associated to a slightly increased urea clearance with no change being observed for medium and large molecules. Qd optimisation to the minimal level assuring an adequate dialysis dose and allowing water and dialysate use to be rationalised should be recommended.

  9. Serum sclerostin: relation with mortality and impact of hemodiafiltration.

    Science.gov (United States)

    Lips, Lotte; de Roij van Zuijdewijn, Camiel L M; Ter Wee, Piet M; Bots, Michiel L; Blankestijn, Peter J; van den Dorpel, Marinus A; Fouque, Denis; de Jongh, Renate; Pelletier, Solenne; Vervloet, Marc G; Nubé, Menso J; Grooteman, Muriel P C

    2017-07-01

    The glycoprotein sclerostin (Scl; 22 kDa), which is involved in bone metabolism, may play a role in vascular calcification in haemodialysis (HD) patients. In the present study, we investigated the relation between serum Scl (sScl) and mortality. The effects of dialysis modality and the magnitude of the convection volume in haemodiafiltration (HDF) on sScl were also investigated. In a subset of patients from the CONTRAST study, a randomized controlled trial comparing HDF with HD, sScl was measured at baseline and at intervals of 6, 12, 24 and 36 months. Patients were divided into quartiles, according to their baseline sScl. The relation between time-varying sScl and mortality with a 4-year follow-up period was investigated using crude and adjusted Cox regression models. Linear mixed models were used for longitudinal measurements of sScl. The mean (±standard deviation) age of 396 test subjects was 63.6 (±13.9 years), 61.6% were male and the median follow-up was 2.9 years. Subjects with the highest sScl had a lower mortality risk than those with the lowest concentrations [adjusted hazard ratio 0.51 (95% confidence interval, CI, 0.31-0.86, P = 0.01)]. Stratified models showed a stable sScl in patients treated with HD (Δ +2.9 pmol/L/year, 95% CI -0.5 to +6.3, P = 0.09) and a decreasing concentration in those treated with HDF (Δ -4.5 pmol/L/year, 95% CI -8.0 to -0.9, P = 0.02). The relative change in the latter group was related to the magnitude of the convection volume. (i) A high sScl is associated with a lower mortality risk in patients with end-stage kidney disease; (ii) treatment with HDF causes sScl to fall; and (iii) the relative decline in patients treated with HDF is dependent on the magnitude of the convection volume. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  10. Redefining continuing education delivery.

    Science.gov (United States)

    Carlton, K H

    1997-01-01

    individual health-care worker consumer. A number of national and world-wide trends are propelling rapid changes in the delivery modalities and types of emerging providers for health-care CE. Examples of these advanced telecommunications applications of CE opportunities for health-care personnel are becoming more prevalent in the literature and the pattern of CE marketing, and delivery evolution can be seen readily on the Internet. Continued program success and viability will belong to the individuals and organizations who are able to conceptualize and envision the positive transformations and opportunities that can occur from the evolving paradigm of education for the lifelong learner of the 21st century.

  11. [Generation continuity and integration].

    Science.gov (United States)

    Zakhvatkin, Iu A

    2008-01-01

    Transformation of the cyclic morphoprocesses in Protista toward the terminal-cyclic morphoprocesses in Metazoa had lead to integration of the fomer's life circles into the latter's ontogenesis and began to supply the newly emerging ecosystems with the regular income of mortomasses. According to the palintomic hypothesis of A.A. Zakhvatkin, it was the egg that became a means of the metazoan generation continuity, and not the half set of organells acquired by descendants of a divided maternal cell in Protozoa. Origin of Metazoa and of their ontogenesis was accomplished by hypetrophic distomy and subsequent palintomic division of the protist parental cell, these processes being comparable to the ovogenesis and ovocyte division in the Metazoa. Division process in the most primitive metazoans, Leptolida and Calcarea, retained certains features of its palintomic nature that are clear in the Ctenophora, the latter though specific being most similar in this respect to the spongs and not to the Coelenterata whith whom they were united in the same phylum formerly. The ovogenesis perfection controlled by the maternal organism and leading to an increment of the nuclear-plasmic tension due to enrichment of egg with the yolk, promoted the embrionization of development and formation of the egg morphogenetic environment providing for the earlier formation processes without participation of the parental recombined genotypes. With all this, far earlier appearence of symmetry elements of definitive forms is embriogenesis along the ascending trend from the lower Metazoa to the most advanced insects. The unordered correspondence of the polarity axis of egg and the oral-aboral axis of blastula-like larva (1) is replaced by protaxony (2) in which these axes coincide, all formation processes reaching their perfection in the homoquadrant spiral division of annelids, which became a means of ovoplasma segregation. Afterward, a herequadrant division and plagioxony are developed in the course

  12. Continuous Positive Airway Pressure (CPAP)

    Science.gov (United States)

    ... ENT Doctor Near You Continuous Positive Airway Pressure (CPAP) Continuous Positive Airway Pressure (CPAP) Patient Health Information ... relations staff at newsroom@entnet.org . What Is CPAP? The most common and effective nonsurgical treatment for ...

  13. A Dynamic Continuation-Passing Style for Dynamic Delimited Continuations

    DEFF Research Database (Denmark)

    Biernacki, Dariusz; Danvy, Olivier; Millikin, Kevin Scott

    2005-01-01

    We present a new abstract machine that accounts for dynamic delimited continuations. We prove the correctness of this new abstract machine with respect to a pre-existing, definitional abstract machine. Unlike this definitional abstract machine, the new abstract machine is in defunctionalized form......, which makes it possible to state the corresponding higher-order evaluator. This evaluator is in continuation+state passing style and threads a trail of delimited continuations and a meta-continuation. Since this style accounts for dynamic delimited continuations, we refer to it as `dynamic continuation......-passing style.' We show that the new machine operates more efficiently than the definitional one and that the notion of computation induced by the corresponding evaluator takes the form of a monad. We also present new examples and a new simulation of dynamic delimited continuations in terms of static ones....

  14. Exoplanets: The Hunt Continues!

    Science.gov (United States)

    2001-04-01

    Swiss Telescope at La Silla Very Successful Summary The intensive and exciting hunt for planets around other stars ( "exoplanets" ) is continuing with great success in both hemispheres. Today, an international team of astronomers from the Geneva Observatory and other research institutes [1] is announcing the discovery of no less than eleven new, planetary companions to solar-type stars, HD 8574, HD 28185, HD 50554, HD 74156, HD 80606, HD 82943, HD 106252, HD 141937, HD 178911B, HD 141937, among which two new multi-planet systems . The masses of these new objects range from slightly less than to about 10 times the mass of the planet Jupiter [2]. The new detections are based on measured velocity changes of the stars [3], performed with the CORALIE spectrometer on the Swiss 1.2-m Leonard Euler telescope at the ESO La Silla Observatory , as well as with instruments on telescopes at the Haute-Provence Observatory and on the Keck telescopes on Mauna Kea (Hawaii, USA). Some of the new planets are unusual: * a two-planet system (around the star HD 82943) in which one orbital period is nearly exactly twice as long as the other - cases like this (refered to as "orbital resonance") are well known in our own solar system; * another two-planet system (HD 74156), with a Jupiter-like planet and a more massive planet further out; * a planet with the most elongated orbit detected so far (HD 80606), moving between 5 and 127 million kilometers from the central star; * a giant planet moving in an orbit around its Sun-like central star that is very similar to the one of the Earth and whose potential satellites (in theory, at least) might be "habitable". At this moment, there are 63 know exoplanet candidates with minimum masses below 10 Jupiter masses, and 67 known objects with minimum masses below 17 Jupiter masses. The present team of astronomers has detected about half of these. PR Photo 13a/01 : Radial-velocity measurements of HD 82943, a two-planet system . PR Photo 13b/01 : Radial

  15. The random continued fraction transformation

    Science.gov (United States)

    Kalle, Charlene; Kempton, Tom; Verbitskiy, Evgeny

    2017-03-01

    We introduce a random dynamical system related to continued fraction expansions. It uses random combinations of the Gauss map and the Rényi (or backwards) continued fraction map. We explore the continued fraction expansions that this system produces, as well as the dynamical properties of the system.

  16. Continuous downstream processing of biopharmaceuticals.

    Science.gov (United States)

    Jungbauer, Alois

    2013-08-01

    Continuous manufacturing has been applied in many different industries but has been pursued reluctantly in biotechnology where the batchwise process is still the standard. A shift to continuous operation can improve productivity of a process and substantially reduce the footprint. Continuous operation also allows robust purification of labile biomolecules. A full set of unit operations is available to design continuous downstream processing of biopharmaceuticals. Chromatography, the central unit operation, is most advanced in respect to continuous operation. Here, the problem of 'batch' definition has been solved. This has also paved the way for implementation of continuous downstream processing from a regulatory viewpoint. Economic pressure, flexibility, and parametric release considerations will be the driving force to implement continuous manufacturing strategies in future. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Continuous Non-malleable Codes

    DEFF Research Database (Denmark)

    Faust, Sebastian; Mukherjee, Pratyay; Nielsen, Jesper Buus

    2014-01-01

    or modify it to the encoding of a completely unrelated value. This paper introduces an extension of the standard non-malleability security notion - so-called continuous non-malleability - where we allow the adversary to tamper continuously with an encoding. This is in contrast to the standard notion of non...... is necessary to achieve continuous non-malleability in the split-state model. Moreover, we illustrate that none of the existing constructions satisfies our uniqueness property and hence is not secure in the continuous setting. We construct a split-state code satisfying continuous non-malleability. Our scheme...... is based on the inner product function, collision-resistant hashing and non-interactive zero-knowledge proofs of knowledge and requires an untamperable common reference string. We apply continuous non-malleable codes to protect arbitrary cryptographic primitives against tampering attacks. Previous...

  18. Sibling bereavement and continuing bonds.

    Science.gov (United States)

    Packman, Wendy; Horsley, Heidi; Davies, Betty; Kramer, Robin

    2006-11-01

    Historically, from a Freudian and medical model perspective, emotional disengagement from the deceased was seen as essential to the successful adaptation of bereavement. A major shift in the bereavement literature has occurred and it is now generally accepted that despite the permanence of physical separation, the bereaved remains involved and connected to the deceased and can be emotionally sustained through continuing bonds. The majority of literature has focused on adults and on the nature of continuing bonds following the death of a spouse. In this article, the authors demonstrate how the continuing bonds concept applies to the sibling relationship. We describe the unique continued relationship formed by bereaved children and adolescents following a sibling loss, highlight the factors that influence the siblings continuing bonds expressions, and offer clinical interventions. In our view, mental health professionals can play an important role in helping parents encourage activities that may facilitate the creation and maintenance of continuing bonds in their children.

  19. The Continued Assessment of Self-Continuity and Identity

    Science.gov (United States)

    Dunkel, Curtis S.; Minor, Leslie; Babineau, Maureen

    2010-01-01

    Studies have found that self-continuity is predictive of a substantial number of important outcome variables. However, a recent series of studies brings into question the traditional method of measuring self-continuity in favor of an alternative (B. M. Baird, K. Le, & R. E. Lucas, 2006). The present study represents a further comparison of…

  20. Beyond Continuous Delivery: An Empirical Investigation of Continuous Deployment Challenges

    DEFF Research Database (Denmark)

    Shahin, Mojtaba; Ali Babar, Muhammad; Zahedi, Mansooreh

    2017-01-01

    Context: A growing number of software organizations have been adopting Continuous DElivery (CDE) and Continuous Deployment (CD) practices. Researchers have started investing significant efforts in studying different aspects of CDE and CD. Many studies refer to CDE (i.e., where an application is p...

  1. Continuous exponential martingales and BMO

    CERN Document Server

    Kazamaki, Norihiko

    1994-01-01

    In three chapters on Exponential Martingales, BMO-martingales, and Exponential of BMO, this book explains in detail the beautiful properties of continuous exponential martingales that play an essential role in various questions concerning the absolute continuity of probability laws of stochastic processes. The second and principal aim is to provide a full report on the exciting results on BMO in the theory of exponential martingales. The reader is assumed to be familiar with the general theory of continuous martingales.

  2. Continuous acoustic emission from aluminium

    International Nuclear Information System (INIS)

    Fenici, P.; Kiesewetter, N.; Schiller, P.

    1976-01-01

    Continuous acoustic emission of aluminum single crystals and polycrystals during tensile tests at constant cross-head speed and at room temperature is measured with a Root Mean Square Level recorder. By means of the Kaiser effect it is shown that the continuous emission is related to the plastic deformation. The plot of continuous emission against strain takes different shapes for pure single crystals, pure polycrystals and impure polycrystals. The measured voltages have about the same value for pure single and polycrystals and are considerably greater than that for impure polycrystals. A method is developed to distinguish between continuous emission and burst

  3. Renal replacement therapy in healthy adult horses.

    Science.gov (United States)

    Wong, D M; Witty, D; Alcott, C J; Sponseller, B A; Wang, C; Hepworth, K

    2013-01-01

    Renal replacement therapy (RRT) has been implemented extensively in people to facilitate recovery from acute renal failure (ARF). RRT has not been explored in horses, but might provide a further treatment option in horses with ARF. To investigate efficacy and safety of RRT in horses. Five healthy adult horses. A prospective study was performed on horses restrained in stocks and intravenously connected to a commercial RRT machine to allow continuous venovenous hemodiafiltration to be performed for 6 hours. The RRT machine was set at the following flow rates: blood flow rate 250 mL/min; dialysate rate 3,000 mL/h; prefilter replacement pump 3,000 mL/h; and postfilter replacement pump rate 2,000 mL/h. Balanced electrolyte solution was used as dialysate and replacement fluid. Heart rate, respiratory rate, body temperature, direct arterial blood pressure, urine output, and various clinicopathologic parameters were measured over the study period. Renal replacement therapy was successfully performed in horses, resulting in a mean creatinine clearance of 0.127 mL/kg/min (68.9 mL/min) and urea reduction ratio of 24%. No adverse effects were detected although a significant decrease in rectal temperature was observed (P ≤ .007). A significant increase in serum phosphorus (P ≤ .001) and decrease in BUN (P replacement therapy can safely and effectively be used in adult horses. Copyright © 2013 by the American College of Veterinary Internal Medicine.

  4. Continuous supersonic plasma wind tunnel

    DEFF Research Database (Denmark)

    Andersen, S.A.; Jensen, Vagn Orla; Nielsen, P.

    1968-01-01

    The B field configuration of a Q-device has been modified into a magnetic Laval nozzle. Continuous supersonic plasma flow is observed with M≈3......The B field configuration of a Q-device has been modified into a magnetic Laval nozzle. Continuous supersonic plasma flow is observed with M≈3...

  5. Perspectives: The Continuous Improvement Trap

    Science.gov (United States)

    Arnold, David L.

    2011-01-01

    Accrediting agencies, legislators, pundits, and even higher educational professionals have become enamored with applying the language of continuous improvement to learning outcomes. The Southern Association of Colleges and Schools Commission on Colleges specifically uses the term "continuing improvement" in Core Standard 2.5, one of its…

  6. Continual integral in perturbation theory

    International Nuclear Information System (INIS)

    Slavnov, A.A.

    1975-01-01

    It is shown that all results obtained by means of continual integration within the framework of perturbation theory are completely equivalent to those obtained by the usual diagram technique and are therfore just as rigorous. A rigorous justification is given for the rules for operating with continual integrals in perturbation theory. (author)

  7. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis.

    Science.gov (United States)

    Brain, Matthew; Winson, Elizabeth; Roodenburg, Owen; McNeil, John

    2017-02-20

    Optimising filter life and performance efficiency in continuous renal replacement therapy has been a focus of considerable recent research. Larger high quality studies have predominantly focussed on optimal anticoagulation however CRRT is complex and filter life is also affected by vascular access, circuit and management factors. We performed a systematic search of the literature to identify and quantify the effect of vascular access, circuit and patient factors that affect filter life and presented the results as a meta-analysis. A systematic review and meta-analysis was performed by searching Pubmed (MEDLINE) and Ovid EMBASE libraries from inception to 29 th February 2016 for all studies with a comparator or independent variable relating to CRRT circuits and reporting filter life. Included studies documented filter life in hours with a comparator other than anti-coagulation intervention. All studies comparing anticoagulation interventions were searched for regression or hazard models pertaining to other sources of variation in filter life. Eight hundred nineteen abstracts were identified of which 364 were selected for full text analysis. 24 presented data on patient modifiers of circuit life, 14 on vascular access modifiers and 34 on circuit related factors. Risk of bias was high and findings are hypothesis generating. Ranking of vascular access site by filter longevity favours: tunnelled semi-permanent catheters, femoral, internal jugular and subclavian last. There is inconsistency in the difference reported between femoral and jugular catheters. Amongst published literature, modality of CRRT consistently favoured continuous veno-venous haemodiafiltration (CVVHD-F) with an associated 44% lower failure rate compared to CVVH. There was a trend favouring higher blood flow rates. There is insufficient data to determine advantages of haemofilter membranes. Patient factors associated with a statistically significant worsening of filter life included mechanical

  8. Continuous renal replacement therapy in neonates and small infants: development and first-in-human use of a miniaturised machine (CARPEDIEM).

    Science.gov (United States)

    Ronco, Claudio; Garzotto, Francesco; Brendolan, Alessandra; Zanella, Monica; Bellettato, Massimo; Vedovato, Stefania; Chiarenza, Fabio; Ricci, Zaccaria; Goldstein, Stuart L

    2014-05-24

    Peritoneal dialysis is the renal replacement therapy of choice for acute kidney injury in neonates, but in some cases is not feasible or effective. Continuous renal replacement therapy (CRRT) machines are used off label in infants smaller than 15 kg and are not designed specifically for small infants. We aimed to design and create a CRRT machine specifically for neonates and small infants. We prospectively planned a 5-year project to conceive, design, and create a miniaturised Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM), specifically for neonates and small infants. We created the new device and assessed it with in-vitro laboratory tests, completed its development to meet regulatory requirements, and obtained a licence for human use. Once approved, we used the machine to treat a critically ill neonate The main characteristics of CARPEDIEM are the low priming volume of the circuit (less than 30 mL), miniaturised roller pumps, and accurate ultrafiltration control via calibrated scales with a precision of 1 g. In-vitro tests confirmed that both hardware and software met the specifications. We treated a 2·9 kg neonate with haemorrhagic shock, multiple organ dysfunction, and severe fluid overload for more than 400 h with the CARPEDIEM, using continuous venovenous haemofiltration, single-pass albumin dialysis, blood exchange, and plasma exchange. The patient's 65% fluid overload, raised creatinine and bilirubin concentrations, and severe acidosis were all managed safely and effectively. Despite the severity of the illness, organ function was restored and the neonate survived and was discharged from hospital with only mild renal insufficiency that did not require renal replacement therapy. The CARPEDIEM CRRT machine can be used to provide various treatment modalities and support for multiple organ dysfunction in neonates and small infants. The CARPEDIEM could reduce the range of indications for peritoneal dialysis, widen the range of indications for CRRT

  9. Protein design using continuous rotamers.

    Directory of Open Access Journals (Sweden)

    Pablo Gainza

    2012-01-01

    Full Text Available Optimizing amino acid conformation and identity is a central problem in computational protein design. Protein design algorithms must allow realistic protein flexibility to occur during this optimization, or they may fail to find the best sequence with the lowest energy. Most design algorithms implement side-chain flexibility by allowing the side chains to move between a small set of discrete, low-energy states, which we call rigid rotamers. In this work we show that allowing continuous side-chain flexibility (which we call continuous rotamers greatly improves protein flexibility modeling. We present a large-scale study that compares the sequences and best energy conformations in 69 protein-core redesigns using a rigid-rotamer model versus a continuous-rotamer model. We show that in nearly all of our redesigns the sequence found by the continuous-rotamer model is different and has a lower energy than the one found by the rigid-rotamer model. Moreover, the sequences found by the continuous-rotamer model are more similar to the native sequences. We then show that the seemingly easy solution of sampling more rigid rotamers within the continuous region is not a practical alternative to a continuous-rotamer model: at computationally feasible resolutions, using more rigid rotamers was never better than a continuous-rotamer model and almost always resulted in higher energies. Finally, we present a new protein design algorithm based on the dead-end elimination (DEE algorithm, which we call iMinDEE, that makes the use of continuous rotamers feasible in larger systems. iMinDEE guarantees finding the optimal answer while pruning the search space with close to the same efficiency of DEE.Software is available under the Lesser GNU Public License v3. Contact the authors for source code.

  10. Continuous culture apparatus and methodology

    International Nuclear Information System (INIS)

    Conway, H.L.

    1975-01-01

    At present, we are investigating the sorption of potentially toxic trace elements by phytoplankton under controlled laboratory conditions. Continuous culture techniques were used to study the mechanism of the sorption of the trace elements by unialgal diatom populations and the factors influencing this sorption. Continuous culture methodology has been used extensively to study bacterial kinetics. It is an excellent technique for obtaining a known physiological state of phytoplankton populations. An automated method for the synthesis of continuous culture medium for use in these experiments is described

  11. Manipulating continuous variable photonic entanglement

    International Nuclear Information System (INIS)

    Plenio, M.B.

    2005-01-01

    I will review our work on photonic entanglement in the continuous variable regime including both Gaussian and non-Gaussian states. The feasibility and efficiency of various entanglement purification protocols are discussed this context. (author)

  12. Continuing education and professional development

    International Nuclear Information System (INIS)

    Adams, Edwina

    2002-01-01

    The success of a profession will be determined upon its education and training. A profession is required to encompass: a core body of knowledge; a set of ethical codes of practice; and have practitioners with humanistic qualities. In order to maintain the success of a profession it is necessary to have continuing education, which enhances professional development. Continuing professional education includes a form of self-regulation, which ensures the maintenance of a minimum standard of practice in this ever-changing workplace, and by regulating this standard, the discipline becomes more accountable to the client and the profession as a whole. In Australia, the Nuclear Medicine society's continuing education programs and Universities offering postgraduate programs promote continuing education. If technologists are to successfully keep up with developments in instrumentation, protocols and changing health care requirements, we must ensure that the education of practitioners does not cease at certification of entry to the workplace (Au)

  13. Rapid Continuous Multimaterial Extrusion Bioprinting

    NARCIS (Netherlands)

    Liu, Wanjun; Zhang, Yu Shrike; Heinrich, Marcel A.; De Ferrari, F; Jang, HL; Bakht, SM; Alvarez, MM; Yang, J; Li, YC; Trujillo-de Stantiago, G; Miri, AK; Zhu, K; Khoshakhlagh, P; Prakash, G; Cheng, H; Guan, X; Zhong, Z; Ju, J; Zhu, GH; Jin, X; Ryon Shin, Su; Dokmeci, M.R.; Khademhosseini, Ali

    The development of a multimaterial extrusion bioprinting platform is reported. This platform is capable of depositing multiple coded bioinks in a continuous manner with fast and smooth switching among different reservoirs for rapid fabrication of complex constructs, through digitally controlled

  14. Continuation of superpave projects monitoring.

    Science.gov (United States)

    2011-07-01

    This study involved the continuous monitoring of material properties and field performance of twelve Superpave project sections in Florida for the establishment of reasonable and effective mixture design guidelines and criteria, the identification an...

  15. Continuous Delivery and Quality Monitoring

    CERN Multimedia

    CERN. Geneva

    2016-01-01

    After introducing Continuous Delivery, I will switch the topic and try to answer the question how much should we invest in quality and how to do it efficiently. My observations reveal that software quality is often considered as the slo...

  16. Stratigraphy -- The Fall of Continuity.

    Science.gov (United States)

    Byers, Charles W.

    1982-01-01

    Reviews advances in stratigraphy as illustrated in the current geological literature, discussing discontinuity and how the recognition of discontinuity in the stratigraphic record is changing views of Superposition and Original Lateral Continuity. (Author/JN)

  17. Qubit Complexity of Continuous Problems

    National Research Council Canada - National Science Library

    Papageorgiou, A; Traub, J. F

    2005-01-01

    .... The authors show how to obtain the classical query complexity for continuous problems. They then establish a simple formula for a lower bound on the qubit complexity in terms of the classical query complexity...

  18. Competitive Strategy in Continuing Education.

    Science.gov (United States)

    Baden, Clifford

    1987-01-01

    Reviews strategic variables available to those planning continuing education marketing programs. Discusses generic competitive strategies: (1) overall cost leadership, (2) differentiation, and (3) specialization. Mentions several potential problems. (CH)

  19. Continuous-Energy Data Checks

    Energy Technology Data Exchange (ETDEWEB)

    Haeck, Wim [Radioprotection and Nuclear Safety Institute, Fontenay-aux-Roses (France); Conlin, Jeremy Lloyd [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); McCartney, Austin Paul [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Parsons, Donald Kent [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-05-25

    The purpose of this report is to provide an overview of all Quality Assurance tests that have to be performed on a nuclear data set to be transformed into an ACE formatted nuclear data file. The ACE file is capable of containing different types of data such as continuous energy neutron data, thermal scattering data, etc. Within this report, we will limit ourselves to continuous energy neutron data.

  20. Atypical work and employment continuity

    OpenAIRE

    Addison, John T.; Surfield, Christopher J.

    2009-01-01

    Atypical employment arrangements such as agency temporary work and contracting have long been criticized as offering more precarious and unstable work than regular employment. Using data from two datasets – the CAEAS and the NLSY79 – we determine whether workers who take such jobs rather than regular employment, or the alternative of continued job search, subsequently experience greater or lesser employment continuity. Observed differences between the various working arrangements are starkest...

