"SYMBIOTIC" HEMOFILTRATION FOR CHRONIC RENAL F AILURE COMPENSATION

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E. A. Yumatov

2015-01-01

Full Text Available AbstractWidely used nowadays hemodialysis and hemofiltration cannot replace completely the excretory function of human kidneys in the natural conditions of physiological regulation. The aim of our study is to develop and create a new method and apparatus for CRF patients «symbiotic» compensation, based on hemofiltration and healthy humans kidneys natural physiological functions, excluding mixing of partners blood.Method of «symbiotic» hemofiltration is based on mutual exchange of equivalent blood ultrafiltrate volumes between healthy person and CRF patient, needed to be cleansed from metabolites. During exchange procedure patient’s and a healthy person’s circulations are separated by hemofilters excluding blood mixing.During CRF patient’s blood cleansing from metabolic products separate hemofiltration of healthy donor and CRF patient in equal volumes is processed. Patient’s blood ultrafiltrate enters the bloodstream of a healthy person, as a healthy person ultrafiltrate in the same extent enters the bloodstream of CRF patient. At the same time remaining after filtration blood components of donor and patient are returned in their bloodstream respectively.Fundamentally important advantage of «symbiotic» hemofiltration is that CRF patient’s blood is cleansed from uremic metabolites due to healthy human kidneys natural physiological functions. «Symbiotic» hemofiltration is a highly effective physiological method of CRP patient’s blood purification from the uremic substances.

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

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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.

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

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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.

The big bang of hemofiltration: the beginning of a new era in the third millennium for extra-corporeal blood purification!

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Honore', P M; Joannes-Boyau, O; Merson, L; Boer, W; Piette, V; Galloy, A-C; Janvier, G

2006-07-01

Since the last decade, hemofiltration and especially high volume hemofiltration has rapidly evolved from a somewhat experimental treatment towards a potentially effective 'adjunctive' therapy in severe septic shock and especially refractory or catecholamine resistant hypodynamic septic shock. Nevertheless, this approach lacks prospective randomized studies (PRT'S) evaluating the critical role of early hemofiltration in sepsis. An important step forward which could be called the 'big bang' in term of hemofiltration was the publication of a PRT in patients with acute renal failure (ARF) (1). Before this study (2), nobody believed that hemofiltration could change the survival rate in intensive care. Since that big bang, many physicians consider that hemofiltration at a certain dose can change the survival rate in intensive care. So the world of hemofiltration in ICU is not a definitive world, it is still in expansion. Indeed, we now have to try to define what will be the exact dose we need in septic acute renal failure. This dose might well be 'higher' than 35 ml/kg/hour in the septic acute renal failure 'group' as suggested by many studies (2-5). At present, it is the issue of continuous dose of high volume hemofiltration that has to be tested in future randomized studies. Since the Vicenza study (2) has shown that 35 ml/kg/h is the best dose in terms of survival, dealing with non septic acute renal failure in ICU, several studies from different groups have shown that, in septic acute renal failure, a higher dose might correlate with better survival. This has also been shown in some way by the study of the 'Vicenza group' but not with a statistically significant value (2). New PRT'S have just started in Europe like the IVOIRE study (hIgh VOlume in Intensive caRE) (6) and the RENAL study. Another large study is looking more basically at dose in non septic acute renal failure in Australasia and is led by the group of Rinaldo Bellomo in Melbourne (7) as well as the ATN

Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

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Rabie Soliman

2016-01-01

Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

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

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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.

Physical Compatibility of Magnesium Sulfate and Sodium Bicarbonate in a Pharmacy-compounded Bicarbonate-buffered Hemofiltration Solution

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Moriyama, Brad; Henning, Stacey A.; Jin, Haksong; Kolf, Mike; Rehak, Nadja N.; Danner, Robert L.; Walsh, Thomas J.; Grimes, George J.

2011-01-01

PURPOSE To assess the physical compatibility of magnesium sulfate and sodium bicarbonate in a pharmacy-compounded bicarbonate-buffered hemofiltration solution used at the National Institutes of Health Clinical Center (http://www.cc.nih.gov). METHODS Two hemofiltration fluid formulations with a bicarbonate of 50 mEq/L and a magnesium of 1.5 mEq/L or 15 mEq/L were prepared in triplicate with an automated compounding device. The hemofiltration solution with a bicarbonate of 50 mEq/L and a magnesium of 1.5 mEq/L contains the maximum concentration of additives that we use in clinical practice. The hemofiltration solution of 15 mEq/L of magnesium and 50 mEq/L of bicarbonate was used to study the physicochemical properties of this interaction. The solutions were stored without light protection at 22 to 25 °C for 48 hours. Physical compatibility was assessed by visual inspection and microscopy. The pH of the solutions was assayed at 3 to 4 hours and 52 to 53 hours after compounding. In addition, electrolyte and glucose concentrations in the solutions were assayed at two time points after preparation: 3 to 4 hours and 50 to 51 hours. RESULTS No particulate matter was observed by visual and microscopic inspection in the compounded hemofiltration solutions at 48 hours. Electrolyte and glucose concentrations and pH were similar at both time points after solution preparation. CONCLUSION Magnesium sulfate (1.5 mEq/L) and sodium bicarbonate (50 mEq/L) were physically compatible in a pharmacy-compounded bicarbonate-buffered hemofiltration solution at room temperature without light protection at 48 hours. PMID:20237384

Automatic Control of Veno-Venous Extracorporeal Lung Assist.

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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.

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

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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.

Effect of continuous hemofiltration on internal environment and survival rate of severe heatstroke dogs with shock

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Guang-ming CHEN

2011-08-01

Full Text Available Objective To explore the effect of continuous hemofiltration(CHF on internal environment and survival rate of severe heatstroke dogs with shock.Methods Sixteen healthy male dogs were randomly divided into heatshock group(HS group,n=8 and continuous hemofiltration group(CHF group,n=8.Severe heatstroke model was established by applying high temperature to whole body,and then the animals were removed from the heating cabin as soon as they presented manifestations of shock.Dogs of HS group were put into an ordinary environment,while dogs of CHF group received CHF treatment.The core temperature(Tc,mean arterial pressure(MAP,blood gas analysis,serum electrolytes and survival rate of dogs in two groups were observed.Results The time from heat exposure to shock was 107.0±28.5min and 111.4±22.2min in HS group and CHF group respectively(t=-0.354,P=0.729.The Tc in CHF group declined to normal level 15 to 30 minitues after CHF treatment,while the Tc in HS group remained at a level higher than that before heat exposure at 90min after shock.The Tc of two groups showed significant difference at each time point after shock(P < 0.01.The MAP of both groups was obviously lowered than that before heatstroke.The MAP of CHF group raised gradually 30 min after treatment,while the MAP of HS group rose very slowly,and it was significantly lower than that of CHF group at each time point after 45min(P < 0.05,P < 0.01.All the dogs in both groups manifested hyperventilation and respiratory alkalosis when shock appeared.After shock,respiratory alkalosis in HS group gradually became metabolic acidosis,with some animals manifested combined metabolic and respiratory acidosis because of respiratory decompensation,while the blood gas levels in CHF group recovered to normal gradually.The blood gas levels of two groups showed significant difference at each time point after shock(P < 0.05,P < 0.01.Hypernatremia,hyperchloraemia and hyperpotassaemia were found in all animals of both

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

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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.

RETRACTED: Six different hemofiltration devices for blood conservation in cardiac surgery.

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Boldt, J; Zickmann, B; Fedderson, B; Herold, C; Dapper, F; Hempelmann, G

1991-05-01

Hemofiltration devices and the Cell Saver are the most often used techniques to reduce homologous blood requirements in cardiac surgery. In a controlled, randomized study, 105 patients underwent elective aortocoronary bypass grafting. Six different hemofilters (HF-80, HFT 14, CPB 7000, Cobe 1200, UF-205, BC-140) were tested and compared with the Cell Saver (Cell Saver 4) for blood concentration during and after cardiopulmonary bypass. Efficacy, practicality, and laboratory indices including coagulation variables were documented through the morning of the first postoperative day. The HF-80 and UF-205 were the most effective devices for blood concentration. At the end of the operation, the number of platelets was least reduced in these two groups (HF-80, -7%; UF-205, -6%). Moreover, both devices had a significantly higher filtration rate than the other hemofilters. Use of the Cell Saver resulted in the lowest values in coagulation variables (AT-III, fibrinogen, number of platelets) and the most pronounced deterioration in protein homeostasis (colloid osmotic pressure, albumin). In this group, the AT-III concentration was reduced until the morning of the first postoperative day. No negative effects were seen in regard to hemofiltration (free hemoglobin and polymorphonuclear elastase; the Cell Saver group had similar values for these variables). We conclude that blood salvage with hemofiltration devices is superior to that with the Cell Saver. There were, however, significant differences among the hemofilters. The HF-80 and UF-205 were the most effective devices in this study.

Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit.

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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.

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

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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.

Study on the treatment of acute thallium poisoning.

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Zhang, Hong-Tao; Qiao, Bao-Ping; Liu, Bao-Ping; Zhao, Xian-Guo

2014-05-01

Acute thallium poisoning rarely occurs but is a serious and even fatal medical condition. Currently, patients with acute thallium poisoning are usually treated with Prussian blue and blood purification therapy. However, there are few studies about these treatments for acute thallium poisoning. Nine patients with acute thallium poisoning from 1 family were treated successfully with Prussian blue and different types of blood purification therapies and analyzed. Prussian blue combined with sequential hemodialysis, hemoperfusion and/or continuous veno-venous hemofiltration were effective for the treatment of patients with acute thallium poisoning, even after delayed diagnosis. Blood purification therapies help in the clearance of thallium in those with acute thallium poisoning. Prussian blue treatment may do the benefit during this process.

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

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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.

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.

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

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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.

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

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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

Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy

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Pyoung Ahn

2013-12-01

Full Text Available Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

Impossible Airway Requiring Venovenous Bypass for Tracheostomy

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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.

Early Stage Blood Purification for Paraquat Poisoning: A Multicenter Retrospective Study.

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Li, An; Li, Wenxiong; Hao, Fengtong; Wang, Haishi

2016-01-01

To evaluate the efficacy of conservative treatment vs. hemoperfusion (HP) vs. HP + continuous veno-venous hemofiltration (CVVH) for acute Paraquat (PQ) poisoning. This was a multicenter retrospective study of patients with PQ poisoning between January 2013 and June 2014. Clinical data and PQ serum levels were collected at baseline and after 24, 48, and 72 h of treatment. Seventy-five, 65, and 43 underwent conservative treatment only (conservative treatment group), conservative treatment + HP (HP group), and conservative treatment + HP + CVVH (HP + CVVH group), respectively. PQ serum levels decreased in all groups after 72 h of treatment (p treatment group. More importantly, PQ blood levels were significantly lower in the HP + CVVH group compared with the HP group at 24 h (p treatment group (p poisoning could decrease PQ blood levels, alleviate organ damage, and increase survival. © 2016 S. Karger AG, Basel.

Transfer of endogenous pyrogens across artificial membranes?

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Lonnemann, G; Linnenweber, S; Burg, M; Koch, K M

1998-05-01

Synthetic high-flux dialyzer membranes used in continuous veno-venous hemofiltration are permeable to middle molecular size endogenous pyrogens, the pro-inflammatory cytokines IL-1 beta and TNF-alpha. The quantities removed by sieving are, however, negligible in vitro as well as in vivo. Adsorption of cytokines to the membrane polymer is the major mechanism of pyrogen removal. Adsorption seems to be semispecific for pro-inflammatory cytokines because levels of anti-inflammatory mediators were not changed or even increased during CVVH. Thus, CVVH may change cytokine profiles in septic patients supporting the predominance of anti-inflammatory over pro-inflammatory activity in plasma. It remains to be demonstrated whether modifications of extracorporeal blood purification systems (high-volume CVVH, plasma separation + adsorption) are able to amplify the change in cytokine profiles and whether this change influences outcome of septic patients.

HEMOFILTRATION AND COUPLED PLASMA FILTRATION ADSORPTION IMPACT ON TACROLIMUS BLOOD CONCENTRATION IN RENAL TRANSPLANT RECIPIENTS

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A.V. Vatazin

2014-01-01

Full Text Available Aim. To study the effect of hemofi ltration and coupled plasma fi ltration adsorption on tacrolimus blood concentration in renal transplant recipients.Methods and results. The study included 8 renal transplant recipients. In these patients immediately after the operation was performed the coupled plasma fi ltration adsorption with hemofiltration using a cartridge Mediasorb to reduce the severity of reperfusion injury. We have found that during this extracorporeal blood correction procedure there was statistically not signifi cant decrease of tacrolimus blood concentration. However, concentration of tacrolimus remained in the therapeutic range even after the procedure and it was not signifi cantly different from the control point С0.Conclusion. Coupled plasma fi ltration adsorption is safe in renal transplant recipients and has no signifi cant impact on tacrolimus blood concentration. However, the downward trend in the concentration of tacrolimus in the course of these procedures, especially in continuous or semicontinuous mode, as well as in patients with low hematocrit and hypoalbuminemia, requires individual monitoring.

Intracranial Pressure during HighVolume Hemofiltration in Severe Sepsis

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A. P. Berdnikov

2014-01-01

Full Text Available Objective: to define the prognostic value of intracranial pressure (ICP changes in highvolume hemofiltration (HVHF in patients with severe sepsis and normal preperfusion ICP.Subjects and methods. A retrospective study was conducted in 50 patients (a total of 134 sessions with severe sepsis and normal baseline ICP who received ther apy using HVHF for extrarenal indications. Based on ICP changes before and after HVHF, the investigators identified 2 groups: 1 no ICP changes (n=81; 2 elevated ICP (n=53.Conclusion. HVHF is ineffective when the normal preperfusion ICP is increased in patients with severe sepsis who have a concurrence of an arteriovenous carbon dioxide difference of more than 8 mm Hg and a Glasgow coma score of less than 10.

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

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

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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.

Delay in onset of metabolic alkalosis during regional citrate anti-coagulation in continous renal replacement therapy with calcium-free replacement solution

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See Kay

2009-01-01

Full Text Available Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group, received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020. When calcium-containing replacement solution was used, more citrate was required (mean 280ml/h, CI 227.2-332.8 vs. 265ml/h, CI 203.4-326.6, P = 0.069, but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6ml/h, CI 26.8-76.4, P ≤ 0.0001.

Severe Leptospirosis with Multiple Organ Failure Successfully Treated by Plasma Exchange and High-Volume Hemofiltration

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Vincent Bourquin

2011-01-01

Full Text Available Background. Leptospirosis is a spirochetal zoonosis with complex clinical features including renal and liver failure. Case report. We report the case of a Swiss fisherman presenting with leptospirosis. After initial improvement, refractory septic shock and severe liver and kidney failure developed. The expected mortality was estimated at 90% with clinical scores. The patient underwent plasma exchanges and high-volume hemofiltration (HVHF with complete recovery of hepatic and kidney functions. Discussion. Plasma exchanges and HVHF may confer survival benefit on patients with severe leptospirosis, refractory septic shock, and multiple-organ failure.

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

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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

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

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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

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

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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.

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

[Efficiency of high-volume hemofiltration in patients with severe sepsis and intracranial hypertension].

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Musaeva, T S; Berdnikov, A P; Goncharenko, S I; Denisova, E A

2014-01-01

We performed a retrospective study in 68 patients (144 procedures) with severe sepsis and intracranial hypertension measured by the pressure in the central retinal vein. The patients underwent high-volume hemofiltration (HV-HF) for extrarenal indications. Increased pressure in the central retinal vein was accompanied by critical points of cerebral perfusion pressure and the growth of neurological deficit with inhibition level of consciousness to coma 1. In this case, IHV-HF may be associated with the formation of the critical points of cerebral perfihsion and severe disorders of microcirculation and the lack of resolution of tissue hypoperfusion. In case of intracranial hypertension IHV-HF is not effective in the category of patients where there is a combination ΔpCO2 > 5.9 mm Hg level and GCS <10 points.

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

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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.

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

Fatal manganese intoxication due to an error in the elaboration of Epsom salts for a liver cleansing diet.

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Sánchez, Baltasar; Casalots-Casado, Jaume; Quintana, Salvador; Arroyo, Amparo; Martín-Fumadó, Carles; Galtés, Ignasi

2012-11-30

We describe the case of a 50-year-old man with a fatal intoxication after accidental massive oral ingestion of manganese. The patient presented with lethargy, diffuse abdominal pain, vomiting, and profuse diarrhea after ingesting Epsom salts (magnesium sulfate heptahydrate) during a liver cleansing diet. Despite intensive care management with intubation, prone position ventilation, continuous venovenous hemofiltration, and multiple transfusions, he progressed to refractory shock with multiple organ dysfunction resulting in death within 72 h. Similar patients arrived at several hospitals with identical epidemiology (all had ingested the same salt obtained in the same place). Clinical and forensic investigations (X-ray diffraction) discovered that the supplier had mistakenly prepared the salts with hydrated manganese sulfate instead of magnesium sulfate heptahydrate. The results enabled the other patients to be successfully treated for hydrated manganese sulfate intoxication with life support in the intensive care unit and chelation therapy (EDTA). We describe the clinical presentation of acute manganese poisoning and alert professionals to the risk of an increasingly popular diet. This case demonstrates the importance of collaboration between clinicians, pathologists, and forensic scientists to resolve a difficult-to-diagnose case. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

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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.

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

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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.

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.

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.

Colchicine triggered severe rhabdomyolysis after long-term low-dose simvastatin therapy: a case report.

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Frydrychowicz, Clara; Pasieka, Bastian; Pierer, Matthias; Mueller, Wolf; Petros, Sirak; Weidhase, Lorenz

2017-01-04

Rhabdomyolysis is a widely recognized yet rare complication in statin use. Rhabdomyolysis might be triggered by the prescription of high doses of statins or by statin accumulation due to interactions with concomitant medication. Muscle cell destruction as evidenced by myoglobin elevation can induce potentially life-threatening acute renal failure. We report a case of a 70-year-old obese white man with sudden onset of severe rhabdomyolysis with consecutive renal failure. His medication included low-dose simvastatin, which he had taken for 6 years up until the event. The statin was withdrawn immediately. After 3 days of veno-venous hemofiltration his renal function was completely restored. Clinicians in both primary and special care might be unaware that side effects of statins do occur even after a long uneventful statin medication; they should be advised not to exclude that possibility upfront, even if a patient has tolerated the medication for years.

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.

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

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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.

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

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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.

Active Detoxification in the Treatment of Abdominal Sepsis

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O. M. Shevtsova

2009-01-01

Full Text Available Objective: to evaluate the efficiency of extracorporeal detoxification techniques in patients with abdominal sepsis. Subjects and methods. Three hundred and seventy-nine patients with acute generalized peritonitis were examined. Extracorporeal detoxifying techniques were used during conventional therapy in Group 1 (n=319; the other patients received only traditional therapy (a control group. The time course of changes in the parameters of toxemia, a hemostasiogram, and an immunogram were examined. Results. The study indicated significantly reduced endotoxemia and better blood aggregation resulting from the use of plasmapheresis, cryoplasmasorption, and plasmasorption, as well as stimulated immunity when the above techniques were combined with autoblood photomodification and extracorporeal immunopharmacotherapy in patients with abdominal sepsis. In severe abdominal sepsis and infectious-toxic shock, there was regression of multiple organ dysfunction and lower mortality when venovenous hemofiltration was applied. Conclusion. A differential approach to using active detoxifying techniques is needed, by taking into account the severity of the disease. Key words: abdominal sepsis, detoxifying techniques.