  1. Continuous Disintegrations of Gaussian Processes

    OpenAIRE

    LaGatta, Tom

    2010-01-01

    The goal of this paper is to understand the conditional law of a stochastic process once it has been observed over an interval. To make this precise, we introduce the notion of a continuous disintegration: a regular conditional probability measure which varies continuously in the conditioned parameter. The conditioning is infinite-dimensional in character, which leads us to consider the general case of probability measures in Banach spaces. Our main result is that for a certain quantity $M$ b...

  2. Business continuity 2014: From traditional to integrated Business Continuity Management.

    Science.gov (United States)

    Ee, Henry

    As global change continues to generate new challenges and potential threats to businesses, traditional business continuity management (BCM) slowly reveals its limitations and weak points to ensuring 'business resiliency' today. Consequently, BCM professionals also face the challenge of re-evaluating traditional concepts and introducing new strategies and industry best practices. This paper points to why traditional BCM is no longer sufficient in terms of enabling businesses to survive in today's high-risk environment. It also looks into some of the misconceptions about BCM and other stumbling blocks to establishing effective BCM today. Most importantly, however, this paper provides tips based on the Business Continuity Institute's (BCI) Good Practices Guideline (GPG) and the latest international BCM standard ISO 22301 on how to overcome the issues and challenges presented.

  3. Continuous carbon nanotube reinforced composites.

    Science.gov (United States)

    Ci, L; Suhr, J; Pushparaj, V; Zhang, X; Ajayan, P M

    2008-09-01

    Carbon nanotubes are considered short fibers, and polymer composites with nanotube fillers are always analogues of random, short fiber composites. The real structural carbon fiber composites, on the other hand, always contain carbon fiber reinforcements where fibers run continuously through the composite matrix. With the recent optimization in aligned nanotube growth, samples of nanotubes in macroscopic lengths have become available, and this allows the creation of composites that are similar to the continuous fiber composites with individual nanotubes running continuously through the composite body. This allows the proper utilization of the extreme high modulus and strength predicted for nanotubes in structural composites. Here, we fabricate such continuous nanotube polymer composites with continuous nanotube reinforcements and report that under compressive loadings, the nanotube composites can generate more than an order of magnitude improvement in the longitudinal modulus (up to 3,300%) as well as damping capability (up to 2,100%). It is also observed that composites with a random distribution of nanotubes of same length and similar filler fraction provide three times less effective reinforcement in composites.

  4. Entanglement-continuous unitary transformations

    Energy Technology Data Exchange (ETDEWEB)

    Sahin, Serkan; Orus, Roman [Institute of Physics, Johannes Gutenberg University, 55099 Mainz (Germany)

    2016-07-01

    In this talk we present a new algorithm for quantum many-body systems using continuous unitary transformations (CUT) and tensor networks (TNs). With TNs we are able to approximate the solution to the flow equations that lie at the heart of continuous unitary transformations. We call this method Entanglement-Continuous Unitary Transformations (eCUT). It allows us to compute expectation values of local observables as well as tensor network representations of ground states and low-energy excited states. An implementation of the method is shown for 1d systems using matrix product operators. We show preliminary results for the 1d transverse-field Ising model to demonstrate the feasibility of the method.

  5. Continuous fractional distillation of petroleum

    Energy Technology Data Exchange (ETDEWEB)

    1921-11-05

    This invention has for its object a process of distillation, fractional, and continuous, of shale oil, tar, etc., characterized by the vapors leaving the evaporation chamber being forced, before condensation, to go over a continuous circuit. The vapors traverse first a preheater then return to the vaporization chamber in which they are passed along large surfaces and by application of the counter-current principle in contact with the liquid to be distilled. They stream through the chamber in a continuous manner (the quantity of vapor emitted in the circuit being determined in a manner to advance the distillation just to completion); the excess of vapor formed being removed from the circuit and sent to a condensing apparatus for fractionation.

  6. Baseline budgeting for continuous improvement.

    Science.gov (United States)

    Kilty, G L

    1999-05-01

    This article is designed to introduce the techniques used to convert traditionally maintained department budgets to baseline budgets. This entails identifying key activities, evaluating for value-added, and implementing continuous improvement opportunities. Baseline Budgeting for Continuous Improvement was created as a result of a newly named company president's request to implement zero-based budgeting. The president was frustrated with the mind-set of the organization, namely, "Next year's budget should be 10 to 15 percent more than this year's spending." Zero-based budgeting was not the answer, but combining the principles of activity-based costing and the Just-in-Time philosophy of eliminating waste and continuous improvement did provide a solution to the problem.

  7. Distributed synthesis in continuous time

    DEFF Research Database (Denmark)

    Hermanns, Holger; Krčál, Jan; Vester, Steen

    2016-01-01

    We introduce a formalism modelling communication of distributed agents strictly in continuous-time. Within this framework, we study the problem of synthesising local strategies for individual agents such that a specified set of goal states is reached, or reached with at least a given probability....... The flow of time is modelled explicitly based on continuous-time randomness, with two natural implications: First, the non-determinism stemming from interleaving disappears. Second, when we restrict to a subclass of non-urgent models, the quantitative value problem for two players can be solved in EXPTIME....... Indeed, the explicit continuous time enables players to communicate their states by delaying synchronisation (which is unrestricted for non-urgent models). In general, the problems are undecidable already for two players in the quantitative case and three players in the qualitative case. The qualitative...

  8. Continuous biodisel productions: A review

    Directory of Open Access Journals (Sweden)

    Stamenković Ivica S.

    2009-01-01

    Full Text Available Continuous biodiesel production on laboratory and industrial scale was analyzed, with focus on their advantages and disadvantages. Attention was paid to specific characteristics of industrial processes in order to point out the advanced technologies. The well-known base-catalyzed continuous biodiesel production processes are related to problems caused by the immiscibility of the reactants (alcohol and oil, application of relatively high operating temperature (usually the boiling temperature of alcohol or one near it and obtained yield of methyl ester yields lower than desired. One way to overcome these problems is to employ special reactor design favoring the emulsion process and increasing the overall rate of biodiesel production process, even at room temperature and atmospheric pressure. The second way is to apply heterogeneous catalysts in continuous processes, which will probably be the optimal approach to economically justified and environmentally friendly biodiesel production.

  9. Continuous-variable quantum games

    International Nuclear Information System (INIS)

    Li Hui; Du Jiangfeng; Massar, Serge

    2002-01-01

    We investigate the quantization of games in which the players can access to a continuous set of classical strategies, making use of continuous-variable quantum systems. For the particular case of the Cournot's duopoly, we find that, even though the two players both act as 'selfishly' in the quantum game as they do in the classical game, they are found to virtually cooperate due to the quantum entanglement between them. We also find that the original Einstein-Podolksy-Rosen state contributes to the best profits that the two firms could ever attain. Moreover, we propose a practical experimental setup for the implementation of such quantum games

  10. Continuous lengths of oxide superconductors

    Science.gov (United States)

    Kroeger, Donald M.; List, III, Frederick A.

    2000-01-01

    A layered oxide superconductor prepared by depositing a superconductor precursor powder on a continuous length of a first substrate ribbon. A continuous length of a second substrate ribbon is overlaid on the first substrate ribbon. Sufficient pressure is applied to form a bound layered superconductor precursor powder between the first substrate ribbon and the second substrate ribbon. The layered superconductor precursor is then heat treated to establish the oxide superconducting phase. The layered oxide superconductor has a smooth interface between the substrate and the oxide superconductor.

  11. Continuous production of polymethylpentene membranes

    Science.gov (United States)

    Epperson, B.J.; Burnett, L.J.; Helm, V.D.

    1983-11-15

    Gas separation membranes may be prepared in a continuous manner by passing a porous support which may, if so desired, be backed by a fabric through a solution of polymethylpentene dissolved in an organic solvent such as hexane. The support member is passed through the solution while one side thereof is in contact with a roller, thereby permitting only one side of the support member to be coated with the polymer. After continuously withdrawing the support member from the bath, the solvent is allowed to evaporate and the resulting membrane is recovered.

  12. LANL continuity of operations plan

    Energy Technology Data Exchange (ETDEWEB)

    Senutovitch, Diane M [Los Alamos National Laboratory

    2010-12-22

    The Los Alamos National Laboratory (LANL) is a premier national security research institution, delivering scientific and engineering solutions for the nation's most crucial and complex problems. Our primary responsibility is to ensure the safety, security, and reliability of the nation's nuclear stockpile. LANL emphasizes worker safety, effective operational safeguards and security, and environmental stewardship, outstanding science remains the foundation of work at the Laboratory. In addition to supporting the Laboratory's core national security mission, our work advances bioscience, chemistry, computer science, earth and environmental sciences, materials science, and physics disciplines. To accomplish LANL's mission, we must ensure that the Laboratory EFs continue to be performed during a continuity event, including localized acts of nature, accidents, technological or attack-related emergencies, and pandemic or epidemic events. The LANL Continuity of Operations (COOP) Plan documents the overall LANL COOP Program and provides the operational framework to implement continuity policies, requirements, and responsibilities at LANL, as required by DOE 0 150.1, Continuity Programs, May 2008. LANL must maintain its ability to perform the nation's PMEFs, which are: (1) maintain the safety and security of nuclear materials in the DOE Complex at fixed sites and in transit; (2) respond to a nuclear incident, both domestically and internationally, caused by terrorist activity, natural disaster, or accident, including mobilizing the resources to support these efforts; and (3) support the nation's energy infrastructure. This plan supports Continuity of Operations for Los Alamos National Laboratory (LANL). This plan issues LANL policy as directed by the DOE 0 150.1, Continuity Programs, and provides direction for the orderly continuation of LANL EFs for 30 days of closure or 60 days for a pandemic/epidemic event. Initiation of COOP operations may

  13. Coordination in continuously repeated games

    NARCIS (Netherlands)

    Weeren, A.J.T.M.; Schumacher, J.M.; Engwerda, J.C.

    1995-01-01

    In this paper we propose a model to describe the effectiveness of coordination in a continuously repeated two-player game. We study how the choice of a decision rule by a coordinator affects the strategic behavior of the players, resulting in more or less cooperation. Our model requires the analysis

  14. Teamwork, Leadership, and Continuous Improvement

    NARCIS (Netherlands)

    Keijser, Wouter Alexander; Glaudemans, Andor; Medema, Jitze; Dierckx, Rudi; Ahaus, Kees

    2017-01-01

    In this chapter, we describe the enhanced TeamSTEPPS® curriculum as fundament to creating a “culture of continuous improvement” in nuclear medicine. This evidence-based and modular teamwork system is deployed in concordance with a novel medical leadership development program. It provides a

  15. For Time-Continuous Optimisation

    DEFF Research Database (Denmark)

    Heinrich, Mary Katherine; Ayres, Phil

    2016-01-01

    Strategies for optimisation in design normatively assume an artefact end-point, disallowing continuous architecture that engages living systems, dynamic behaviour, and complex systems. In our Flora Robotica investigations of symbiotic plant-robot bio-hybrids, we re- quire computational tools...

  16. Geodesic continued fractions and LLL

    NARCIS (Netherlands)

    Beukers, F

    2014-01-01

    We discuss a proposal for a continued fraction-like algorithm to determine simultaneous rational approximations to dd real numbers α1,…,αdα1,…,αd. It combines an algorithm of Hermite and Lagarias with ideas from LLL-reduction. We dynamically LLL-reduce a quadratic form with parameter tt as t↓0t↓0.

  17. Continuity and Change in Appalachia.

    Science.gov (United States)

    Shinn, Larry D.

    1999-01-01

    Appalachian continuities include attachment to land and religion, high teen pregnancy, and low literacy and income. Trends in Appalachia that institutions of higher education must address are higher rates of college attendance, migration to urban areas, changes in student learning styles, and increasing pressure to educate students to workplace…

  18. Continuous supersonic plasma wind tunnel

    DEFF Research Database (Denmark)

    Andersen, S.A.; Jensen, Vagn Orla; Nielsen, P.

    1969-01-01

    The normal magnetic field configuration of a Q device has been modified to obtain a 'magnetic Laval nozzle'. Continuous supersonic plasma 'winds' are obtained with Mach numbers ~3. The magnetic nozzle appears well suited for the study of the interaction of supersonic plasma 'winds' with either...

  19. Comprehensive geriatric assessment | Lipschitz | Continuing ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 25, No 9 (2007) > ... EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL.

  20. Administrative Computing in Continuing Education.

    Science.gov (United States)

    Broxton, Harry

    1982-01-01

    Describes computer applications in the Division of Continuing Education at Brigham Young University. These include instructional applications (computer assisted instruction, computer science education, and student problem solving) and administrative applications (registration, payment records, grades, reports, test scoring, mailing, and others).…

  1. In the interest of continuity

    CERN Multimedia

    Association du personnel

    2009-01-01

    Every five years a new Management takes over the fifth floor of the Main Building. The arrival of a new Director-General comes with a desire to change the managerial style. Whilst not contesting the current need for this, we would like to remind you that continuity in the Organization is ensured by the personnel and its Staff Association representatives.

  2. Pythagorean Approximations and Continued Fractions

    Science.gov (United States)

    Peralta, Javier

    2008-01-01

    In this article, we will show that the Pythagorean approximations of [the square root of] 2 coincide with those achieved in the 16th century by means of continued fractions. Assuming this fact and the known relation that connects the Fibonacci sequence with the golden section, we shall establish a procedure to obtain sequences of rational numbers…

  3. Workload Control with Continuous Release

    NARCIS (Netherlands)

    Phan, B. S. Nguyen; Land, M. J.; Gaalman, G. J. C.

    2009-01-01

    Workload Control (WLC) is a production planning and control concept which is suitable for the needs of make-to-order job shops. Release decisions based on the workload norms form the core of the concept. This paper develops continuous time WLC release variants and investigates their due date

  4. Continuous hydrino thermal power system

    Energy Technology Data Exchange (ETDEWEB)

    Mills, Randell L.; Zhao, Guibing; Good, William [BlackLight Power, Inc., 493 Old Trenton Road, Cranbury, NJ 08512 (United States)

    2011-03-15

    The specifics of a continuous hydrino reaction system design are presented. Heat from the hydrino reactions within individual cells provide both reactor power and the heat for regeneration of the reactants. These processes occur continuously and the power from each cell is constant. The conversion of thermal power to electrical power requires the use of a heat engine exploiting a cycle such as a Rankine, Brayton, Stirling, or steam-engine cycle. Due to the temperatures, economy goal, and efficiency, the Rankine cycle is the most practical and can produce electricity at 30-40% efficiency with a component capital cost of about $300 per kW electric. Conservatively, assuming a conversion efficiency of 25% the total cost with the addition of the boiler and chemical components is estimated at $1064 per kW electric. (author)

  5. Continuous-Variable Entanglement Swapping

    Directory of Open Access Journals (Sweden)

    Kevin Marshall

    2015-05-01

    Full Text Available We present a very brief overview of entanglement swapping as it relates to continuous-variable quantum information. The technical background required is discussed and the natural link to quantum teleportation is established before discussing the nature of Gaussian entanglement swapping. The limitations of Gaussian swapping are introduced, along with the general applications of swapping in the context of to quantum communication and entanglement distribution. In light of this, we briefly summarize a collection of entanglement swapping schemes which incorporate a non-Gaussian ingredient and the benefits of such schemes are noted. Finally, we motivate the need to further study and develop such schemes by highlighting requirements of a continuous-variable repeater.

  6. Continuous hydrino thermal power system

    International Nuclear Information System (INIS)

    Mills, Randell L.; Zhao, Guibing; Good, William

    2011-01-01

    The specifics of a continuous hydrino reaction system design are presented. Heat from the hydrino reactions within individual cells provide both reactor power and the heat for regeneration of the reactants. These processes occur continuously and the power from each cell is constant. The conversion of thermal power to electrical power requires the use of a heat engine exploiting a cycle such as a Rankine, Brayton, Stirling, or steam-engine cycle. Due to the temperatures, economy goal, and efficiency, the Rankine cycle is the most practical and can produce electricity at 30-40% efficiency with a component capital cost of about $300 per kW electric. Conservatively, assuming a conversion efficiency of 25% the total cost with the addition of the boiler and chemical components is estimated at $1064 per kW electric.

  7. Analytic continuation in perturbative QCD

    International Nuclear Information System (INIS)

    Caprini, Irinel

    2002-01-01

    We discuss some attempts to improve standard perturbative expansion in QCD by using the analytic continuation in the momentum and the Borel complex planes. We first analyse the momentum-plane analyticity properties of the Borel-summed Green functions in perturbative QCD and the connection between the Landau singularities and the infrared renormalons. By using the analytic continuation in the Borel complex plane, we propose a new perturbative series replacing the standard expansion in powers of the normalized coupling constant a. The new expansion functions have branch point and essential singularities at the origin of the complex a-plane and divergent Taylor expansions in powers of a. On the other hand the modified expansion of the QCD correlators is convergent under rather conservative conditions. (author)

  8. PIPER Continuous Adiabatic Demagnetization Refrigerator

    Science.gov (United States)

    Kimball, Mark O.; Shirron, Peter J.; Canavan, Edgar R.; James, Bryan L.; Sampson, Michael A.; Letmate, Richard V.

    2017-01-01

    We report upon the development and testing of a 4-stage adiabatic demagnetization refrigerator (ADR) capable of continuous cooling at 0.100 Kelvin. This cooler is being built to cool the detector array aboard NASA's Primordial Inflation Polarization Explorer (PIPER) observatory. The goal of this balloon mission is to measure the primordial gravitational waves that should exist if the theory of cosmological inflation is correct. At altitude, the ADR will hold the array of transition-edge sensors at 100 mK continuously while periodically rejecting heat to a 1.2 K pumped helium bath. During testing on ground, the array is held at the same temperature but heat is rejected to a 4.2 K helium bath indicating the flexibility in this coolers design.

  9. Nasal continuous positive airway pressure

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Lamwers, Stephanie; Tepel, Martin

    2012-01-01

    Obstructive sleep apnoea (OSA) is linked to increased cardiovascular risk. This risk can be reduced by nasal continuous positive airway pressure (nCPAP) treatment. As OSA is associated with an increase of several vasoconstrictive factors, we investigated whether nCPAP influences the digital volume...... pulse wave. We performed digital photoplethysmography during sleep at night in 94 consecutive patients who underwent polysomnography and 29 patients treated with nCPAP. Digital volume pulse waves were obtained independently of an investigator and were quantified using an algorithm for continuous.......01; n = 94) and the arousal index (Spearman correlation, r = 0.21; p CPAP treatment, the AHI was significantly reduced from 27 ± 3 events · h(-1) to 4 ± 2 events · h(-1) (each n = 29; p

  10. Personal continuous route pattern mining

    Institute of Scientific and Technical Information of China (English)

    Qian YE; Ling CHEN; Gen-cai CHEN

    2009-01-01

    In the daily life, people often repeat regular routes in certain periods. In this paper, a mining system is developed to find the continuous route patterns of personal past trips. In order to count the diversity of personal moving status, the mining system employs the adaptive GPS data recording and five data filters to guarantee the clean trips data. The mining system uses a client/server architecture to protect personal privacy and to reduce the computational load. The server conducts the main mining procedure but with insufficient information to recover real personal routes. In order to improve the scalability of sequential pattern mining, a novel pattern mining algorithm, continuous route pattern mining (CRPM), is proposed. This algorithm can tolerate the different disturbances in real routes and extract the frequent patterns. Experimental results based on nine persons' trips show that CRPM can extract more than two times longer route patterns than the traditional route pattern mining algorithms.

  11. Continuous lactation in dairy cows

    DEFF Research Database (Denmark)

    Madsen, Torben Gosvig; Nielsen, Mette Benedicte Olaf; Andersen, Jens Bech

    2008-01-01

    Reports over the past decade have indicated that normal lactational performance can be achieved in genetically superior and high-producing dairy cows, even when the dry period between 2 lactations is omitted. The hypothesis tested in this experiment was that normal lactogenesis I and metabolic...... function may be achievable in continuously milked high-yielding dairy cows as a result of the genetic selection for lactation performance and hence longevity of mammary epithelial cells. The milk production and mammary nutrient uptake in response to omission of the dry period for cows with an expected peak...... milk yield higher than 45 kg/d were studied in 28 Holstein dairy cows managed without bovine somatotropin. Performance and metabolic parameters were followed in late gestation and in the following early lactation. Fourteen cows were milked continuously throughout late gestation, and another 14 dairy...

  12. Black holes by analytic continuation

    CERN Document Server

    Amati, Daniele

    1997-01-01

    In the context of a two-dimensional exactly solvable model, the dynamics of quantum black holes is obtained by analytically continuing the description of the regime where no black hole is formed. The resulting spectrum of outgoing radiation departs from the one predicted by the Hawking model in the region where the outgoing modes arise from the horizon with Planck-order frequencies. This occurs early in the evaporation process, and the resulting physical picture is unconventional. The theory predicts that black holes will only radiate out an energy of Planck mass order, stabilizing after a transitory period. The continuation from a regime without black hole formation --accessible in the 1+1 gravity theory considered-- is implicit in an S matrix approach and provides in this way a possible solution to the problem of information loss.

  13. Continuous monitoring of gaseous effluents

    International Nuclear Information System (INIS)

    Velasco, A.; Giraut, H.; Prado, M.; Bonino, A.D.

    1990-01-01

    The system allows to continuously determine the radioactive materials discharge (iodine, noble gases and aerosols) to the environment. It consists in compelling, by a pump, a known and fixed fraction of the total flow and preserving the aerosols by a filter. The gas -now free from aerosols- traverses an activated carbon filter which keeps the iodine; after being free from aerosols and iodine, the effluent traverses a measurement chambers for noble gases which has a scintillator. (Author) [es

  14. Developing a Continuous Improvement System

    Science.gov (United States)

    2016-09-16

    disagree that continuous improvement is critical to an organization’s suc-cess, since conducting business using a status quo philosophy will not work...for implementing one of these processes include: better operational efficiency, increased customer satisfaction, improved employee morale ...when a problem in reliability or maintenance may become the greatest opportunity. As described in the January-February 2011 issue of Defense AT&L

  15. Zeolites with continuously tuneable porosity

    OpenAIRE

    Wheatley, Paul S; Chlubná-Eliášová, Pavla; Greer, Heather; Zhou, Wuzong; Seymour, Valerie R; Dawson, Daniel M; Ashbrook, Sharon E; Pinar, Ana B; McCusker, Lynne B; Opanasenko, Maksym; Cejka, Jiří; Morris, Russell E

    2014-01-01

    Czech Science Foundation. Grant Number: P106/12/G015 Zeolites are important materials whose utility in industry depends on the nature of their porous structure. Control over microporosity is therefore a vitally important target. Unfortunately, traditional methods for controlling porosity, in particular the use of organic structure-directing agents, are relatively coarse and provide almost no opportunity to tune the porosity as required. Here we show how zeolites with a continuously tuneabl...

  16. Continuous alcoholic fermentation of molasses

    Energy Technology Data Exchange (ETDEWEB)

    Kazimierz, J

    1962-01-01

    The first Polish plant for ontinuous alcohol fermentation of molasses is described. Continuous fermentation permits a better use of the installation, automatic control, and shorter fermentation time. It yields more CO/sub 2/ for dry ice manufacture and decreases corrosion of apparatus. From 22 to 24% mash is used, giving a yield of 61.1 of 100-proof alc./kg. sucrose and an average of 37 kg. of dry yeast/1000 l. alcohol

  17. Manioc alcohol by continuous fermentation

    Energy Technology Data Exchange (ETDEWEB)

    Del Bianco, V; de Queiroz Araujo, N; Miceli, A; Souza e Silva, P C; da Silva Burle, J A

    1976-01-01

    EtOH was produced from dry cassava meal by first obtaining a glucose syrup by enzymic action, then fermenting the syrup with yeast. Bacillus subtilis amylase and Aspergillus awamori amyloglucosidase were prepared by growing the organisms on cassava meal. Both enzymes were used to saccharify the cassava starch to syrup. Saccharomyces cervisiae ATCC 1133 was then used in a continuous process to produce EtOH.

  18. Correlates of oral contraception continuation.

    Science.gov (United States)

    Ewer, P A; Gibbs, J O

    1971-05-01

    A sample of 139 predominantly black, young, low-income patients who had accepted oral contraception at a publicly supported family planning clinic has been analyzed for correlates of oral contraception continuation. Interviews were conducted 10-12 months after the clinic visit; at this time 38% of the patients continued taking oral contraceptives. It was found that patients with the highest continuation rates were 18-24 years old, in the 2-3 parity group, living with their husbands, had low-parity mothers, and were able to fill prescriptions in less time with more convenient methods of transportation. Discontinuers tended to have high-parity mothers, live with parents or head their own households, and to be in the 13-17 or 25-45 year old age groups. Fear of long-term use of oral contraceptives and perceived side effects appeared to be implicated in discontinuation. The rate of discontinuation may be associated with irregular coital experience and less consistent exposure to pregnancy.

  19. Topological Photonics for Continuous Media

    Science.gov (United States)

    Silveirinha, Mario

    Photonic crystals have revolutionized light-based technologies during the last three decades. Notably, it was recently discovered that the light propagation in photonic crystals may depend on some topological characteristics determined by the manner how the light states are mutually entangled. The usual topological classification of photonic crystals explores the fact that these structures are periodic. The periodicity is essential to ensure that the underlying wave vector space is a closed surface with no boundary. In this talk, we prove that it is possible calculate Chern invariants for a wide class of continuous bianisotropic electromagnetic media with no intrinsic periodicity. The nontrivial topology of the relevant continuous materials is linked with the emergence of edge states. Moreover, we will demonstrate that continuous photonic media with the time-reversal symmetry can be topologically characterized by a Z2 integer. This novel classification extends for the first time the theory of electronic topological insulators to a wide range of photonic platforms, and is expected to have an impact in the design of novel photonic systems that enable a topologically protected transport of optical energy. This work is supported in part by Fundacao para a Ciencia e a Tecnologia Grant Number PTDC/EEI-TEL/4543/2014.

  20. High-throughput continuous cryopump

    International Nuclear Information System (INIS)

    Foster, C.A.

    1986-01-01

    A cryopump with a unique method of regeneration which allows continuous operation at high throughput has been constructed and tested. Deuterium was pumped continuously at a throughput of 30 Torr.L/s at a speed of 2000 L/s and a compression ratio of 200. Argon was pumped at a throughput of 60 Torr.L/s at a speed of 1275 L/s. To produce continuous operation of the pump, a method of regeneration that does not thermally cycle the pump is employed. A small chamber (the ''snail'') passes over the pumping surface and removes the frost from it either by mechanical action with a scraper or by local heating. The material removed is topologically in a secondary vacuum system with low conductance into the primary vacuum; thus, the exhaust can be pumped at pressures up to an effective compression ratio determined by the ratio of the pumping speed to the leakage conductance of the snail. The pump, which is all-metal-sealed and dry and which regenerates every 60 s, would be an ideal system for pumping tritium. Potential fusion applications are for mpmp limiters, for repeating pneumatic pellet injection lines, and for the centrifuge pellet injector spin tank, all of which will require pumping tritium at high throughput. Industrial applications requiring ultraclean pumping of corrosive gases at high throughput, such as the reactive ion etch semiconductor process, may also be feasible

  1. From turnaround to continuous innovation

    DEFF Research Database (Denmark)

    Bjarnø, Ole-Christian

    2002-01-01

    In this article a five year longitudinal study performed at a medium-sized producer of electronics is reported during which we studied the company's change process. The paper deals with the concept of strategic sourcing as a component in turnaround change management. Based on theories of strategic...... sourcing, explorative case research and continuous innovation a series of findings is identified, and from these findings a management model is proposed. This model is intended to fill in an identified gap in the toolbox for maintenance and further development of the business partners network established...

  2. Drift vortices in continuous media

    International Nuclear Information System (INIS)

    Chernousenko, V.M.; Chernenko, I.V.; Chernyshenko, S.V.

    1989-01-01

    The work is devoted to investigation into the problems of large-scale cortex drift and generation in continuous media based on the solution of notably non-linear differential equations. Using the capability of the modern computer technique it is possible to consider a series of cases with regard to medium viscosity and its inhomogeneity and with regard to three-dimensional vortex nature. Based on the solutions obtained the large-scale steady-state vortex generation processes are considered. The results can be used when studying non-linear phenomena in plasma and processes of substance and energy transfer in non-equilibrium media. 16 refs.; 5 figs

  3. Roc curves for continuous data

    CERN Document Server

    Krzanowski, Wojtek J

    2009-01-01

    Since ROC curves have become ubiquitous in many application areas, the various advances have been scattered across disparate articles and texts. ROC Curves for Continuous Data is the first book solely devoted to the subject, bringing together all the relevant material to provide a clear understanding of how to analyze ROC curves.The fundamental theory of ROC curvesThe book first discusses the relationship between the ROC curve and numerous performance measures and then extends the theory into practice by describing how ROC curves are estimated. Further building on the theory, the authors prese

  4. Fuzzy extractors for continuous distributions

    OpenAIRE

    Buhan, I.R.; Doumen, J.M.; Hartel, Pieter H.; Veldhuis, Raymond N.J.

    2006-01-01

    We show that there is a direct relation between the maximum length of the keys extracted from biometric data and the error rates of the biometric system. The length of the bio-key depends on the amount of distinguishing information that can be extracted from the source data. This information can be used a-priori to evaluate the potential of the biometric data in the context of a specific cryptographic application. We model the biometric data more naturally as a continuous distribution and we ...

  5. FACTORS INFLUENCING CONTINUOUS ORGANISATIONAL CHANGE

    Directory of Open Access Journals (Sweden)

    Alexandru Rizescu

    2016-10-01

    Full Text Available Change involves the continuous adjustment to the external conditions of organizations in the operating environment, in parallel with the growth of domestic stability. This process constitutes the dilemma of change-stability, which can be tackled only through a vision of the future, meaning the idorganization of organization-environment interaction along with a flexible organizational structure, the use of advanced technology and the existence of a system of rewarding employees that reflects the values and priorities of both, organizational norms and individual needs.

  6. A community continuity programme: volunteer faculty mentors and continuity learning.

    Science.gov (United States)

    McGeehan, John; English, Richard; Shenberger, Keith; Tracy, Gerald; Smego, Raymond

    2013-02-01

    Longitudinal generalist preceptorship experiences early in medical education can have beneficial effects on how students practise the art and science of medicine, regardless of their eventual career choices. We evaluated the first 2 years of implementation of an integrated, regional campus-based, early clinical experience programme, the Community Continuity Program, at our new community-based medical school that is under the supervision of volunteer primary care faculty members acting as continuity mentors (CMs). Curricular components for years 1 and 2 consisted of three annual 1-week community-based experiences with CMs, extensive physical diagnosis practice, interprofessional learning activities, a multigenerational family care experience, a mandatory Community Health Research Project (CHRP) in year 1 and a mandatory Quality Improvement Project in year 2. Outcome measures included student, faculty member and programme evaluations, student reflective narratives in portal-based e-journals, a Liaison Committee on Medical Education (LCME) self-study student survey and serial level-of-empathy surveys.   Students found all elements of this integrated community experience programme beneficial and worthwhile, especially the CMs and the use of standardised and real-life patients. CMs noted effective and professional student-patient interactions. The number of reflective e-journal postings per student during year1 ranged from 14 to 81 (mean, 47). Serial empathy questionnaires administered over 2 years demonstrated preservation of student empathy, and students believed that the programme had a positive effect on their personal level of empathy.   An integrative, longitudinal, community-based, early clinical experience programme driven by volunteer CMs provides patient-centered instruction for preclinical students in the clinical, social, behavioural, ethical and research foundations of medicine. © Blackwell Publishing Ltd 2013.

  7. Earl occurring and continuing effects

    International Nuclear Information System (INIS)

    Scott, B.R.; Hahn, F.F.

    1989-01-01

    This chapter develops health-risk models for early and continuing effects of exposure to beta or gamma radiation that could be associated with light water nuclear power plant accidents. The main purpose of the chapter is to provide details on each health-risk model and on the data used. Early and continuing effects considered are prodromal symptoms and nonneoplastic diseases that usually occur soon after a brief radiation exposure. These effects are generally associated with relatively high (greater than 1 Gy) absorbed organ doses. For most of the effects considered, there is an absorbed organ dose threshold below which no effects are seen. Some information is provided on health effects observed in victims of the Chernobyl power plant accident. Organs of primary interest, because of their high sensitivity or their potential for receiving large doses, are bone marrow, gastrointestinal tract, thyroid glands, lungs, skin, gonads, and eyes. Exposure of the fetus is also considered. Additional data and modeling techniques available since publication of the Reactor Safety Study were used to obtain models for morbidity and mortality

  8. Early occurring and continuing effects

    International Nuclear Information System (INIS)

    Scott, B.R.; Hahn, F.F.

    1985-01-01

    This chapter deals with health-risk estimates for early and continuing effects of exposure to ionizing radiations that could be associated with light water nuclear power plants accidents. Early and continuing effects considered are nonneoplastic diseases and symptoms that normally occur soon after radiation exposure, but may also occur after years have passed. They are generally associated with relatively high (greater than 1 Gy) doses. For most of the effects considered, there is a practical dose threshold. Organs of primary interest, because of their high sensitivity or the likelihood of receiving a large radiation dose, are bone marrow, gastrointestinal tract, thyroid glands, lungs, skin, gonads, and eyes. In utero exposure of the fetus is also considered. New data and modeling techniques available since publication of the Reactor Safety Study (WASH 1400, 1975) were used along with data cited in the Study to develop improved health-risk models for morbidity and mortality. The new models are applicable to a broader range of accident scenarios, provide a more detailed treatment of dose protraction effects, and include morbidity effects not considered in the Reactor Safety Study. 115 references, 20 figures, 19 tables

  9. Accelerator based continuous neutron source.

    CERN Document Server

    Shapiro, S M; Ruggiero, A G

    2003-01-01

    Until the last decade, most neutron experiments have been performed at steady-state, reactor-based sources. Recently, however, pulsed spallation sources have been shown to be very useful in a wide range of neutron studies. A major review of neutron sources in the US was conducted by a committee chaired by Nobel laureate Prof. W. Kohn: ''Neutron Sources for America's Future-BESAC Panel on Neutron Sources 1/93''. This distinguished panel concluded that steady state and pulsed sources are complementary and that the nation has need for both to maintain a balanced neutron research program. The report recommended that both a new reactor and a spallation source be built. This complementarity is recognized worldwide. The conclusion of this report is that a new continuous neutron source is needed for the second decade of the 20 year plan to replace aging US research reactors and close the US neutron gap. it is based on spallation production of neutrons using a high power continuous superconducting linac to generate pr...

  10. Continuous Risk Management: An Overview

    Science.gov (United States)

    Rosenberg, Linda; Hammer, Theodore F.

    1999-01-01

    Software risk management is important because it helps avoid disasters, rework, and overkill, but more importantly because it stimulates win-win situations. The objectives of software risk management are to identify, address, and eliminate software risk items before they become threats to success or major sources of rework. In general, good project managers are also good managers of risk. It makes good business sense for all software development projects to incorporate risk management as part of project management. The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to implement risk management. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This is an introductory tutorial to continuous risk management based on this course. The rational for continuous risk management and how it is incorporated into project management are discussed. The risk management structure of six functions is discussed in sufficient depth for managers to understand what is involved in risk management and how it is implemented. These functions include: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  11. Continuous auditing: A literature review

    Directory of Open Access Journals (Sweden)

    Flávia Cruz de Souza

    2008-09-01

    Full Text Available Recent fraud scandals involving highly known corporations like Enron, WorldCom, and Xerox have eroded public confidence in financial reporting. At the same time, the auditing profession has suffered a big hit. In this scenario, Continuous Auditing (CA seems to have emerged as a response to recover the credibility of the auditing profession as well as meeting Sarbanes-Oxley (SOX requirements. This study, that adopts an exploratory approach, analyzes the existing literature on this topic. First, we address the concepts, models and implications of CA. After, throughout a search on the journals indexed at the CAPES's Basis, a literature review is conducted. A total of 57 articles were selected. We analyze authorship, affiliation, publications, year and type of research of papers that have addressed CA. Findings evidence that most articles addressing CA are non-empirical and adopt a conceptual approach. Also, there is an increasing tendency of continuous auditing studies. Rutgers University seems to be the World's leading research center on CA. This study aims to contribute to the Accounting Science by evidencing possibilities for research and publication in CA.

  12. Continuous positive airway pressure (CPAP).

    Science.gov (United States)

    Sahni, R; Wung, J T

    1998-01-01

    Progress in neonatal intensive care is closely linked to improvements in the management of respiratory failure in small infants. This applies to the care of the preterm infants with immature lungs, and also to treatment of the preterm or full term infants with specific diseases that are associated with respiratory failure. Respiratory distress of the newborn continues to account for significant morbidity in the intensive care unit. The spectrum of disease ranges from mild distress to severe respiratory failure requiring varying degrees of support. The current modalities of ventilatory assistance range from the more benign continuous positive airway pressure (CPAP) to conventional mechanical ventilation, and on to high frequency ventilation. It is a reasonable supposition that the type of ventilatory assistance provided to these infants should be graded according to the severity of the disease. However, the principal objective in selecting the mode of respiratory support should be to use a modality which results in minimal volo- or barotrauma to the infant. The following detailed description on CPAP explains its physiological effects, delivery system, indications for use, application, maintenance, and associated complications. The equipment described is simple to use, has a greater cost benefit, and has a more universal application, which is of help to smaller units including those in the developing parts of the world. We have also included our institutional clinical experience of CPAP usage in very low birth weight infants from the periods before and after commercial availability of surfactant in the United States.

  13. Reliability and continuous regeneration model

    Directory of Open Access Journals (Sweden)

    Anna Pavlisková

    2006-06-01

    Full Text Available The failure-free function of an object is very important for the service. This leads to the interest in the determination of the object reliability and failure intensity. The reliability of an element is defined by the theory of probability.The element durability T is a continuous random variate with the probability density f. The failure intensity (tλ is a very important reliability characteristics of the element. Often it is an increasing function, which corresponds to the element ageing. We disposed of the data about a belt conveyor failures recorded during the period of 90 months. The given ses behaves according to the normal distribution. By using a mathematical analysis and matematical statistics, we found the failure intensity function (tλ. The function (tλ increases almost linearly.

  14. Zeolites with Continuously Tuneable Porosity**

    Science.gov (United States)

    Wheatley, Paul S; Chlubná-Eliášová, Pavla; Greer, Heather; Zhou, Wuzong; Seymour, Valerie R; Dawson, Daniel M; Ashbrook, Sharon E; Pinar, Ana B; McCusker, Lynne B; Opanasenko, Maksym; Čejka, Jiří; Morris, Russell E

    2014-01-01

    Zeolites are important materials whose utility in industry depends on the nature of their porous structure. Control over microporosity is therefore a vitally important target. Unfortunately, traditional methods for controlling porosity, in particular the use of organic structure-directing agents, are relatively coarse and provide almost no opportunity to tune the porosity as required. Here we show how zeolites with a continuously tuneable surface area and micropore volume over a wide range can be prepared. This means that a particular surface area or micropore volume can be precisely tuned. The range of porosity we can target covers the whole range of useful zeolite porosity: from small pores consisting of 8-rings all the way to extra-large pores consisting of 14-rings. PMID:25284344

  15. Continuous method of natrium purification

    International Nuclear Information System (INIS)

    Batoux, B.; Laurent-Atthalin, A.; Salmon, M.

    1975-01-01

    An improvement of the known method for the production of highly pure sodium from technically pure sodium which still contains several hundred ppm metallic impurities is proposed. These impurities, first of all Ca and Ba, are separated by oxidation with sodium peroxide. The continuous method is new which can also be performed on a technically large scale and which results in a degree of purity of less than 10 ppm Ca. Under N 2 -atmosphere, highly dispersed sodium peroxide is added to a flow of sodium, and at 100 0 C to 150 0 C, thoroughly mixed, the suspension is heated under turbulence to 200 0 C to 300 0 C, and the forming oxides are separated. Exact data for an optimum reaction guide as well as a flow diagram are supplied. (UWI) [de

  16. Continuously variable focal length lens

    Science.gov (United States)

    Adams, Bernhard W; Chollet, Matthieu C

    2013-12-17

    A material preferably in crystal form having a low atomic number such as beryllium (Z=4) provides for the focusing of x-rays in a continuously variable manner. The material is provided with plural spaced curvilinear, optically matched slots and/or recesses through which an x-ray beam is directed. The focal length of the material may be decreased or increased by increasing or decreasing, respectively, the number of slots (or recesses) through which the x-ray beam is directed, while fine tuning of the focal length is accomplished by rotation of the material so as to change the path length of the x-ray beam through the aligned cylindrical slows. X-ray analysis of a fixed point in a solid material may be performed by scanning the energy of the x-ray beam while rotating the material to maintain the beam's focal point at a fixed point in the specimen undergoing analysis.

  17. Production expansion continues to accelerate

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This paper reports that Saudi Arabian Oil Co. (Saudi Aramco) is continuing its accelerated Crude Oil Expansion Program initiated in 1989 that aims at achieving a 10 million bpd productive capacity by 1995. In addition to major engineering, construction and renovation work related to production expansion, Saudi Aramco drilling and workover operations have been markedly expanded. Since January 1991, rig activity has doubled. As an indication of aging of Saudi production, projects include modernizing current injection water treatment facilities, installing a new seawater injection plant on the Persian Gulf, installing dewatering facilities in a number of locations and installing a pilot gas lift project. In addition, equipment orders indicate the new discoveries south of Riyadh may also need the assistance of water injection from inception of production

  18. Continuous method of natrium purification

    Energy Technology Data Exchange (ETDEWEB)

    Batoux, B; Laurent-Atthalin, A; Salmon, M

    1975-05-28

    An improvement of the known method for the production of highly pure sodium from technically pure sodium which still contains several hundred ppm metallic impurities is proposed. These impurities, first of all Ca and Ba, are separated by oxidation with sodium peroxide. The new continuous method can be performed on a technically large scale and results in a degree of purity of less than 10 ppm Ca. Under N/sub 2/ -atmosphere, highly dispersed sodium peroxide is added to a flow of sodium, and at 100/sup 0/C to 150/sup 0/C, thoroughly mixed, the suspension is heated under turbulence to 200/sup 0/C to 300/sup 0/C, and the forming oxides are separated. Exact data for an optimum reaction guide as well as a flow diagram are supplied.

  19. Sustaining motivation for continuous improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Kofoed, Lise Busk

    2007-01-01

    The objective of this article is to explore possibilities for improving motivation for participation in Continuous Improvement (CI). Due to a number of issues, for example, challenges with measuring outcomes of CI activities on performance, the inherent slower, incremental rather than big bang...... activities is an important issue for managers. The paper begins with a short description of CI, with an emphasis on barriers to successful implementation cited in the literature. Thereafter, a number of widely-acknowledged-albeit perhaps somewhat dated-theories of motivation are explored in relation...... to the elements of CI in practice. Based on their own experiences with CI implementation in numerous action-research based studies, the authors propose a scenario for motivating CI participation through emphasis on factors common to the presented motivational theories. The paper ends with insights into future...

  20. Continuous improvement of software quality

    International Nuclear Information System (INIS)

    Sivertsen, Terje

    1999-04-01

    The present report is the first Halden Work Report delivered from the OECD Halden Reactor Project's research activity on formal methods and software quality. Of particular concern in this activity is to reach a consensus between regulators, licensees and the nuclear industry on questions related to the effective, industrial use of formal methods. The report gives considerable attention to the importance of continuous improvement as a characteristic of a living software quality system, and to the need of providing a basis for software process/product quality integration. In particular, the report discusses these aspects from the perspectives of defect prevention, formal methods, Total Quality Management (TQM), and Bayesian Belief Nets. Another concern is to promote controlled experiments on the use of new methods, techniques, and tools. This is achieved partly by reviewing suggestions on the collection and experimental use of data, and by surveying a number of metrics believed to have some potential for comparison studies (author) (ml)

  1. Continuous improvement of pump seals

    International Nuclear Information System (INIS)

    Wong, W.; Eyvindson, A.; Rhodes, D.B.

    2003-01-01

    Pump seal reliability continues to be an area needing improvement and ongoing vigilance. Methods have been developed for identifying and assessing factors relating to seal performance, selecting the most relevant ones for a specific station, and then focusing on the most significant aspects and how to improve. Discussion invariably addresses maintenance practices, seal design, monitoring capabilities, operating conditions, transients, and pump and motor design. Success in reliability improvement requires ongoing dialogue among the station operators, pump manufacturers and seal designers. AECL CAN-seals lead the nuclear industry in reliability and seal life. They effectively save operators millions of dollars in outage time and person-rem. This paper describes some of the significant developments in AECL's ongoing program in seal R and D, as well as recent new installations following the most demanding seal qualification programs to date. (author)

  2. Participation in online continuing education.

    Science.gov (United States)

    Farrell, Barbara; Ward, Natalie; Jennings, Brad; Jones, Caitlin; Jorgenson, Derek; Gubbels-Smith, Ashley; Dolovich, Lisa; Kennie, Natalie

    2016-02-01

    The ADAPT (ADapting pharmacists' skills and Approaches to maximize Patients' drug Therapy effectiveness) e-learning programme requires weekly participation in module activities and facilitated discussion to support skill uptake. In this study, we sought to describe the extent and pattern of, satisfaction with and factors affecting participation in the initial programme offering and reasons for withdrawal. Mixed methods - convergent parallel approach. Participation was examined in qualitative data from discussion boards, assignments and action plans. Learner estimations of time commitment and action plan submission rates were calculated. Surveys (Likert scale and open-ended questions) included mid-point and final, exit and participation surveys. Eleven of 86 learners withdrew, most due to time constraints (eight completed an exit survey; seven said they would take ADAPT again). Thirty-five of 75 remaining learners completed a participation survey. Although 50-60% of the remaining 75 learners actively continued participating, only 15/35 respondents felt satisfied with their own participation. Learners spent 3-5 h/week (average) on module activities. Factors challenging participation included difficulty with technology, managing time and group work. Factors facilitating participation included willingness to learn (content of high interest) and supportive work environment. Being informed of programme time scheduling in advance was identified as a way to enhance participation. This study determined extent of learner participation in an online pharmacist continuing education programme and identified factors influencing participation. Interactions between learners and the online interface, content and with other learners are important considerations for designing online education programmes. Recommendations for programme changes were incorporated following this evaluation to facilitate participation. © 2015 Royal Pharmaceutical Society.

  3. 42 CFR 441.60 - Continuing care.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Continuing care. 441.60 Section 441.60 Public... Periodic Screening, Diagnosis, and Treatment (EPSDT) of Individuals Under Age 21 § 441.60 Continuing care. (a) Continuing care provider. For purposes of this subpart, a continuing care provider means a...

  4. 40 CFR 1065.150 - Continuous sampling.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Continuous sampling. 1065.150 Section... ENGINE-TESTING PROCEDURES Equipment Specifications § 1065.150 Continuous sampling. You may use continuous sampling techniques for measurements that involve raw or dilute sampling. Make sure continuous sampling...

  5. Wide area continuous offender monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Hoshen, J. [Lucent Technologies (United States); Drake, G. [New Mexico Dept. of Corrections, Santa Fe, NM (United States); Spencer, D. [Sandia National Labs., Albuquerque, NM (United States)

    1996-11-01

    The corrections system in the U.S. is supervising over five million offenders. This number is rising fast and so are the direct and indirect costs to society. To improve supervision and reduce the cost of parole and probation, first generation home arrest systems were introduced in 1987. While these systems proved to be helpful to the corrections system, their scope is rather limited because they only cover an offender at a single location and provide only a partial time coverage. To correct the limitations of first-generation systems, second-generation wide area continuous electronic offender monitoring systems, designed to monitor the offender at all times and locations, are now on the drawing board. These systems use radio frequency location technology to track the position of offenders. The challenge for this technology is the development of reliable personal locator devices that are small, lightweight, with long operational battery life, and indoors/outdoors accuracy of 100 meters or less. At the center of a second-generation system is a database that specifies the offender`s home, workplace, commute, and time the offender should be found in each. The database could also define areas from which the offender is excluded. To test compliance, the system would compare the observed coordinates of the offender with the stored location for a given time interval. Database logfiles will also enable law enforcement to determine if a monitored offender was present at a crime scene and thus include or exclude the offender as a potential suspect.

  6. Continuous atmosperic pollutant distribution monitor

    International Nuclear Information System (INIS)

    Burger, L.W.

    1984-06-01

    The feasibility of an on-line continuous pollutant distribution monitor has been established. The device employs a small microprocessor to simulate atmospheric dispersion using the segmented Gaussian plume model, an anemometer-bivane to measure the wind conditions, and a control 'box' with which certain model parameters can be specified and changed without interrupting the execution of the computer program. The output of the device is in the form of contours of equal ground-level concentrations on a colour monitor, or a printer dump of the associated graphic screen. The device is only suitable for short range predictions due to the memory limitations of the microprocessor. Predictions are updated approximately once every minute. Various case studies were performed to investigate the behaviour of the model when subjected to controlled input data. A series of short-range experimental runs were conducted in which predicted SO 2 concentrations were compared with measured values. The performance of the model in the case studies was acceptable, and comparisons with the measured SO 2 concentration values proved the model to overpredict by about 30%, which is considered satisfactory. This study can be applied to radioactive effluents transport in the atmosphere

  7. Continuous electrodeionization through electrostatic shielding

    International Nuclear Information System (INIS)

    Dermentzis, Konstantinos

    2008-01-01

    We report a new continuous electrodeionization cell with electrostatically shielded concentrate compartments or electrochemical Faraday cages formed by porous electronically and ionically conductive media, instead of permselective ion exchange membranes. Due to local elimination of the applied electric field within the compartments, they electrostatically retain the incoming ions and act as 'electrostatic ion pumps' or 'ion traps' and therefore concentrate compartments. The porous media are chemically and thermally stable. Electrodeionization or electrodialysis cells containing such concentrate compartments in place of ion exchange membranes can be used to regenerate ion exchange resins and produce deionized water, to purify industrial effluents and desalinate brackish or seawater. The cells can work by polarity reversal without any negative impact to the deionization process. Because the electronically and ionically active media constituting the electrostatically shielded concentrate compartments are not permselective and coions are not repelled but can be swept by the migrating counterions, the cells are not affected by the known membrane associated limitations, such as concentration polarization or scaling and show an increased current efficiency

  8. Continuous sampling from distributed streams

    DEFF Research Database (Denmark)

    Graham, Cormode; Muthukrishnan, S.; Yi, Ke

    2012-01-01

    A fundamental problem in data management is to draw and maintain a sample of a large data set, for approximate query answering, selectivity estimation, and query planning. With large, streaming data sets, this problem becomes particularly difficult when the data is shared across multiple distribu......A fundamental problem in data management is to draw and maintain a sample of a large data set, for approximate query answering, selectivity estimation, and query planning. With large, streaming data sets, this problem becomes particularly difficult when the data is shared across multiple...... distributed sites. The main challenge is to ensure that a sample is drawn uniformly across the union of the data while minimizing the communication needed to run the protocol on the evolving data. At the same time, it is also necessary to make the protocol lightweight, by keeping the space and time costs low...... for each participant. In this article, we present communication-efficient protocols for continuously maintaining a sample (both with and without replacement) from k distributed streams. These apply to the case when we want a sample from the full streams, and to the sliding window cases of only the W most...