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

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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.

Hepatorenal Syndrome

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Pınar Zeyneloğlu

2012-04-01

Full Text Available Renal failure is a common major complication in patients with advanced cirrhosis and generally indicates a poor prognosis when combined with liver failure. Hepatorenal syndrome (HRS is characterised by a combination of disturbances in circulatory and kidney function. Arterial pressure is decreased in the systemic circulation due to reduced total systemic vascular resistance. Kidney dysfunction is caused by reduction in renal blood flow. The diagnosis of HRS is based on exclusion of other disorders that cause acute kidney injury in cirrhosis as there are no specific tests. There are two types of HRS with different characteristics and prognostics. Liver transplantation is the treatment of choice for all patients without contraindication. The best approach to the pharmacologic management is the administration vasoconstrictor drugs based on the pathogenesis. Many vasoconstrictors including vasopressin analogues (terlipressin, ornipressin and vasopressin, somatostatin analogues (octreotide and alpha-adrenergic analogues (midodrine and norepinephrine have been studied. In most of the studies intravenous albumin therapy was coadministered with vasoconstrictor drugs and suggested that albumin should be considered as the component of pharmacologic intervention in patients with HRS. Renal replacement therapy in the form of hemodialysis or continuous venovenous hemofiltration has been used in the management of HRS patients awaiting transplantation or in those with acute potentially reversible conditions. The artificial hepatic support systems require further investigation. (Journal of the Turkish Society Intensive Care 2012; 10: 37-44

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.

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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.

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

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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.

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

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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.

CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations.

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Lorenzin, Anna; Garzotto, Francesco; Alghisi, Alberta; Neri, Mauro; Galeano, Dario; Aresu, Stefania; Pani, Antonello; Vidal, Enrico; Ricci, Zaccaroa; Murer, Luisa; Goldstein, Stuart L; Ronco, Claudio

2016-10-01

The CARdiorenal PEDIatric EMergency (CARPEDIEM) machine was originally designed to perform only continuous venovenous hemofiltration (CVVH) in neonatal and pediatric patients. In some cases, adequate convective clearance may not be reached because of a limited blood flow. In such conditions, the application of diffusive clearance [continuous venovenous hemodialysis (CVVHD)] would help optimize blood purification. In this study, the CARPEDIEM™ machine was modified to enable the circulation of dialysis through the filter allowing testing of the performance of CARPEDIEM™ machine in CVVHD. Three different polyethersulfone hemodialyzers (surface area = 0.1 m(2), 0.2 m(2), and 0.35 m(2), respectively) were tested in vitro with a scheduled combination of plasma flow rates (Qp = 10-20-30 ml/min) and dialysis fluid flow rate (Qd = 5-10-15 ml/min). Three sessions were performed in co-current and one in counter-current configuration (as control) for each filter size. Clearance was measured from the blood and dialysate sides and results with mass balance error greater than 5 % were discarded. Urea and creatinine clearances for each plasma/dialysate combination are reported: clearance increase progressively for every filter proportionally to plasma flow rates. Similarly, clearances increase progressively with dialysate flow rates at a given plasma flow. The clearance curve tends to present a steep increase for small increases in plasma flow in the range below 10 ml/min, while the curve tends to plateau for values averaging 30 ml/min. As expected, the plateau is reached earlier with the smaller filter showing the effect of membrane surface-area limitation. At every plasma flow, the effect of dialysate flow increase is evident and well defined, showing that saturation of effluent was not achieved completely in any of the experimental conditions explored. No differences (p > 0.05 for all values) were obtained in experiments using whole blood instead of

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.

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

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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

Understanding the continuous renal replacement therapy circuit for acute renal failure support: a quality issue in the intensive care unit.

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Boyle, Martin; Baldwin, Ian

2010-01-01

Delivery of renal replacement therapy is now a core competency of intensive care nursing. The safe and effective delivery of this form of therapy is a quality issue for intensive care, requiring an understanding of the principles underlying therapy and the functioning of machines used. Continuous hemofiltration, first described in 1977, used a system where blood flowed from arterial to venous cannulas through a small-volume, low-resistance, and high-flux filter. Monitoring of these early systems was limited, and without a machine interface, less nursing expertise was required. Current continuous renal replacement therapy machines offer user-friendly interfaces, cassette-style circuits, and comprehensive circuit diagnostics and monitoring. Although these machines conceal complexity behind a user-friendly interface, it remains important that nurses have sufficient knowledge for their use and the ability to compare and contrast circuit setups and functions for optimal and efficient treatment.

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

A Differential Approach to Choosing Extracorporeal Detoxification Methods for Abdominal Sepsis

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L. Ye Shukevich

2005-01-01

Full Text Available A differential approach to choosing the methods of extracorporeal detoxification in the complex treatment of abdominal sepsis in the context of endogenous intoxication in order to enhance the efficiency of medical measures was pathogeneti-cally substantiated. In 51 patients diagnosed as having abdominal sepsis, the latter was characterized as the endogenous intoxication syndrome in relation to the accumulation of low and medium molecular-weight substances (plasma and red blood cells in the body and their physiological elimination with urine. An original formula was used to calculate the integral marker – the endogenous intoxication index correlating with the routine severity rating scales APACHE II and SOFA and reflecting the severity of endotoxicosis. According to the values of the endogenous intoxication index and to the sum of scores by the APACHE II and SOFA scales, the patients were divided into 3 groups of the clinicopathogenetic types of endogenous intoxication. According to the type of endogenous intoxication, the authors proposed a differential approach to choosing the modes of efferent therapy for abdominal sepsis: high-volume plasmapheresis in the subcompensated type and prolonged venovenous hemofiltration, which improved the results of treatment and reduced mortality rates.

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

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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.

Treatment of severe acute pancreatitis

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Praznik Ivan

2014-01-01

Full Text Available Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or other organ systems. The severe form of the disease occurs in 10-20% of cases, and usually requires prolonged hospitalization due to a frequent local and systemic complications. Additionally, considerable mortality despite diagnostic and therapeutic advances, makes this disease a serious health problem nowadays. The aim of this study was to conduct a review of randomized controlled trials to determine differences in the efficiency between standard methods of treatment for severe acute pancreatitis and new treatment ways in terms of decreased mortality. Search of the 'Medline' database of original scientific papers and systematic review articles was made, using a combination of the following keywords: acute pancreatitis, treatment, mortality. In total 914 papers were found, published in the last 13 years; 14 of 64 randomized controlled clinical trials met the selection criteria and were eligible for inclusion. From a total of 16 papers, the conservative treatment was related to 11, which includes some of the new treatment methods, while the effects of new methods of treatment have been the subject of research in the four studies. Combined endoscopic and surgical treatment was applied in only one study. The largest sample of 290 patients was included in the study with platelet activation factor antagonist, while the smallest sample of 22 patients was used in the study that compared total parenteral with enteral nutrition. Continuous regional arterial infusion of protease inhibitors in combination with antibiotics, intravenous supplementation of alanyl-glutamine dipeptide and the early, high-volume continuous veno-venous hemofiltration showed the best results in the treatment of patients with severe acute pancreatitis. Also, the use of low molecular weight heparin and enteral nutrition significantly reduced mortality.

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

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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.

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

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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.

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

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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.

Back to the future: extended dialysis for treatment of acute kidney injury in the intensive care unit.

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Kielstein, Jan T; Schiffer, Mario; Hafer, Carsten

2010-01-01

On September 11, 1945, Maria Schafstaat was the first patient who successfully underwent a dialysis treatment for acute kidney injury (AKI). The ingenious design of the first dialysis machine, made of cellophane tubing wrapped around a cylinder that rotated in a bath of fluid, together with the brave determination to treat patients with AKI, enabled the Dutch physician W.J. Kolff to save the life of the 67-year-old woman. By treating her for 690 minutes (i.e., 11.5 hours) with a blood flow rate of 116 ml/min, Kolff also set the coordinates of a renal replacement therapy that has enjoyed an unsurpassed renaissance over the last decade for treatment of severely ill patients with AKI in the intensive care unit (ICU). Prolonged dialysis time with low flow rates - these days, called extended dialysis (ED) - combines several advantages of both intermittent and continuous techniques, which makes it an ideal treatment method for ICU patients with AKI. This review summarizes our knowledge of this method, which is increasingly used in many centers worldwide. We reflect on prospective controlled studies in critically ill patients that have documented that small-solute clearance with ED is comparable with that of intermittent hemodialysis and continuous venovenous hemofiltration, as well as on studies showing that patients' cardiovascular stability during ED is similar to that with continuous renal replacement therapy. Furthermore, we report on logistic and economic advantages of this method. We share our view on how extended dialysis offers ample opportunity for a collaborative interaction between nephrologists and intensivists as the nephrology staff, enabling optimal treatment of complex critically ill patients by using the skill and knowledge of 2 indispensable specialties in the ICU. Lastly, we address the problem of ED intensity, which does not seem to have an impact on survival at higher doses, a finding that might be caused by the fact that we still adhere to dosing

“ICE” – A rare cause for coagulopathy in a case of massive post-partum hemorrhage

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Navkiran Singh Gill

2017-05-01

Full Text Available A case of massive post-partum hemorrhage in East-Malaysia, associated with 3-4 methylene-dioxy-methamphetamine (MDMA abuse otherwise known as Ecstasy or locally as “ICE”, injected by the patient as a means to suppress labor pains prior to hospital presentation. We report a rare case of substance abuse that lead to life threatening hemorrhage in a maternal patient of productive age group. Presenting to the labor suite in second stage of labor in breech presentation, exhibiting active neuropsychiatric symptoms of intoxication like euphoria, drowsiness, mydriasis but able to obey commands. A rapid response by the Obstetric on-call team proceeded with an assisted-breech delivery. Post-delivery, a baby girl with poor Apgar score was born and intubated. The mother was then posted for an Examination Under Anesthesia as she was noted to have slow blood oozing per-vaginally using a single shot spinal as she exhibited features of difficult intubation and high risk of aspiration. During the procedure, she tipped into massive PPH complicated with DIVC, and was rushed into the intensive care unit for stabilization and back into the operation theatre, needing a total abdominal hysterectomy (TAH as definitive bleeding control. She required large scale resuscitative efforts peri-operatively including continuous veno-venous hemofiltration (CVVH as well as regional intensive care consultation. We describe, chronologically the anesthetic challenges faced in managing a patient in acute substance intoxication at presentation to our district hospital during twilight hours. We then explain the pharmacodynamics of MDMA in provoking coagulopathy. No reports of similar cases in the South-East Asia region.

Acute metformin intoxication: 2012 experience of Emergency Departement of Lodi, Italy.

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Acquistapace, Giulia; Rossi, Marco; Garbi, Mara; Cosci, Pablo; Canetta, Ciro; Manelli, Anna; Ricevuti, Giovanni

2014-10-01

Background: Metformin is a biguanide antihyperglycemic agent that decreases insulin resistance. It is removed through renal mechanisms and its clearance is reduced in renal failure. Metformin ingestion should always be considered in the differential diagnosis of any patient with metabolic acidosis and increased lactate level. Hemodialysis and continuous veno-venous hemofiltration (CVVH) are both efficient methods to treat metformin intoxication and correct metabolic abnormalities. Patient 1: A 63-year-old man with type 2 diabetes mellitus presented to emergency department (ED) of Lodi (Italy) for dyspnea. He also reported having diarrhea for 10 days. Initial investigations revealed metabolic acidosis with hyperlactatemia and hypoglycemia (54 mg/dL), metformin concentration was 41 μg/mL (normal value <4 μg/mL). His hemodynamic condition became rapidly unstable and hypotension worsened despite CVVH being performed. Death occurred in 24 h. Patient 2: A 76-year-old man with type 2 diabetes mellitus presented to ED of Lodi for dyspnea. He referred a recent surgery amputation of the left foot's fifth phalanx for osteomyelitis, in levofloxacin therapy. Initial investigations revealed metabolic acidosis with hyperlactatemia and severe hypoglycemia (20 mg/dL). Two hemodialysis sessions were performed with complete normalization of the serum concentration of metformin. In our two cases the genesis of metformin intoxication was clear, powered by acute renal failure, but less obvious was the etiology of acute renal damage responsible for metformin accumulation. Damage due to renal hypoperfusion or the direct toxic effect of metformin should be considered. Additionally, for the second patient, we can also hypothesize that interstitial nephritis was exacerbated by levofloxacin.

[Comparison of curative effect of low flow rate plasma exchange combined with hemofiltration for treatment of liver failure].

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Yang, Yong-feng; Huang, Ping; Zhang, Ning; Gai, Xiao-dong; Feng, Xiao-ning; Zhong, Yan-dan; Wang, Li-rong; Yang, Yi-jun; Zhao, Wei

2009-02-01

To investigate the effect of plasma exchange (PE) combined with hemofiltration (HF) on liver failure. Seventy-seven inpatients with liver failure admitted during January 2006 to August 2007 were randomly assigned to receive PE combined with HF (PE+HF group, 38 cases), or PE alone (PE group, 39 cases). Forty-one inpatients with liver failure who had not received artificial liver support treatment were assigned to serve as control group. The survival rates and biochemical parameters of three groups were compared. There was no significant difference in biochemical parameters before treatment among three groups. Compared with pre-treatment values, albumin (Alb), cholinesterase (ChE) and prothrombin activity (PTA) of both PE group and PE+HF group were significantly increased after treatment, and total bilirubin (TBIL), alanine transaminase (ALT), aspartate transaminase (AST) of both PE group and PE+HF group were significantly decreased after treatment (Prate of PE group, PE+HF group and control group was 48.7% (19/39), 68.4% (26/38), and 29.3% (12/41) respectively. The survival rate of PE+HF group was significantly higher than that of control group (chi(2)=12.11, Prate of recovery of consciousness of patients with hepatic encephalopathy in PE+HF group was higher than that of PE group (42.8% vs. 0, P<0.05). Compared with PE alone, the result was better when it was combined with HF in correction of electrolyte disturbance and acid-base imbalance (19/23 vs. 0/21, P<0.05). Treatment of liver failure by PE combined with HF is safe and effective, and its efficacy is higher than PE alone.

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

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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.

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

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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.

Acute renal failure and severe rhabdomyolysis in a patient with resistant thrombotic thrombocytopenic purpura

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Al Qahtani S

2011-10-01

Full Text Available Saad Al Qahtani Intensive Care Department, Critical Care Response Team, King Abdulaziz Medical City (KAMC, National Guard Health Affairs; King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Kingdom of Saudi Arabia Abstract: Thrombotic thrombocytopenic purpura (TTP is a rare, life-threatening disorder. This paper describes the case of a 39-year-old Sudanese male who presented to the emergency room with fever, jaundice, decreased level of consciousness, and worsening kidney function for 7 days, a high lactate dehydrogenase level (1947, severe thrombocytopenia (platelets 8, and numerous schistocytes in the peripheral blood smear. The patient was admitted with a diagnosis of TTP for plasma exchange. Fourteen days later, his creatinine kinase (CK level rose to >50,000 IU; rhabdomyolysis was suggested. Continuous venovenous hemodialysis (CVVHD was started. The patient's CK level remained high, despite CVVHD, until the 6th day, after which this parameter gradually started to decrease. This report highlights a resistant case of TTP that presented with concomitant severe rhabdomyolysis, which demanded aggressive, continuous intervention. Keywords: TTP, CVVHD, continuous venovenous hemodialysis

Experimental study of the portable blood purification system for treatment of acute renal failure in dogs under the field condition in a high-altitude environment

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Hai-bin LI

2014-01-01

Full Text Available Objective　To reproduce the model of acute renal failure (ARF in beagles for comprehensively evaluating the safety, stability and validity of the continuous blood purification system under the field condition in a high-altitude environment. Methods　Adult beagle ARF model was reproduced by bilateral nephrectomy. All ARF dogs underwent continuous veno-venous hemofiltration with a blood purification machine. Vital signs, renal function, liver function and plasma ion-levels before and after the therapy were analyzed through self-controlled study. Performance of the continuous blood purification machine running in a highaltitude environment was evaluated. Results　Blood urea nitrogen (BUN and creatinine (Cr of six dogs were assayed 24 hours after nephrectomy, the difference showed statistical significance compared with those before the surgery (P＜0.05, implying that six ARF models were reproduced successfully. Six dogs experienced continuous renal replacement therapy (CRRT with external jugular vein double-lumen tube placement (3 dogs or femoral vein catheter placement (3 dogs. Five dogs successfully finished the whole experiment, and one dog died because of falling off of the dialysis tube and blood loss. The continuous blood purification machine was sensitive with rapid release of warning signals when the condition was abnormal. Compared to that before CRRT, there were no statistically significant differences in heart rate, respiratory rate and blood pressure in ARF models 2, 4 hours after CRRT (P＞0.05. And there were no statistically significant differences in ALT, AST and T-Bil in ARF models between that before and 2, 4 hours after CRRT (P＞0.05. However, 2, 4 hours after CRRT, BUN and Cr levels descended significantly (P＜0. 05, so was K+ level (P＜0. 05. There were no complications such as hemorrhage or hypotension. There were no statistical differences in volume of replacement fluid or discarded fluid between before and after CRRT

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

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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.

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

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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. 

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

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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.

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

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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.

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

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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.

Extreme lactic acidosis type B associated with metformin treatment

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Vernersson, Einar; Frid, Anders; Sterner, Gunnar

2011-01-01

The elimination of metformin is exclusively through the kidneys and elevated plasma concentrations can cause lactic acidosis. We report a case of severe lactic acidosis (pH 6.60) occuring with ostensibly normal therapeutic doses of metformin in the setting of acute renal failure. Continuous veno-venous haemodiafiltration decreased plasma metformin concentrations from 266 lmol/L at presentation to 68 lmol/L, 21 h later. The patient improved rapidly. PMID:25984205

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

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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.

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

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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

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

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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.

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

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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.

[Star fruit (Averrhoa carambola) toxic encephalopathy].

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Signaté, A; Olindo, S; Chausson, N; Cassinoto, C; Edimo Nana, M; Saint Vil, M; Cabre, P; Smadja, D

2009-03-01

Ingestion of star fruit (Averrhoa carambola) can induce severe intoxication in subjects with chronic renal failure. Oxalate plays a key role in the neurotoxicity of star fruit. We report the cases of two patients with unknown chronic renal insufficiency who developed severe encephalopathy after ingestion of star fruit. The two patients developed intractable hiccups, vomiting, impaired consciousness and status epilepticus. Diffusion-weighted MR imaging showed cortical and thalamic hyperintense lesions related to epileptic status. They improved after being submitted to continuous hemofiltration which constitutes the most effective treatment during the acute phase.

Blood conservation techniques and platelet function in cardiac surgery.

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Boldt, J; Zickmann, B; Czeke, A; Herold, C; Dapper, F; Hempelmann, G

1991-09-01

Postoperative alterations in platelet function induced by cardiopulmonary bypass (CPB) are of importance. The effect on platelet aggregation of three different techniques for reducing blood consumption was studied in 30 patients undergoing elective aortocoronary bypass grafting from the beginning of anesthesia until the 1st postoperative day. The patients were randomly divided into three groups, in which 1) a cell separator was used during and after CPB; 2) a hemofiltration device was used; and 3) high-dose aprotinin was used in order to reduce the need of homologous blood. A fourth group undergoing neurosurgery procedures served as a control. Platelet aggregation induced by adenosine diphosphate (concentration 0.25, 0.50, 1.0, and 2.0 microM), collagen (4 microliters/ml), and epinephrine (25 microM) was determined by the turbidimetric method. Platelet aggregation was not significantly changed in the control group, indicating that the operation itself did not impair platelet function. At the end of the operation (after retransfusion of the salvaged pump blood), the maximum aggregation and maximum gradient of aggregation induced by all three inductors were most reduced (significantly) in the cell-separator patients. On the 1st postoperative day, platelet aggregation in the hemofiltration patients and the patients treated with aprotinin had normalized. Aggregation of patients pretreated with high-dose aprotinin was not different from that of the hemofiltration patients throughout the investigation. Blood loss was significantly highest in the cell-separator group (770 +/- 400 ml on the 1st postoperative day) but was not different between the hemofiltration (390 +/- 230 ml) and the aprotinin-treated patients (260 +/- 160 ml).(ABSTRACT TRUNCATED AT 250 WORDS)

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

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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.

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)

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

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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

Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).

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López Sanchez, M

2017-11-01

Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO 2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

State-of-the-art technocology in blood purification at present

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Zhi-hong LIU

2011-02-01

Full Text Available Objective To review the recent advancement in clinical practices and studies on blood purification techniques,and to provide a guide for further studies on its application in military medicine.Methods Literature published in recent five years limited to blood purification field either in English or Chinese were retrieved by searching PubMed and CHKD.Analysis and summary were performed based on the literature.Results The advancements in blood purification in recent five years could be categorized into four fields,i.e.hemodialysis(HD,peritoneal dialysis(PD,continuous renal replacement therapy(CRRT,and adsorption therapy.The development in HD was aimed at promoting the ability of removal of toxic elements producing uremia and online monitor techniques,and PD was aimed at improvement of patients’ general condition and intervention to reduce the risk factors affecting long-term outcomes,and preparation of new PD solutions to improve the efficacy of PD.In regard to CRRT,the current progress had been focused on initiation time,dose and proposal of new hypothesis for high-volume hemofiltration(HVHF application.Adsorption therapy was another choice of blood purification.Domestic military medicine progress in blood purification in our armed forces was focused on techniques that could be used in treatment of casualties in war,including the basic and clinical study of extracorporeal circuit intervention(ECI for treatment of critically ill patients,problems arising from anticoagulation in ECI for patients with trauma,chemical agents poisoning,and adsorption technique.Conclusions Recently,the main advancement of blood purification technique is combined application of series techniques such as dialysis,hemofiltration,adsorption,and plasma exchange in treatment of critically ill patients.Studies on blood purification in domestic military medicine should be updated continuously to follow closely to the latest achievement in world,and translate these latest

RETRACTED: Acute preoperative plasmapheresis and established blood conservation techniques.

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Boldt, J; Kling, D; Zickmann, B; Jacobi, M; Dapper, F; Hempelmann, G

1990-07-01

Plasmapheresis performed weeks before an operation producing autologous plasma has proved to be of benefit in elective operations. First experiences in acute plasmapheresis, which is performed immediately before the operation, have been reported recently. When acute plasmapheresis is used in cardiac operations, however, it must be viewed in connection with other techniques for reducing blood consumption such as the Cell Saver (CS) and ultrafiltration devices. In 60 patients undergoing elective aortocoronary bypass grafting, acute plasmapheresis was performed, producing either platelet-poor plasma or platelet-rich plasma, in combination with either the Cell Saver or hemofiltration. Fluid balance during cardiopulmonary bypass was significantly lower in the hemofiltration patients. Postoperatively, none of these patients received donor blood, whereas 4 patients of the Cell-Saver groups needed packed red blood cells. AT-III, fibrinogen, the number of platelets, albumin, total protein, and colloid osmotic pressure were less compromised when hemofiltration was used in combination with acute plasmapheresis in contrast to combination with the Cell-Saver technique. Plasma hemoglobin was without differences during the investigation period, and polymorphonuclear elastase was less increased when platelet-rich plasma was produced preoperatively. On the first postoperative day, most of the differences between the groups had already disappeared. We conclude that when acute plasmapheresis is used in cardiac operations, discarding of plasma by the Cell Saver should be avoided and ultrafiltration devices should replace centrifugation techniques for blood conservation.

Calculating evidence-based renal replacement therapy - Introducing an excel-based calculator to improve prescribing and delivery in renal replacement therapy - A before and after study.

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Cottle, Daniel; Mousdale, Stephen; Waqar-Uddin, Haroon; Tully, Redmond; Taylor, Benjamin

2016-02-01

Transferring the theoretical aspect of continuous renal replacement therapy to the bedside and delivering a given "dose" can be difficult. In research, the "dose" of renal replacement therapy is given as effluent flow rate in ml kg -1  h -1 . Unfortunately, most machines require other information when they are initiating therapy, including blood flow rate, pre-blood pump flow rate, dialysate flow rate, etc. This can lead to confusion, resulting in patients receiving inappropriate doses of renal replacement therapy. Our aim was to design an excel calculator which would personalise patient's treatment, deliver an effective, evidence-based dose of renal replacement therapy without large variations in practice and prolong filter life. Our calculator prescribes a haemodialfiltration dose of 25 ml kg -1  h -1 whilst limiting the filtration fraction to 15%. We compared the episodes of renal replacement therapy received by a historical group of patients, by retrieving their data stored on the haemofiltration machines, to a group where the calculator was used. In the second group, the data were gathered prospectively. The median delivered dose reduced from 41.0 ml kg -1  h -1 to 26.8 ml kg -1  h -1 with reduced variability that was significantly closer to the aim of 25 ml kg -1 .h -1 ( p  < 0.0001). The median treatment time increased from 8.5 h to 22.2 h ( p  = 0.00001). Our calculator significantly reduces variation in prescriptions of continuous veno-venous haemodiafiltration and provides an evidence-based dose. It is easy to use and provides personal care for patients whilst optimizing continuous veno-venous haemodiafiltration delivery and treatment times.

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

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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

Commercially available media for flushing extracorporeal bioartificial liver systems prior to connection to the patient's circulation: an in vitro comparative study in two and three dimensional porcine hepatocyte cultures

NARCIS (Netherlands)

Flendrig, L. M.; Sommeijer, D.; Ladiges, N. C.; te Velde, A. A.; Maas, M. A.; Jörning, G. G.; Daalhuisen, J.; Chamuleau, R. A.

1998-01-01

Extracorporeal bioartificial liver (BAL) systems based on hepatocytes need to be flushed before clinical application, as hepatocyte culture media are not approved for medical use. Commercially available 0.9% NaCl solution and hemofiltration solution (both supplemented with 10% human albumin) were

Automated multi-dimensional liquid chromatography : sample preparation and identification of peptides from human blood filtrate

NARCIS (Netherlands)

Machtejevas, Egidijus; John, Harald; Wagner, Knut; Standker, Ludger; Marko-Varga, Gyorgy; Georg Forssmann, Wolf; Bischoff, Rainer; K. Unger, Klaus

2004-01-01

A comprehensive on-line sample clean-up with an integrated two-dimensional HPLC system was developed for the analysis of natural peptides. Samples comprised of endogenous peptides with molecular weights up to 20 kDa were generated from human hemofiltrate (HF) obtained from patients with chronic

Complete resolution of transplantation-associated thrombotic microangiopathy and hepatic veno-occlusive disease by defibrotide and plasma exchange.

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Beşişik, Sevgi Kalayoğlu; Oztürk, Gülistan Bahat; Calişkan, Yaşar; Sargin, Deniz

2005-03-01

Transplantation-associated thrombotic microangiopathy has been associated with significantly reduced survival following allogeneic bone marrow transplantation. We describe here the course of Transplantation-associated thrombotic microangiopathy and hepatic veno-occlusive disease, and response to plasma exchange therapy. A 19-year-old male patient underwent hematopoietic stem cell transplantation (HSCT) from his HLA-matched brother for lymphoblastic lymphoma in the first complete remission. Transplantation-associated thrombotic microangiopathy was diagnosed 17 days after transplantation. At that time, neurological abnormalities were not present. Cyclosporin A (CsA) was discontinued. Hematological stabilization was recorded. On day +20, abdominal distention, painful hepatomegaly and ascites complicated the clinical picture. With a high hepatic venous pressure gradient (18mmH20), veno-occlusive disease of the liver was diagnosed and defibrotide was started, which resulted in a dramatic cessation of pain and increase in urinary output. However, transplantation-associated thrombotic microangiopathy-related symptoms progressed and plasma exchange was instituted, which resulted in worsening of veno-occlusive disease symptoms. He was referred to the Intensive Care Unit due to respiratory compromise and was intubated. Plasma exchange was continued in order after hemofiltration. In three days, fever resolved, hemofiltration could be stopped, and ventilator dependence ended. After 19 aphereses, serum LDH level returned to normal and schistocytes were minimal on microscopic examination of the blood film. Platelet count increase was more gradual. Plasma exchange was discontinued. On the 40th day of defibrotide, all symptoms related with veno-occlusive disease were resolved and defibrotide was stopped. We think that our case is important to establish the relation and management strategy of these two small vessel complications of HSCT.

Successful Management of Airway Emergency in a Patient with Esophageal Cancer

Directory of Open Access Journals (Sweden)

Samina Park

2015-05-01

Full Text Available A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO corrected the patient’s respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.

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

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

Directory of Open Access Journals (Sweden)

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

Complicated Candida parapsilosis peritonitis on peritoneal dialysis in a neonate with renal failure because of bilateral adrenal abscesses

Directory of Open Access Journals (Sweden)

I. Cheng

2011-10-01

Full Text Available We present a full-term female infant with a difficult delivery course complicated with Escherichia coli sepsis and bilateral adrenal abscesses. She developed renal failure and received peritoneal dialysis. Peritonitis of Candida parapsilosis developed later. The infant was successfully treated with hemofiltration and a combination of antifungal agents.

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.

Modeling and Hemofiltration Treatment of Acute Inflammation

Directory of Open Access Journals (Sweden)

Robert S. Parker

2016-10-01

Full Text Available The body responds to endotoxins by triggering the acute inflammatory response system to eliminate the threat posed by gram-negative bacteria (endotoxin and restore health. However, an uncontrolled inflammatory response can lead to tissue damage, organ failure, and ultimately death; this is clinically known as sepsis. Mathematical models of acute inflammatory disease have the potential to guide treatment decisions in critically ill patients. In this work, an 8-state (8-D differential equation model of the acute inflammatory response system to endotoxin challenge was developed. Endotoxin challenges at 3 and 12 mg/kg were administered to rats, and dynamic cytokine data for interleukin (IL-6, tumor necrosis factor (TNF, and IL-10 were obtained and used to calibrate the model. Evaluation of competing model structures was performed by analyzing model predictions at 3, 6, and 12 mg/kg endotoxin challenges with respect to experimental data from rats. Subsequently, a model predictive control (MPC algorithm was synthesized to control a hemoadsorption (HA device, a blood purification treatment for acute inflammation. A particle filter (PF algorithm was implemented to estimate the full state vector of the endotoxemic rat based on time series cytokine measurements. Treatment simulations show that: (i the apparent primary mechanism of HA efficacy is white blood cell (WBC capture, with cytokine capture a secondary benefit; and (ii differential filtering of cytokines and WBC does not provide substantial improvement in treatment outcomes vs. existing HA devices.

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…

Unusual case of a vanishing bronchus of the left allograft in a lung transplant recipient

Directory of Open Access Journals (Sweden)

Don Hayes

2013-01-01

Full Text Available We present an interesting case of a complete vanishing of the left main bronchus in a lung transplant recipient who had a successful outcome due to acute respiratory support with venovenous extracorporeal membrane oxygenation in order to perform airway dilation.

Modeling acardiac twin pregnancies

NARCIS (Netherlands)

de Groot, Rosa; van den Wijngaard, Jeroen P. H. M.; Umur, Asli; Beek, Johan F.; Nikkels, Peter G. J.; van Gemert, Martin J. C.

2007-01-01

Acardiac twin pregnancies are a rare but severe complication of monochorionic twinning, where the acardiac twin lacks cardiac function but nevertheless grows during pregnancy because it is perfused by the pump twin through a set of placental arterioarterial and venovenous anastomoses. Because the

Vascular anastomosis by Argon Laser

International Nuclear Information System (INIS)

Gomes, O.M.; Macruz, R.; Armelin, E.; Brum, J.M.G.; Ribeiro, M.P.; Mnitentog, J.; Verginelli, G.; Pileggi, F.; Zerbini, E.J.

1982-01-01

Twenty four mongrel dogs, wheighing 13 to 24 kilograms were studied. After anesthesia, intubation and controlled ventilation, they were submitted to three types of vascular anastomosis: Group I - eight dogs with saphenous vein inter-carotid arteries by-pass: Group II - eight dogs with left mammary artery - left anterior descending coronary artery by-pass; Group III - eight dogs with venovenous anastomosis. In all groups 0.8 to 15 watts of Argon Laser power was applied to a total time of 90 to 300 seconds. The lower power for venovenous anastomosis and the greater for the arterial ones. The mean valves of resistence of the Laser anastomosis to pressure induced rupture was 730 mmHg in the immediate post operative study, and superior to 2.500 mmHg 30 days after. No signs of occlusion was demonstrated at the anastomosis sites by the angiographic and anathomo-patological study performed. (Author) [pt

Extracorporeal gas exchange with the DeltaStream rotary blood pump in experimental lung injury.

Science.gov (United States)

Dembinski, Rolf; Kopp, Rüdger; Henzler, Dietrich; Hochhausen, Nadine; Oslender, Nicole; Max, Martin; Rossaint, Rolf; Kuhlen, Ralf

2003-06-01

In most severe cases of the acute respiratory distress syndrome, veno-venous extracorporeal membrane oxygenation (ECMO) can be used to facilitate gas exchange. However, the clinical use is limited due to the size and the concomitant risk of severe adverse events of conventionally-used centrifugal blood pumps with high extracorporeal blood volumes. The DeltaStream blood pump is a small-sized rotary blood pump that may reduce extracorporeal blood volume, foreign surfaces, contact activation of the coagulation system, and blood trauma. The aim of the present study was to test the safety and efficacy of the DeltaStream pump for ECMO in animals with normal lung function and experimental acute lung injury (ALI). Therefore, veno-venous ECMO was performed for 6 hours in mechanically ventilated pigs with normal lung function (n=6) and with ALI induced by repeated lung lavage (n=6) with a blood flow of 30% of the cardiac output. Gas flow with a FiO2 of 1.0 was set to equal blood flow. With a mean activated clotting time of 121 +/- 22 s, no circulatory impairment or thrombus formation was revealed during ECMO. Furthermore, free plasma Hb did not increase. In controls, hemodynamics and gas exchange remained unchanged. In animals with ALI, hemodynamics remained stable and gas transfer across the extracorporeal oxygenators was optimal, but only in 2 animals was a marked increase in PaO2 observed. CO2 removal was efficacious in all animals. We concluded that the DeltaStream blood pump may be used for veno-venous ECMO without major blood damage or hemodynamic impairment.

The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture

Directory of Open Access Journals (Sweden)

Ju-Hee Park

2016-02-01

Full Text Available Extracorporeal membrane oxygenation (ECMO has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

Gardening can induce pulmonary failure: Aspergillus ARDS in an immunocompetent patient, a case report.

Science.gov (United States)

Jung, Nina; Mronga, Silke; Schroth, Susanne; Vassiliou, Timon; Sommer, Frank; Walthers, Eduard; Aepinus, Christian; Jerrentrup, Andreas; Vogelmeier, Claus; Holland, Angelique; Koczulla, Rembert

2014-11-26

Acute Aspergillus fumigatus infection in immunocompetent patients is rare. This is the first known case of a patient who survived Aspergillus sepsis after being treated early with veno-venous extracorporeal membrane (ECMO) and antifungal therapy. An immunocompetent 54-year-old woman was exposed to plant mulch during gardening and subsequently developed pulmonary failure that progressed to sepsis with multiorgan failure. Owing to her severe clinical condition, she was treated for acute respiratory distress syndrome (ARDS) with veno-venous ECMO. Empiric antifungal therapy comprising voriconazole was also initiated owing to her history and a previous case report of aspergillosis after plant mulch exposure, though there was no microbiological proof at the time. A. fumigatus was later cultured and detected on antibody testing. The patient recovered, and ECMO was discontinued 1 week later. After 7 days of antifungal treatment, Aspergillus antibodies were undetectable. In cases of sepsis that occur after gardening, clinicians should consider Aspergillus inhalation as an aetiology, and early antimycotic therapy is recommended.

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.

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

Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation.

Science.gov (United States)

Askenazi, David J; Ambalavanan, Namasivayam; Hamilton, Kiya; Cutter, Gary; Laney, Debbie; Kaslow, Richard; Georgeson, Keith; Barnhart, Douglas C; Dimmitt, Reed A

2011-01-01

To determine the independent impact of acute kidney injury (AKI) and renal replacement therapy (RRT) in infants and children who receive extracorporeal membrane oxygenation. Despite continued expertise/technological advancement, patients who receive extracorporeal membrane oxygenation have high mortality. AKI and RRT portend poor outcomes independent of comorbidities and illness severity in several critically ill populations. Retrospective cohort study. The primary variables explored are AKI (categorical complication code for serum creatinine > 1.5 mg/dL or International Statistical Classification of Diseases and Related Health Problems, Revision 9 for acute renal failure), and RRT (complication/Current Procedural Terminology code for dialysis or hemofiltration). Multiple variables previously associated with mortality in this population were controlled, using logistic stepwise regression. Decision tree modeling was performed to determine optimal variables and cut points to predict mortality. Critically ill neonates (0-30 days old) and children (> 30 days but optimizing the timing/delivery of RRT may positively impact survival.

Extracorporeal membrane oxygenation after intravenous injection of paraffin oil

DEFF Research Database (Denmark)

Pasgaard, Thomas; Huynh, Anh-Nhi Thi; Gjedsted, Jakob

2016-01-01

We present a rare cause of acute respiratory distress syndrome (ARDS) due to an accidental intravascular injection of paraffin oil. While there is no specific therapy, we decided to support the patient with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to allow the ARDS to resolve. A...

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

A Patient with MSUD: Acute Management with Sodium Phenylacetate/Sodium Benzoate and Sodium Phenylbutyrate

OpenAIRE

K?se, Melis; Canda, Ebru; Kagnici, Mehtap; U?ar, Sema Kalkan; ?oker, Mahmut

2017-01-01

In treatment of metabolic imbalances caused by maple syrup urine disease (MSUD), peritoneal dialysis, and hemofiltration, pharmacological treatments for elimination of toxic metabolites can be used in addition to basic dietary modifications. Therapy with sodium phenylacetate/benzoate or sodium phenylbutyrate (NaPB) in urea-cycle disorder cases has been associated with a reduction in branched-chain amino acid (BCAA) concentrations when the patients are on adequate dietary protein intake. Moreo...