  9. Continuously Connected With Mobile IP

    Science.gov (United States)

    2002-01-01

    Cisco Systems developed Cisco Mobile Networks, making IP devices mobile. With this innovation, a Cisco router and its connected IP devices can roam across network boundaries and connection types. Because a mobile user is able to keep the same IP address while roaming, a live IP connection can be maintained without interruption. Glenn Research Center jointly tested the technology with Cisco, and is working to use it on low-earth-orbiting research craft. With Cisco's Mobile Networks functionality now available in Cisco IOS Software release 12.2(4)T, the commercial advantages and benefits are numerous. The technology can be applied to public safety, military/homeland security, emergency management services, railroad and shipping systems, and the automotive industry. It will allow ambulances, police, firemen, and the U.S. Coast Guard to stay connected to their networks while on the move. In the wireless battlefield, the technology will provide rapid infrastructure deployment for U.S. national defense. Airline, train, and cruise passengers utilizing Cisco Mobile Networks can fly all around the world with a continuous Internet connection. Cisco IOS(R) Software is a registered trademark of Cisco Systems.

  10. Continuous Integration in PHP web applications development

    OpenAIRE

    Hujer, Martin

    2011-01-01

    This work deals with continuous integration of web applications, especially those in PHP language. The main objective is the selection of the server for continuous integration, its deployment and configuration for continuous integration of PHP web applications. The first chapter describes the concept of continuous integration and its individual techniques. The second chapter deals with the choice of server for continuous integration and its basic settings. The third chapter contains an overvi...

  11. Alternate fusion -- continuous inertial confinement

    International Nuclear Information System (INIS)

    Barnes, D.C.; Turner, L.; Nebel, R.A.

    1993-01-01

    The authors argue that alternate approaches to large tokamak confinement are appropriate for fusion applications if: (1) They do not require magnetic confinement of a much higher quality than demonstrated in tokamaks; (2) Their physics basis may be succinctly stated and experimentally tested; (3) They offer near-term applications to important technical problems; and (4) Their cost to proof-of-principle is low enough to be consistent with current budget realities. An approach satisfying all of these criteria is presented. Fusion systems based on continuous inertial confinement are described. In these approaches, the inertia of a nonequilibrium plasma is used to produce local concentrations of plasma density in space and/or time. One implementation (inertial electrostatic confinement) which has been investigated both experimentally and theoretically uses a system of electrostatic grids to accelerate plasma ions toward a spherical focus. This system produced a steady 2 x 10 10 D-T neutrons/second with an overall fusion gain of 10 -5 in a sphere of about 9 cm radius. Recent theoretical developments show how to raise the fusion gain to order unity or greater by replacing the internal grids by a combination of applied magnetic and electrostatic fields. In these approaches, useful thermonuclear conditions may be produced in a system as small as a few mm radius. Confinement is that of a nonneutralized plasma. A pure electron plasma with a radial beam velocity distribution is absolutely confined by an applied Penning trap field. Spherical convergence of the confined electrons forms a deep virtual cathode near r = 0, in which thermonuclear ions are absolutely confined at useful densities. The authors have examined the equilibrium, stability, and classical relaxation of such systems, and obtained many positive physics results. Equilibria exist for both pure electron and partially charge-neutralized systems with arbitrarily high core-plasma densities

  12. Chemical Continuous Time Random Walks

    Science.gov (United States)

    Aquino, T.; Dentz, M.

    2017-12-01

    Traditional methods for modeling solute transport through heterogeneous media employ Eulerian schemes to solve for solute concentration. More recently, Lagrangian methods have removed the need for spatial discretization through the use of Monte Carlo implementations of Langevin equations for solute particle motions. While there have been recent advances in modeling chemically reactive transport with recourse to Lagrangian methods, these remain less developed than their Eulerian counterparts, and many open problems such as efficient convergence and reconstruction of the concentration field remain. We explore a different avenue and consider the question: In heterogeneous chemically reactive systems, is it possible to describe the evolution of macroscopic reactant concentrations without explicitly resolving the spatial transport? Traditional Kinetic Monte Carlo methods, such as the Gillespie algorithm, model chemical reactions as random walks in particle number space, without the introduction of spatial coordinates. The inter-reaction times are exponentially distributed under the assumption that the system is well mixed. In real systems, transport limitations lead to incomplete mixing and decreased reaction efficiency. We introduce an arbitrary inter-reaction time distribution, which may account for the impact of incomplete mixing. This process defines an inhomogeneous continuous time random walk in particle number space, from which we derive a generalized chemical Master equation and formulate a generalized Gillespie algorithm. We then determine the modified chemical rate laws for different inter-reaction time distributions. We trace Michaelis-Menten-type kinetics back to finite-mean delay times, and predict time-nonlocal macroscopic reaction kinetics as a consequence of broadly distributed delays. Non-Markovian kinetics exhibit weak ergodicity breaking and show key features of reactions under local non-equilibrium.

  13. Opportunities of Continuing Adult Education

    Directory of Open Access Journals (Sweden)

    Lidija Ušeckienė

    2011-04-01

    Full Text Available After becoming the member state of the European Union, Lithuania undertook all the obligations of a member state. One of them is the implementation of The Lisbon Strategy aiming at the worlds most dynamic and competitive knowledge– based economy by 2010. Under the strategy, a stronger economy will drive job creation, sustainable development, and social inclusion. These changes demand the modernisation of education systems in the E U states, Lithuania among them. To achieve this objective, political forces came to an agreement on the future of Lithuanian education. In 2003 The Seimas of the Republic of Lithuania approved of National Education Strategy 2003–2012. This strategy is special not only because it is based on the experiences of the reform, addresses current and future world’s challenges and opportunities, maintains links with other strategic national reforms, but also emphasises efforts to ensure quality lifelong education for Lithuanian population and striving to become a partner in modern knowledge-based economy. Therefore, an extensive discussion on lifelong education strategies on individual and institution levels in all spheres of social and personal life has started in the E U and Lithuania. Nowadays lifelong learning is not just one aspect of education and training; it gradually is becoming the most important principle in the continuum of complex learning contexts. Such vision must be implemented this decade. The object of the research: the preconditions for the development of continuing adult education. The aim of the research: to examine the peculiarities of the preconditions for the development of continuing adult education in Pakruojis region. The methods of the research: analysis of references and documents on education; an anonymous survey in written form (a questionnaire; statistical analysis of data. The sample. The research was conducted in Pakruojis region in January-April, 2006. 300 respondents of different age

  14. Mercury Continuous Emmission Monitor Calibration

    Energy Technology Data Exchange (ETDEWEB)

    John Schabron; Eric Kalberer; Ryan Boysen; William Schuster; Joseph Rovani

    2009-03-12

    Mercury continuous emissions monitoring systems (CEMs) are being implemented in over 800 coal-fired power plant stacks throughput the U.S. Western Research Institute (WRI) is working closely with the Electric Power Research Institute (EPRI), the National Institute of Standards and Technology (NIST), and the Environmental Protection Agency (EPA) to facilitate the development of the experimental criteria for a NIST traceability protocol for dynamic elemental mercury vapor calibrators/generators. These devices are used to calibrate mercury CEMs at power plant sites. The Clean Air Mercury Rule (CAMR) which was published in the Federal Register on May 18, 2005 and vacated by a Federal appeals court in early 2008 required that calibration be performed with NIST-traceable standards. Despite the vacature, mercury emissions regulations in the future will require NIST traceable calibration standards, and EPA does not want to interrupt the effort towards developing NIST traceability protocols. The traceability procedures will be defined by EPA. An initial draft traceability protocol was issued by EPA in May 2007 for comment. In August 2007, EPA issued a conceptual interim traceability protocol for elemental mercury calibrators. The protocol is based on the actual analysis of the output of each calibration unit at several concentration levels ranging initially from about 2-40 {micro}g/m{sup 3} elemental mercury, and in the future down to 0.2 {micro}g/m{sup 3}, and this analysis will be directly traceable to analyses by NIST. The EPA traceability protocol document is divided into two separate sections. The first deals with the qualification of calibrator models by the vendors for use in mercury CEM calibration. The second describes the procedure that the vendors must use to certify the calibrators that meet the qualification specifications. The NIST traceable certification is performance based, traceable to analysis using isotope dilution inductively coupled plasma

  15. Almost contra-g-continuous functions

    International Nuclear Information System (INIS)

    Keskin, Aynur; Noiri, Takashi

    2009-01-01

    In this paper, we introduce and investigate the notion of almost contra-g-continuous functions which is weaker than both notions of contra-continuous functions [Dontchev J. Contra-continuous functions and strongly S-closed mappings. Int J Math Math Sci 1996;19:303-10] and (θ,s)-continuous functions [Joseph JK, Kwak MK. On S-closed spaces. Proc Am Math Soc 1980;80:341-8.] in topological spaces. We discuss the relationships with some other related functions. At the same time, we show that almost-g-continuity and (LC,s)-continuity are independent of each other.

  16. Almost contra-g-continuous functions

    Energy Technology Data Exchange (ETDEWEB)

    Keskin, Aynur [Department of Mathematics, Faculty of Science and Arts, Selcuk University Campus, 42075 Konya (Turkey); 2949-1 Shiokita-cho, Hinagu, Yatsushiro-shi, Kumamoto-ken 869-5142 (Japan)], E-mail: akeskin@selcuk.edu.tr; Noiri, Takashi [Department of Mathematics, Faculty of Science and Arts, Selcuk University Campus, 42075 Konya (Turkey); 2949-1 Shiokita-cho, Hinagu, Yatsushiro-shi, Kumamoto-ken 869-5142 (Japan)], E-mail: t.noiri@nifty.com

    2009-10-15

    In this paper, we introduce and investigate the notion of almost contra-g-continuous functions which is weaker than both notions of contra-continuous functions [Dontchev J. Contra-continuous functions and strongly S-closed mappings. Int J Math Math Sci 1996;19:303-10] and ({theta},s)-continuous functions [Joseph JK, Kwak MK. On S-closed spaces. Proc Am Math Soc 1980;80:341-8.] in topological spaces. We discuss the relationships with some other related functions. At the same time, we show that almost-g-continuity and (LC,s)-continuity are independent of each other.

  17. Effectiveness of continuing medical education.

    Science.gov (United States)

    Marinopoulos, Spyridon S; Dorman, Todd; Ratanawongsa, Neda; Wilson, Lisa M; Ashar, Bimal H; Magaziner, Jeffrey L; Miller, Redonda G; Thomas, Patricia A; Prokopowicz, Gregory P; Qayyum, Rehan; Bass, Eric B

    2007-01-01

    Despite the broad range of continuing medical education (CME) offerings aimed at educating practicing physicians through the provision of up-to-date clinical information, physicians commonly overuse, under-use, and misuse therapeutic and diagnostic interventions. It has been suggested that the ineffective nature of CME either accounts for the discrepancy between evidence and practice or at a minimum contributes to this gap. Understanding what CME tools and techniques are most effective in disseminating and retaining medical knowledge is critical to improving CME and thus diminishing the gap between evidence and practice. The purpose of this review was to comprehensively and systematically synthesize evidence regarding the effectiveness of CME and differing instructional designs in terms of knowledge, attitudes, skills, practice behavior, and clinical practice outcomes. We formulated specific questions with input from external experts and representatives of the Agency for Healthcare Research and Quality (AHRQ) and the American College of Chest Physicians (ACCP) which nominated this topic. We systematically searched the literature using specific eligibility criteria, hand searching of selected journals, and electronic databases including: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Abstracts of Reviews of Effects (DARE), PsycINFO, and the Educational Resource Information Center (ERIC). Two independent reviewers conducted title scans, abstract reviews, and then full article reviews to identify eligible articles. Each eligible article underwent double review for data abstraction and assessment of study quality. Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible. Despite this, the

  18. Implantable Nanosensors: Towards Continuous Physiologic Monitoring

    OpenAIRE

    Ruckh, Timothy T.; Clark', Heather A.

    2013-01-01

    Continuous physiologic monitoring would add greatly to both home and clinical medical treatment for chronic conditions. Implantable nanosensors are a promising platform for designing continuous monitoring systems. This feature reviews design considerations and current approaches towards such devices.

  19. The structural properties of sustainable, continuous change

    DEFF Research Database (Denmark)

    Håkonsson, Dorthe Døjbak; Klaas, Johann Peter; Carroll, Timothy

    2013-01-01

    this relationship by exploring what structural properties enable continuous change in inertia-generating organizations and what their performance consequences are in dynamic environments. The article has three main findings: First, employing managers who anticipate change is not enough to generate continuous change......; it is also necessary to raise both the rate of responsiveness and desired performance. Second, continuous change increases average organizational performance and reduces its variation. Third, organizations’ capacity for continuous change is counterintuitively limited by the organizations’ capacity to build...

  20. Security Support in Continuous Deployment Pipeline

    DEFF Research Database (Denmark)

    Ullah, Faheem; Raft, Adam Johannes; Shahin, Mojtaba

    2017-01-01

    Continuous Deployment (CD) has emerged as a new practice in the software industry to continuously and automatically deploy software changes into production. Continuous Deployment Pipeline (CDP) supports CD practice by transferring the changes from the repository to production. Since most of the CDP...... penetration tools. Our findings indicate that the applied tactics improve the security of the major components (i.e., repository, continuous integration server, main server) of a CDP by controlling access to the components and establishing secure connections....

  1. A decomposition of pairwise continuity via ideals

    Directory of Open Access Journals (Sweden)

    Mahes Wari

    2016-02-01

    Full Text Available In this paper, we introduce and study the notions of (i, j - regular - ℐ -closed sets, (i, j - Aℐ -sets, (i, j - ℐ -locally closed sets, p- Aℐ -continuous functions and p- ℐ -LC-continuous functions in ideal bitopological spaces and investigate some of their properties. Also, a new decomposition of pairwise continuity is obtained using these sets.

  2. 78 FR 21245 - Continuity of Operations Plan

    Science.gov (United States)

    2013-04-10

    ...; Order No. 778] Continuity of Operations Plan AGENCY: Federal Energy Regulatory Commission, DOE. ACTION: Final rule. SUMMARY: In this Final Rule the Commission revises its Continuity of Operations Plan... Commission's Continuity of Operations Plan (COOP) regulations to incorporate its regional offices into the...

  3. 15 CFR 923.57 - Continuing consultation.

    Science.gov (United States)

    2010-01-01

    ... § 923.57 Continuing consultation. (a) As required by subsection 306(d)(3)(B) of the Act, a State must establish an effective mechanism for continuing consultation and coordination between the management agency... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Continuing consultation. 923.57...

  4. Continuous Improvement in Schools: Understanding the Practice

    Science.gov (United States)

    Anderson, Stephen; Kumari, Roshni

    2009-01-01

    This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

  5. 21 CFR 868.5895 - Continuous ventilator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continuous ventilator. 868.5895 Section 868.5895...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5895 Continuous ventilator. (a) Identification. A continuous ventilator (respirator) is a device intended to mechanically control or assist...

  6. Reinforcement Learning in Continuous Action Spaces

    NARCIS (Netherlands)

    Hasselt, H. van; Wiering, M.A.

    2007-01-01

    Quite some research has been done on Reinforcement Learning in continuous environments, but the research on problems where the actions can also be chosen from a continuous space is much more limited. We present a new class of algorithms named Continuous Actor Critic Learning Automaton (CACLA)

  7. 78 FR 16447 - Rehabilitation Continuing Education Program (RCEP) for the Technical Assistance and Continuing...

    Science.gov (United States)

    2013-03-15

    ... (RCEP) for the Technical Assistance and Continuing Education Centers (TACE Centers); Proposed Extension... (RCEP) for the Technical Assistance and Continuing Education Centers (TACE Centers), the Secretary... with disabilities through enhanced technical assistance (TA) and continuing education (CE) for State...

  8. Internal factors influencing the knowledge continuity ensuring

    Directory of Open Access Journals (Sweden)

    Hana Urbancová

    2012-01-01

    Full Text Available The aim of the systematic ensuring of knowledge continuity is the continuity of an organisation’s development, the quality of managerial positions and the continuity of decision-making. By ensuring knowledge continuity, organisations may gain a performance-enhancing factor. The objective of the article is to identify the level of impact of decisive internal factors determining knowledge continuity ensuring and contributing to the efficiency of the organisations. Knowledge continuity ensuring as an internal force, however, can together with the right employees, help adapt more quickly to external conditions that organisations can hardly control. Monitoring and ensuring knowledge continuity can contribute to a higher quality of processes in general, in particular processes exploiting knowledge, and thus help improve the level of management. The first part of the article presents theoretical views on the aspects of knowledge continuity ensuring in organisations while the second part analyses the findings of the surveys carried out among managers in organisations in the Czech Republic. Based on the summary of the outcomes obtained it is possible to say that internal factors influence knowledge continuity ensuring in organisations, however, the level of impact of individual factors is determined by their size. The findings regarding the impact of each of the factors show that the most significant barriers to knowledge continuity ensuring are those associated with the human factor.

  9. Voltage stability, bifurcation parameters and continuation methods

    Energy Technology Data Exchange (ETDEWEB)

    Alvarado, F L [Wisconsin Univ., Madison, WI (United States)

    1994-12-31

    This paper considers the importance of the choice of bifurcation parameter in the determination of the voltage stability limit and the maximum power load ability of a system. When the bifurcation parameter is power demand, the two limits are equivalent. However, when other types of load models and bifurcation parameters are considered, the two concepts differ. The continuation method is considered as a method for determination of voltage stability margins. Three variants of the continuation method are described: the continuation parameter is the bifurcation parameter the continuation parameter is initially the bifurcation parameter, but is free to change, and the continuation parameter is a new `arc length` parameter. Implementations of voltage stability software using continuation methods are described. (author) 23 refs., 9 figs.

  10. Business continuity management in international organisations.

    Science.gov (United States)

    Adamou, Christel

    2014-01-01

    In the area of business continuity management, a preliminary review of the literature reveals extensive knowledge, expertise and experience concerning organisations in the private and public sectors. It is interesting to note, however, that there is little literature about business continuity management in international organisations, although these entities are complex and particularly prone to threats. This apparent absence of literature suggests that business continuity management has not yet hit the agenda of international organisations. In recent years, member states have encouraged senior management to design and implement business continuity strategies to minimise the mishandling of an internal crisis and build organisational resilience, but very few of them have actually been able to design and implement comprehensive business continuity programmes. Based on actual experience working in international organisations, this paper outlines some of the challenges faced by international organisations in developing and implementing business continuity activities and attempts to make suggestions for further improvement.

  11. Quantum engineering of continuous variable quantum states

    International Nuclear Information System (INIS)

    Sabuncu, Metin

    2009-01-01

    Quantum information with continuous variables is a field attracting increasing attention recently. In continuous variable quantum information one makes use of the continuous information encoded into the quadrature of a quantized light field instead of binary quantities such as the polarization state of a single photon. This brand new research area is witnessing exciting theoretical and experimental achievements such as teleportation, quantum computation and quantum error correction. The rapid development of the field is mainly due higher optical data rates and the availability of simple and efficient manipulation tools in continuous-variable quantum information processing. We in this thesis extend the work in continuous variable quantum information processing and report on novel experiments on amplification, cloning, minimal disturbance and noise erasure protocols. The promising results we obtain in these pioneering experiments indicate that the future of continuous variable quantum information is bright and many advances can be foreseen. (orig.)

  12. Quantum engineering of continuous variable quantum states

    Energy Technology Data Exchange (ETDEWEB)

    Sabuncu, Metin

    2009-10-29

    Quantum information with continuous variables is a field attracting increasing attention recently. In continuous variable quantum information one makes use of the continuous information encoded into the quadrature of a quantized light field instead of binary quantities such as the polarization state of a single photon. This brand new research area is witnessing exciting theoretical and experimental achievements such as teleportation, quantum computation and quantum error correction. The rapid development of the field is mainly due higher optical data rates and the availability of simple and efficient manipulation tools in continuous-variable quantum information processing. We in this thesis extend the work in continuous variable quantum information processing and report on novel experiments on amplification, cloning, minimal disturbance and noise erasure protocols. The promising results we obtain in these pioneering experiments indicate that the future of continuous variable quantum information is bright and many advances can be foreseen. (orig.)

  13. The induction on a continuous variable

    International Nuclear Information System (INIS)

    Zhang Jingzhong.

    1989-06-01

    Mathematical induction is a useful tool. But it could be used to prove only the proposition with form P(n) for the natural number n. Could the natural number n be replaced by a continuous variable x? Yes, and then we have the continuous induction. The continuous induction is very easy to grasp by the students who have learned mathematical induction. And it can be used to prove many basic propositions in the elementary calculus. (author)

  14. Applying andragogy in nursing continuing education.

    Science.gov (United States)

    Nielsen, B B

    1989-01-01

    Andragogy, a philosophical orientation for adult education, receives little attention in the nursing continuing education literature. Yet, the tenets of andragogy form the organizing framework for programming. This article defines andragogy and provides selected results of a research study designed to test andragogical concepts in long-term oncology nursing continuing education programs. The results of the study suggest a new way of viewing the goals of nursing continuing education activities.

  15. Penerapan Business Continuity Pada Bank Central Asia

    OpenAIRE

    Chandra, Keefe Darius

    2017-01-01

    Banks are financial institutions that have a major impact on the economic system and can affect people's lives. Hence, regulators concerned in organizing business continuity of the banking industries. PT. Bank Central Asia, Tbk. (BCA) represents businesses in the banking sector that can not escape from the natural and man threats which can interfere the bank's business. This case study presents a glimpse of how the business continuity run in BCA. Moreover, business continuity in banking can n...

  16. Automatic penalty continuation in structural topology optimization

    DEFF Research Database (Denmark)

    Rojas Labanda, Susana; Stolpe, Mathias

    2015-01-01

    this issue is addressed. We propose an automatic continuation method, where the material penalization parameter is included as a new variable in the problem and a constraint guarantees that the requested penalty is eventually reached. The numerical results suggest that this approach is an appealing...... alternative to continuation methods. Automatic continuation also generally obtains better designs than the classical formulation using a reduced number of iterations....

  17. Hanford year 2000 Business Continuity Plan

    Energy Technology Data Exchange (ETDEWEB)

    ROGGENKAMP, S.L.

    1999-11-01

    The goal of Department of Energy Richland Operations (DOE-RL) Year 2000 (Y2K) effort is to ensure that the Hanford site successfully continues its mission as we approach and enter the 21th century. The Y2K Business Continuity Planning process provides a structured approach to identify Y2K risks to the site and to mitigate these risks through Y2K Contingency Planning, ''Zero-Day'' Transition Planning and Emergency Preparedness. This document defines the responsibilities, processes and plans for Hanford's Y2K Business Continuity. It identifies proposed business continuity drills, tentative schedule and milestones.

  18. Some continual integrals from gaussian forms

    International Nuclear Information System (INIS)

    Mazmanishvili, A.S.

    1985-01-01

    The result summary of continual integration of gaussian functional type is given. The summary contains 124 continual integrals which are the mathematical expectation of the corresponding gaussian form by the continuum of random trajectories of four types: real-valued Ornstein-Uhlenbeck process, Wiener process, complex-valued Ornstein-Uhlenbeck process and the stochastic harmonic one. The summary includes both the known continual integrals and the unpublished before integrals. Mathematical results of the continual integration carried in the work may be applied in the problem of the theory of stochastic process, approaching to the finding of mean from gaussian forms by measures generated by the pointed stochastic processes

  19. National Continuity Policy: A Brief Overview

    National Research Council Canada - National Science Library

    Petersen, R. E

    2007-01-01

    .... Government continuity planning also incorporates efforts to maintain and preserve constitutional government, based on the assumption that certain essential activities typically provided by government...

  20. Hanford year 2000 Business Continuity Plan

    International Nuclear Information System (INIS)

    VORNEY, S.V.