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....

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.

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

CA.R.PE.DI.E.M. (Cardio-Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey.

Science.gov (United States)

Ronco, Claudio; Garzotto, Francesco; Ricci, Zaccaria

2012-08-01

Pedriatric acute kidney injury (AKI) is a well-described clinical syndrome that is characterized by a reduction of both the urine output and glomerular filtration rate. AKI in critically ill children is typically associated with multiple organ dysfunction. A dramatic increase in the incidence of AKI in pediatric intensive care units has been observed in the last 10 years. Unfortunately, the absence of sufficiently effective preventive and therapeutic measures at the present time has limited significant improvements in AKI care. Morality in patients with severe AKI remains unacceptably high (>50 %), with renal replacement therapy (RRT) remaining the most effective form of support for these patients. Despite technological advances during the last 10 years which have resulted in the development of the so-called "third-generation dialysis machines" that are characterized by the highest level of safety and accuracy, a truly pedriatric RRT system has never been developed. Consequently, dialysis/hemofiltration in critically ill children is currently performed by adapting adult systems to the much smaller pediatric patients. In particular, research in this field should focus on children weighing less than 10 kg for whom the delivery of RRT is a clinical and technological challenge. We describe here the evolution of pediatric RRT during the last 30 years and report in detail on the CARPEDIEM project, which has recently been established to finally provide neonates and infants with a reliable dialysis machine that is specifically designed for this age group.

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

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.

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…

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.

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.

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.

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

Directory of Open Access Journals (Sweden)

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.

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...

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....

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...

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...

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

Hybrid configurations via percutaneous access for extracorporeal membrane oxygenation: a single-center experience.

Science.gov (United States)

Biscotti, Mauer; Lee, Alison; Basner, Robert C; Agerstrand, Cara; Abrams, Darryl; Brodie, Daniel; Bacchetta, Matthew

2014-01-01

Use of extracorporeal membrane oxygenation (ECMO) in adults has surged in recent years. Typical configurations are venovenous (VV), which provides respiratory support, or venoarterial (VA), which provides both respiratory and circulatory support. In patients supported with VV ECMO who develop hemodynamic compromise, an arterial limb can be added (venovenous-arterial ECMO) to provide additional circulatory support. For patients on VA ECMO who develop concomitant respiratory failure in the setting of some residual cardiac function, an oxygenated reinfusion limb can be added to the internal jugular vein (venoarterial-venous ECMO) to improve oxygen delivery to the cerebral and coronary circulation. Such hybrid configurations can provide differential support for various forms of cardiopulmonary failure. We describe 21 patients who ultimately received a hybrid configuration at our institution between 2012 and 2013. Eight patients (38.1%) died during ECMO support, four patients (19.0%) died after decannulation but before hospital discharge, and nine patients (42.9%) survived to hospital discharge. Our modest survival rate is likely related to the complexity and severity of illness of these patients, and this relative success suggests that hybrid configurations can be effective. It serves patients well to maintain a flexible and adaptable approach to ECMO configurations for their variable cardiopulmonary needs.

Extracorporeal Membrane Oxygenation and Modern Detoxification Techniques in a Puerpera with Viral and Bacterial Pneumonia Caused by Flu A(H1N1 Virus

Directory of Open Access Journals (Sweden)

R. A. Kornelyuk

2017-01-01

Full Text Available Outbreaks of viral infections have become a global healthcare challenge over the last decade. The 2009—2010 flu A (H1N1 outbreak resulted in global pandemia, associated with high morbidity and mortality reaching 31%. Another flu A (H1N1 outbreak occurred in 2015—2016. There is a strong probability that it may be repeated in the future. This infection is associated with its high incidence among pregnant women. There are some published reports describing the efficacy and safety of veno%venous extracorporeal membrane oxygenation (ECMO in patients with severe acute respiratory distress syndrome that is refractory to standard therapeutic options. The article presents a clinical case of a successful use of extracorporeal membrane oxygenation and intermittent renal replacement therapy in a puerpera with acute respiratory distress syndrome caused by flu A (H1N1-related severe viral and bacterial pneumonia. The positive effects of the combination of veno%venous extracorporeal membrane oxygenation and modern detoxification techniques have been demonstrated. Revealed organizational problemswere related to selection criteria for prescription of extracorporeal gas exchange, as well as to carrying out the procedure in an institution in the deficiency of the experienced staff and corresponding equipment.

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 ...

Developing the PLA critical care medicine is critical for advancing the level of battle wound treatment in the new era

Directory of Open Access Journals (Sweden)

Wei-qin LI

2017-04-01

Full Text Available Critical care medicine is an emerging unique specialty developed from the later 20th century, since then, it has been enriched with theoretical and practical experiences and becomes the most active subject in the field of clinical medicine. Critical care medicine of the PLA has attained significant achievements in the treatment and research of severe trauma, sepsis, severe heat stroke, multiple organ failure and severe acute pancreatitis. Besides, it stands in the leading position in the organ function maintenance of critically ill patients, continuous hemofiltration and nutrition support in China. Furthermore, critical care medicine plays an important role in the rescue of critically ill patients, medical support and disaster relief. As the relationship between battle wound rescue system and critical care medicine has been increasingly close, transition in the form of war in the new period brings new tasks to battle wound treatment constantly. Combined with the characteristics of information-oriented war condition in the future, developing the PLA critical care medicine and advancing the level of battle wound treatment in the new period point out the direction for the future work of critical care medicine. DOI: 10.11855/j.issn.0577-7402.2017.02.01

Current Applications for the Use of Extracorporeal Carbon Dioxide Removal in Critically Ill Patients

Directory of Open Access Journals (Sweden)

Luigi Camporota

2016-01-01

Full Text Available Mechanical ventilation in patients with respiratory failure has been associated with secondary lung injury, termed ventilator-induced lung injury. Extracorporeal venovenous carbon dioxide removal (ECCO2R appears to be a feasible means to facilitate more protective mechanical ventilation or potentially avoid mechanical ventilation in select patient groups. With this expanding role of ECCO2R, we aim to describe the technology and the main indications of ECCO2R.

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.

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.

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.

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.

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.

Intensive care management of severe hypernatraemia in the context of group A streptococcal septicaemia.

Science.gov (United States)

Davies, Bethan; Jesty, Robert; Uddin, Shahana; Metaxa, Victoria

2018-04-26

This case describes a 54-year-old woman with exudative eczema, who was admitted to the intensive care unit with a serum sodium concentration of 191 mmol/L, secondary to profound dehydration in the context of group A streptococcal septicaemia. Successful rehydration and electrolyte normalisation was achieved with continuous venovenous haemodiafiltration (CVVHDF), the replacement fluid of which was infused with hypertonic saline to limit the rate of sodium reduction. This case report comments on three areas of interest. First, hypernatraemia of this level is unusual. Second, the infusion of hypertonic saline into the replacement fluid of the CVVHDF filter is not common practice but successfully ensured a controlled reduction in serum sodium concentration while aggressively replacing a 9 L water deficit. Third, the notable physiological reserve demonstrated by the patient: despite an extraordinary serum sodium concentration in the context of overwhelming streptococcal septicaemia, she has made a full cognitive recovery. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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.

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...

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...

Detoxification in Abdominal Sepsis

Directory of Open Access Journals (Sweden)

A. F. Potapov

2005-01-01

Full Text Available Objective. To comparatively analyze the efficiency of methods for extracorporeal detoxification (ED of the body in abdominal sepsis (AS and to choose the optimum detoxifying methods in relation to the level of endotoxicosis.Material and methods. 56 patients (41 males and 15 females; mean age 39.4±12.2 years with surgical abdominal infection of various genesis, complicated by the development of sepsis whose treatment included ED methods, were examined. The level of intoxication and the efficiency of detoxification were evaluated by general clinical and biochemical blood parameters, the leukocytic intoxication index, the levels of low and medium molecular-weight substances in the body’s media. Hemosorption, plasmapheresis, hemodialysis, hemodiafiltration, and hemofiltration were used for detoxification.Results. Surgical abdominal infection is accompanied by endotoxemia that has no clear nosological specificity, but it depends on the pattern of a clinical course of the disease and is most pronounced in the septic syndrome. In AS, 80.4% of the patients are observed to have an irreversible decompensation phase and a terminal degree of endotoxicosis, which require detoxification. The use of different ED methods according to the level of intoxication may reduce the level of endotoxicosis and yield a persistent beneficial effect in 85.2% of cases of its application. Conclusion. Filtration and dialysis techniques (hemodialysis, hemofiltration, and hemodiafiltration are the methods of choice in AS. Hemosorption and plasmapheresis may be recommended for use at the early stages of endotoxicosis development and in preserved renal excretory function.

Decomposition of fuzzy continuity and fuzzy ideal continuity via fuzzy idealization

International Nuclear Information System (INIS)

Zahran, A.M.; Abbas, S.E.; Abd El-baki, S.A.; Saber, Y.M.

2009-01-01

Recently, El-Naschie has shown that the notion of fuzzy topology may be relevant to quantum paretical physics in connection with string theory and E-infinity space time theory. In this paper, we study the concepts of r-fuzzy semi-I-open, r-fuzzy pre-I-open, r-fuzzy α-I-open and r-fuzzy β-I-open sets, which is properly placed between r-fuzzy openness and r-fuzzy α-I-openness (r-fuzzy pre-I-openness) sets regardless the fuzzy ideal topological space in Sostak sense. Moreover, we give a decomposition of fuzzy continuity, fuzzy ideal continuity and fuzzy ideal α-continuity, and obtain several characterization and some properties of these functions. Also, we investigate their relationship with other types of function.

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...

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...

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

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.

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.

Modified temporary end-to-side portocaval shunt in liver and small bowel transplantation.

Science.gov (United States)

Molmenti, E P; Marsh, J W; Molmenti, H; Reyes, J; Fung, J J

2001-10-01

Piggyback orthotopic liver transplantation (LTx) has permitted the elimination of extra-corporeal venovenous bypass. In some instances, an internal temporary portocaval shunt has to be constructed in order to prevent hemodynamic instability. We describe a technique in which a donor iliac vein graft is used to bridge the distance between the portal vein and vena cava in cases where a direct shunt cannot be constructed. This technique can be applied to liver Tx as well as to liver and small bowel Tx.

Business continuity after catastrophic medical events: the Joplin medical business continuity report.

Science.gov (United States)

Carlton, Paul K; Bringle, Dottie

2012-01-01

On May 22, 2011, The St Johns Mercy Medical Center in Joplin, MO, was destroyed by an F-5 tornado. There were 183 patients in the building at that time in this 367-bed Medical Center. The preparation and response were superbly done and resulted in many lives saved. This report is focused on the reconstitution phase of this disaster response, which includes how to restore business continuity. As 95 percent of our medical capacity resides in the private sector in the United States, we must have a proper plan for how to restore business continuity or face the reality of the medical business failing and not providing critical medical services to the community. A tornado in 2007 destroyed a medical center in Sumter County, GA, and it took more than 365 days to restore business continuity at a cost of $18M. The plan executed by the Mercy Medical System after the disaster in Joplin restored business continuity in 88 days and cost a total of $6.6M, with all assets being reusable. The recommendation from these lessons learned is that every county, state, and Federal Emergency Management Agency region has a plan on the shelf to restore business continuity and the means to be able to do so. The hard work that the State of Missouri and the Mercy Medical System did after this disaster can serve as a model for the nation in how to quickly recover from any loss of medical capability.

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.

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.

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...

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

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...

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...

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

Formalizing Implementation Strategies for First-Class Continuations

DEFF Research Database (Denmark)

Danvy, Olivier

1999-01-01

We present the first formalization of implementation strategies for first-class continuations. The formalization hinges on abstract machines for continuation-passing style (CPS) programs with a special treatment for the current continuation, accounting for the essence of first-class continuations......-class continuations and that second-class continuations are stackable. A large body of work exists on implementing continuations, but it is predominantly empirical and implementation-oriented. In contrast, our formalization abstracts the essence of first-class continuations and provides a uniform setting...

Formalizing Implementation Strategies for First-Class Continuations

DEFF Research Database (Denmark)

Danvy, Olivier

2000-01-01

We present the first formalization of implementation strategies for first-class continuations. The formalization hinges on abstract machines for continuation-passing style (CPS) programs with a special treatment for the current continuation, accounting for the essence of first-class continuations......-class continuations and that second-class continuations are stackable. A large body of work exists on implementing continuations, but it is predominantly empirical and implementation-oriented. In contrast, our formalization abstracts the essence of first-class continuations and provides a uniform setting...

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 ...

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.

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.

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.

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

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.

High-precision terahertz frequency modulated continuous wave imaging method using continuous wavelet transform

Science.gov (United States)

Zhou, Yu; Wang, Tianyi; Dai, Bing; Li, Wenjun; Wang, Wei; You, Chengwu; Wang, Kejia; Liu, Jinsong; Wang, Shenglie; Yang, Zhengang

2018-02-01

Inspired by the extensive application of terahertz (THz) imaging technologies in the field of aerospace, we exploit a THz frequency modulated continuous-wave imaging method with continuous wavelet transform (CWT) algorithm to detect a multilayer heat shield made of special materials. This method uses the frequency modulation continuous-wave system to catch the reflected THz signal and then process the image data by the CWT with different basis functions. By calculating the sizes of the defects area in the final images and then comparing the results with real samples, a practical high-precision THz imaging method is demonstrated. Our method can be an effective tool for the THz nondestructive testing of composites, drugs, and some cultural heritages.

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.

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.

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

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 ...

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...

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.

Respiratory Strategies and Airway Management in Patients with Pulmonary Alveolar Proteinosis: A Review

Directory of Open Access Journals (Sweden)

Tomas Vymazal

2015-01-01

Full Text Available Background. Pulmonary alveolar proteinosis is a rare disorder characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Treatment methods include noninvasive pharmacological approaches and invasive procedures, such as whole-lung lavage under general anesthesia. Methods. Based on the literature search using free-term key words, we have analyzed published articles concerning the perioperative management of adult and pediatric patients with pulmonary alveolar proteinosis. Results and Discussion. In total, 184 publications were analyzed. Only a few manuscripts were related to anesthetic, respiratory, and airway management in patients suffering from pulmonary alveolar proteinosis. Airway should be strictly separated using a double-lumen tube. Respiratory strategies involve the use of manual clapping, continuous positive airway pressure, high-frequency jet ventilation of the affected lung, and employment of venovenous extracorporeal membrane oxygenation in the most serious of cases. Conclusion. The goal of this review is to summarize the current published information about an anesthetic management strategy with a focus on airway management, ventilation, and oxygenation techniques in PAP patients.

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

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....

Alveolar and serum concentrations of imipenem in two lung transplant recipients supported with extracorporeal membrane oxygenation.

Science.gov (United States)

Welsch, C; Augustin, P; Allyn, J; Massias, L; Montravers, P; Allou, N

2015-02-01

Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly used in patients with respiratory failure who fail conventional treatment. Postoperative pneumonia is the most common infection after lung transplantation (40%). Imipenem is frequently used for empirical treatment of nosocomial pneumonia in the intensive care unit. Nevertheless, few data are available on the impact of ECMO on pharmacokinetics, and no data on imipenem dosing during ECMO. Currently, no guidelines exist for antibiotic dosing during ECMO support. We report the cases of 2 patients supported with venovenous ECMO for refractory acute respiratory distress syndrome following single lung transplantation for pulmonary fibrosis, treated empirically with 1 g of imipenem intravenously every 6 h. Enterobacter cloacae was isolated from the respiratory sample of Patient 1 and Klebsiella pneumoniae was isolated from the respiratory sample of Patient 2. Minimum inhibitory concentrations of the 2 isolated strains were 0.125 and 0.25 mg/L, respectively. Both patients were still alive on day 28. This is the first report, to our knowledge, of imipenem concentrations in lung transplantation patients supported with ECMO. This study confirms high variability in imipenem trough concentrations in patients on ECMO and with preserved renal function. An elevated dosing regimen (4 g/24 h) is more likely to optimize drug exposure, and therapeutic drug monitoring is recommended, where available. Population pharmacokinetic studies are indicated to develop evidence-based dosing guidelines for ECMO patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Formalizing Implementation Strategies for First-Class Continuations

DEFF Research Database (Denmark)

Danvy, Olivier

1999-01-01

. These abstract machines are proven equivalent to a standard, substitution-based abstract machine. The proof techniques work uniformly for various representations of continuations. As a byproduct, we also present a formal proof of the two folklore theorems that one continuation identifier is enough for second......-class continuations and that second-class continuations are stackable. A large body of work exists on implementing continuations, but it is predominantly empirical and implementation-oriented. In contrast, our formalization abstracts the essence of first-class continuations and provides a uniform setting...

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)

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.

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?”.

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

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...

Control systems engineering in continuous pharmaceutical manufacturing. May 20-21, 2014 Continuous Manufacturing Symposium.

Science.gov (United States)

Myerson, Allan S; Krumme, Markus; Nasr, Moheb; Thomas, Hayden; Braatz, Richard D

2015-03-01

This white paper provides a perspective of the challenges, research needs, and future directions for control systems engineering in continuous pharmaceutical processing. The main motivation for writing this paper is to facilitate the development and deployment of control systems technologies so as to ensure quality of the drug product. Although the main focus is on small-molecule pharmaceutical products, most of the same statements apply to biological drug products. An introduction to continuous manufacturing and control systems is followed by a discussion of the current status and technical needs in process monitoring and control, systems integration, and risk analysis. Some key points are that: (1) the desired objective in continuous manufacturing should be the satisfaction of all critical quality attributes (CQAs), not for all variables to operate at steady-state values; (2) the design of start-up and shutdown procedures can significantly affect the economic operation of a continuous manufacturing process; (3) the traceability of material as it moves through the manufacturing facility is an important consideration that can at least in part be addressed using residence time distributions; and (4) the control systems technologies must assure quality in the presence of disturbances, dynamics, uncertainties, nonlinearities, and constraints. Direct measurement, first-principles and empirical model-based predictions, and design space approaches are described for ensuring that CQA specifications are met. Ways are discussed for universities, regulatory bodies, and industry to facilitate working around or through barriers to the development of control systems engineering technologies for continuous drug manufacturing. Industry and regulatory bodies should work with federal agencies to create federal funding mechanisms to attract faculty to this area. Universities should hire faculty interested in developing first-principles models and control systems technologies for

7 CFR 205.406 - Continuation of certification.

Science.gov (United States)

2010-01-01

..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Certification § 205.406 Continuation of certification. (a) To continue... 7 Agriculture 3 2010-01-01 2010-01-01 false Continuation of certification. 205.406 Section 205.406...

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...

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

Some properties of contra-γ-continuous functions

International Nuclear Information System (INIS)

Nasef, Arafa A.