    1999-01-01

    The goal of Department of Energy Richland Operations (DOE-RL) Year 2000 (Y2K) effort is to ensure that the Hanford site successfully continues its mission as we approach and enter the 21th century. The Y2K Business Continuity Planning process provides a structured approach to identify Y2K risks to the site and to mitigate these risks through Y2K Contingency Planning, ''Zero-Day'' Transition Planning and Emergency Preparedness. This document defines the responsibilities, processes and plans for Hanford's Y2K Business Continuity. It identifies proposed business continuity drills, tentative schedule and milestones

  1. Measuring business continuity programmes in large organisations.

    Science.gov (United States)

    Green, Christopher

    2014-01-01

    In the field of business continuity management, organisations commit sums of money (often very large sums) to develop and maintain their continuity capability. Despite this, there is almost no measurement of whether this expense offers value for money, or whether it is targeted in the right areas. This paper will explain some methods of measuring components of a business continuity programme. The important outputs from this measurement activity are to demonstrate that an organisation's continuity capability is improving over time, and to identify areas of weakness that should be targeted during future work.

  2. Improvised bubble continuous positive airway pressure (BCPAP ...

    African Journals Online (AJOL)

    Improvised bubble continuous positive airway pressure (BCPAP) device at the National Hospital Abuja gives immediate improvement in respiratory rate and oxygenation in neonates with respiratory distress.

  3. Periodic Continuing Disability Review Case Backlog

    Data.gov (United States)

    Social Security Administration — The Social Security Administration (SSA) conducts periodic CDRs to ensure that only those beneficiaries who remain disabled continue to receive monthly benefits. The...

  4. 7 CFR 58.315 - Continuous churns.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Continuous churns. 58.315 Section 58.315 Agriculture....315 Continuous churns. All product contact surfaces of the churn and related equipment shall be of..., Rubber, and Rubber-Like Materials. All product contact surfaces of the churn and related equipment shall...

  5. C-SPARQL : SPARQL for continuous querying

    OpenAIRE

    Barbieri, Davide Francesco; Braga, Daniele; Ceri, Stefano; Valle, Emanuele Della; Grossniklaus, Michael

    2009-01-01

    C-SPARQL is an extension of SPARQL to support continuous queries, registered and continuously executed over RDF data streams, considering windows of such streams. Supporting streams in RDF format guarantees interoperability and opens up important applications, in which reasoners can deal with knowledge that evolves over time. We present C-SPARQL by means of examples in Urban Computing.

  6. Continuous fragment of the mu-calculus

    NARCIS (Netherlands)

    Fontaine, G.

    2008-01-01

    In this paper we investigate the Scott continuous fragment of the modal μ-calculus. We discuss its relation with constructivity, where we call a formula constructive if its least fixpoint is always reached in at most ω steps. Our main result is a syntactic characterization of this continuous

  7. CONTINUOUS EXHALED BREATH ANALYSIS ON THE ICU

    International Nuclear Information System (INIS)

    Bos, Lieuwe D. J.; Sterk, Peter J.; Schultz, Marcus J.

    2011-01-01

    During admittance to the ICU, critically ill patients frequently develop secondary infections and/or multiple organ failure. Continuous monitoring of biological markers is very much needed. This study describes a new method to continuously monitor biomarkers in exhaled breath with an electronic nose.

  8. Operator continued fraction and bound states

    International Nuclear Information System (INIS)

    Pindor, M.

    1984-01-01

    The effective Hamiltonian of the model space perturbation theory (multilevel Rayleigh-Schroedinger theory) is expressed as an operator continued fraction. In the case of a nondegenerate model space the expression becomes an operator branched continued fraction. The method is applied to the harmonic oscillator with the kinetic energy treated as the perturbation and to the anharmonic oscillator

  9. 77 FR 43488 - Continuity of Operations Plan

    Science.gov (United States)

    2012-07-25

    ...; Order No. 765] Continuity of Operations Plan AGENCY: Federal Energy Regulatory Commission, DOE. ACTION... Operations Plan to allow the Commission the discretion to better address not only long-term and catastrophic... discretion regarding: the activation and deactivation of the Continuity of Operations Plan and any suspension...

  10. Competency-based continuing professional development

    NARCIS (Netherlands)

    Campbell, Craig; Silver, Ivan; Sherbino, Jonathan; Ten Cate, Olle; Holmboe, Eric S.

    2010-01-01

    Competence is traditionally viewed as the attainment of a static set of attributes rather than a dynamic process in which physicians continuously use their practice experiences to "progress in competence'' toward the attainment of expertise. A competency-based continuing professional development

  11. Assessment of Continuing Interprofessional Education: Lessons Learned

    Science.gov (United States)

    Simmons, Brian; Wagner, Susan

    2009-01-01

    Although interprofessional education (IPE) and continuing interprofessional education (CIPE) are becoming established activities within the education of health professions, assessment of learners continues to be limited. Arguably, this in part is due to a lack of IPE and CIPE within in the clinical workplace. The accountability of…

  12. Stieltjes' continued fraction for the gamma function

    International Nuclear Information System (INIS)

    Cha, B.W.

    1980-01-01

    The first forty-one coefficients of a continued fraction for 1n GAMMA(z)+z-(z-1/2) 1n z-1n√2π, are given. The computation, based on Wall's algorithm for converting a function's power series representation to a continued fraction representation, was run on the algebraic manipulation system MACSYMA

  13. Variance Swap Replication: Discrete or Continuous?

    Directory of Open Access Journals (Sweden)

    Fabien Le Floc’h

    2018-02-01

    Full Text Available The popular replication formula to price variance swaps assumes continuity of traded option strikes. In practice, however, there is only a discrete set of option strikes traded on the market. We present here different discrete replication strategies and explain why the continuous replication price is more relevant.

  14. Continuous oxygen therapy for hypoxic pulmonary disease

    DEFF Research Database (Denmark)

    Ringbaek, Thomas J

    2005-01-01

    Continuous oxygen therapy (COT) has become widely accepted in the last 20 years in patients with continuous hypoxemia. This review focuses on guidelines for COT, adherence to these guidelines, and the effect of COT on survival, hospitalization, and quality of life. Guidelines for COT are mainly b...... based on three randomized studies where documentation of hypoxemia (P(a)O2...

  15. Continuous Variable Quantum Communication and Computation

    DEFF Research Database (Denmark)

    Andersen, Ulrik Lund; Dong, Ruifang; Jezek, Miroslav

    2011-01-01

    We use squeezed states of light to implement a robust continuous variable quantum key distribution scheme and an optical Hadamard gate based on coherent state qubits.......We use squeezed states of light to implement a robust continuous variable quantum key distribution scheme and an optical Hadamard gate based on coherent state qubits....

  16. A Reflection on Continuing Professional Education Research

    Science.gov (United States)

    Brennan, Barrie

    2017-01-01

    Barrie Brennan's thesis entitled "Continuing Professional Education in Australia. A Tale of Missed Opportunities" offers a history of Continuing Professional Development (CPD) in the Australian context. This paper arose from Brennan's research for his thesis and is focused on issues that arose from the introduction of Australia's…

  17. Continuity of care: some experiences and thoughts.

    Science.gov (United States)

    Volpe, F J

    1994-09-01

    Continuity of health care is a goal to be achieved. Most are for it. Many claim to provide it. But how do we know we have it? What are the key features of continuity? While dictionaries do not define the phrase "continuity of health care," we do find definitions of "continuity." The Oxford English Dictionary, Second Edition, includes in its definitions: "the state or quality of being uninterrupted in sequence or succession, or in essence or idea; connectedness, coherence, unbroken..." Stedman's Medical Dictionary includes: "absence of interruption, a succession of parts intimately united..." These definitions stress an uninterrupted succession and include the concept that there needs to be a connection to the parts. Without that connection, continuity, in health care delivery or elsewhere, does not exist.

  18. An Operational Foundation for Delimited Continuations

    DEFF Research Database (Denmark)

    Biernacka, Malgorzata; Biernacki, Dariusz; Danvy, Olivier

    2004-01-01

    We present an abstract machine and a reduction semantics for the lambda-calculus extended with control operators that give access to delimited continuations in the CPS hierarchy. The abstract machine is derived from an evaluator in continuation-passing style (CPS); the reduction semantics (i.......e., a small-step operational semantics with an explicit representation of evaluation contexts) is constructed from the abstract machine; and the control operators are the shift and reset family. We also present new applications of delimited continuations in the CPS hierarchy: finding list prefixes...

  19. Managerial implications for improving continuous production processes

    DEFF Research Database (Denmark)

    Capaci, Francesca; Vanhatalo, Erik; Bergquist, Bjarne

    2017-01-01

    . In this article we highlight SPC and DoE implementation challenges described in the literature for managers, researchers and practitioners interested in continuous production process improvement. The results may help managers support the implementation of these methods and make researchers and practitioners aware......Data analytics remains essential for process improvement and optimization. Statistical process control and design of experiments are among the most powerful process and product improvement methods available. However, continuous process environments challenge the application of these methods...... of methodological challenges in continuous process environments...

  20. Building a global business continuity programme.

    Science.gov (United States)

    Lazcano, Michael

    2014-01-01

    Business continuity programmes provide an important function within organisations, especially when aligned with and supportive of the organisation's goals, objectives and organisational culture. Continuity programmes for large, complex international organisations, unlike those for compact national companies, are more difficult to design, build, implement and maintain. Programmes for international organisations require attention to structural design, support across organisational leadership and hierarchy, seamless integration with the organisation's culture, measured success and demonstrated value. This paper details practical, but sometimes overlooked considerations for building successful global business continuity programmes.

  1. Continuity relations and quantum wave equations

    International Nuclear Information System (INIS)

    Goedecke, G.H.; Davis, B.T.

    2010-01-01

    We investigate the mathematical synthesis of the Schroedinger, Klein-Gordon, Pauli-Schroedinger, and Dirac equations starting from probability continuity relations. We utilize methods similar to those employed by R. E. Collins (Lett. Nuovo Cimento, 18 (1977) 581) in his construction of the Schroedinger equation from the position probability continuity relation for a single particle. Our new results include the mathematical construction of the Pauli-Schroedinger and Dirac equations from the position probability continuity relations for a particle that can transition between two states or among four states, respectively.

  2. Continuity of operations/continuity of government for state-level transportation organizations : brief.

    Science.gov (United States)

    2011-09-01

    As a result of a federal requirement, all non-federal entities that own or operate critical : infrastructure are required to develop Continuity of Operations/Continuity of Government : (COOP/COG) Plans. Transportation is a critical infrastructure com...

  3. On characteristic classes and continuous cohomology

    International Nuclear Information System (INIS)

    Bott, R.

    1986-01-01

    The paper was presented at the workshop on 'Supersymmetry and its applications', Cambridge, United Kingdom, 1985. Six theorems on characteristic classes and continuous cohomology are described, in connection with the theory of anomalies. (UK)

  4. Guiding Simulations and Experiments using Continuation

    DEFF Research Database (Denmark)

    When applying continuation of periodic solutions to high-dimensional finite element models one might face a dilemma. The mesh resolution and thus the dimension N of the model are typically chosen such that a given computer system can store the information necessary to perform one integration step...... for dimension N, but not for larger dimensions. In other words, a model is usually implemented as a carefully derived implicit integration scheme tailored for numerically stable simulations with the highest spacial resolution admitted by the computational power available. On the other hand, stable numerical...... developed method of control based continuation allows the continuation of periodic solutions without a reduction of the model resolution, and even directly in physical experiments. Moreover, both a simulation as well as an experiment can run asynchronously from the actual continuation method, which...

  5. Self-similar continued root approximants

    International Nuclear Information System (INIS)

    Gluzman, S.; Yukalov, V.I.

    2012-01-01

    A novel method of summing asymptotic series is advanced. Such series repeatedly arise when employing perturbation theory in powers of a small parameter for complicated problems of condensed matter physics, statistical physics, and various applied problems. The method is based on the self-similar approximation theory involving self-similar root approximants. The constructed self-similar continued roots extrapolate asymptotic series to finite values of the expansion parameter. The self-similar continued roots contain, as a particular case, continued fractions and Padé approximants. A theorem on the convergence of the self-similar continued roots is proved. The method is illustrated by several examples from condensed-matter physics.

  6. Reliable dynamics in Boolean and continuous networks

    International Nuclear Information System (INIS)

    Ackermann, Eva; Drossel, Barbara; Peixoto, Tiago P

    2012-01-01

    We investigate the dynamical behavior of a model of robust gene regulatory networks which possess ‘entirely reliable’ trajectories. In a Boolean representation, these trajectories are characterized by being insensitive to the order in which the nodes are updated, i.e. they always go through the same sequence of states. The Boolean model for gene activity is compared with a continuous description in terms of differential equations for the concentrations of mRNA and proteins. We found that entirely reliable Boolean trajectories can be reproduced perfectly in the continuous model when realistic Hill coefficients are used. We investigate to what extent this high correspondence between Boolean and continuous trajectories depends on the extent of reliability of the Boolean trajectories, and we identify simple criteria that enable the faithful reproduction of the Boolean dynamics in the continuous description. (paper)

  7. 27 CFR 478.55 - Continuing partnerships.

    Science.gov (United States)

    2010-04-01

    ... is not terminated on death or insolvency of a partner, but continues until the winding up of the... own name from the date of acquisition, as provided in § 478.44. The rule set forth in this section...

  8. 27 CFR 555.58 - Continuing partnerships.

    Science.gov (United States)

    2010-04-01

    ... death or insolvency of a partner, but continues until the winding up of the partnership affairs is... obtain a license or permit in his own name from the date of acquisition, as provided in § 555.45. The...

  9. Women's Ways of Coping with Continuing Education.

    Science.gov (United States)

    Clouder, Lynn

    1997-01-01

    Women may attempt to cope with conflicting school and family roles by trying to work harder, altering personal expectations or behavior, or altering externally imposed expectations. When possible, continuing educators can help by transforming the inflexibilities of higher education. (SK)

  10. Comparing the Discrete and Continuous Logistic Models

    Science.gov (United States)

    Gordon, Sheldon P.

    2008-01-01

    The solutions of the discrete logistic growth model based on a difference equation and the continuous logistic growth model based on a differential equation are compared and contrasted. The investigation is conducted using a dynamic interactive spreadsheet. (Contains 5 figures.)

  11. Occupational Analysis: A Continuous Improvement Approach

    National Research Council Canada - National Science Library

    Duffy, Tom

    1998-01-01

    .... In doing so, the Air Force has implemented "Quality Air Force (QAF)" (AF Handbook 90-502). QAF is a leadership commitment that inspires trust, teamwork, and continuous improvement everywhere in the Air Force...

  12. Relationship between Continuous Assessment and Academic ...

    African Journals Online (AJOL)

    Government, school administration and teachers should ensure effective ... and practice of continuous assessment to improve on students' performance. ... as well as teacher dwelling on its outcome to adjust the teaching and learning process.

  13. On the continuity of the entropy

    International Nuclear Information System (INIS)

    Lassner, G.; Lassner, G.A.

    1977-01-01

    It is shown for a quantum-mechanical system with finite degree of freedom taking into account also unbounded observables one gets physical topologies on the state-observable system with respect to which the entropy becomes a continuous function

  14. Scaling Concepts in Describing Continuous Phase Transitions

    Indian Academy of Sciences (India)

    The behaviour near such a continuous transition point displays many remarkable .... for the free energy, and the remaining statements can be obtained from thermodynamic ... axis are close to zero, leading to a 2D-spin system. Theoretically ...

  15. A continuation multilevel Monte Carlo algorithm

    KAUST Repository

    Collier, Nathan; Haji Ali, Abdul Lateef; Nobile, Fabio; von Schwerin, Erik; Tempone, Raul

    2014-01-01

    We propose a novel Continuation Multi Level Monte Carlo (CMLMC) algorithm for weak approximation of stochastic models. The CMLMC algorithm solves the given approximation problem for a sequence of decreasing tolerances, ending when the required error

  16. Ethical Issues in Marketing and Continuing Education.

    Science.gov (United States)

    Martel, Laurence D.; Colley, Robert M.

    1986-01-01

    Raises ethical considerations relevant to the marketing of continuing education and suggests two approaches to their resolution: deontology (all actions guided by universal rules are moral) and teleology (consequences of an action determine whether it is moral). (CH)

  17. Dietitians' perceptions of the continuing professional development ...

    African Journals Online (AJOL)

    ADSA) would be upheld to portray ... accumulation and awarding of points or Continuing Education Units. (CEUs) and a reduced annual point .... of earnings for private practising dietitians, while out of office. Suggestions included centrally located ...

  18. Communicating with adolescents | Campbell | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 25, No 5 (2007) >. Log in or Register to get access to full text downloads.

  19. Analytic continuation of dual Feynman amplitudes

    International Nuclear Information System (INIS)

    Bleher, P.M.

    1981-01-01

    A notion of dual Feynman amplitude is introduced and a theorem on the existence of analytic continuation of this amplitude from the convergence domain to the whole complex is proved. The case under consideration corresponds to massless power propagators and the analytic continuation is constructed on the propagators powers. Analytic continuation poles and singular set of external impulses are found explicitly. The proof of the theorem on the existence of analytic continuation is based on the introduction of α-representation for dual Feynman amplitudes. In proving, the so-called ''trees formula'' and ''trees-with-cycles formula'' are established that are dual by formulation to the trees and 2-trees formulae for usual Feynman amplitudes. (Auth.)

  20. The Petroleum continues being the king

    International Nuclear Information System (INIS)

    Carta Petrolera

    2001-01-01

    In spite of the environmental inconveniences and the rapids advances in technologies and alternative products, the black gold continue being for many years, the fuel of the world economy. A comparison is made among the traditional and new energy

  1. Multipliers for continuous frames in Hilbert spaces

    International Nuclear Information System (INIS)

    Balazs, P; Bayer, D; Rahimi, A

    2012-01-01

    In this paper, we examine the general theory of continuous frame multipliers in Hilbert space. These operators are a generalization of the widely used notion of (discrete) frame multipliers. Well-known examples include anti-Wick operators, STFT multipliers or Calderón–Toeplitz operators. Due to the possible peculiarities of the underlying measure spaces, continuous frames do not behave quite as their discrete counterparts. Nonetheless, many results similar to the discrete case are proven for continuous frame multipliers as well, for instance compactness and Schatten-class properties. Furthermore, the concepts of controlled and weighted frames are transferred to the continuous setting. This article is part of a special issue of Journal of Physics A: Mathematical and Theoretical devoted to ‘Coherent states: mathematical and physical aspects’. (paper)

  2. Learning Styles in Continuing Medical Education.

    Science.gov (United States)

    Bennet, Nancy L.; Fox, Robert D.

    1984-01-01

    Synthesizes literature on cognitive style and considers issues about its role in continuing medical education research, including whether it should be used as a dependent or independent variable and how it may be used in causal models. (SK)

  3. A Continuous Game of Sankes and Ladders

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 14; Issue 8. The Control of Tuberculosis: A Continuous Game of Sankes and Ladders. T Ramakrishnan P Chandrasekhar. Classics Volume 14 Issue 8 August 2009 pp 820-834 ...

  4. Continuous-variable quantum homomorphic signature

    Science.gov (United States)

    Li, Ke; Shang, Tao; Liu, Jian-wei

    2017-10-01

    Quantum cryptography is believed to be unconditionally secure because its security is ensured by physical laws rather than computational complexity. According to spectrum characteristic, quantum information can be classified into two categories, namely discrete variables and continuous variables. Continuous-variable quantum protocols have gained much attention for their ability to transmit more information with lower cost. To verify the identities of different data sources in a quantum network, we propose a continuous-variable quantum homomorphic signature scheme. It is based on continuous-variable entanglement swapping and provides additive and subtractive homomorphism. Security analysis shows the proposed scheme is secure against replay, forgery and repudiation. Even under nonideal conditions, it supports effective verification within a certain verification threshold.

  5. Strategic continuity planning: the first critical step.

    Science.gov (United States)

    Smith, Jack

    2013-01-01

    Many companies (and business continuity professionals) believe a company needs a comprehensive, all-inclusive business continuity plan. Often they reach this conclusion after other companies or potential clients have requested to see their business continuity plan as a precondition of doing business. Companies without 'a plan' are then tempted to go out and hire a business continuity person and tell them to 'Create a plan!' This makes perfect sense to the executive team, but this approach will probably not work in a real event. This paper addresses the shortcomings of producing tactical documentation and calling it 'The Plan', and discusses ways to engage management in the development of a corporate strategy to be used during and after an event.

  6. Continuous Intravenous Milrinone Therapy in Pediatric Outpatients

    OpenAIRE

    Curley, Michelle; Liebers, Jill; Maynard, Roy

    2017-01-01

    Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac tran...

  7. Humility Through Humiliation in Continuity Clinic.

    Science.gov (United States)

    Lelkes, Efrat

    2016-01-01

    For freshly minted MDs, residency represents a period of transition from being a medical student to becoming a physician. This evolution is often fraught. Continuity clinic-a mandatory component of pediatric residency training-can be a battleground for this tribulation. This essay explores the author's journey from the first days of her continuity clinic to the last. The author recounts her struggles, her fears, her certainty of being an imposter, and her steps towards becoming a pediatrician.

  8. A lattice hierarchy and its continuous limits

    International Nuclear Information System (INIS)

    Fan Engui

    2008-01-01

    By introducing a discrete spectral problem, we derive a lattice hierarchy which is integrable in Liouville's sense and possesses a multi-Hamiltonian structure. It is show that the discrete spectral problem converges to the well-known AKNS spectral problem under a certain continuous limit. In particular, we construct a sequence of equations in the lattice hierarchy which approximates the AKNS hierarchy as a continuous limit

  9. Continuity of Local Time: An applied perspective

    OpenAIRE

    Ramirez, Jorge M.; Waymire, Edward C.; Thomann, Enrique A.

    2015-01-01

    Continuity of local time for Brownian motion ranks among the most notable mathematical results in the theory of stochastic processes. This article addresses its implications from the point of view of applications. In particular an extension of previous results on an explicit role of continuity of (natural) local time is obtained for applications to recent classes of problems in physics, biology and finance involving discontinuities in a dispersion coefficient. The main theorem and its corolla...

  10. Continuous Time Dynamic Contraflow Models and Algorithms

    Directory of Open Access Journals (Sweden)

    Urmila Pyakurel

    2016-01-01

    Full Text Available The research on evacuation planning problem is promoted by the very challenging emergency issues due to large scale natural or man-created disasters. It is the process of shifting the maximum number of evacuees from the disastrous areas to the safe destinations as quickly and efficiently as possible. Contraflow is a widely accepted model for good solution of evacuation planning problem. It increases the outbound road capacity by reversing the direction of roads towards the safe destination. The continuous dynamic contraflow problem sends the maximum number of flow as a flow rate from the source to the sink in every moment of time unit. We propose the mathematical model for the continuous dynamic contraflow problem. We present efficient algorithms to solve the maximum continuous dynamic contraflow and quickest continuous contraflow problems on single source single sink arbitrary networks and continuous earliest arrival contraflow problem on single source single sink series-parallel networks with undefined supply and demand. We also introduce an approximation solution for continuous earliest arrival contraflow problem on two-terminal arbitrary networks.

  11. Creating meaningful business continuity management programme metrics.

    Science.gov (United States)

    Strong, Brian

    2010-11-01

    The popular axiom, 'what gets measured gets done', is often applied in the quality management and continuous improvement disciplines. This truism is also useful to business continuity practitioners as they continually strive to prove the value of their organisation's investment in a business continuity management (BCM) programme. BCM practitioners must also remain relevant to their organisations as executives focus on the bottom line and maintaining stakeholder confidence. It seems that executives always find a way, whether in a hallway or elevator, to ask BCM professionals about the company's level of readiness. When asked, they must be ready with an informed response. The establishment of a process to measure business continuity programme performance and organisational readiness has emerged as a key component of US Department of Homeland Security 'Voluntary Private Sector Preparedness (PS-Prep) Program' standards where the overarching goal is to improve private sector preparedness for disasters and emergencies. The purpose of this paper is two-fold: to introduce continuity professionals to best practices that should be considered when developing a BCM metrics programme as well as providing a case study of how a large health insurance company researched, developed and implemented a process to measure BCM programme performance and company readiness.

  12. Management continuity in local health networks

    Directory of Open Access Journals (Sweden)

    Mylaine Breton

    2012-04-01

    Full Text Available Introduction: Patients increasingly receive care from multiple providers in a variety of settings. They expect management continuity that crosses boundaries and bridges gaps in the healthcare system. To our knowledge, little research has been done to assess coordination across organizational and professional boundaries from the patients' perspective. Our objective was to assess whether greater local health network integration is associated with management continuity as perceived by patients. Method: We used the data from a research project on the development and validation of a generic and comprehensive continuity measurement instrument that can be applied to a variety of patient conditions and settings. We used the results of a cross-sectional survey conducted in 2009 with 256 patients in two local health networks in Quebec, Canada. We compared four aspects of management continuity between two contrasting network types (highly integrated vs. poorly integrated. Results: The scores obtained in the highly integrated network are better than those of the poorly integrated network on all dimensions of management continuity (coordinator role, role clarity and coordination between clinics, and information gaps between providers except for experience of care plan. Conclusion: Some aspects of care coordination among professionals and organizations are noticed by patients and may be valid indicators to assess care coordination.

  13. Singular continuous spectrum for palindromic Schroedinger operators

    International Nuclear Information System (INIS)

    Hof, A.; Knill, O.; Simon, B.