2005-01-01

The notion of contra-continuity was introduced and investigated by Dontchev [Int. J. Math. Math. Sci. 19 (1996) 303]. In this paper, we apply the notion of γ-open sets in topological spaces to present and study a new class of functions called contra-γ-continuous functions which lies between classes of contra-semi-continuous functions and contra-β-continuous functions. We speculate that contra-γ-continuity may be relevant to the physics of fractal and cantorian spacetime

40 CFR Table 11 to Subpart Wwww of... - Data Requirements for New and Existing Continuous Lamination and Continuous Casting Lines...

Science.gov (United States)

2010-07-01

... Continuous Lamination and Continuous Casting Lines Complying With a Percent Reduction Limit or a Lbs/Ton...—Data Requirements for New and Existing Continuous Lamination and Continuous Casting Lines Complying... lamination lines and continuous casting lines you must determine the data in the following table: For each...

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

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.

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…

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)

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.

40 CFR Table 12 to Subpart Wwww of... - Data Requirements for New and Existing Continuous Lamination Lines and Continuous Casting Lines...

Science.gov (United States)

2010-07-01

... Continuous Lamination Lines and Continuous Casting Lines Complying With a Lbs/Ton Organic HAP Emissions Limit... Requirements for New and Existing Continuous Lamination Lines and Continuous Casting Lines Complying With a Lbs... with a lbs/ton organic HAP emissions limit for continuous lamination lines and continuous casting lines...

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...

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

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.

Design and construction of a vertical hydroponic system with semi-continuous and continuous nutrient cycling

Science.gov (United States)

Siswanto, Dian; Widoretno, Wahyu

2017-11-01

Problems due to the increase in agricultural land use change can be solved by hydroponic system applications. Many hydroponic studies have been conducted in several countries while their applications in Indonesia requires modification and adjustment. This research was conducted to design and construct a hydroponic system with semi-continuous and continuous nutrition systems. The hydroponic system which was used adapts the ebb and flow system, and the nutrient film technique (NFT). This hydroponic system was made from polyvinyl chloride (PVC) pipes with a length of 197 cm, a diameter of 16 cm, and a slope of 4°. It was constructed from four PVC pipes. In semi-continuous irrigation treatment, nutrients flow four to six times for each of ten minutes depending on plant development and the estimated evapotranspiration occurring, while in a continuous nutrient system the nutrients are streamed for twenty-four hours without stopping at a maximum flow rate of 13.7 L per second.

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.

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)

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...

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.

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)

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.

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.)

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.

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.

Analysis of fatigue resistance of continuous and non-continuous welded rectangular frame intersections by finite element method

International Nuclear Information System (INIS)

McCoy, M. L.; Moradi, R.; Lankarani, H. M.

2011-01-01

Agricultural and construction equipment are commonly implemented with rectangular tubing in their structural frame designs. A typical joining method to fabricate these frames is by welding and the use of ancillary structural plating at the connections. This aids two continuous members to pass through an intersection point of the frame with some degree of connectivity, but the connections are highly unbalanced as the tubing centroids exhibit asymmetry. Due to the practice of welded continuous member frame intersections in current agricultural equipment designs, a conviction may exist that welded continuous member frames are superior in structural strength over that of structural frame intersections implementing welded non-continuous members where the tubing centroids lie within two planes of symmetry, a connection design that would likely fabricating a more fatigue resistant structural frame. Three types of welded continuous tubing frame intersections currently observed in the designs of agricultural equipment were compared to two non-continuous frame intersection designs. Each design was subjected to the same loading condition and then examined for stress levels using the Finite Element Method to predict fatigue life. Results demonstrated that a lighter weight, non-continuous member frame intersection design was two magnitudes superior in fatigue resistance than some current implemented frame designs when using Stress-Life fatigue prediction methods and empirical fatigue strengths for fillet welds. Stress-Life predictions were also made using theoretical fatigue strength calculations for the fatigue strength at the welds for comparison to the empirical derived weld fatigue strength

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…

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

Science.gov (United States)

2011-09-01

The Homeland Security Presidential Directive 20 (HSPD-20) requires all local, state, tribal and territorial government agencies, : and private sector owners of critical infrastructure and key resources (CI/KR) to create a Continuity of Operations/Con...

A study on the continuing education of radiologic technologists: Focused on current status and satisfaction of continuing education

International Nuclear Information System (INIS)

Min, Hye Lim; Choi, In Seok; Nam, So Ra; Kim, Hyun Ji; Yoon, Yong Su; Her, Jae; Han, Seong Gyu; Kim, Jung Min; Ahn, Duck Sun

2014-01-01

In this study, we surveyed the current status, satisfaction and demand of radiologic technologist continuing education for 93 radiologic technologists who participated in the continuing education. To understand the current status and general evaluation and to find out the improvement direction, survey was conducted on 3 categories: participation, satisfaction and demand of continuing education. In addition, we analyzed the continuing education implementation status and the management system by collecting related regulations. As a result, the education completion rates of radiologic technologists from 2010 to 2012 were respectively 42.6%, 43.4% and 34.2%; the rates were similar to other medical technician’s average education completion rates. According to the survey, in case of participation, the most frequent answer was ‘more than five times less than 10 times per year’ with 48.4% and in satisfaction section, the most common answer was ‘Average(3)’ with 34.4%. In demand of continuing education section, 32.8% of the respondents chose ‘Clinical skill training in major field’. In the results of this research, continuing education needs to be managed in the direction of helping radiologists improve their personal ability and self development. Furthermore, to meet the demand of radiologists, the quality of continuing education should be improved to satisfy the educatee

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)

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.

Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.

Science.gov (United States)

Fairbrother, Peter; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian

2012-09-01

Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways. A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in 2009. A qualitative study, nested within the TELESCOT COPD randomised control trial, was undertaken to explore the views of patients and professionals on telemonitoring. The perceived impact of telemonitoring on continuity of care was investigated as part of the research. Semi-structured interviews were undertaken with 38 patients (47% male, mean age 67.5 years). A maximum variation sample in relation to age, sex, socio-economic background, disease severity, and compliance with telemonitoring was recruited. Thirty-two stakeholders (healthcare professionals and managers) were interviewed. Transcribed coded data were analysed thematically using the framework approach. Interpretation was supported by multidisciplinary discussion. Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services. Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs. However, professionals described many operational challenges arising from the 'bolting-on' of telemonitoring provision to existing usual care provision which, they considered, resulted in the proliferation of additional managerial discontinuities. Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity of clinical management in the development of telemonitoring services.

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...

Continuity diaphragm for skewed continuous span precast prestressed concrete girder bridges.

Science.gov (United States)

2004-10-01

Continuity diaphragms used on skewed bents in prestressed girder bridges cause difficulties in detailing and : construction. Details for bridges with large diaphragm skew angles (>30) have not been a problem for LA DOTD. : However, as the skew angl...

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.)

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.)

40 CFR 205.57-8 - Continued testing.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Continued testing. 205.57-8 Section 205.57-8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) NOISE ABATEMENT PROGRAMS TRANSPORTATION EQUIPMENT NOISE EMISSION CONTROLS Medium and Heavy Trucks § 205.57-8 Continued...

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...

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...

19 CFR 191.153 - Continuous Customs custody.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Continuous Customs custody. 191.153 Section 191.153 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) DRAWBACK Merchandise Exported From Continuous Customs Custody § 191.153...

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.

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,

22 CFR 126.12 - Continuation in force.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Continuation in force. 126.12 Section 126.12... PROVISIONS § 126.12 Continuation in force. All determinations, authorizations, licenses, approvals of... previous provisions of this subchapter, continue in full force and effect until or unless modified, revoked...

21 CFR 870.1210 - Continuous flush catheter.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continuous flush catheter. 870.1210 Section 870.1210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... that permits continuous intravascular flushing at a slow infusion rate for the purpose of eliminating...

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.

Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model.

Science.gov (United States)

Park, Marcelo; Mendes, Pedro Vitale; Costa, Eduardo Leite Vieira; Barbosa, Edzangela Vasconcelos Santos; Hirota, Adriana Sayuri; Azevedo, Luciano Cesar Pontes

2016-01-01

The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure. The factors associated with oxygen - and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested. Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.036mmHg/mL/min), cardiac output (beta coefficient = -11.970mmHg/L/min) and pulmonary shunting (beta coefficient = -0.232mmHg/%). Furthermore, the initial oxygen partial pressure and carbon dioxide partial pressure measurements were also associated with oxygenation, with beta coefficients of 0.160 and 0.442mmHg/mmHg, respectively. Carbon dioxide partial pressure was associated with cardiac output (beta coefficient = 3.578mmHg/L/min), sweep gas flow (beta coefficient = -2.635mmHg/L/min), temperature (beta coefficient = 4.514mmHg/ºC), initial pH (beta coefficient = -66.065mmHg/0.01 unit) and hemoglobin (beta coefficient = 6.635mmHg/g/dL). In conclusion, elevations in blood and sweep gas flows in an apneic veno-venous extracorporeal membrane oxygenation model resulted in an increase in oxygen partial pressure and a reduction in carbon dioxide partial pressure 2, respectively. Furthermore, without the possibility of causal inference, oxygen partial pressure was negatively associated with pulmonary shunting and cardiac output, and carbon dioxide partial pressure was positively associated with cardiac output, core temperature and initial hemoglobin.

Single Center Experience with the AngioVac Aspiration System

Energy Technology Data Exchange (ETDEWEB)

Salsamendi, Jason, E-mail: jsalsamendi@med.miami.edu; Doshi, Mehul, E-mail: mdoshi@med.miami.edu; Bhatia, Shivank, E-mail: sbhatia1@med.miami.edu [University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Vascular and Interventional Radiology (United States); Bordegaray, Matthew, E-mail: matthewbordegaray@gmail.com [University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department Radiology (United States); Arya, Rahul, E-mail: rahul.arya@jhsmiami.org [University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Vascular and Interventional Radiology (United States); Morton, Connor, E-mail: cmorton@med.miami.edu [University of Miami Miller School of Medicine (United States); Narayanan, Govindarajan, E-mail: gnarayanan@med.miami.edu [University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Vascular and Interventional Radiology (United States)

2015-08-15

PurposeThe AngioVac catheter system is a mechanical suction device designed for removal of intravascular material using extracorporeal veno-venous bypass circuit. The purpose of this study is to present the outcomes in patients treated with the AngioVac aspiration system and to discuss its efficacy in different vascular beds.Materials and MethodsA retrospectively review was performed of seven patients treated with AngioVac between October 2013 and December 2014. In 6/7 cases, the AngioVac cannula was inserted percutaneously and the patient was placed on veno-venous bypass. In one of the cases, the cannula was inserted directly into the Fontan circuit after sternotomy and the patient was maintained on cardiopulmonary bypass. Thrombus location included iliocaval (2), SVC (1), pulmonary arteries (1), Fontan circuit and Glenn shunt with pulmonary artery extension (1), right atrium (1), and IVC with renal vein extension (1).ResultsThe majority of thrombus (50–95 %) was removed in 5/7 cases, and partial thrombus removal (<50 %) was confirmed in 2/7 cases. Mean follow-up was 205 days (range 64–403 days). All patients were alive at latest follow-up. Minor complications included three neck hematomas in two total patients. No major complications occurred.ConclusionAngioVac is a useful tool for acute thrombus removal in the large vessels. The setup and substantial cost may limit its application in straightforward cases. More studies are needed to establish the utility of AngioVac in treatment of intravascular and intracardiac material.

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

Rethinking The Future of Auditing: How an Integrated Continuous Auditing Approach Can Leverage the Full Potential of Continuous Auditing

OpenAIRE

Weins, Sebastian; Alm, Bastian; Wang, Tawei

2016-01-01

The concept of Continuous Auditing has been around for more than three decades. The ongoing discussion on the benefits and models on adoption has made Continuous Auditing become a more critical issue. Although a lot of progress has been made in previous years, we argue that the entire potential of Continuous Auditing still remains unrevealed. This paper provides a new conceptual framework on how to bring Continuous Auditing to the next level. It goes beyond the existing technical concepts and...

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.

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

40 CFR 130.5 - Continuing planning process.

Science.gov (United States)

2010-07-01

... QUALITY PLANNING AND MANAGEMENT § 130.5 Continuing planning process. (a) General. Each State shall establish and maintain a continuing planning process (CPP) as described under section 303(e)(3)(A)-(H) of... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Continuing planning process. 130.5...

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...

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.

Equipment and Analytical Companies Meeting Continuous Challenges May 20-21 2014 Continuous Manufacturing Symposium.

Science.gov (United States)

Page, Trevor; Dubina, Henry; Fillipi, Gabriele; Guidat, Roland; Patnaik, Saroj; Poechlauer, Peter; Shering, Phil; Guinn, Martin; Mcdonnell, Peter; Johnston, Craig

2015-03-01

This white paper focuses on equipment, and analytical manufacturers' perspectives, regarding the challenges of continuous pharmaceutical manufacturing across five prompt questions. In addition to valued input from several vendors, commentary was provided from experienced pharmaceutical representatives, who have installed various continuous platforms. Additionally, a small medium enterprise (SME) perspective was obtained through interviews. A range of technical challenges is outlined, including: the presence of particles, equipment scalability, fouling (and cleaning), technology derisking, specific analytical challenges, and the general requirement of improved technical training. Equipment and analytical companies can make a significant contribution to help the introduction of continuous technology. A key point is that many of these challenges exist in batch processing and are not specific to continuous processing. Backward compatibility of software is not a continuous issue per se. In many cases, there is available learning from other industries. Business models and opportunities through outsourced development partners are also highlighted. Agile smaller companies and academic groups have a key role to play in developing skills, working collaboratively in partnerships, and focusing on solving relevant industry challenges. The precompetitive space differs for vendor companies compared with large pharmaceuticals. Currently, there is no strong consensus around a dominant continuous design, partly because of business dynamics and commercial interests. A more structured common approach to process design and hardware and software standardization would be beneficial, with initial practical steps in modeling. Conclusions include a digestible systems approach, accessible and published business cases, and increased user, academic, and supplier collaboration. This mirrors US FDA direction. The concept of silos in pharmaceutical companies is a common theme throughout the white

Equipment and analytical companies meeting continuous challenges. May 20-21, 2014 Continuous Manufacturing Symposium.

Science.gov (United States)

Page, Trevor; Dubina, Henry; Fillipi, Gabriele; Guidat, Roland; Patnaik, Saroj; Poechlauer, Peter; Shering, Phil; Guinn, Martin; Mcdonnell, Peter; Johnston, Craig

2015-03-01

This white paper focuses on equipment, and analytical manufacturers' perspectives, regarding the challenges of continuous pharmaceutical manufacturing across five prompt questions. In addition to valued input from several vendors, commentary was provided from experienced pharmaceutical representatives, who have installed various continuous platforms. Additionally, a small medium enterprise (SME) perspective was obtained through interviews. A range of technical challenges is outlined, including: the presence of particles, equipment scalability, fouling (and cleaning), technology derisking, specific analytical challenges, and the general requirement of improved technical training. Equipment and analytical companies can make a significant contribution to help the introduction of continuous technology. A key point is that many of these challenges exist in batch processing and are not specific to continuous processing. Backward compatibility of software is not a continuous issue per se. In many cases, there is available learning from other industries. Business models and opportunities through outsourced development partners are also highlighted. Agile smaller companies and academic groups have a key role to play in developing skills, working collaboratively in partnerships, and focusing on solving relevant industry challenges. The precompetitive space differs for vendor companies compared with large pharmaceuticals. Currently, there is no strong consensus around a dominant continuous design, partly because of business dynamics and commercial interests. A more structured common approach to process design and hardware and software standardization would be beneficial, with initial practical steps in modeling. Conclusions include a digestible systems approach, accessible and published business cases, and increased user, academic, and supplier collaboration. This mirrors US FDA direction. The concept of silos in pharmaceutical companies is a common theme throughout the white

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.

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…

32 CFR 724.218 - Limitation-Continuance and Postponements.

Science.gov (United States)

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Limitation-Continuance and Postponements. 724... Limitation—Continuance and Postponements. (a) A continuance of a discharge review hearing may be authorized... continuance is of reasonable duration and is essential to achieving a full and fair hearing. When a proposal...

The use of renal replacement therapy in acute decompensated heart failure.

Science.gov (United States)

Udani, Suneel M; Murray, Patrick T

2009-01-01

The worsening of renal function in the context of decompensated heart failure is an increasingly common clinical scenario, dubbed the cardiorenal syndrome. Its development is not completely understood; however, it results from the hemodynamic and neurohumoral alterations that occur in the setting of left ventricular pressure and volume overload with poor cardiac output. Diuretics have been the mainstay of treatment; however, they are often unsuccessful in reversing the vicious cycle of volume overload, worsening cardiac function, and azotemia. Renal replacement therapy (RRT) in the form of isolated or continuous ultrafiltration (UF) with or without a component of solute clearance (hemofiltration or hemodialysis) has been increasingly utilized as a therapeutic tool in this setting. Initial clinical trial data on the use of UF have demonstrated promising cardiac outcomes with regard to fluid removal and symptom relief without worsening renal function. The addition of a component of solute clearance may provide additional benefits in these patients with varying degrees of renal impairment. The exact clinical setting in which the various forms of RRT should be applied as initial or early therapy for acute decompensated heart failure (ADHF) remains unknown. More research examining the use of RRT in ADHF is necessary; however, it appears that the patients with the most severe clinical presentations have the best chance of benefiting from the early application of RRT.

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...

A Health Care Project Management Office's Strategies for Continual Change and Continuous Improvement.

Science.gov (United States)

Lavoie-Tremblay, Mélanie; Aubry, Monique; Richer, Marie-Claire; Cyr, Guylaine

Health care organizations need project and change management support in order to achieve successful transformations. A project management office (PMO) helps support the organizations through their transformations along with increasing their capabilities in project and change management. The aim of the present study was to extend understanding of the continuous improvement mechanisms used by PMOs and to describe PMO's strategies for continual change and continuous improvement in the context of major transformation in health care. This study is a descriptive case study design with interviews conducted from October to December 2015 with PMO's members (3 managers and 1 director) and 3 clients working with the PMO after a major redevelopment project ended (transition to the new facility). Participants suggested a number of elements including carefully selecting the members of the PMO, having a clear mandate for the PMO, having a method and a discipline at the same time as allowing openness and flexibility, clearly prioritizing projects, optimizing collaboration, planning for everything the PMO will need, not overlooking organizational culture, and retaining the existing support model. This study presents a number of factors ensuring the sustainability of changes.

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.

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)

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...

Successful Use of Extracorporeal Life Support after Double Traumatic Tracheobronchial Injury in a Patient with Severe Acute Asthma

Directory of Open Access Journals (Sweden)

Xavier Valette

2011-01-01

Full Text Available We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO2 removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma.

Single-quadrature continuous-variable quantum key distribution

DEFF Research Database (Denmark)

Gehring, Tobias; Jacobsen, Christian Scheffmann; Andersen, Ulrik Lund

2016-01-01

Most continuous-variable quantum key distribution schemes are based on the Gaussian modulation of coherent states followed by continuous quadrature detection using homodyne detectors. In all previous schemes, the Gaussian modulation has been carried out in conjugate quadratures thus requiring two...... commercialization of continuous-variable quantum key distribution, provided that the low noise requirement can be achieved....

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.

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…

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.

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.

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

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...

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.

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.

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

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

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....

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 ...

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.

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...

Organizzazione bibliografica delle risorse continuative in relazione ai modelli IFLA : Ricerca all'interno del corpus delle risorse continuative croate

Directory of Open Access Journals (Sweden)

Tatijana Petrić

2016-01-01

Full Text Available Comprehensive research on continuing resources has not been conducted in Croatia, therefore this paper will indicate the current bibliographic organisation of continuing resources in comparison to the parameters set by the IFLA models, and the potential flaws of the IFLA models in the bibliographic organisation of continuing resources, in comparison to the valid national code which is used in Croatian cataloguing practice. Research on the corpus of Croatian continuing resources was performed in the period from 2000 and 2011. By using the listed population through the method of deliberate stratified sampling, the titles which had been observed were selected. Through the method of observation of bibliographic records of the selected sample in the NUL catalogue, the frequency of occurrence of parameters from the IFLA models that should identify continuing resources will be recorded and should also show the characteristics of continuing resources. In determining the parameters of observation, the FRBR model is viewed in terms of bibliographic data, FRAD is viewed in terms of other groups or entities or controlled access points for work, person and the corporate body and FRSAD in terms of the third group of entities as the subject or the subject access to continuing resources. Research results indicate that the current model of bibliographic organisation presents a high frequency of attributes that are listed in the IFLA models for all types of resources, although that was not envisaged by the PPIAK, and it is clear that the practice has moved away from the national code which does not offer solutions for all types of resources and ever more so demanding users. The current model of bibliographic organisation of the corpus of Croatian continuing resources in regards to the new IFLA model requires certain changes in order for the user to more easily access and identify continuing resources. The research results also indicate the need to update the

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.

On a non-continuous and stronger form of Levine's semi-continuous functions

OpenAIRE

Caldas, Miguel; Jafari, Saeid; Saraf, Ratnesh Kumar

2009-01-01

The concept of a (δ,β) irresolute function in topological spaces is introduced and studied. Some of their characteristic properties are considered. We also investigate the relationships between these classes of functions and other classes of non-continuous functions.

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

Continuous-time quantum walks on star graphs

International Nuclear Information System (INIS)

Salimi, S.

2009-01-01

In this paper, we investigate continuous-time quantum walk on star graphs. It is shown that quantum central limit theorem for a continuous-time quantum walk on star graphs for N-fold star power graph, which are invariant under the quantum component of adjacency matrix, converges to continuous-time quantum walk on K 2 graphs (complete graph with two vertices) and the probability of observing walk tends to the uniform distribution.

Studying Implementation within a Continuous Continuous-Improvement Process: What Happens When We Design with Adaptations in Mind?

Science.gov (United States)

Tichnor-Wagner, Ariel; Allen, Danielle; Socol, Allison Rose; Cohen-Vogel, Lora; Rutledge, Stacey A.; Xing, Qi W.

2018-01-01

Background/Context: This study examines the implementation of an academic and social-emotional learning innovation called Personalization for Academic and Social-Emotional Learning, or PASL. The innovation was designed, tested, and implemented using a continuous continuous-improvement model. The model emphasized a top-and-bottom process in which…

Early diagnosis of leptospirosis

Directory of Open Access Journals (Sweden)

Andrea Babic-Erceg

2014-06-01

Full Text Available A 25-years old man from Zagreb, Croatia, was admitted to the University Hospital for Infectious Diseases four days after the onset of symptoms such as fever, intense pain in the calves and anuria. The patient owned a rabbit and, before the onset of the disease, repaired some rubber pipes damaged by rodents. At admission, he had a severe clinical picture with fever, hypotension, jaundice, immobility, and pain in leg muscles. Treatment with ceftriaxone was initiated in combination with volume restitution. Renal failure soon ensued. Consequently continuous venovenous hemodiaphiltration therapy was performed. Due to acute respiratory distress syndrome, the patient was mechanically ventilated. The patient’s condition gradually improved and he recovered fully from multi-organ failure. Diagnosis was confirmed by a microscopic agglutination test (MAT covering 15 leptospira serovars and real-time polymerase-chain reaction (PCR. The first serum sample taken on day 6 tested negative for leptospira, while PCR showed positive results for leptospiral DNA. The second serum sample taken on day 13 tested positive for serovar Canicola serogroup Canicola, serovar Patoc, serovar Grippotyphosa serogroup Grippotyphosa and serovar Tarassovi serogroup Tarassovi (titre 4000, 4000, 1000 and 2000, respectively, while PCR was negative. This report highlights the benefits of combining MAT and PCR methods in early diagnosis of leptospirosis.

Improving Survival in Decompensated Cirrhosis

Directory of Open Access Journals (Sweden)

Amar Nath Mukerji

2012-01-01

Full Text Available Mortality in cirrhosis is consequent of decompensation, only treatment being timely liver transplantation. Organ allocation is prioritized for the sickest patients based on Model for End Stage Liver Disease (MELD score. In order to improve survival in patients with high MELD score it is imperative to preserve them in suitable condition till transplantation. Here we examine means to prolong life in high MELD score patients till a suitable liver is available. We specially emphasize protection of airways by avoidance of sedatives, avoidance of Bilevel Positive Airway Pressure, elective intubation in grade III or higher encephalopathy, maintaining a low threshold for intubation with lesser grades of encephalopathy when undergoing upper endoscopy or colonoscopy as pre transplant evaluation or transferring patient to a transplant center. Consider post-pyloric tube feeding in encephalopathy to maintain muscle mass and minimize risk of aspiration. In non intubated and well controlled encephalopathy, frequent physical mobility by active and passive exercises are recommended. When renal replacement therapy is needed, night-time Continuous Veno-Venous Hemodialysis may be useful in keeping the daytime free for mobility. Sparing and judicious use of steroids needs to be borne in mind in treatment of ARDS and acute hepatitis from alcohol or autoimmune process.

Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report [v1; ref status: indexed, http://f1000r.es/24q

Directory of Open Access Journals (Sweden)

Dino Mijatovic

2014-03-01

Full Text Available Introduction: Hemolytic-uremic syndrome (HUS is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS, toxic megacolon with ileus, pancreatitis, central nervous system (CNS disorders and multiple organ failure (MOF. Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. In the next week of, what initially appeared as typical HUS, she developed MOF, including ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis. Conclusions: Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.

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....

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.

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.

Future Supply Chains Enabled by Continuous Processing-Opportunities Challenges May 20-21 2014 Continuous Manufacturing Symposium.

Science.gov (United States)

Srai, Jagjit Singh; Badman, Clive; Krumme, Markus; Futran, Mauricio; Johnston, Craig

2015-03-01

This paper examines the opportunities and challenges facing the pharmaceutical industry in moving to a primarily "continuous processing"-based supply chain. The current predominantly "large batch" and centralized manufacturing system designed for the "blockbuster" drug has driven a slow-paced, inventory heavy operating model that is increasingly regarded as inflexible and unsustainable. Indeed, new markets and the rapidly evolving technology landscape will drive more product variety, shorter product life-cycles, and smaller drug volumes, which will exacerbate an already unsustainable economic model. Future supply chains will be required to enhance affordability and availability for patients and healthcare providers alike despite the increased product complexity. In this more challenging supply scenario, we examine the potential for a more pull driven, near real-time demand-based supply chain, utilizing continuous processing where appropriate as a key element of a more "flow-through" operating model. In this discussion paper on future supply chain models underpinned by developments in the continuous manufacture of pharmaceuticals, we have set out; The paper recognizes that although current batch operational performance in pharma is far from optimal and not necessarily an appropriate end-state benchmark for batch technology, the adoption of continuous supply chain operating models underpinned by continuous production processing, as full or hybrid solutions in selected product supply chains, can support industry transformations to deliver right-first-time quality at substantially lower inventory profiles. © 2015 The Authors. Journal of Pharmaceutical Sciences published by Wiley Periodicals, Inc. and the American Pharmacists Association. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Curvature-Continuous 3D Path-Planning Using QPMI Method

Directory of Open Access Journals (Sweden)

Seong-Ryong Chang

2015-06-01

Full Text Available It is impossible to achieve vertex movement and rapid velocity control in aerial robots and aerial vehicles because of momentum from the air. A continuous-curvature path ensures such robots and vehicles can fly with stable and continuous movements. General continuous path-planning methods use spline interpolation, for example B-spline and Bézier curves. However, these methods cannot be directly applied to continuous path planning in a 3D space. These methods use a subset of the waypoints to decide curvature and some waypoints are not included in the planned path. This paper proposes a method for constructing a curvature-continuous path in 3D space that includes every waypoint. The movements in each axis, x, y and z, are separated by the parameter u. Waypoint groups are formed, each with its own continuous path derived using quadratic polynomial interpolation. The membership function then combines each continuous path into one continuous path. The continuity of the path is verified and the curvature-continuous path is produced using the proposed method.

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.

Rough case-based reasoning system for continues casting

Science.gov (United States)

Su, Wenbin; Lei, Zhufeng

2018-04-01

The continuous casting occupies a pivotal position in the iron and steel industry. The rough set theory and the CBR (case based reasoning, CBR) were combined in the research and implementation for the quality assurance of continuous casting billet to improve the efficiency and accuracy in determining the processing parameters. According to the continuous casting case, the object-oriented method was applied to express the continuous casting cases. The weights of the attributes were calculated by the algorithm which was based on the rough set theory and the retrieval mechanism for the continuous casting cases was designed. Some cases were adopted to test the retrieval mechanism, by analyzing the results, the law of the influence of the retrieval attributes on determining the processing parameters was revealed. A comprehensive evaluation model was established by using the attribute recognition theory. According to the features of the defects, different methods were adopted to describe the quality condition of the continuous casting billet. By using the system, the knowledge was not only inherited but also applied to adjust the processing parameters through the case based reasoning method as to assure the quality of the continuous casting and improve the intelligent level of the continuous casting.

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

Identification of parameters of discrete-continuous models

International Nuclear Information System (INIS)

Cekus, Dawid; Warys, Pawel

2015-01-01

In the paper, the parameters of a discrete-continuous model have been identified on the basis of experimental investigations and formulation of optimization problem. The discrete-continuous model represents a cantilever stepped Timoshenko beam. The mathematical model has been formulated and solved according to the Lagrange multiplier formalism. Optimization has been based on the genetic algorithm. The presented proceeding’s stages make the identification of any parameters of discrete-continuous systems possible

Identification of parameters of discrete-continuous models

Energy Technology Data Exchange (ETDEWEB)

Cekus, Dawid, E-mail: cekus@imipkm.pcz.pl; Warys, Pawel, E-mail: warys@imipkm.pcz.pl [Institute of Mechanics and Machine Design Foundations, Czestochowa University of Technology, Dabrowskiego 73, 42-201 Czestochowa (Poland)

2015-03-10

In the paper, the parameters of a discrete-continuous model have been identified on the basis of experimental investigations and formulation of optimization problem. The discrete-continuous model represents a cantilever stepped Timoshenko beam. The mathematical model has been formulated and solved according to the Lagrange multiplier formalism. Optimization has been based on the genetic algorithm. The presented proceeding’s stages make the identification of any parameters of discrete-continuous systems possible.

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

Stressful Events and Continued Smoking and Continued Alcohol Consumption during Mid-Pregnancy

NARCIS (Netherlands)

Beijers, C.; Ormel, J.; Meijer, J. L.; Verbeek, T.; Bockting, C. L. H.; Burger, H.

2014-01-01

Aim: to examine whether the severity of different categories of stressful events is associated with continued smoking and alcohol consumption during mid-pregnancy. Also, we explored the explanation of these associations by anxiety and depressive symptoms during pregnancy. Finally, we studied whether

Stressful events and continued smoking and continued alcohol consumption during mid-pregnancy

NARCIS (Netherlands)

Beijers, Chantal; Ormel, Johan; Meijer, Judith L; Verbeek, Tjitte; Bockting, Claudi L H; Burger, Huibert

2014-01-01

Aim: to examine whether the severity of different categories of stressful events is associated with continued smoking and alcohol consumption during mid-pregnancy. Also, we explored the explanation of these associations by anxiety and depressive symptoms during pregnancy. Finally, we studied whether

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

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.

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.

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)

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

Potential of Continuous Manufacturing for Liposomal Drug Products.

Science.gov (United States)

Worsham, Robert D; Thomas, Vaughan; Farid, Suzanne S

2018-05-21

Over the last several years, continuous manufacturing of pharmaceuticals has evolved from bulk APIs and solid oral dosages into the more complex realm of biologics. The development of continuous downstream processing techniques has allowed biologics manufacturing to realize the benefits (e.g. improved economics, more consistent quality) that come with continuous processing. If relevant processing techniques and principles are selected, the opportunity arises to develop continuous manufacturing designs for additional pharmaceutical products including liposomal drug formulations. Liposome manufacturing has some inherent aspects that make it favorable for a continuous process. Other aspects such as formulation refinement, materials of construction, and aseptic processing need development, but present an achievable challenge. This paper reviews the current state of continuous manufacturing technology applicable to liposomal drug product manufacturing and an assessment of the challenges and potential of this application. This article is protected by copyright. All rights reserved.

Determinants of Customer Continuance Intention of Online Shopping

Directory of Open Access Journals (Sweden)

Al-maghrabi, T.

2011-01-01

Full Text Available The purpose of this study is to clarify theory and identify factors that could explain the level of continuance intention of e-shopping. A revised technology acceptance model integrates expectation confirmation theory and investigates effects of age differences. An online survey of internet shoppers in Saudi Arabia. Structural equation modelling and invariance analysis confirm model fit. The findings confirm that perceived usefulness, enjoyment and social pressure are determinants of e-shopping continuance. The structural weights are mostly equivalent between young and old but the regression path from perceived usefulness to social pressure is stronger for younger respondents. This research moves beyond e-shopping intentions to factors affecting e-shopping continuance, explaining 55% of intention to continue shopping online. Online strategies cannot ignore direct and indirect effects on continuance intentions. The findings contribute to literature on internet shopping and continuance intentions in the context of Saudi Arabia.

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...

The Ferris Educational Mission: A Continuing Study by the Ferris Educational Planning Committee, Part II: Continuing Education.

Science.gov (United States)

Ferris State Coll., Big Rapids, MI.

This document, the second of a two-part study, focuses on the area of continuing and adult education at Ferris State College (FSC), Michigan. An overview of the status of adult and continuing education and recommendations are provided by the schools of allied health, business, general education, education, pharmacy, technical and applied arts, and…

42 CFR 456.236 - Continued stay review process.

Science.gov (United States)

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... each continued stay of a recipient in the mental hospital, the committee, subgroup or designee reviews... committee, subgroup or designee finds that a recipient's continued stay in the mental hospital is needed...

Usability, Quality, Value and E-Learning Continuance Decisions

Science.gov (United States)

Chiu, Chao-Min; Hsu, Meng-Hsiang; Sun, Szu-Yuan; Lin, Tung-Ching; Sun, Pei-Chen

2005-01-01

Previous research suggests that an eventual information technology (IT) success depend on both its initial adoption (acceptance) and subsequent continued usage (continuance). Expectancy disconfirmation theory (EDT) has been successfully used to predict users' intention to continue using information technologies. This study proposed a decomposed…

Continuous Improvement and Collaborative Improvement: Similarities and Differences

DEFF Research Database (Denmark)

Middel, Rick; Boer, Harry; Fisscher, Olaf

2006-01-01

the similarities and differences between key components of continuous and collaborative improvement by assessing what is specific for continuous improvement, what for collaborative improvement, and where the two areas of application meet and overlap. The main conclusions are that there are many more similarities...... between continuous and collaborative improvement. The main differences relate to the role of hierarchy/market, trust, power and commitment to collaboration, all of which are related to differences between the settings in which continuous and collaborative improvement unfold....

26 CFR 1.708-1 - Continuation of partnership.

Science.gov (United States)

2010-04-01

....708-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Partners and Partnerships § 1.708-1 Continuation of partnership. (a) General rule... assignment to a successor in interest), bequest, or inheritance, or the liquidation of a partnership interest...

Contribution of continuous assessment to student learning in ...

African Journals Online (AJOL)

The study seeks to find out whether continuous assessment contributes to students' performance mathematics. The objectives of this study were to find out whether; Students see continuous assessment as a motivating factor in their learning, there is any workload involved in filling of continuous assessment termly, ...

Development and application of novelty pretreatment method for the concurrent quantitation of eleven water-soluble B vitamins in ultrafiltrates after renal replacement therapy.

Science.gov (United States)

Wirkus, Dorota; Jakubus, Aleksandra; Owczuk, Radosław; Stepnowski, Piotr; Paszkiewicz, Monika

2017-02-01

Continous renal replacement therapy (CRRT) is particularly recommended for septic shock patients in intensive care units. The CRRT technique used most frequently is high volume continuous veno-venous haemofiltration. It provides a high rate of clearance of uremic toxins and inflammatory cytokines. However, it should also be taken into account that substances important for homeostasis may be concurrently unintentionally removed. Accordingly, water-soluble vitamins can be removed during continuous renal replacement therapy, and the estimate of the loss is critical to ensure appropriate supplementation. The aim of this work was to develop a simple methodology for a purification step prior to the LC-MS/MS determination of water-soluble vitamins in ultrafiltrate samples. For this purpose, two types of resin and a mix of resins were used as sorbents for the purification step. Moreover, parameters such as the amount of resin and the extraction time were optimized. The LC-MS/MS method was developed and validated for final determination of 11 vitamins. The results demonstrated the high purification capability of DEAE Sephadex resin with recoveries between 65 and 101% for water-soluble vitamins from ultrafiltrate samples. An optimized method was applied to assess the loss of B-group vitamins in patients after 24h of renal replacement therapy. The loss of vitamins B2, B6 pyridoxamine, B6 pyridoxal, B7, B1, and B5 in ultrafiltrates was similar in all patients. In the native ultrafiltrates, vitamins B6 pyridoxine, B9 and B12 were not detected. Copyright © 2016 Elsevier B.V. All rights reserved.

Ultraweak Continuity of σ-derivations on von Neumann Algebras

International Nuclear Information System (INIS)

Mirzavaziri, Madjid; Moslehian, Mohammad Sal

2009-01-01

Let σ be a surjective ultraweakly continuous *-linear mapping and d be a σ-derivation on a von Neumann algebra. We show that there are a surjective ultraweakly continuous *-homomorphism and a Σ-derivation such that D is ultraweakly continuous if and only if so is d. We use this fact to show that the σ-derivation d is automatically ultraweakly continuous. We also prove the converse in the sense that if σ is a linear mapping and d is an ultraweakly continuous *-σ-derivation, then there is an ultraweakly continuous linear mapping such that d is a *-Σ-derivation

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

On asymptotic continuity of functions of quantum states

International Nuclear Information System (INIS)

Synak-Radtke, Barbara; Horodecki, Michal

2006-01-01

A useful kind of continuity of quantum states functions in asymptotic regime is so-called asymptotic continuity. In this letter, we provide general tools for checking if a function possesses this property. First we prove equivalence of asymptotic continuity with so-called robustness under admixture. This allows us to show that relative entropy distance from a convex set including a maximally mixed state is asymptotically continuous. Subsequently, we consider arrowing-a way of building a new function out of a given one. The procedure originates from constructions of intrinsic information and entanglement of formation. We show that arrowing preserves asymptotic continuity for a class of functions (so-called subextensive ones). The result is illustrated by means of several examples. (letter to the editor)

Continuous reformulations for zero-one programming problems

OpenAIRE

Marianna De Santis; Francesco Rinaldi

2010-01-01

In this work, we study continuous reformulations of zero-one programming problems. We prove that, under suitable conditions, the optimal solutions of a zero-one programming problem can be obtained by solving a specific continuous problem.