    1995-01-01

    We give new examples of discrete Schroedinger operators with potentials taking finitely many values that have purely singular continuous spectrum. If the hull X of the potential is strictly ergodic, then the existence of just one potential x in X for which the operator has no eigenvalues implies that there is a generic set in X for which the operator has purely singular continuous spectrum. A sufficient condition for the existence of such an x is that there is a z element of X that contains arbitrarily long palindromes. Thus we can define a large class of primitive substitutions for which the operators are purely singularly continuous for a generic subset in X. The class includes well-known substitutions like Fibonacci, Thue-Morse, Period Doubling, binary non-Pisot and ternary non-Pisot. We also show that the operator has no absolutely continuous spectrum for all x element of X if X derives from a primitive substitution. For potentials defined by circle maps, x n =l J (θ 0 +nα), we show that the operator has purely singular continuous spectrum for a generic subset in X for all irrational α and every half-open interval J. (orig.)

  14. Design Feature 7: Continuous Preclosure Ventilation

    International Nuclear Information System (INIS)

    A.T. Watkins

    1999-01-01

    This design feature (DF) is intended to evaluate the effects of continuous ventilation in the emplacement drifts during preclosure and how the effects, if any, compare to the Viability Assessment (VA) reference design for postclosure long term performance. This DF will be evaluated against a set of criteria provided by the License Application Design Selection (LADS) group. The VA reference design included a continuous ventilation airflow quantity of 0.1 m 3 /s in the emplacement drifts in the design of the repository subsurface facilities. The effects of this continuous ventilation during the preclosure was considered to have a negligible effect on postclosure performance and therefore is not included during postclosure in the assessment of the long term performance. This DF discusses the effects of continuous ventilation on the emplacement drift environment and surrounding rock conditions during preclosure for three increased airflow quantities. The three cases of continuous ventilation systems are: System A, 1.0 m 3 /s (Section 8), System B, 5.0 m 3 /s (Section 9), and System C, 10.0 m 3 /s (Section 10) in each emplacement drift split. An emplacement drift split is half total length of emplacement drift going from the east or west main to the exhaust main. The difference in each system is the quantity of airflow in the emplacement drifts

  15. Generalized continued fractions and ergodic theory

    International Nuclear Information System (INIS)

    Pustyl'nikov, L D

    2003-01-01

    In this paper a new theory of generalized continued fractions is constructed and applied to numbers, multidimensional vectors belonging to a real space, and infinite-dimensional vectors with integral coordinates. The theory is based on a concept generalizing the procedure for constructing the classical continued fractions and substantially using ergodic theory. One of the versions of the theory is related to differential equations. In the finite-dimensional case the constructions thus introduced are used to solve problems posed by Weyl in analysis and number theory concerning estimates of trigonometric sums and of the remainder in the distribution law for the fractional parts of the values of a polynomial, and also the problem of characterizing algebraic and transcendental numbers with the use of generalized continued fractions. Infinite-dimensional generalized continued fractions are applied to estimate sums of Legendre symbols and to obtain new results in the classical problem of the distribution of quadratic residues and non-residues modulo a prime. In the course of constructing these continued fractions, an investigation is carried out of the ergodic properties of a class of infinite-dimensional dynamical systems which are also of independent interest

  16. Simple chloride sensors for continuous groundwater monitoring

    DEFF Research Database (Denmark)

    Thorn, Paul; Mortensen, John

    2012-01-01

    The development of chloride sensors which can be used for continuous, on-line monitoring of groundwater could be very valuable in the management of our coastal water resources. However, sensor stability, drift, and durability all need to be addressed in order for the sensors to be used in continu......The development of chloride sensors which can be used for continuous, on-line monitoring of groundwater could be very valuable in the management of our coastal water resources. However, sensor stability, drift, and durability all need to be addressed in order for the sensors to be used...... in continuous application. This study looks at the development of a simple, inexpensive chloride electrode, and evaluates its performance under continuous use, both in the laboratory and in a field test in a monitoring well. The results from the study showed a consistent response to changing chloride...... concentrations over longer periods. The signal was seen to be stable, with regular drift in both laboratory and field test. In the field application, the sensor signal was corrected for drift, and errors were observed to be under 7% of that of conductivity measurements. The study also found that the chloride...

  17. Resiliency scoring for business continuity plans.

    Science.gov (United States)

    Olson, Anna; Anderson, Jamie

    Through this paper readers will learn of a scoring methodology, referred to as resiliency scoring, which enables the evaluation of business continuity plans based upon analysis of their alignment with a predefined set of criteria that can be customised and are adaptable to the needs of any organisation. This patent pending tool has been successful in driving engagement and is a powerful resource to improve reporting capabilities, identify risks and gauge organisational resilience. The role of business continuity professionals is to aid their organisations in planning and preparedness activities aimed at mitigating the impacts of potential disruptions and ensuring critical business functions can continue in the event of unforeseen circumstances. This may seem like a daunting task for what can typically be a small team of individuals. For this reason, it is important to be able to leverage industry standards, documented best practices and effective tools to streamline and support your continuity programme. The resiliency scoring methodology developed and implemented at Target has proven to be a valuable tool in taking the organisation's continuity programme to the next level. This paper will detail how the tool was developed and provide guidance on how it can be customised to fit your organisation's unique needs.

  18. Discrete and continuous simulation theory and practice

    CERN Document Server

    Bandyopadhyay, Susmita

    2014-01-01

    When it comes to discovering glitches inherent in complex systems-be it a railway or banking, chemical production, medical, manufacturing, or inventory control system-developing a simulation of a system can identify problems with less time, effort, and disruption than it would take to employ the original. Advantageous to both academic and industrial practitioners, Discrete and Continuous Simulation: Theory and Practice offers a detailed view of simulation that is useful in several fields of study.This text concentrates on the simulation of complex systems, covering the basics in detail and exploring the diverse aspects, including continuous event simulation and optimization with simulation. It explores the connections between discrete and continuous simulation, and applies a specific focus to simulation in the supply chain and manufacturing field. It discusses the Monte Carlo simulation, which is the basic and traditional form of simulation. It addresses future trends and technologies for simulation, with par...

  19. Modeling Suspension and Continuation of a Process

    Directory of Open Access Journals (Sweden)

    Oleg Svatos

    2012-04-01

    Full Text Available This work focuses on difficulties an analyst encounters when modeling suspension and continuation of a process in contemporary process modeling languages. As a basis there is introduced general lifecycle of an activity which is then compared to activity lifecycles supported by individual process modeling languages. The comparison shows that the contemporary process modeling languages cover the defined general lifecycle of an activity only partially. There are picked two popular process modeling languages and there is modeled real example, which reviews how the modeling languages can get along with their lack of native support of suspension and continuation of an activity. Upon the unsatisfying results of the contemporary process modeling languages in the modeled example, there is presented a new process modeling language which, as demonstrated, is capable of capturing suspension and continuation of an activity in much simpler and precise way.

  20. Continuity planning for workplace infectious diseases.

    Science.gov (United States)

    Welch, Nancy; Miller, Pamela Blair; Engle, Lisa

    2016-01-01

    Traditionally, business continuity plans prepare for worst-case scenarios; people plan for the exception rather than the common. Plans focus on infrastructure damage and recovery wrought by such disasters as hurricanes, terrorist events or tornadoes. Yet, another very real threat looms present every day, every season and can strike without warning, wreaking havoc on the major asset -- human capital. Each year, millions of dollars are lost in productivity, healthcare costs, absenteeism and services due to infectious, communicable diseases. Sound preventive risk management and recovery strategies can avert this annual decimation of staff and ensure continuous business operation. This paper will present a strong economic justification for the recognition, prevention and mitigation of communicable diseases as a routine part of continuity planning for every business. Recommendations will also be provided for environmental/engineering controls as well as personnel policies that address employee and customer protection, supply chain contacts and potential legal issues.

  1. Will the urge to merge continue?

    International Nuclear Information System (INIS)

    Gobert, W.A.

    2001-01-01

    A review of oil and gas markets was presented along with mergers and acquisitions activity. The objective of the exercise was to determine if the current trend of mergers within the oil industry will continue. The review of oil and gas markets included a historical look at crude oil and natural gas prices as well as on industry activity as a whole. A series of economic indicator graphs demonstrate that buyers wallets are full, oil and gas prices have beat the estimates, purchase prices have inflated and shareholders continue to sell at a discount. This information has led the author to conclude that the trend to merge will definitely continue. 2 tabs., 18 figs

  2. Why Do We Continue Doing Science?

    Directory of Open Access Journals (Sweden)

    Javier Leach

    2015-01-01

    Full Text Available In this paper I speak from both a scientific and religious perspective. From this dual perspective I question the motivations that drive us to continue in the effort of doing scientific work. I ask the why and the wherefore of scientific work. To answer this question: What drives us to continue doing Science? I raise a preliminary question: What do we mean when we say ‘Science’? After briefly describing how the language of Modern Science has evolved in the last centuries, I distinguish between the knowledge that can be expressed by the formal languages of mathematics and the more personal and internal knowledge that can only be expressed by other languages that I call languages of symbol. Finally I propose positive and religious values that move us to continue doing science, while, together with more critical voices, also show the relativity of scientific work

  3. Petroleum demand continues to grow but slowly

    International Nuclear Information System (INIS)

    Anon.

    1998-01-01

    While it is always entertaining and intellectually stimulating to look at all the marvelous technological alternatives just around the corner for transport, the transport task in Australia continues to grow and so does petroleum consumption. Australia presently consumes more than 750,000 barrels per day of petroleum products. Latest figures are given for petroleum consumption up to the end of August 1998. They indicate that total demand for petrol has continued to grow, but very slowly. Growth in 1997-1998 compared with 1996-1997 was only 0.3%. This trend for very low growth has been continued into July and August, perhaps indicative of a slow down in the economy

  4. Catalytic Synthesis of Nitriles in Continuous Flow

    DEFF Research Database (Denmark)

    Nordvang, Emily Catherine

    The objective of this thesis is to report the development of a new, alternative process for the flexible production of nitrile compounds in continuous flow. Nitriles are an important class of compounds that find applications as solvents, chemical intermediates and pharmaceutical compounds......, alternative path to acetonitrile from ethanol via the oxidative dehydrogenation of ethylamine. The catalytic activity and product ratios of the batch and continuous flow reactions are compared and the effect of reaction conditions on the reaction is investigated. The effects of ammonia in the reaction...... dehydrogenation of ethylamine and post-reaction purging.Chapter 4 outlines the application of RuO2/Al2O3 catalysts to the oxidative dehydrogenation of benzylamine in air, utilizing a new reaction setup. Again, batch and continuous flow reactions are compared and the effects of reaction conditions, ammonia...

  5. Perturbation theory for continuous stochastic equations

    International Nuclear Information System (INIS)

    Chechetkin, V.R.; Lutovinov, V.S.

    1987-01-01

    The various general perturbational schemes for continuous stochastic equations are considered. These schemes have many analogous features with the iterational solution of Schwinger equation for S-matrix. The following problems are discussed: continuous stochastic evolution equations for probability distribution functionals, evolution equations for equal time correlators, perturbation theory for Gaussian and Poissonian additive noise, perturbation theory for birth and death processes, stochastic properties of systems with multiplicative noise. The general results are illustrated by diffusion-controlled reactions, fluctuations in closed systems with chemical processes, propagation of waves in random media in parabolic equation approximation, and non-equilibrium phase transitions in systems with Poissonian breeding centers. The rate of irreversible reaction X + X → A (Smoluchowski process) is calculated with the use of general theory based on continuous stochastic equations for birth and death processes. The threshold criterion and range of fluctuational region for synergetic phase transition in system with Poissonian breeding centers are also considered. (author)

  6. National Security Technology Incubation Project Continuation Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2008-09-30

    This document contains a project continuation plan for the National Security Technology Incubator (NSTI). The plan was developed as part of the National Security Preparedness Project (NSPP) funded by a Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant. This continuation plan describes the current status of NSTI (staffing and clients), long-term goals, strategies, and long-term financial solvency goals.The Arrowhead Center of New Mexico State University (NMSU) is the operator and manager of the NSTI. To realize the NSTI, Arrowhead Center must meet several performance objectives related to planning, development, execution, evaluation, and sustainability. This continuation plan is critical to the success of NSTI in its mission of incubating businesses with security technology products and services.

  7. Continuing medical education in radiation oncology

    International Nuclear Information System (INIS)

    Chauvet, B.; Barillot, I.; Denis, F.; Cailleux, P.E.; Ardiet, J.M.; Mornex, F.

    2012-01-01

    In France, continuing medical education (CME) and professional practice evaluation (PPE) became mandatory by law in July 2009 for all health professionals. Recently published decrees led to the creation of national specialty councils to implement this organizational device. For radiation oncology, this council includes the French Society for Radiation Oncology (SFRO), the National Radiation Oncology Syndicate (SNRO) and the Association for Continuing Medical Education in Radiation Oncology (AFCOR). The Radiation Oncology National Council will propose a set of programs including CME and PPE, professional thesaurus, labels for CME actions consistent with national requirements, and will organize expertise for public instances. AFCOR remains the primary for CME, but each practitioner can freely choose an organisation for CME, provided that it is certified by the independent scientific commission. The National Order for physicians is the control authority. Radiation oncology has already a strong tradition of independent CME that will continue through this major reform. (authors)

  8. Enhancing infrastructure resilience through business continuity planning.

    Science.gov (United States)

    Fisher, Ronald; Norman, Michael; Klett, Mary

    2017-01-01

    Critical infrastructure is crucial to the functionality and wellbeing of the world around us. It is a complex network that works together to create an efficient society. The core components of critical infrastructure are dependent on one another to function at their full potential. Organisations face unprecedented environmental risks such as increased reliance on information technology and telecommunications, increased infrastructure interdependencies and globalisation. Successful organisations should integrate the components of cyber-physical and infrastructure interdependencies into a holistic risk framework. Physical security plans, cyber security plans and business continuity plans can help mitigate environmental risks. Cyber security plans are becoming the most crucial to have, yet are the least commonly found in organisations. As the reliance on cyber continues to grow, it is imperative that organisations update their business continuity and emergency preparedness activities to include this.

  9. Intergenerational continuity in high conflict family environments

    Science.gov (United States)

    Rothenberg, W. Andrew; Hussong, Andrea M.; Chassin, Laurie

    2016-01-01

    In the current study, we examined continuity in conflict across generations and explored potential mediators and moderators that could explain this continuity. We followed 246 targets from adolescence to adulthood and examined family conflict as reported by multiple reporters in targets' family of origin and current families. Results showed that conflict in the current family was strongly correlated with that of the family of origin in women but not in men. Continuity in family conflict across generations was mediated by patterns of elevated adolescent externalizing behavior in members of the second generation (G2). Additionally, analyses revealed an interaction between both G2 partners' externalizing behavior such that if one partner in the G2 family demonstrated high levels of externalizing behavior, elevated levels of family conflict resulted. Potential explanations and implications of these findings are considered. PMID:26018605

  10. Applications of a fast, continuous wavelet transform

    Energy Technology Data Exchange (ETDEWEB)

    Dress, W.B.

    1997-02-01

    A fast, continuous, wavelet transform, based on Shannon`s sampling theorem in frequency space, has been developed for use with continuous mother wavelets and sampled data sets. The method differs from the usual discrete-wavelet approach and the continuous-wavelet transform in that, here, the wavelet is sampled in the frequency domain. Since Shannon`s sampling theorem lets us view the Fourier transform of the data set as a continuous function in frequency space, the continuous nature of the functions is kept up to the point of sampling the scale-translation lattice, so the scale-translation grid used to represent the wavelet transform is independent of the time- domain sampling of the signal under analysis. Computational cost and nonorthogonality aside, the inherent flexibility and shift invariance of the frequency-space wavelets has advantages. The method has been applied to forensic audio reconstruction speaker recognition/identification, and the detection of micromotions of heavy vehicles associated with ballistocardiac impulses originating from occupants` heart beats. Audio reconstruction is aided by selection of desired regions in the 2-D representation of the magnitude of the transformed signal. The inverse transform is applied to ridges and selected regions to reconstruct areas of interest, unencumbered by noise interference lying outside these regions. To separate micromotions imparted to a mass-spring system (e.g., a vehicle) by an occupants beating heart from gross mechanical motions due to wind and traffic vibrations, a continuous frequency-space wavelet, modeled on the frequency content of a canonical ballistocardiogram, was used to analyze time series taken from geophone measurements of vehicle micromotions. By using a family of mother wavelets, such as a set of Gaussian derivatives of various orders, features such as the glottal closing rate and word and phrase segmentation may be extracted from voice data.

  11. Vector continued fractions using a generalized inverse

    International Nuclear Information System (INIS)

    Haydock, Roger; Nex, C M M; Wexler, Geoffrey

    2004-01-01

    A real vector space combined with an inverse (involution) for vectors is sufficient to define a vector continued fraction whose parameters consist of vector shifts and changes of scale. The choice of sign for different components of the vector inverse permits construction of vector analogues of the Jacobi continued fraction. These vector Jacobi fractions are related to vector and scalar-valued polynomial functions of the vectors, which satisfy recurrence relations similar to those of orthogonal polynomials. The vector Jacobi fraction has strong convergence properties which are demonstrated analytically, and illustrated numerically

  12. Continuous-variable quantum information processing

    DEFF Research Database (Denmark)

    Andersen, Ulrik Lund; Leuchs, G.; Silberhorn, C.

    2010-01-01

    the continuous degree of freedom of a quantum system for encoding, processing or detecting information, one enters the field of continuous-variable (CV) quantum information processing. In this paper we review the basic principles of CV quantum information processing with main focus on recent developments...... in the field. We will be addressing the three main stages of a quantum information system; the preparation stage where quantum information is encoded into CVs of coherent states and single-photon states, the processing stage where CV information is manipulated to carry out a specified protocol and a detection...... stage where CV information is measured using homodyne detection or photon counting....

  13. 'Sure, I Would Like to Continue'

    DEFF Research Database (Denmark)

    Schoenau-Fog, Henrik; Bjørner, Thomas

    2012-01-01

    In order to explore one aspect of the engaging nature of computer games, this study will propose a method that aims at classifying the experience of engagement in video games. Inspired by a literature review, we will focus on the fundamental causes of engagement that motivate a player so much...... that he or she wants to continue playing. By organizing this willingness to continue playing into six broad types of causes of engagement—intellectual, physical, sensory, social, narrative, and emotional—we describe a typology of player engagement and a method that is intended to map players’ experience...

  14. A Continuation Method for Weakly Kannan Maps

    Directory of Open Access Journals (Sweden)

    Ariza-Ruiz David

    2010-01-01

    Full Text Available The first continuation method for contractive maps in the setting of a metric space was given by Granas. Later, Frigon extended Granas theorem to the class of weakly contractive maps, and recently Agarwal and O'Regan have given the corresponding result for a certain type of quasicontractions which includes maps of Kannan type. In this note we introduce the concept of weakly Kannan maps and give a fixed point theorem, and then a continuation method, for this class of maps.

  15. Continuous Intravenous Milrinone Therapy in Pediatric Outpatients.

    Science.gov (United States)

    Curley, Michelle; Liebers, Jill; Maynard, Roy

    Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac transplant, or as palliative therapy for cardiomyopathy. The aim of this article is to review the medical literature and describe a home infusion company's experience with pediatric outpatient milrinone therapy.

  16. Continuous precipitation process of plutonium salts

    International Nuclear Information System (INIS)

    Richard, P.

    1967-03-01

    This work concerns the continuous precipitation process of plutonium oxalate. Investigations about the solubility of different valence states in nitric-oxalic and in nitric-sulfuric-oxalic medium lead to select the precipitation process of tetravalent plutonium oxalate. Settling velocity and granulometry of tetravalent oxalate plutonium have been studied with variation of several precipitation parameters such as: temperature, acidity, excess of oxalic acid and aging time. Then are given test results of some laboratory continuous apparatus. Conditions of operation with adopted tubular apparatus are defined in conclusion. A flow-sheet is given for a process at industrial scale. (author) [fr

  17. Parameter Estimation in Continuous Time Domain

    Directory of Open Access Journals (Sweden)

    Gabriela M. ATANASIU

    2016-12-01

    Full Text Available This paper will aim to presents the applications of a continuous-time parameter estimation method for estimating structural parameters of a real bridge structure. For the purpose of illustrating this method two case studies of a bridge pile located in a highly seismic risk area are considered, for which the structural parameters for the mass, damping and stiffness are estimated. The estimation process is followed by the validation of the analytical results and comparison with them to the measurement data. Further benefits and applications for the continuous-time parameter estimation method in civil engineering are presented in the final part of this paper.

  18. Continuous flow nitration in miniaturized devices

    Directory of Open Access Journals (Sweden)

    Amol A. Kulkarni

    2014-02-01

    Full Text Available This review highlights the state of the art in the field of continuous flow nitration with miniaturized devices. Although nitration has been one of the oldest and most important unit reactions, the advent of miniaturized devices has paved the way for new opportunities to reconsider the conventional approach for exothermic and selectivity sensitive nitration reactions. Four different approaches to flow nitration with microreactors are presented herein and discussed in view of their advantages, limitations and applicability of the information towards scale-up. Selected recent patents that disclose scale-up methodologies for continuous flow nitration are also briefly reviewed.

  19. Multimedia Mapping using Continuous State Space Models

    DEFF Research Database (Denmark)

    Lehn-Schiøler, Tue

    2004-01-01

    In this paper a system that transforms speech waveforms to animated faces are proposed. The system relies on continuous state space models to perform the mapping, this makes it possible to ensure video with no sudden jumps and allows continuous control of the parameters in 'face space'. Simulations...... are performed on recordings of 3-5 sec. video sequences with sentences from the Timit database. The model is able to construct an image sequence from an unknown noisy speech sequence fairly well even though the number of training examples are limited....

  20. Temporary quadriplegia following continuous thoracic paravertebral block.

    Science.gov (United States)

    Calenda, Emile; Baste, Jean Marc; Danielou, Eric; Michelin, Paul

    2012-05-01

    A case of temporary quadriplegia following a continuous thoracic paravertebral block in an adult patient scheduled for video-assisted thoracoscopy is presented. An 18-gauge Tuohy needle was inserted under direct vision by the surgeon but the tip of the catheter was not localized. Postoperatively, the patient developed temporary quadriplegia 90 minutes after the start of a continuous infusion of ropivacaine 0.2%. Imaging studies showed that the catheter was localized in the intrathecal space. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. A Typology of Continuous Improvement Implementation Processes

    DEFF Research Database (Denmark)

    Rijnders, Sander; Boer, Harry

    2004-01-01

    This article presents a typology of continuous improvement (CI) implementation processes. The typology is based on an empirical study of 26 companies engaged in the implementation of CI. The data underpinning the typology was collected through retrospective interviews guided by a semi-structured ......This article presents a typology of continuous improvement (CI) implementation processes. The typology is based on an empirical study of 26 companies engaged in the implementation of CI. The data underpinning the typology was collected through retrospective interviews guided by a semi...

  2. Human Resource Management for Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Laugen, Bjørge Timenes; Boer, Harry

    2007-01-01

    This paper investigates the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, company performance. The paper begins with a brief review...... of the HRM and CI literature and then presents statistical analyses of data collected from the Continuous Improvement Network Survey (2003), which demonstrate that HRM has a significant effect on CI behaviour and company performance, with the strongest relationship between HRM, CI and performance occurring...

  3. Continuous Competence Development Model for Teacher Teams

    DEFF Research Database (Denmark)

    Weitze, Charlotte Lærke

    2014-01-01

    "This paper presents the development of the IT‐Pedagogical Think Tank for Teacher Teams (ITP4T), a continuous competence development model. The model was co‐designed following a design‐based research approach with teachers from VUC Storstrøm’s (VUC) Global Classroom (GC), an innovative hybrid...... to create their own continuous competence development. This article describes how and why the different components of the model were developed in response to the teachers’ challenges. Such challenges included lack of time, competence and support from the educational organisation to innovate learning design...

  4. CONTINUOUS ANALYZER UTILIZING BOILING POINT DETERMINATION

    Science.gov (United States)

    Pappas, W.S.

    1963-03-19

    A device is designed for continuously determining the boiling point of a mixture of liquids. The device comprises a distillation chamber for boiling a liquid; outlet conduit means for maintaining the liquid contents of said chamber at a constant level; a reflux condenser mounted above said distillation chamber; means for continuously introducing an incoming liquid sample into said reflux condenser and into intimate contact with vapors refluxing within said condenser; and means for measuring the temperature of the liquid flowing through said distillation chamber. (AEC)

  5. Continuous Certification Within Residency: An Educational Model.

    Science.gov (United States)

    Rachlin, Susan; Schonberger, Alison; Nocera, Nicole; Acharya, Jay; Shah, Nidhi; Henkel, Jacqueline

    2015-10-01

    Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  6. [Traumatic tricuspid valve insufficiency with right-to-left shunt: bridging using extracorporeal venovenous membrane oxygenation].

    Science.gov (United States)

    Weber, S U; Hammerstingl, C; Mellert, F; Baumgarten, G; Putensen, C; Knuefermann, P

    2012-01-01

    The case of a young male motor vehicle driver is reported who suffered multiple trauma in a car accident with pulmonary and cardiac contusions. In the course of severe pneumonia and traumatic tricuspid valve insufficiency a right-to-left shunt with refractory hypoxemia developed across a pre-existing atrial septal defect (ASD). The patient could be successfully treated by the combination of extracorporeal membrane oxygenation for bridging, interventional ASD occlusion and in the long-term by operative reconstruction of the tricuspid valve.