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...

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...

Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center.

Science.gov (United States)

Flannery, Alexander H; Thompson Bastin, Melissa L; Montgomery-Yates, Ashley; Hook, Corrine; Cassity, Evan; Eaton, Phillip M; Morris, Peter E

2018-01-01

Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.

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...

Establishment of a reversible model of prehepatic portal hypertension in rats.

Science.gov (United States)

Zhao, Xin; Dou, Jian; Gao, Qing-Jun

2016-08-01

The aim of the present study was to improve upon the traditional model of pre-hepatic portal hypertension in rats, and simulate the anhepatic phase of orthotopic liver transplantation without veno-venous bypass. A reversible model of portal hypertension was induced by portal vein ligation, with a label ring ligated along the portal vein. A total of 135 male Wistar rats were divided into three groups: i) Normal control (NC) group; ii) portal hypertensive control (PHTC) group; and iii) reperfusion (R) group. In the R group, rats with portal hypertension underwent simultaneous clamping of the portal triad and retrohepatic vena cava for 1 h, followed by removal of the clamps to enable blood reperfusion. Portal venography and portal vein pressure were recorded during the surgery. Arterial oxygen pressure (PaO 2 ), and alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) levels were determined, and pathological changes of the liver were investigated by immunohistochemical staining. The results demonstrated that, 3 weeks after portal vein ligation, the vein area and the free portal pressures in the PHTC group were significantly increased compared with those in the NC group. The serum ALT and AST levels in the R group at different time points were significantly elevated compared with those in the PHTC group, and reached their maximal levels at 24 h after reperfusion. Furthermore, the PaO 2 at 24 h after reperfusion was significantly decreased. In conclusion, the reversible model of pre-hepatic portal hypertension in rats was successfully established using the introduction of a label ring. This model may be useful for basic research focusing on the anhepatic phase of orthotopic liver transplantation without veno-venous bypass.

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.)

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...

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)

How unique is continuity of care? A review of continuity and related concepts.

Science.gov (United States)

Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; van den Bosch, Wil J H M

2012-06-01

The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management. We identified and reviewed articles including a definition of one of these concepts by performing an extensive literature search in PubMed. In addition, we checked the definition of these concepts in the Oxford English Dictionary. Definitions of continuity, coordination, integration, patient-centred care and case management vary over time. These concepts show both great entanglement and also demonstrate differences. Three major common themes could be identified within these concepts: personal relationship between patient and care provider, communication between providers and cooperation between providers. Most definitions of the concepts are formulated from the patient's perspective. The identified themes appear to be core elements of care to patients. Thus, it may be valuable to develop an instrument to measure these three common themes universally. In the patient-centred medical home, such an instrument might turn out to be an important quality measure, which will enable researchers and policy makers to compare care settings and practices and to evaluate new care interventions from the patient perspective.

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...

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.

Airline business continuity and IT disaster recovery sites.

Science.gov (United States)

Haji, Jassim

2016-01-01

Business continuity is defined as the capability of the organisation to continue delivery of products or services at acceptable predefined levels following a disruptive incident. Business continuity is fast evolving to become a critical and strategic decision for any organisation. Transportation in general, and airlines in particular, is a unique sector with a specialised set of requirements, challenges and opportunities. Business continuity in the airline sector is a concept that is generally overlooked by the airline managements. This paper reviews different risks related to airline processes and will also propose solutions to these risks based on experiences and good industry practices.

Continuity of Accelerator Operations during an Extended Pandemic

International Nuclear Information System (INIS)

Noel Okay

2010-01-01

The Operations group for the Continuous Electron Accelerator Facility in Newport News Virginia has developed a Continuity of Operations plan for pandemic conditions when high absenteeism may impact accelerator control room operations. Protocols to address both the potential spread of illnesses in the control room environment as well as maintaining minimum staffing requirements for contiguous accelerator operation will be presented. During acute pandemic conditions local government restrictions may prevent continued operations but during extended periods of high absenteeism accelerator operations can continue when some added precautionary measures and staffing adjustments are made in the way business is done.

The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.

Science.gov (United States)

Fenwick, Jennifer; Sidebotham, Mary; Gamble, Jenny; Creedy, Debra K

2018-02-01

Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work pwork-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

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.

Continuous nowhere differentiable functions the monsters of analysis

CERN Document Server

Jarnicki, Marek

2015-01-01

This book covers the construction, analysis, and theory of continuous nowhere differentiable functions, comprehensively and accessibly. After illuminating the significance of the subject through an overview of its history, the reader is introduced to the sophisticated toolkit of ideas and tricks used to study the explicit continuous nowhere differentiable functions of Weierstrass, Takagi–van der Waerden, Bolzano, and others. Modern tools of functional analysis, measure theory, and Fourier analysis are applied to examine the generic nature of continuous nowhere differentiable functions, as well as linear structures within the (nonlinear) space of continuous nowhere differentiable functions. To round out the presentation, advanced techniques from several areas of mathematics are brought together to give a state-of-the-art analysis of Riemann’s continuous, and purportedly nowhere differentiable, function. For the reader’s benefit, claims requiring elaboration, and open problems, are clearly indicated. An a...

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....

Lp-continuity for Calderón–Zygmund operator

Indian Academy of Sciences (India)

Given a Calderón–Zygmund (- for short) operator , which satisfies Hörmander condition, we prove that: if maps all the characteristic atoms to W L 1 , then is continuous from L p to L p ( 1 < p < ∞ ) . So the study of strong continuity on arbitrary function in L p has been changed into the study of weak continuity on ...

Preparation of nanoparticles by continuous-flow microfluidics

International Nuclear Information System (INIS)

Jahn, Andreas; Reiner, Joseph E.; Vreeland, Wyatt N.; DeVoe, Don L.; Locascio, Laurie E.; Gaitan, Michael

2008-01-01

We review a variety of micro- and nanoparticle formulations produced with microfluidic methods. A diverse variety of approaches to generate microscale and nanoscale particles has been reported. Here we emphasize the use of microfluidics, specifically microfluidic systems that operate in a continuous flow mode, thereby allowing continuous generation of desired particle formulations. The generation of semiconductor quantum dots, metal colloids, emulsions, and liposomes is considered. To emphasize the potential benefits of the continuous-flow microfluidic methodology for nanoparticle generation, preliminary data on the size distribution of liposomes formed using the microfluidic approach is compared to the traditional bulk alcohol injection method.

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/

Indefinite and Continuative Interpretations of the English Present Perfect

Directory of Open Access Journals (Sweden)

Katarina Dea Žetko

2005-06-01

Full Text Available The objective of our paper is to demonstrate that the English present perfect is not by inherent meaning either indefinite or continuative. Notions like indefinite and continuative are contextdependent interpretations of whole constructions and their broader context. However, continuative interpretation can also be triggered by certain adverbials, negative constructions and verbs in the progressive form. But, even these factors do not always guarantee continuative interpretations. Construction, continuative meaning can be cancelled by the context in a broader sense, this fact being a proof that this meaning is merely an implicature. We will demonstrate how different factors interact and trigger either indefinite or continuative interpretations which are not inherent in the present perfect itself. Our paper will attempt to provide sufficient evidence that there is no indefinite/continuative distinction in the English present perfect, the inherent meaning or function of the present perfect is merely to locate the situation somewhere within a period that starts before the time of utterance and leads up to it.

Virtual continuity of measurable functions and its applications

Science.gov (United States)

Vershik, A. M.; Zatitskii, P. B.; Petrov, F. V.

2014-12-01

A classical theorem of Luzin states that a measurable function of one real variable is `almost' continuous. For measurable functions of several variables the analogous statement (continuity on a product of sets having almost full measure) does not hold in general. The search for a correct analogue of Luzin's theorem leads to a notion of virtually continuous functions of several variables. This apparently new notion implicitly appears in the statements of embedding theorems and trace theorems for Sobolev spaces. In fact it reveals the nature of such theorems as statements about virtual continuity. The authors' results imply that under the conditions of Sobolev theorems there is a well-defined integration of a function with respect to a wide class of singular measures, including measures concentrated on submanifolds. The notion of virtual continuity is also used for the classification of measurable functions of several variables and in some questions on dynamical systems, the theory of polymorphisms, and bistochastic measures. In this paper the necessary definitions and properties of admissible metrics are recalled, several definitions of virtual continuity are given, and some applications are discussed. Bibliography: 24 titles.

CONTINUOUS IMPROVEMENT PRACTICE IN LARGE ENTERPRISES: STUDY RESULTS

Directory of Open Access Journals (Sweden)

Dorota Stadnicka

2015-03-01

Full Text Available Continuous improvement is indispensable for ensuring the company's development and its survival on the constantly changing global market. Continuous improvement is particularly important in the quality and production management systems. A company should deliver a product compliant with a client's requirements in a specified time and at an appropriate price. That is why, continuous improvement refers to different areas of an organization's functioning and it is an integral part of Lean Manufacturing. This article presents the results of the study conducted in production enterprises on a limited area. The aim of the study was the assessment of the implementation of continuous improvement in Lean Manufacturing, and, in particular, employees' involvement in the problem identification and in reporting improvements as well as the way of motivating employees to involve themselves. The authors also tried to identify the factors influencing the elements of a continuous improvement system.

Development of vacuum continuous casting technology for uranium

International Nuclear Information System (INIS)

Lee, Y.S.; Kim, C. K.; Kim, K. H.; Lee, D. B.; Kim, J. D.; Jang, S. J.; Ahn, H. S.; Shin, Y. J.

2001-02-01

The spent fuel disposal process of new dry storage concept has been developed in KAERI, in which the uranium metal abstracted by Li-reduction of spent fuel will be formed to long rods and then the rods will be arranged uniformly in canister. The objective of this study is to review the feasibility of applying the continuous casting method to cast a long rod with modifying the vacuum high-frequency induction furnace to vacuum continuous casting system, which was normally used to cast the uranium. The results are as follows. With the nozzle size of 3mm and the withdrawal speed of 3.5 mm/sec, the length of 160mm, diameter of 30 mm continuous casting uranium bar was successfully cast. This result shows there might be a possibility of continuous casting of uranium and helps the design and fabrication of new continuous casting equipment

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...

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

Continuous improvement and the mini-company concept

NARCIS (Netherlands)

de Leede, Jan; Looise, Jan C.

1999-01-01

The key issue of continuous improvement (CI) seems to be the problem of combining extensive employee involvement with market orientation and continuation of CI. In this article we review some existing organisational designs for CI on these three essential characteristics of CI. As an alternative to

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...

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…

Continuous spin fields of mixed-symmetry type

Science.gov (United States)

Alkalaev, Konstantin; Grigoriev, Maxim

2018-03-01

We propose a description of continuous spin massless fields of mixed-symmetry type in Minkowski space at the level of equations of motion. It is based on the appropriately modified version of the constrained system originally used to describe massless bosonic fields of mixed-symmetry type. The description is shown to produce generalized versions of triplet, metric-like, and light-cone formulations. In particular, for scalar continuous spin fields we reproduce the Bekaert-Mourad formulation and the Schuster-Toro formulation. Because a continuous spin system inevitably involves infinite number of fields, specification of the allowed class of field configurations becomes a part of its definition. We show that the naive choice leads to an empty system and propose a suitable class resulting in the correct degrees of freedom. We also demonstrate that the gauge symmetries present in the formulation are all Stueckelberg-like so that the continuous spin system is not a genuine gauge theory.

Continuous precipitation process of plutonium salts; Procede continu de precipitation des sels de plutonium

Energy Technology Data Exchange (ETDEWEB)

Richard, P [Commissariat a l' Energie Atomique, Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires

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) [French] Cette etude porte sur la precipitation continue de l'oxalate de plutonium. L'etude de la solubilite des differentes valences du plutonium dans des milieux acides nitrique-oxalique, puis nitrique-sulfurique-oxalique conduit a choisir la precipitation de l'oxalate de plutonium tetravalent. L'etude porte ensuite sur la sedimentation et la granulometrie de l'oxalate de Pu{sup 4+} obtenue en faisant varier differents parametres de la precipitation : la temperature, l'acidite, l'exces oxalique et le temps de murissement. La derniere partie traite des resultats obtenus avec plusieurs types d'appareils continus essayes au laboratoire. En conclusion sont donnees les conditions de marche de l'appareil tubulaire adopte, ainsi qu'une extrapolation a l'echelle industrielle sous forme d'un flow-sheet. (auteur)

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.

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

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.

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…

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…

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

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

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.

How unique is continuity of care? A review of continuity and related concepts.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den

2012-01-01

BACKGROUND: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. OBJECTIVE: In order to clarify the confusion of

How unique is continuity of care? A review of continuity and related concepts

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; van den Bosch, W.J.H.M.

2012-01-01

Background: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of

How unique is continuity of care? A review of continuity and related concepts.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den

2012-01-01

Background: The concept of ‘continuity of care’ has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of

The Role of Motivation in Continuing Education for Pharmacists

NARCIS (Netherlands)

Tjin a Tsoi, Sharon

2017-01-01

Healthcare professionals, including pharmacists, need to continuously update their knowledge and are, therefore, expected to participate in Continuing Education (CE) and Continuous Professional Development (CPD) activities on a regular basis. Lack of intrinsic (or autonomous) motivation appears to

Multi-stage continuous alcohol fermentation with cane molasses

Energy Technology Data Exchange (ETDEWEB)

Chu, C J; Chiou, C J; Ng, A K; Lin, T C; Hwang, E C; Rao, C H

1970-01-01

It was reported that 6 to 7% ethanol was produced by single-stage continuous 12-hour cycle fermentation of molasses containing 12% sugar using a new strain, Saccharomyces formensensis, isolated from a stock culture. A higher yield of ethanol was obtained from 2-stage and 3-stage continuous fermentation of molasses containing more sugar at 24- and 36-hour cycles, respectively. In the 2-stage 24-hour cycle continuous fermentation of molasses containing 15% sugar with an agitation speed 300 rpm, 9.2% ethanol resulted. Only 3% sugar remained unconsumed. In the 3-stage 36-hour cycle continuous fermentation of molasses containing 15% sugar with 300 rpm agitation, 12.5% ethanol resulted.

Continuous-time quantum random walks require discrete space

International Nuclear Information System (INIS)

Manouchehri, K; Wang, J B

2007-01-01

Quantum random walks are shown to have non-intuitive dynamics which makes them an attractive area of study for devising quantum algorithms for long-standing open problems as well as those arising in the field of quantum computing. In the case of continuous-time quantum random walks, such peculiar dynamics can arise from simple evolution operators closely resembling the quantum free-wave propagator. We investigate the divergence of quantum walk dynamics from the free-wave evolution and show that, in order for continuous-time quantum walks to display their characteristic propagation, the state space must be discrete. This behavior rules out many continuous quantum systems as possible candidates for implementing continuous-time quantum random walks

Continuous-time quantum random walks require discrete space

Science.gov (United States)

Manouchehri, K.; Wang, J. B.

2007-11-01

Quantum random walks are shown to have non-intuitive dynamics which makes them an attractive area of study for devising quantum algorithms for long-standing open problems as well as those arising in the field of quantum computing. In the case of continuous-time quantum random walks, such peculiar dynamics can arise from simple evolution operators closely resembling the quantum free-wave propagator. We investigate the divergence of quantum walk dynamics from the free-wave evolution and show that, in order for continuous-time quantum walks to display their characteristic propagation, the state space must be discrete. This behavior rules out many continuous quantum systems as possible candidates for implementing continuous-time quantum random walks.

Continuous support for women during childbirth.

Science.gov (United States)

Bohren, Meghan A; Hofmeyr, G Justus; Sakala, Carol; Fukuzawa, Rieko K; Cuthbert, Anna

2017-07-06

Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine. The primary objective was to assess the effects, on women and their babies, of continuous, one-to-one intrapartum support compared with usual care, in any setting. Secondary objectives were to determine whether the effects of continuous support are influenced by:1. Routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour, including: policies about the presence of support people of the woman's own choosing; epidural analgesia; and continuous electronic fetal monitoring.2. The provider's relationship to the woman and to the facility: staff member of the facility (and thus has additional loyalties or responsibilities); not a staff member and not part of the woman's social network (present solely for the purpose of providing continuous support, e.g. a doula); or a person chosen by the woman from family members and friends;3. Timing of onset (early or later in labour);4. Model of support (support provided only around the time of childbirth or extended to include support during the antenatal and postpartum periods);5. Country income level (high-income compared to low- and middle-income). We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 June 2017) and reference lists of retrieved studies. All published and unpublished randomised controlled trials, cluster-randomised trials comparing continuous support during labour with usual care. Quasi-randomised and cross-over designs were not eligible for inclusion. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We sought

Unicorn: Continual Learning with a Universal, Off-policy Agent

OpenAIRE

Mankowitz, Daniel J.; Žídek, Augustin; Barreto, André; Horgan, Dan; Hessel, Matteo; Quan, John; Oh, Junhyuk; van Hasselt, Hado; Silver, David; Schaul, Tom

2018-01-01

Some real-world domains are best characterized as a single task, but for others this perspective is limiting. Instead, some tasks continually grow in complexity, in tandem with the agent's competence. In continual learning, also referred to as lifelong learning, there are no explicit task boundaries or curricula. As learning agents have become more powerful, continual learning remains one of the frontiers that has resisted quick progress. To test continual learning capabilities we consider a ...

Cigarette continuity programs and social support for smoking.

Science.gov (United States)

Sumner, W; Dunaway, M; Dillman, D G

1998-01-01

To describe smokers' participation in cigarette continuity programs and the prevalence and structure of cooperative teams of smokers. Cross-sectional survey of smoking histories and continuity-program participation by individuals and their family members in a convenience sample of 176 current smokers at the University of Kentucky Chandler Medical Center, Lexington. Fisher exact test or chi2 tests were used to compare proportions. One of 3 smokers collected coupons for a continuity program. Three quarters of the collectors redeemed their own coupons, and one quarter gave coupons to another collector. Coupon collectors reported an average team size of more than 2 members. One fifth of collectors were teammates with another generation of family members, and one quarter of collectors aged 24 to 35 years were teammates with their children. Smokers were often aware of their relatives' coupon-collecting habits. Continuity programs have been a popular means of reinforcing smoking, especially within families and groups of friends. Continuity programs are novel in encouraging smoking and brand loyalty between generations. Continuity-program participants need to be aware of the risk of promoting smoking initiation by their children. Health advocates could use similar strategies to promote smoking cessation and prevention within families and other social groups.

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

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)

[Update in continuous renal replacement techniques].