  7. Venovenøs hæmodiafiltrering til baclofenforgiftet patient

    DEFF Research Database (Denmark)

    Nielsen, Simon Uhl; Jansen, Tejs; Johansen, Sys Stybe

    2011-01-01

    Twice a young man was admitted to hospital upon having taken baclofen overdoses by intention. The ingested dose was 1,850 mg at the first episode and up to 2,500 mg at the second. In both cases the patient had severe overdose symptoms and scored 4-5 on the Glascow Coma Scale and was admitted...

  8. A Technique for Autologous Priming of the Veno-Venous Bypass Circuit during Liver Transplantation

    OpenAIRE

    Shackelford, Anthony G.; Hodge, Ashley B.; Chavin, Kenneth D.; Baliga, Prabhakar K.

    2011-01-01

    Orthotopic liver transplantations (OLT) have been associated with significant blood loss and hemodilution, necessitating significant homologous blood component replacement. Increasing administration of homologous blood products has been found to be inversely related to patient and graft survival. Various methods to reduce the amount of blood products patients receive during OLT, such as antifibrinolytic therapy, thromboelastography-guided transfusion, phlebotomy, reduced central venous pressu...

  9. Continuous professional development of educators: the state ...

    African Journals Online (AJOL)

    Continuous Professional Development (CPD) for educators should form an integral part of an education system. CPD should include diverse programmes that are reflective and that promote and embrace technological development. Such programmes would make it possible to respond to challenges brought about by ...

  10. Continuing professional development | Hellenberg | South African ...

    African Journals Online (AJOL)

    It would be unlikely that many of today\\'s practicing family doctors have not been involved in Continuing Medical Education (CME) activities. It would be equally unlikely, however, that these activities were part of any contextually structured educational plan towards professional development. Often driven by external need ...

  11. Continuing Professional Development in the quantity surveying ...

    African Journals Online (AJOL)

    This research study was conducted in order to investigate Continuing Professional Development (CPD) in the South African quantity surveying profession. The study further aimed to establish the reasons why some quantity surveyors do not acquire the required CPD hours and face losing their professional registration with ...

  12. 12th International Symposium Continuous Surface Mining

    CERN Document Server

    2015-01-01

    This edited volume contains research results presented at the 12th International Symposium Continuous Surface Mining, ISCSM Aachen 2014. The target audience primarily comprises researchers in the lignite mining industry and practitioners in this field but the book may also be beneficial for graduate students.

  13. Continued pollution from mining at Maarmorilik

    DEFF Research Database (Denmark)

    Voigt, Steen

    2008-01-01

    Almost 20 years after the closure of the lead and zinc mine at Maarmorilik in the municipality of Uummannaq in North West Greenland pollution of surrounding fiords and land stretches with the metals continues, all though in a much lesser degree than earlier. This shows a new report by the Danish...

  14. Software Tools Used for Continuous Assessment

    Directory of Open Access Journals (Sweden)

    Corina SBUGHEA

    2016-04-01

    Full Text Available he present paper addresses the subject of continuous evaluation and of the IT tools that support it. The approach starts from the main concepts and methods used in the teaching process, according to the assessment methodology and, then, it focuses on their implementation in the Wondershare QuizCreator software.

  15. Riesz basis for strongly continuous groups.

    NARCIS (Netherlands)

    Zwart, Heiko J.

    Given a Hilbert space and the generator of a strongly continuous group on this Hilbert space. If the eigenvalues of the generator have a uniform gap, and if the span of the corresponding eigenvectors is dense, then these eigenvectors form a Riesz basis (or unconditional basis) of the Hilbert space.

  16. Barriers to continuous professional development participation for ...

    African Journals Online (AJOL)

    Background. Updating knowledge and skills on an ongoing basis is an important requirement if one is to remain professionally relevant. Formalised continuous professional development (CPD) is, therefore, essential to stay up to date in a dynamic work environment. The majority of radiographers in Kenya work in remote ...

  17. Colorectal cancer screening | Schneider | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 27, No 5 (2009) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  18. Correlating continuous assessment scores to junior secondary ...

    African Journals Online (AJOL)

    This study investigated the relationship between continuous assessment scores and junior secondary school certificate examination(JSCE) final scores in Imo State. A sample of four hundred students were purposively selected from thirty eight thousand students who took the 1997 JSCE in Imo State. The data used were ...

  19. Continue morbiditeits registratie peilstations Nederland 2001.

    NARCIS (Netherlands)

    Bartelds, A.I.M.

    2002-01-01

    Het aantal nieuwe patiënten met diabetes mellitus is de afgelopen tien jaar met éénderde toegenomen (van 25.500 per jaar in 1990 naar 36.000 in 2001). Het gaat hierbij vooral om ouderen boven de 60 jaar. Dit blijkt uit de jaarcijfers van de Continue Morbiditeitsregistratie (CMR) Peilstations van het

  20. Automatic continuity for homomorphisms into free products

    DEFF Research Database (Denmark)

    Slutsky, Konstantin

    2013-01-01

    A homomorphism from a completely metrizable topological group into a free product of groups whose image is not contained in a factor of the free product is shown to be continuous with respect to the discrete topology on the range. In particular, any completely metrizable group topology on a free ...

  1. Teacher Research as Continuous Process Improvement

    Science.gov (United States)

    Ellis, Charles; Castle, Kathryn

    2010-01-01

    Purpose: Teacher research (inquiry) has been characterized as practice improvement, professional development and action research, among numerous names and descriptions. The purpose of this paper is to support the case that teacher research is also a form of quality improvement known as continuous process improvement (CPI).…

  2. A Continuous Improvement Capital Funding Model.

    Science.gov (United States)

    Adams, Matt

    2001-01-01

    Describes a capital funding model that helps assess facility renewal needs in a way that minimizes resources while maximizing results. The article explains the sub-components of a continuous improvement capital funding model, including budgeting processes for finish renewal, building performance renewal, and critical outcome. (GR)

  3. Layerless fabrication with continuous liquid interface production.

    Science.gov (United States)

    Janusziewicz, Rima; Tumbleston, John R; Quintanilla, Adam L; Mecham, Sue J; DeSimone, Joseph M

    2016-10-18

    Despite the increasing popularity of 3D printing, also known as additive manufacturing (AM), the technique has not developed beyond the realm of rapid prototyping. This confinement of the field can be attributed to the inherent flaws of layer-by-layer printing and, in particular, anisotropic mechanical properties that depend on print direction, visible by the staircasing surface finish effect. Continuous liquid interface production (CLIP) is an alternative approach to AM that capitalizes on the fundamental principle of oxygen-inhibited photopolymerization to generate a continual liquid interface of uncured resin between the growing part and the exposure window. This interface eliminates the necessity of an iterative layer-by-layer process, allowing for continuous production. Herein we report the advantages of continuous production, specifically the fabrication of layerless parts. These advantages enable the fabrication of large overhangs without the use of supports, reduction of the staircasing effect without compromising fabrication time, and isotropic mechanical properties. Combined, these advantages result in multiple indicators of layerless and monolithic fabrication using CLIP technology.

  4. Continuing Bonds after Suicide Bereavement in Childhood

    Science.gov (United States)

    Wood, Lindsey; Byram, Victoria; Gosling, A. Sophie; Stokes, Julie

    2012-01-01

    It has been argued that the grieving process after suicide bereavement has unique properties (e.g., J. R. Jordan, 2001). A qualitative study was conducted to explore one aspect of the grieving process--continuing bonds--after suicide bereavement in childhood. Data were collected through semi-structured interviews with 10 suicide-bereaved children…

  5. Minimizing convex functions by continuous descent methods

    Directory of Open Access Journals (Sweden)

    Sergiu Aizicovici

    2010-01-01

    Full Text Available We study continuous descent methods for minimizing convex functions, defined on general Banach spaces, which are associated with an appropriate complete metric space of vector fields. We show that there exists an everywhere dense open set in this space of vector fields such that each of its elements generates strongly convergent trajectories.

  6. Continued bleeding following acute intracerebral hemorrhage

    NARCIS (Netherlands)

    Brouwers, H.B.

    2014-01-01

    In this Ph.D. thesis, ‘Continued bleeding following acute intracerebral hemorrhage’, we have discussed the background literature, risk factors, and underlying biology of hematoma expansion, as well as the clinical applicability of the CT angiography (CTA) 'spot sign' as an imaging marker of this

  7. Continue service improvement at CERN computing centre

    International Nuclear Information System (INIS)

    Lopez, M Barroso; Everaerts, L; Meinhard, H; Baehler, P; Haimyr, N; Guijarro, J M

    2014-01-01

    Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

  8. Continuous Variables Quantum Information in Noisy Environments

    DEFF Research Database (Denmark)

    Berni, Adriano

    safe from the detrimental effects of noise and losses. In the present work we investigate continuous variables Gaussian quantum information in noisy environments, studying the effects of various noise sources in the cases of a quantum metrological task, an error correction scheme and discord...

  9. Continuity in Multi-Device Interaction

    DEFF Research Database (Denmark)

    Raptis, Dimitrios; Kjeldskov, Jesper; Skov, Mikael

    2016-01-01

    ’s Continuity. The study was done through surveying 3361 posts from technology web sites, discussion forums, and blogs, with a qualitative analysis of 1603 posts. Our findings present challenges in six themes of privacy, appropriation, customization, awareness, exclusion, and troubleshooting in relation...

  10. Continuing Professional Development in the quantity surveying ...

    African Journals Online (AJOL)

    1991-01-01

    Jan 1, 1991 ... The research established that quantity surveyors regarded handing in their CPD ... Surveying, Walter Sisulu University, PO Box 1421, East London, 5200, South Africa. ... Keywords: Continuing professional development, quantity surveying, perception .... In spite of this opportunity enshrined in the Act, the.

  11. Handbook of Marketing for Continuing Education.

    Science.gov (United States)

    Simerly, Robert G.; And Others

    This comprehensive guide to effectively marketing continuing education programs and courses consists of the following chapters: (1) "The Strategic Role of Marketing for Organizational Success" (Robert G. Simerly); (2) "Integrating Marketing into Strategic Planning" (Simerly); (3) "Learning More about Your Market: Sources and Uses of Data" (Dennis…

  12. More about ... Immunology | Singh | Continuing Medical Education

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 30, No 8 (2012) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  13. A Continuous, Fluorogenic Sirtuin 2 Deacylase Assay

    DEFF Research Database (Denmark)

    Galleano, Iacopo; Schiedel, Matthias; Jung, Manfred

    2016-01-01

    and kinetic insight regarding sirtuin inhibitors, it is important to have access to efficient assays. In this work, we report readily synthesized fluorogenic substrates enabling enzyme-economical evaluation of SIRT2 inhibitors in a continuous assay format as well as evaluation of the properties of SIRT2...

  14. Continual Learning through Evolvable Neural Turing Machines

    DEFF Research Database (Denmark)

    Lüders, Benno; Schläger, Mikkel; Risi, Sebastian

    2016-01-01

    Continual learning, i.e. the ability to sequentially learn tasks without catastrophic forgetting of previously learned ones, is an important open challenge in machine learning. In this paper we take a step in this direction by showing that the recently proposed Evolving Neural Turing Machine (ENTM...

  15. The battle of the dumps continues

    International Nuclear Information System (INIS)

    Anon.

    1976-01-01

    Although East Rand Gold and Uranium Company is about to start exploitation of the old slimes dams to produce gold, uranium and sulphuric acid, the battle to suppress dust and establish vegetation on the old dumps continues. The physical problems, planning, co-ordination and legal aspects of mine dump reclamation are outlined

  16. Continuous innovation in the drug life cycle

    NARCIS (Netherlands)

    Langedijk, J.

    2016-01-01

    Patients may benefit from new uses for old drugs. Competent authorities such as the European Medicines Agency evaluate the quality, efficacy and safety of a medicinal product for the use in a well-defined therapeutic indication. Innovations may continue upon the approval, for example through the

  17. Continuous glucose monitoring in acute coronary syndrome.

    Science.gov (United States)

    Rodríguez-Quintanilla, Karina Alejandra; Lavalle-González, Fernando Javier; Mancillas-Adame, Leonardo Guadalupe; Zapata-Garrido, Alfonso Javier; Villarreal-Pérez, Jesús Zacarías; Tamez-Pérez, Héctor Eloy

    2013-01-01

    Diabetes mellitus is an independent risk factor for cardiovascular disease. To compare the efficacy of devices for continuous glucose monitoring and capillary glucose monitoring in hospitalized patients with acute coronary syndrome using the following parameters: time to achieve normoglycemia, period of time in normoglycemia, and episodes of hypoglycemia. We performed a pilot, non-randomized, unblinded clinical trial that included 16 patients with acute coronary artery syndrome, a capillary or venous blood glucose ≥ 140 mg/dl, and treatment with a continuous infusion of fast acting human insulin. These patients were randomized into 2 groups: a conventional group, in which capillary measurement and recording as well as insulin adjustment were made every 4h, and an intervention group, in which measurement and recording as well as insulin adjustment were made every hour with a subcutaneous continuous monitoring system. Student's t-test was applied for mean differences and the X(2) test for qualitative variables. We observed a statistically significant difference in the mean time for achieving normoglycemia, favoring the conventional group with a P = 0.02. Continuous monitoring systems are as useful as capillary monitoring for achieving normoglycemia. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  18. Continuous deionization of a dilute nickel solution

    NARCIS (Netherlands)

    Spoor, P.B.; Koene, L.; Veen, ter W.R.; Janssen, L.J.J.

    2002-01-01

    This paper describes the continuous removal of nickel ions from a dilute solution using a hybrid ion-exchange/electrodialysis process. Emphasis was placed on the ionic state of the bed during the process, and the mass balance of ions in the system. Much of this information was obtained by analysing

  19. A generalized scheme for designing multistable continuous ...

    Indian Academy of Sciences (India)

    In this paper, a generalized scheme is proposed for designing multistable continuous dynamical systems. The scheme is based on the concept of partial synchronization of states and the concept of constants of motion. The most important observation is that by coupling two mdimensional dynamical systems, multistable ...

  20. Sticky continuous processes have consistent price systems

    DEFF Research Database (Denmark)

    Bender, Christian; Pakkanen, Mikko; Sayit, Hasanjan

    Under proportional transaction costs, a price process is said to have a consistent price system, if there is a semimartingale with an equivalent martingale measure that evolves within the bid-ask spread. We show that a continuous, multi-asset price process has a consistent price system, under...

  1. The Continuity Project, Fall 1997 Report.

    Science.gov (United States)

    Wasilko, Peter J.

    The Continuity Project is a research, development, and technology transfer initiative aimed at creating a "Library of the Future" by combining features of an online public access catalog (OPAC) and a campus wide information system (CWIS) with advanced facilities drawn from such areas as artificial intelligence (AI), knowledge…

  2. Computer-Assisted Instruction and Continuing Motivation.

    Science.gov (United States)

    Mosley, Mary Lou; And Others

    Effects of two feedback conditions--comment and no comment--on the motivation of sixth grade students to continue with computer assisted instruction (CAI) were investigated, and results for boys and for girls were compared. Subjects were 62 students--29 boys and 33 girls--from a suburban elementary school who were randomly assigned to the comment…

  3. A continuation method for emission tomography

    International Nuclear Information System (INIS)

    Lee, M.; Zubal, I.G.

    1993-01-01

    One approach to improved reconstructions in emission tomography has been the incorporation of additional source information via Gibbs priors that assume a source f that is piecewise smooth. A natural Gibbs prior for expressing such constraints is an energy function E(f,l) defined on binary valued line processes l as well as f. MAP estimation leads to the difficult problem of minimizing a mixed (continuous and binary) variable objective function. Previous approaches have used Gibbs 'potential' functions, φ(f v ) and φ(f h ), defined solely on spatial derivatives, f v and f h , of the source. These φ functions implicitly incorporate line processes, but only in an approximate manner. The correct φ function, φ * , consistent with the use of line processes, leads to difficult minimization problems. In this work, the authors present a method wherein the correct φ * function is approached through a sequence of smooth φ functions. This is the essence of a continuation method in which the minimum of the energy function corresponding to one member of the φ function sequence is used as an initial condition for the minimization of the next, less approximate, stage. The continuation method is implemented using a GEM-ICM procedure. Simulation results show improvement using the continuation method relative to using φ * alone, and to conventional EM reconstructions

  4. Continuous pneumothorax monitoring by remittance measurement

    NARCIS (Netherlands)

    Beek, J. F.; Sterenborg, H. J.; van Gemert, M. J.

    1993-01-01

    The feasibility of a noninvasive method, based on a remittance measurement, to monitor continuously for the occurrence of pneumothorax in neonates under ventilation, was investigated through animal experiments. Light from a He-Ne laser (632.8 nm) or a semiconductor laser (790 nm) was incident on the

  5. CONTINUING MEDICAL EDUCATION: CLOSING THE GAP ...

    African Journals Online (AJOL)

    drclement

    ABSTRACT. Continuing medical education (CME) has long been recognized as the key to updating and maintaining the knowledge and skill of health professionals.CME activities are well advocated, accepted and regulated in the developed world with sanctions for non-participation. In developing countries, including West ...

  6. Continuous variable tripartite entanglement from twin nonlinearities

    International Nuclear Information System (INIS)

    Olsen, M K; Bradley, A S

    2006-01-01

    In this work, we analyse and compare the continuous variable tripartite entanglement available from the use of two concurrent or cascaded χ (2) nonlinearities. We examine both idealized travelling-wave models and more experimentally realistic intracavity models, showing that tripartite entangled outputs are readily producible. These may be a useful resource for applications such as quantum cryptography and teleportation

  7. Screening for diabetic retinopathy | Rice | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 31, No 4 (2013) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  8. Marketing Realities in Continuing Professional Education.

    Science.gov (United States)

    Craven, Ruth F.; DuHamel, Martha B.

    2000-01-01

    Describes tenets of continuing professional education marketing: identify target audience, define mission, assess community needs, identify competition, establish credibility, develop marketing plans, provide options, evaluate, and develop high-quality programs. Offers advice for pricing, cancellations, new courses, promotion expenses, direct…

  9. The effectiveness of students redrafting continuous assessment ...

    African Journals Online (AJOL)

    In order to improve academic language competence, students in two academic literacy modules at the University of Johannesburg were given opportunities to resubmit continuous assessment tasks utilising tutor feedback to improve performance. Despite the potential benefits to the students, not all of them were taking ...

  10. Solidification control in continuous casting of steel

    Indian Academy of Sciences (India)

    Unknown

    Solidification in continuous casting (CC) technology is initiated in a water- ..... to fully austenitic solidification, and FP between 0 and 1 indicates mixed mode. ... the temperature interval (LIT – TSA) corresponding to fs = 0⋅9 → 1, is in reality the.

  11. Pipe Rolling from Continuous Cast Metal

    International Nuclear Information System (INIS)

    Zhordania, I.; Chkhartishvili, I.; Lordkipanidze, J.; Melashvili, Z.; Papava, K.; Khundadze, K.

    2007-01-01

    The approach to manufacturing of high quality pipes as a result of solid and hollow billet rolling from continuous cast metal is shown. Optimal parameters of piercing, temperature of piercing and piercing rolling mill rollers speed have been experimentally established. (author)

  12. Improvised bubble continuous positive airway pressure

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2014-08-15

    Aug 15, 2014 ... Abstract: Background: Prematur- ity accounts for 25% of Neonatal mortality in Nigeria and Respira- tory Distress Syndrome is respon- sible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket ...

  13. Ethical Issues in Continuing Professional Education.

    Science.gov (United States)

    Lawler, Patricia Ann

    2000-01-01

    Continuing professional education practitioners often face ethical dilemmas regarding their obligations to multiple stakeholders and issues arising in new arenas such as the workplace, distance education, and collaboration with business. Codes of ethics can guide practice, but practitioners should also identify their personal core values system…

  14. Learning Styles and Continuing Medical Education.

    Science.gov (United States)

    Van Voorhees, Curtis; And Others

    1988-01-01

    The Gregorc Style Delineator--Word Matrix was administered to 2,060 physicians in order to gain a better understanding of their participation in continuing medical education. The study showed that 63 percent preferred the concrete sequential learning style. Different style preferences may account for some of the apparent disparity between…

  15. Continuous vasopressin replacement in diabetes insipidus.

    OpenAIRE

    Ralston, C; Butt, W

    1990-01-01

    Five children who developed diabetes insipidus as a manifestation of severe brain injury received continuous intravenous treatment with a solution containing both aqueous vasopressin and appropriate crystalloid replacement. Polyuria, hypernatraemia, and decreased urine osmolalities were safely corrected in all patients within eight to 28 hours.

  16. Neural networks in continuous optical media

    International Nuclear Information System (INIS)

    Anderson, D.Z.

    1987-01-01

    The authors' interest is to see to what extent neural models can be implemented using continuous optical elements. Thus these optical networks represent a continuous distribution of neuronlike processors rather than a discrete collection. Most neural models have three characteristic features: interconnections; adaptivity; and nonlinearity. In their optical representation the interconnections are implemented with linear one- and two-port optical elements such as lenses and holograms. Real-time holographic media allow these interconnections to become adaptive. The nonlinearity is achieved with gain, for example, from two-beam coupling in photorefractive media or a pumped dye medium. Using these basic optical elements one can in principle construct continuous representations of a number of neural network models. The authors demonstrated two devices based on continuous optical elements: an associative memory which recalls an entire object when addressed with a partial object and a tracking novelty filter which identifies time-dependent features in an optical scene. These devices demonstrate the potential of distributed optical elements to implement more formal models of neural networks

  17. Alexander Graham Bell in Professional Continuing Education

    Science.gov (United States)

    Kasworm, Carol; Hampton, Leonard A.

    1976-01-01

    The University of Georgia Center for Continuing Education and the School of Pharmacy developed and presented, as a pilot project, a series of four telelectures at 10 locations throughout the State. Participating pharmacists were receptive to the approach and reported favorable reactions in the evaluation. (LH)

  18. Second Order Ideal-Ward Continuity

    Directory of Open Access Journals (Sweden)

    Bipan Hazarika

    2014-01-01

    Full Text Available The main aim of the paper is to introduce a concept of second order ideal-ward continuity in the sense that a function f is second order ideal-ward continuous if I-limn→∞Δ2f(xn=0 whenever I-limn→∞Δ2xn=0 and a concept of second order ideal-ward compactness in the sense that a subset E of R is second order ideal-ward compact if any sequence x=(xn of points in E has a subsequence z=(zk=(xnk of the sequence x such that I-limk→∞Δ2zk=0 where Δ2zk=zk+2-2zk+1+zk. We investigate the impact of changing the definition of convergence of sequences on the structure of ideal-ward continuity in the sense of second order ideal-ward continuity and compactness of sets in the sense of second order ideal-ward compactness and prove related theorems.

  19. Analytic continuation of weighted Bergman kernels

    Czech Academy of Sciences Publication Activity Database

    Engliš, Miroslav

    2010-01-01

    Roč. 94, č. 6 (2010), s. 622-650 ISSN 0021-7824 R&D Projects: GA AV ČR IAA100190802 Keywords : Bergman kernel * analytic continuation * Toeplitz operator Subject RIV: BA - General Mathematics Impact factor: 1.450, year: 2010 http://www.sciencedirect.com/science/article/pii/S0021782410000942

  20. Review article: Ethnomusicology and music education: Continuing ...

    African Journals Online (AJOL)

    This review article further explores the nexus between music education and African music/(ethno)musicology that continues the dialogue between the disciplines of musicology and ethnomusicology initiated by Susan Harrop-Allin in SAMUS vol. 25 109-24). Although there has been an explosion of literature over the last five ...

  1. 5 CFR 9701.105 - Continuing collaboration.

    Science.gov (United States)

    2010-01-01

    ... consideration in making a final decision. (f) Nothing in the continuing collaboration process affects the right... established by subpart E of this part, including but not limited to §§ 9701.512 (regarding conferring on... any time. (g) In accordance with 5 U.S.C. 9701(e)(2), any procedures necessary to carry out this...

  2. Continuous Improvement in State Funded Preschool Programs

    Science.gov (United States)

    Jackson, Sarah L.

    2012-01-01

    State funded preschool programs were constantly faced with the need to change in order to address internal and external demands. As programs engaged in efforts towards change, minimal research was available on how to support continuous improvement efforts within the context unique to state funded preschool programs. Guidance available had…

  3. Positive Behavior Support: Sustainability and Continuous Regeneration

    Science.gov (United States)

    McIntosh, Kent; Turri, Mary G.

    2014-01-01

    Because of its widespread adoption and implementation (in over 13,000 schools in the US; Center on Positive Behavioral Interventions and Supports, 2010), there has been increasing attention to how School-wide Positive Behavior Support (SWPBS) systems can be sustained. Sustained implementation can be defined as "continued use of an…

  4. Human Resource Management for Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Boer, Harry; Laugen, Bjørge

    2006-01-01

    The objective of this paper is to investigate the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, organizational performance. The paper i...

  5. Higher Order Continuous SI Engine Observers

    DEFF Research Database (Denmark)

    Vesterholm, Thomas; Hendricks, Elbert; Houbak, Niels

    1992-01-01

    A nonlinear compensator for the fuel film dynamics and a second order nonlinear observer for a spark ignition engine are presented in this paper. The compensator and observer are realized as continuous differential equations and an especially designed integration algorithm is used to integrate them...

  6. Continuous-variable quantum erasure correcting code

    DEFF Research Database (Denmark)

    Lassen, Mikael Østergaard; Sabuncu, Metin; Huck, Alexander

    2010-01-01

    We experimentally demonstrate a continuous variable quantum erasure-correcting code, which protects coherent states of light against complete erasure. The scheme encodes two coherent states into a bi-party entangled state, and the resulting 4-mode code is conveyed through 4 independent channels...

  7. Buckling analysis of continuous welded rail track

    NARCIS (Netherlands)

    Van, M.A.

    1996-01-01

    Continuous welded rail track, compared to jointed track not only reduces maintenance costs, but also increases life time of track components and the comfort of passengers. Since expansion of the rails is hardly possible in CWR-track, a temperature increase will result in high compressive stresses

  8. Online Continuing Medical Education in Saudi Arabia

    Science.gov (United States)

    Alwadie, Adnan D.

    2013-01-01

    As the largest country in the Middle East, Saudi Arabia and its health care system are well positioned to embark on an online learning intervention so that health care providers in all areas of the country have the resources for updating their professional knowledge and skills. After a brief introduction, online continuing medical education is…

  9. Profilometric characterization of DOEs with continuous microrelief

    Science.gov (United States)

    Korolkov, V. P.; Ostapenko, S. V.; Shimansky, R. V.

    2008-09-01

    Methodology of local characterization of continuous-relief diffractive optical elements has been discussed. The local profile depth can be evaluated using "approximated depth" defined without taking a profile near diffractive zone boundaries into account. Several methods to estimate the approximated depth have been offered.

  10. Antibiotic Dosing in Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Shaw, Alexander R; Mueller, Bruce A

    2017-07-01

    Appropriate antibiotic dosing is critical to improve outcomes in critically ill patients with sepsis. The addition of continuous renal replacement therapy makes achieving appropriate antibiotic dosing more difficult. The lack of continuous renal replacement therapy standardization results in treatment variability between patients and may influence whether appropriate antibiotic exposure is achieved. The aim of this study was to determine if continuous renal replacement therapy effluent flow rate impacts attaining appropriate antibiotic concentrations when conventional continuous renal replacement therapy antibiotic doses were used. This study used Monte Carlo simulations to evaluate the effect of effluent flow rate variance on pharmacodynamic target attainment for cefepime, ceftazidime, levofloxacin, meropenem, piperacillin, and tazobactam. Published demographic and pharmacokinetic parameters for each antibiotic were used to develop a pharmacokinetic model. Monte Carlo simulations of 5000 patients were evaluated for each antibiotic dosing regimen at the extremes of Kidney Disease: Improving Global Outcomes guidelines recommended effluent flow rates (20 and 35 mL/kg/h). The probability of target attainment was calculated using antibiotic-specific pharmacodynamic targets assessed over the first 72 hours of therapy. Most conventional published antibiotic dosing recommendations, except for levofloxacin, reach acceptable probability of target attainment rates when effluent rates of 20 or 35 mL/kg/h are used. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  11. Google Scholar and the Continuing Education Literature

    Science.gov (United States)

    Howland, Jared L.; Howell, Scott; Wright, Thomas C.; Dickson, Cody

    2009-01-01

    The recent introduction of Google Scholar has renewed hope that someday a powerful research tool will bring continuing education literature more quickly, freely, and completely to one's computer. The authors suggest that using Google Scholar with other traditional search methods will narrow the research gap between what is discoverable and…

  12. A type system for continuation calculus

    NARCIS (Netherlands)

    Geuvers, J.H.; Geraedts, W.; Geron, B.; Stegeren, van J.; Oliva, P.

    2014-01-01

    Continuation Calculus (CC), introduced by Geron and Geuvers, is a simple foundational model for functional computation. It is closely related to lambda calculus and term rewriting, but it has no variable binding and no pattern matching. It is Turing complete and evaluation is deterministic. Notions

  13. Continuity of pharmaceutical care for psychiatric patients

    NARCIS (Netherlands)

    Abdullah-Koolmees, Heshu

    2015-01-01

    Psychiatric diseases are common. The effective treatment of a psychiatric disease, its (somatic) side effects and any concurrent somatic diseases is important for the patient’s overall health and wellbeing. The studies conducted in psychiatric patients generally focus on the continuation of

  14. Problems of implementing continuous assessment in secondary ...

    African Journals Online (AJOL)

    The paper examined problems of implementing continuous assessment in secondary schools in Obowo local government area of Imo State, Nigeria. Data were collected with the aid of a structured questionnaire administered to 100 randomly selected respondents in the study area. Descriptive statistics were used for data ...

  15. Continuing Professional Education in the Military

    Science.gov (United States)

    Gleiman, Ashley; Zacharakis, Jeff

    2016-01-01

    The military relies on continuing professional education as a key component to the success of its organization. With decreasing budgets and increasing importance for a force that operates efficiently and thinks critically, the cognitive tension among training, education, and learning comes center stage.

  16. Continuous EEG Monitoring in Aneurysmal Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Friberg, Christian Kærsmose; Wellwood, Ian

    2015-01-01

    BACKGROUND: Continuous EEG (cEEG) may allow monitoring of patients with aneurysmal subarachnoid hemorrhage (SAH) for delayed cerebral ischemia (DCI) and seizures, including non-convulsive seizures (NCSz), and non-convulsive status epilepticus (NCSE). We aimed to evaluate: (a) the diagnostic...

  17. 7 CFR 8.7 - Continued use.

    Science.gov (United States)

    2010-01-01

    ... the Secretary of Agriculture 4-H CLUB NAME AND EMBLEM § 8.7 Continued use. (a) The Cooperative... use the 4-H Club Name or Emblem: (1) For their own educational or informational purposes according to... materials bearing the 4-H Club Name or Emblem. (4) Any proposal for distribution on an interstate, regional...

  18. Le continu contre l'espace

    Science.gov (United States)

    Salanskis, Jean-Michel

    Disons pour conclure que, en tout état de cause, la façon de concevoir philosophiquement le conflit du continu et de l'espace que nous avons trouvée chez Hegel n'est pas homogène avec le style et les modalités de la pensée mathématique: 1) d'une part, le lien classique, le lien de référence entre continu et espace en mathématiques n'est pas que l'espace serait premier et privé de pensée, et le continu second, venant dissoudre l'espace en apportant la qualité, l'infini et la pensée, mais tout au contraire, il consiste en ce que l'espace est fondé sur l'abîme infinitaire du continu ; 2) d'autre part, l'éventuel divorce entre l'espace et le continu dans l'aire mathématique n'est pas celui d'une réflexivité purement conceptuelle du continu avec un positivisme géométrique, n'équivaut pas à une rupture disciplinaire ; il est plutôt le symptôme de la dérive d'une herméneutique à l'égard d'une autre, au sein d'un continent juridique commun définissant la discipline (la mathématique ensembliste), cette dérive pouvant, à la limite, induire une refonte de ce sol juridique, sans que jamais il soit question pour autant de nier l'unité des mathématiques, à comprendre ici comme l'unité ultime de responsabilité de la communauté mathématique à l'égard des trois questions Qu'est-ce que l'espace?”, “Qu'est-ce que le continu?” et “Qu'est-ce que l'infini?”.

  19. Assessment of dialyzer surface in online hemodiafiltration; objective choice of dialyzer surface area

    Directory of Open Access Journals (Sweden)

    Francisco Maduell

    2015-05-01

    Conclusion: The increase in 40% and 80% of dialyzer surface area entails an increase in convective volume of 6 and 16% respectively, showing minimal differences both in convective volume and clearance capacity when UFC was greater than 45 mL/h/mmHg. It is advisable to optimise dialyser efficiency to the smallest surface area possible, adjusting treatment prescription.

  20. Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

    OpenAIRE

    Ramponi, Francesco; Ronco, Claudio; Mason, Giacomo; Rettore, Enrico; Marcelli, Daniele; Martino, Francesca; Neri, Mauro; Martin-malo, Alejandro; Canaud, Bernard; Locatelli, Francesco

    2016-01-01

    Francesco Ramponi,1,2 Claudio Ronco,1,3 Giacomo Mason,1 Enrico Rettore,4 Daniele Marcelli,5,6 Francesca Martino,1,3 Mauro Neri,1,7 Alejandro Martin-Malo,8 Bernard Canaud,5,9 Francesco Locatelli10 1International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, 2Department of Economics and Management, University of Padova, Padova, 3Department of Nephrology, San Bortolo Hospital, Vicenza, 4Department of Sociology and Social Research, University of Trento, FBK-IRVAPP & IZA...

  1. Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

    OpenAIRE

    Ramponi F; Ronco C; Mason G; Rettore E; Marcelli D; Martino F; Neri M; Martin-Malo A; Canaud B; Locatelli F

    2016-01-01

    Francesco Ramponi,1,2 Claudio Ronco,1,3 Giacomo Mason,1 Enrico Rettore,4 Daniele Marcelli,5,6 Francesca Martino,1,3 Mauro Neri,1,7 Alejandro Martin-Malo,8 Bernard Canaud,5,9 Francesco Locatelli10 1International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, 2Department of Economics and Management, University of Padova, Padova, 3Department of Nephrology, San Bortolo Hospital, Vicenza, 4Department of Sociology and Social Research, University of Trento, FBK-IRVAPP & IZA, Tr...

  2. Assessment of dialyzer surface in online hemodiafiltration; objective choice of dialyzer surface area

    OpenAIRE

    Francisco Maduell; Raquel Ojeda; Marta Arias-Guillén; Giannina Bazan; Manel Vera; Néstor Fontseré; Elisabeth Massó; Miquel Gómez; Lida Rodas; Mario Jiménez-Hernández; Gastón Piñeiro; Nayra Rico

    2015-01-01

    Introduction: Online haemodiafiltration (OL-HDF) is most effective technique; several randomised studies and meta-analyses have shown a reduction in mortality, with a directly related association with convective volume. At present, it is not properly established whether the increasing in dialyser surface area may suppose better outcomes in terms of convective and clearance efficacy. The purpose of the study was to assess the effect of increase in dialyser surface area on the convective volume...

  3. Excursions in fluvial (dis)continuity

    Science.gov (United States)

    Grant, Gordon E.; O'Connor, James E.; Safran, Elizabeth

    2017-01-01

    Lurking below the twin concepts of connectivity and disconnectivity are their first, and in some ways, richer cousins: continuity and discontinuity. In this paper we explore how continuity and discontinuity represent fundamental and complementary perspectives in fluvial geomorphology, and how these perspectives inform and underlie our conceptions of connectivity in landscapes and rivers. We examine the historical roots of continuum and discontinuum thinking, and how much of our understanding of geomorphology rests on contrasting views of continuity and discontinuity. By continuum thinking we refer to a conception of geomorphic processes as well as geomorphic features that are expressed along continuous gradients without abrupt changes, transitions, or thresholds. Balance of forces, graded streams, and hydraulic geometry are all examples of this perspective. The continuum view has played a prominent role in diverse disciplinary fields, including ecology, paleontology, and evolutionary biology, in large part because it allows us to treat complex phenomena as orderly progressions and invoke or assume equilibrium processes that introduce order and prediction into our sciences.In contrast the discontinuous view is a distinct though complementary conceptual framework that incorporates non-uniform, non-progressive, and non-equilibrium thinking into understanding geomorphic processes and landscapes. We distinguish and discuss examples of three different ways in which discontinuous thinking can be expressed: 1) discontinuous spatial arrangements or singular events; 2) specific process domains generally associated with thresholds, either intrinsic or extrinsic; and 3) physical dynamics or changes in state, again often threshold-linked. In moving beyond the continuous perspective, a fertile set of ideas comes into focus: thresholds, non-equilibrium states, heterogeneity, catastrophe. The range of phenomena that is thereby opened up to scientific exploration similarly expands

  4. Marketing Continuing Education: A Study of Price Strategies. Occasional Papers in Continuing Education, No. 11.

    Science.gov (United States)

    Lamoureux, Marvin E.

    The objective of the study conducted at the Centre for Continuing Education (CCE) at the University of British Columbia was to determine that threshold pricing not only existed for continuing education courses, but also was applicable to an administrative decision-making structure. The first part of the three-part investigation analyzed consumer…

  5. White paper on continuous bioprocessing. May 20-21, 2014 Continuous Manufacturing Symposium.

    Science.gov (United States)

    Konstantinov, Konstantin B; Cooney, Charles L

    2015-03-01

    There is a growing interest in realizing the benefits of continuous processing in biologics manufacturing, which is reflected by the significant number of industrial and academic researchers who are actively involved in the development of continuous bioprocessing systems. These efforts are further encouraged by guidance expressed in recent US FDA conference presentations. The advantages of continuous manufacturing include sustained operation with consistent product quality, reduced equipment size, high-volumetric productivity, streamlined process flow, low-process cycle times, and reduced capital and operating cost. This technology, however, poses challenges, which need to be addressed before routine implementation is considered. This paper, which is based on the available literature and input from a large number of reviewers, is intended to provide a consensus of the opportunities, technical needs, and strategic directions for continuous bioprocessing. The discussion is supported by several examples illustrating various architectures of continuous bioprocessing systems. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

  6. Dynamics of neural networks with continuous attractors

    Science.gov (United States)

    Fung, C. C. Alan; Wong, K. Y. Michael; Wu, Si

    2008-10-01

    We investigate the dynamics of continuous attractor neural networks (CANNs). Due to the translational invariance of their neuronal interactions, CANNs can hold a continuous family of stationary states. We systematically explore how their neutral stability facilitates the tracking performance of a CANN, which is believed to have wide applications in brain functions. We develop a perturbative approach that utilizes the dominant movement of the network stationary states in the state space. We quantify the distortions of the bump shape during tracking, and study their effects on the tracking performance. Results are obtained on the maximum speed for a moving stimulus to be trackable, and the reaction time to catch up an abrupt change in stimulus.

  7. The ultimatum game: Discrete vs. continuous offers

    Science.gov (United States)

    Dishon-Berkovits, Miriam; Berkovits, Richard

    2014-09-01

    In many experimental setups in social-sciences, psychology and economy the subjects are requested to accept or dispense monetary compensation which is usually given in discrete units. Using computer and mathematical modeling we show that in the framework of studying the dynamics of acceptance of proposals in the ultimatum game, the long time dynamics of acceptance of offers in the game are completely different for discrete vs. continuous offers. For discrete values the dynamics follow an exponential behavior. However, for continuous offers the dynamics are described by a power-law. This is shown using an agent based computer simulation as well as by utilizing an analytical solution of a mean-field equation describing the model. These findings have implications to the design and interpretation of socio-economical experiments beyond the ultimatum game.

  8. CONTINEX: A Toolbox for Continuation in Experiments

    DEFF Research Database (Denmark)

    Schilder, Frank; Bureau, Emil; Santos, Ilmar

    2014-01-01

    CONTINEX is a MATLAB toolbox for bifurcation analysis based on the development platform COCO (computational continuation core). CONTINEX is specifically designed for coupling to experimental test specimen via DSPACE, but provides also interfaces to SIMULINK-, ODE-, and so-called equation-free mod......CONTINEX is a MATLAB toolbox for bifurcation analysis based on the development platform COCO (computational continuation core). CONTINEX is specifically designed for coupling to experimental test specimen via DSPACE, but provides also interfaces to SIMULINK-, ODE-, and so-called equation......-free models. The current version of the interface for experimental set-ups implements an algorithm for tuning control parameters, a robust noise-tolerant covering algorithm, and functions for monitoring (in)stability. In this talk we will report on experiments with an impact oscillator with magnetic actuators...

  9. Continuing challenges in nuclear air cleaning

    International Nuclear Information System (INIS)

    Moeller, D.W.

    1976-01-01

    The safe operation of nuclear facilities is heavily dependent upon the adequate performance of air cleaning systems. Although many problems have been solved, new questions and new challenges continue to arise. These are well illustrated by weaknesses in air cleaning and ventilating systems revealed by the Browns Ferry fire, and the need to develop additional data on the reliability of such systems, particularly under emergency conditions, as revealed by the Reactor Safety Study. Assessments of the degree to which engineered safety features can compensate for deficiencies in nuclear power plant sites continue to challenge those involved in risk/benefit evaluations. Additional challenges are being generated by the air cleaning requirements associated with the commercial development of the liquid metal fast breeder reactor

  10. Continuous centrifuge decelerator for polar molecules.

    Science.gov (United States)

    Chervenkov, S; Wu, X; Bayerl, J; Rohlfes, A; Gantner, T; Zeppenfeld, M; Rempe, G

    2014-01-10

    Producing large samples of slow molecules from thermal-velocity ensembles is a formidable challenge. Here we employ a centrifugal force to produce a continuous molecular beam with a high flux at near-zero velocities. We demonstrate deceleration of three electrically guided molecular species, CH3F, CF3H, and CF3CCH, with input velocities of up to 200  m s(-1) to obtain beams with velocities below 15  m s(-1) and intensities of several 10(9)  mm(-2) s(-1). The centrifuge decelerator is easy to operate and can, in principle, slow down any guidable particle. It has the potential to become a standard technique for continuous deceleration of molecules.

  11. Interaction-aided continuous time quantum search

    International Nuclear Information System (INIS)

    Bae, Joonwoo; Kwon, Younghun; Baek, Inchan; Yoon, Dalsun

    2005-01-01

    The continuous quantum search algorithm (based on the Farhi-Gutmann Hamiltonian evolution) is known to be analogous to the Grover (or discrete time quantum) algorithm. Any errors introduced in Grover algorithm are fatal to its success. In the same way the Farhi-Gutmann Hamiltonian algorithm has a severe difficulty when the Hamiltonian is perturbed. In this letter we will show that the interaction term in quantum search Hamiltonian (actually which is in the generalized quantum search Hamiltonian) can save the perturbed Farhi-Gutmann Hamiltonian that should otherwise fail. We note that this fact is quite remarkable since it implies that introduction of interaction can be a way to correct some errors on the continuous time quantum search

  12. VIRTUAL ENVIRONMENT FOR CONTINUING MEDICAL EDUCATION

    Directory of Open Access Journals (Sweden)

    Sorana D. BOLBOACA

    2007-01-01

    Full Text Available The rapid development of communication and information technologies lead to the changes in continuing medical education by offering the possibility to move up-to-date medical information through Internet to the physicians. The main goal of this study was to create a virtual space for continuing medical education. In this context, a number of computer-assisted tools for instruction, evaluation and utilization in daily activity have been developed and integrated into a unitary system. The main imposed specifications of the system were accessibility, integrity, availability, and security.This report describes the characteristics of tables design and organization, and of system integration. The security level was imposed for assuring the accessibility of each physician to medical information useful in his or her activity and the knowledge database development.

  13. Quantitative Tomography for Continuous Variable Quantum Systems

    Science.gov (United States)

    Landon-Cardinal, Olivier; Govia, Luke C. G.; Clerk, Aashish A.

    2018-03-01

    We present a continuous variable tomography scheme that reconstructs the Husimi Q function (Wigner function) by Lagrange interpolation, using measurements of the Q function (Wigner function) at the Padua points, conjectured to be optimal sampling points for two dimensional reconstruction. Our approach drastically reduces the number of measurements required compared to using equidistant points on a regular grid, although reanalysis of such experiments is possible. The reconstruction algorithm produces a reconstructed function with exponentially decreasing error and quasilinear runtime in the number of Padua points. Moreover, using the interpolating polynomial of the Q function, we present a technique to directly estimate the density matrix elements of the continuous variable state, with only a linear propagation of input measurement error. Furthermore, we derive a state-independent analytical bound on this error, such that our estimate of the density matrix is accompanied by a measure of its uncertainty.

  14. a Continuous-Time Positive Linear System

    Directory of Open Access Journals (Sweden)

    Kyungsup Kim

    2013-01-01

    Full Text Available This paper discusses a computational method to construct positive realizations with sparse matrices for continuous-time positive linear systems with multiple complex poles. To construct a positive realization of a continuous-time system, we use a Markov sequence similar to the impulse response sequence that is used in the discrete-time case. The existence of the proposed positive realization can be analyzed with the concept of a polyhedral convex cone. We provide a constructive algorithm to compute positive realizations with sparse matrices of some positive systems under certain conditions. A sufficient condition for the existence of a positive realization, under which the proposed constructive algorithm works well, is analyzed.

  15. The Continuous Electron Beam Accelerator Facility

    International Nuclear Information System (INIS)

    Grunder, H.A.; Bisognano, J.J.; Diamond, W.I.; Hartline, B.K.; Leemann, C.W.; Mougey, J.; Sundelin, R.M.; York, R.C.

    1987-01-01

    On February 13, 1987, construction started on the Continuous Electron Beam Accelerator Facility - a 4-GeV, 200-μA, continuous beam, electron accelerator facility designed for nuclear physics research. The machine has a racetrack configuration with two antiparallel, 500-MeV, superconducting linac segments connected by beam lines to allow four passes of recirculation. The accelerating structure consists of 1500-MHz, five-cell niobium cavities developed at Cornell University. A liquid helium cryogenic system cools the cavities to an operating temperature of 2 K. Beam extraction after any three of the four passes allows simultaneous delivery of up to three beams of independently variable currents and different, but correlated, energies to the three experimental areas. Beam breakup thresholds exceed the design current by nearly two orders of magnitude. Project completion and the start of physics operations are scheduled for 1993. The total estimated cost is $255 million

  16. Developing a Forensic Continuous Audit Model

    Directory of Open Access Journals (Sweden)

    Grover S. Kearns

    2011-06-01

    Full Text Available Despite increased attention to internal controls and risk assessment, traditional audit approaches do not seem to be highly effective in uncovering the majority of frauds. Less than 20 percent of all occupational frauds are uncovered by auditors. Forensic accounting has recognized the need for automated approaches to fraud analysis yet research has not examined the benefits of forensic continuous auditing as a method to detect and deter corporate fraud. The purpose of this paper is to show how such an approach is possible. A model is presented that supports the acceptance of forensic continuous auditing by auditors and management as an effective tool to support the audit function, meet management’s regulatory objectives, and to combat fraud. An approach to developing such a system is presented.

  17. Continuous denitration device by microwave heating

    International Nuclear Information System (INIS)

    Matsumaru, Ken-ichi; Sato, Hajime.

    1982-01-01

    Purpose: To continuously obtain powder of uranium dioxide, plutonium dioxide or a mixture of them respectively from the solution of uranyl nitrate, plutonium nitrate or a mixture of them effectively while maintaining a constant quality. Constitution: Plutonium nitrate or uranium nitrate solution is deposited on a rotational drum having a heater and dried into powderous products. The powderous products are scraped off by a blade, transferred to a belt conveyor, entered into a microwave heating furnace and heated by microwaves while stirring to obtain the powder of plutonium dioxide or uranium dioxide. The powderous products are scraped off by a scraper and collected in a receiving tank for denitration products, whereby the feeding solution can be denitrated continuously. (Horiuchi, T.)

  18. Continuous Dimensionality Characterization of Image Structures

    DEFF Research Database (Denmark)

    Felsberg, Michael; Kalkan, Sinan; Krüger, Norbert

    2009-01-01

    gradient field. By making use of a cone structure and barycentric co-ordinates, we can associate three confidences to the three different ideal cases of intrinsic dimensions corresponding to homogeneous image patches, edge-like structures and junctions. The main novelty of our approach......Intrinsic dimensionality is a concept introduced by statistics and later used in image processing to measure the dimensionality of a data set. In this paper, we introduce a continuous representation of the intrinsic dimension of an image patch in terms of its local spectrum or, equivalently, its...... is the representation of confidences as prior probabilities which can be used within a probabilistic framework. To show the potential of our continuous representation, we highlight applications in various contexts such as image structure classification, feature detection and localisation, visual scene statistics...

  19. Learning to forget: continual prediction with LSTM.

    Science.gov (United States)

    Gers, F A; Schmidhuber, J; Cummins, F

    2000-10-01

    Long short-term memory (LSTM; Hochreiter & Schmidhuber, 1997) can solve numerous tasks not solvable by previous learning algorithms for recurrent neural networks (RNNs). We identify a weakness of LSTM networks processing continual input streams that are not a priori segmented into subsequences with explicitly marked ends at which the network's internal state could be reset. Without resets, the state may grow indefinitely and eventually cause the network to break down. Our remedy is a novel, adaptive "forget gate" that enables an LSTM cell to learn to reset itself at appropriate times, thus releasing internal resources. We review illustrative benchmark problems on which standard LSTM outperforms other RNN algorithms. All algorithms (including LSTM) fail to solve continual versions of these problems. LSTM with forget gates, however, easily solves them, and in an elegant way.

  20. Quantitative Tomography for Continuous Variable Quantum Systems.

    Science.gov (United States)

    Landon-Cardinal, Olivier; Govia, Luke C G; Clerk, Aashish A

    2018-03-02

    We present a continuous variable tomography scheme that reconstructs the Husimi Q function (Wigner function) by Lagrange interpolation, using measurements of the Q function (Wigner function) at the Padua points, conjectured to be optimal sampling points for two dimensional reconstruction. Our approach drastically reduces the number of measurements required compared to using equidistant points on a regular grid, although reanalysis of such experiments is possible. The reconstruction algorithm produces a reconstructed function with exponentially decreasing error and quasilinear runtime in the number of Padua points. Moreover, using the interpolating polynomial of the Q function, we present a technique to directly estimate the density matrix elements of the continuous variable state, with only a linear propagation of input measurement error. Furthermore, we derive a state-independent analytical bound on this error, such that our estimate of the density matrix is accompanied by a measure of its uncertainty.