Science.gov (United States)

Romero-García, M; de la Cueva-Ariza, L; Delgado-Hito, P

2013-01-01

Acute renal failure affects 25% of patients hospitalized in intensive care units. Despite technological advances, the mortality of these patients is still high due to its associated complications. Continuous renal replacement techniques are one of the treatments for acute renal failure because they make it possible to treat the complications and decrease mortality. The nurse's knowledge and skills regarding these techniques will be decisive for the success of the therapy. Consequently, the nurse's experience and training are key components. The objective of this article is to update the knowledge on continuous renal replacement techniques. Keeping this in mind, a review has been made of the physical and chemical principles such as diffusion and convection, among others. A description of the different continuous renal replacement techniques, a presentation of the main vascular access, and a description of the nursing cares and complications related to techniques used have also been provided. Copyright © 2012 Elsevier España, S.L. y SEEIUC. All rights reserved.

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)

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)

Bupivacaine constant continuous surgical wound infusion versus continuous epidural infusion for post cesarean section pain, randomized placebo-controlled study

Directory of Open Access Journals (Sweden)

Hossam A. ELShamaa

2016-10-01

Conclusion: The current study demonstrated that bupivacaine administered by continuous epidural infusion provided a significantly lower pain scores with mobilization, and hence better analgesia for post cesarean section pain in the first postoperative day compared to continuous bupivacaine wound infusion through fenestrated catheter using the constant flow PainFusor system.

42 CFR 456.231 - Continued stay review required.

Science.gov (United States)

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... a review of each recipient's continued stay in the mental hospital to decide whether it is needed...

A Patient with MSUD: Acute Management with Sodium Phenylacetate/Sodium Benzoate and Sodium Phenylbutyrate.

Science.gov (United States)

Köse, Melis; Canda, Ebru; Kagnici, Mehtap; Uçar, Sema Kalkan; Çoker, Mahmut

2017-01-01

In treatment of metabolic imbalances caused by maple syrup urine disease (MSUD), peritoneal dialysis, and hemofiltration, pharmacological treatments for elimination of toxic metabolites can be used in addition to basic dietary modifications. Therapy with sodium phenylacetate/benzoate or sodium phenylbutyrate (NaPB) in urea-cycle disorder cases has been associated with a reduction in branched-chain amino acid (BCAA) concentrations when the patients are on adequate dietary protein intake. Moreover, NaPB in treatment of MSUD patients is also associated with reduction of BCAA levels in a limited number of cases. However, there are not enough studies in the literature about application and efficacy of this treatment. Our case report sets an example of an alternative treatment's efficacy when extracorporeal procedures are not available due to technical difficulties during attack period of the disease.

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....

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.

Conventional blood conservation techniques in 500 consecutive coronary artery bypass operations.

Science.gov (United States)

Ovrum, E; Holen, E A; Abdelnoor, M; Oystese, R

1991-09-01

With use of a nonpharmacological, simple, and inexpensive program for blood conservation, 500 consecutive patients underwent elective coronary artery bypass grafting without need of homologous red cell transfusions in 493 (98.6%). At least one internal mammary artery was grafted in all but 1 patient, with supplemental saphenous vein grafts. Intraoperatively, autologous heparinized blood was removed before bypass and retransfused at the conclusion of extracorporeal circulation. The volume remaining in the oxygenator and tubing set was returned without cell processing or hemofiltration. Using the hard-shell cardiotomy reservoir from the heart-lung machine, autotransfusion of the shed mediastinal blood was continued hourly up to 18 hours after operation. The mean postoperative mediastinal blood loss was 643 +/- 354 mL, whereas 624 +/- 296 mL was autotransfused. Thirteen patients (2.6%) needed reexploration for bleeding, of whom 7 (7/500, 1.4%) received homologous blood. No other patients required red cell transfusions. In addition, 9 patients were given a mean of 2.6 units of fresh frozen plasma because of suspected coagulopathy. No platelets were transfused, and no cryoprecipitate therapy was undertaken. Thus, in total, 484 patients (96.8%) were not exposed to any homologous blood products during the hospital stay. At discharge, the mean hemoglobin concentration was 121 +/- 14 g/L (12.1 +/- 1.4 g/dL) and the hematocrit, 0.36 +/- 0.04. Postoperative complications were few. There was one in-hospital death (0.2%).

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.

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.

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)

Converter of a continuous code into the Grey code

International Nuclear Information System (INIS)

Gonchar, A.I.; TrUbnikov, V.R.

1979-01-01

Described is a converter of a continuous code into the Grey code used in a 12-charged precision amplitude-to-digital converter to decrease the digital component of spectrometer differential nonlinearity to +0.7% in the 98% range of the measured band. To construct the converter of a continuous code corresponding to the input signal amplitude into the Grey code used is the regularity in recycling of units and zeroes in each discharge of the Grey code in the case of a continuous change of the number of pulses of a continuous code. The converter is constructed on the elements of 155 series, the frequency of continuous code pulse passing at the converter input is 25 MHz

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.

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)

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

Analysis of the Concept Continuing Education in Nursing Education

Science.gov (United States)

Agyepong, Edith Biamah; Okyere, Enoch Danso

2018-01-01

The term continuing education is extensively used throughout nursing education literature. This paper sought to re-examine the concept 'continuing education' for its meaning, relevance and appropriateness of application. The authors examined the definitions of continuing education from dictionaries, thesauruses, and current nursing education…

Model checking conditional CSL for continuous-time Markov chains

DEFF Research Database (Denmark)

Gao, Yang; Xu, Ming; Zhan, Naijun

2013-01-01

In this paper, we consider the model-checking problem of continuous-time Markov chains (CTMCs) with respect to conditional logic. To the end, we extend Continuous Stochastic Logic introduced in Aziz et al. (2000) [1] to Conditional Continuous Stochastic Logic (CCSL) by introducing a conditional...

Learning science as a potential new source of understanding and improvement for continuing education and continuing professional development.

Science.gov (United States)

Van Hoof, Thomas J; Doyle, Terrence J

2018-01-15

Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education.

Aspect Of Reliability In Airport Business Continuity Management

Directory of Open Access Journals (Sweden)

Kozłowski Michał

2015-11-01

Full Text Available The paper presents the issue of ensuring the continuity of the operation at the airport. Requirements and objectives relating to business continuity management have been defined in accordance with ISO 22301 international standard. Conducted a study of reliability issues operation of the airport. Defined the function of the reliability and operational readiness of the airport. Presented the concept of using function of operational readiness in the risk assessment for the continuity of the airport.

Cylindrical continuous martingales and stochastic integration in infinite dimensions

NARCIS (Netherlands)

Veraar, M.C.; Yaroslavtsev, I.S.

2016-01-01

In this paper we define a new type of quadratic variation for cylindrical continuous local martingales on an infinite dimensional spaces. It is shown that a large class of cylindrical continuous local martingales has such a quadratic variation. For this new class of cylindrical continuous local

Impact of Continued Biased Disenrollment from the Medic...

Data.gov (United States)

U.S. Department of Health & Human Services — Impact of Continued Biased Disenrollment from the Medicare Advantage Program to Fee-for-Service As reported in Impact of Continued Biased Disenrollment from the...

The Implementation of Continuous Assessment in Writing Classes ...

African Journals Online (AJOL)

The Implementation of Continuous Assessment in Writing Classes the of Jimma ... is the typical nature of summative tests was used to grade students' performance. ... Key words: Continuous assessment, Formative assessment, Summative ...

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...

30 CFR 18.54 - High-voltage continuous mining machines.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false High-voltage continuous mining machines. 18.54... and Design Requirements § 18.54 High-voltage continuous mining machines. (a) Separation of high... ground. (e) Onboard ungrounded, three-phase power circuit. A continuous mining machine designed with an...

Liquid phase oxidation chemistry in continuous-flow microreactors.

Science.gov (United States)

Gemoets, Hannes P L; Su, Yuanhai; Shang, Minjing; Hessel, Volker; Luque, Rafael; Noël, Timothy

2016-01-07

Continuous-flow liquid phase oxidation chemistry in microreactors receives a lot of attention as the reactor provides enhanced heat and mass transfer characteristics, safe use of hazardous oxidants, high interfacial areas, and scale-up potential. In this review, an up-to-date overview of both technological and chemical aspects of liquid phase oxidation chemistry in continuous-flow microreactors is given. A description of mass and heat transfer phenomena is provided and fundamental principles are deduced which can be used to make a judicious choice for a suitable reactor. In addition, the safety aspects of continuous-flow technology are discussed. Next, oxidation chemistry in flow is discussed, including the use of oxygen, hydrogen peroxide, ozone and other oxidants in flow. Finally, the scale-up potential for continuous-flow reactors is described.

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...

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.

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)

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...

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)

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...

The strategic skills of business continuity managers: putting business continuity management into corporate long-term planning.

Science.gov (United States)

Wong, Wei Ning Zechariah

2009-11-01

Despite its rapid development in the last two decades, business continuity management (BCM) as a discipline and a profession is still regarded by many as an operational entity of management. Two main issues are discussed in this paper: the role of BCM in strategic management and the strategic skills of business continuity managers. These issues are crucial as they represent the role of BCM in high-level corporate management. The paper discusses the importance of BCM in the long-term planning of organisational success and the preservation of future competitiveness. Finally, salient points that underpin the importance of its role in sustaining organisational performance are addressed.

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)

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.

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.

Dynamics of continuous medium in space with torsion

International Nuclear Information System (INIS)

Krechet, V.G.

1985-01-01

In frames of Einstein-Cartan gravitation theory general properties of continuous media dynamics using description formalism of continuous medium steam-line congruence geometry are investigated. Raichaudhuri type equations in space with torsion applied to study the problem of singularities in gravitation theory are derived. It is shown that space-time torsion tensor trace may immediately affect volumetric autoparallel divergence and torsion pseudo trace - rotation of continuous medium steam-line congruences. Using formalism considered metrics of homogeneous rotation nonstationary cosmological model is determined and investigated

A new generalization of contra-continuity via Levine's g-closed sets

International Nuclear Information System (INIS)

Caldas, Miguel; Jafari, Saeid; Noiri, Takashi; Simoes, Marilda

2007-01-01

In [Dontchev J. Contra-continuous functions and strongly S-closed spaces. Int J Math Math Sci 1996;19:303-10], Dontchev introduced and investigated a new notion of continuity called contra-continuity. Recently, Jafari and Noiri [Jafari S, Noiri T. Contra-α-continuous functions between topological spaces. Iran Int J Sci 2001;2:153-67, Jafari S, Noiri T. Contra-super-continuous functions. Ann Univ Sci Budapest 1999;42:27-34, Jafari S, Noiri T. On contra-precontinuous functions. Bull Malaysian Math Sci Soc 2002;25(2):115-28] introduced new generalizations of contra-continuity called contra-α-continuity, contra-super-continuity and contra-precontinuity. In this paper, we introduce and investigate a generalization of contra-continuity by utilizing Levine's generalized closed sets

Improved specifications for continuous emission monitoring

International Nuclear Information System (INIS)

Dene, C.E.; Eggleston, T.E.; Gray, W.C. Jr.; Bisha, R.M.

1988-01-01

Continuous emission monitoring (CEM) in the electric utility industry historically has been plagued by poor performance and inconsistent system reliability. These problems have, in part, been caused by the complexity and diversity of the various systems available, and the dissimilarity of continuous emission monitors CEMs relative to conventional power plant instrumentation. Recognizing the problems faced by the utility industry in implementing CEM programs, the Electric Power Research Institute (EPRI) initiated a multi-phase project to define the current state of technology for CEMs and to provide a comprehensive guide for the purchase and installation of a CEM system. The second phase of this project was the application of these guidelines to the actual purchase, installation, and operation of a CEM system for an electric utility generating station. Through this application of the guidelines it has been possible to determine further research needs and areas of the manual which require clarification or enhancement. This paper describes the development of the guidelines and modifications to the guidelines, and discusses EPRI's plans for future activities in the area of continuous emission monitoring

Moving from batch towards continuous organic‐chemical pharmaceutical production

DEFF Research Database (Denmark)

Cervera Padrell, Albert Emili

process understanding. Developing a process within a more flexible design space based on sound engineering judgment potentially allows process optimization once the product has already been approved. Micro‐ and mini‐chemical systems have been envisaged as the optimal scale for pharmaceutical production...... are the highest benefits found? How can a continuous process be designed and implemented? Are continuous processes compatible with slow reactions? Do they allow problem free processing of solid particles? What is the cost needed to implement a continuous process? This PhD thesis tries to answer some of those...... questions through the development of a systematic framework that takes advantage of continuous processing technologies and process systems engineering for the efficient design of continuous pharmaceutical processes. The framework consists of a step‐by‐step procedure that guides the user from drug discovery...

Generation and Testing of the ENDF/B-VI Continuous-Energy Cross-Section Library for Use with Continuous-Energy Versions of KENO

International Nuclear Information System (INIS)

Goluoglu, Sedat; Dunn, Michael E.; Greene, Norman Maurice; Petrie Jr, Lester M.; Hollenbach, Daniel F.

2007-01-01

KENO V.a and KENO-VI are Monte Carlo codes that solve the multigroup form of the Boltzmann transport equation. These codes are part of the SCALE system of codes and are used for performing criticality calculations of systems with fissionable material. In general, continuous-energy Monte Carlo methods are preferred because such an approach avoids many of the assumptions inherent in the multigroup treatment. On the other hand, continuous-energy treatment is much more demanding in terms of computer storage space for data, memory requirements, and calculation speed. Continuous-energy versions of KENO V.a and KENO-VI have been created and are being extensively tested. Generation of ENDF/B-VI continuous-energy cross sections is explained, and the results of the validation and verification of the codes and the data are presented

Future supply chains enabled by continuous processing--opportunities and challenges. May 20-21, 2014 Continuous Manufacturing Symposium.

Science.gov (United States)

Srai, Jagjit Singh; Badman, Clive; Krumme, Markus; Futran, Mauricio; Johnston, Craig

2015-03-01

This paper examines the opportunities and challenges facing the pharmaceutical industry in moving to a primarily "continuous processing"-based supply chain. The current predominantly "large batch" and centralized manufacturing system designed for the "blockbuster" drug has driven a slow-paced, inventory heavy operating model that is increasingly regarded as inflexible and unsustainable. Indeed, new markets and the rapidly evolving technology landscape will drive more product variety, shorter product life-cycles, and smaller drug volumes, which will exacerbate an already unsustainable economic model. Future supply chains will be required to enhance affordability and availability for patients and healthcare providers alike despite the increased product complexity. In this more challenging supply scenario, we examine the potential for a more pull driven, near real-time demand-based supply chain, utilizing continuous processing where appropriate as a key element of a more "flow-through" operating model. In this discussion paper on future supply chain models underpinned by developments in the continuous manufacture of pharmaceuticals, we have set out; The significant opportunities to moving to a supply chain flow-through operating model, with substantial opportunities in inventory reduction, lead-time to patient, and radically different product assurance/stability regimes. Scenarios for decentralized production models producing a greater variety of products with enhanced volume flexibility. Production, supply, and value chain footprints that are radically different from today's monolithic and centralized batch manufacturing operations. Clinical trial and drug product development cost savings that support more rapid scale-up and market entry models with early involvement of SC designers within New Product Development. The major supply chain and industrial transformational challenges that need to be addressed. The paper recognizes that although current batch operational

Distributed public key schemes secure against continual leakage

DEFF Research Database (Denmark)

Akavia, Adi; Goldwasser, Shafi; Hazay, Carmit

2012-01-01

-secure against continual memory leakage. Our DPKE scheme also implies a secure storage system on leaky devices, where a value s can be secretely stored on devices that continually leak information about their internal state to an external attacker. The devices go through a periodic refresh protocol......In this work we study distributed public key schemes secure against continual memory leakage. The secret key will be shared among two computing devices communicating over a public channel, and the decryption operation will be computed by a simple 2-party protocol between the devices. Similarly...... against continual memory leakage, under the Bilinear Decisional Diffie-Hellman and $2$-linear assumptions. Our schemes have the following properties: 1. Our DPKE and DIBE schemes tolerate leakage at all times, including during refresh. During refresh the tolerated leakage is a (1/2-o (1),1)-fraction...

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

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.

Putting Continuous Metaheuristics to Work in Binary Search Spaces

Directory of Open Access Journals (Sweden)

Broderick Crawford

2017-01-01

Full Text Available In the real world, there are a number of optimization problems whose search space is restricted to take binary values; however, there are many continuous metaheuristics with good results in continuous search spaces. These algorithms must be adapted to solve binary problems. This paper surveys articles focused on the binarization of metaheuristics designed for continuous optimization.

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

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.

'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...

Pseudo-Hermitian continuous-time quantum walks

Energy Technology Data Exchange (ETDEWEB)

Salimi, S; Sorouri, A, E-mail: shsalimi@uok.ac.i, E-mail: a.sorouri@uok.ac.i [Department of Physics, University of Kurdistan, PO Box 66177-15175, Sanandaj (Iran, Islamic Republic of)

2010-07-09

In this paper we present a model exhibiting a new type of continuous-time quantum walk (as a quantum-mechanical transport process) on networks, which is described by a non-Hermitian Hamiltonian possessing a real spectrum. We call it pseudo-Hermitian continuous-time quantum walk. We introduce a method to obtain the probability distribution of walk on any vertex and then study a specific system. We observe that the probability distribution on certain vertices increases compared to that of the Hermitian case. This formalism makes the transport process faster and can be useful for search algorithms.

Correlated-Spaces Regression for Learning Continuous Emotion Dimensions

NARCIS (Netherlands)

Nicolaou, M.; Zafeiriou, S.; Pantic, Maja

2013-01-01

Adopting continuous dimensional annotations for affective analysis has been gaining rising attention by researchers over the past years. Due to the idiosyncratic nature of this problem, many subproblems have been identified, spanning from the fusion of multiple continuous annotations to exploiting

Continuous Delivery Practices in a Large Financial Organization

NARCIS (Netherlands)

Vassalo, Carmine; Zampetti, Fiorelli; Romano, D.; Beller, M.M.; Panichella, A.; Di Penta, M; Zaidman, A.E.

2016-01-01

Continuous Delivery is an agile software develop- ment practice in which developers frequently integrate changes into the main development line and produce releases of their software. An automated Continuous Integration infrastructure builds and tests these changes. Claimed advantages of CD include

Continuous variable entanglement distillation of non-Gaussian states

DEFF Research Database (Denmark)

Lassen, Mikael Østergaard; Dong, Ruifang; Heersink, Joel

2009-01-01

We experimentally demonstrate distillation of continuous variable entangled light that has undergone non-Gaussian attenuation loss. The continuous variable entanglement is generated with optical fibers and sent through a lossy channel, where the transmission is varying in time. By employing simple...

Continuous Improvement and Collaborative Improvement: Similarities and Differences

NARCIS (Netherlands)

Middel, H.G.A.; Boer, Harm; Fisscher, O.A.M.

2006-01-01

A substantial body of theoretical and practical knowledge has been developed on continuous improvement. However, there is still a considerable lack of empirically grounded contributions and theories on collaborative improvement, that is, continuous improvement in an inter-organizational setting. The

Mapping of uncertainty relations between continuous and discrete time.

Science.gov (United States)

Chiuchiù, Davide; Pigolotti, Simone

2018-03-01

Lower bounds on fluctuations of thermodynamic currents depend on the nature of time, discrete or continuous. To understand the physical reason, we compare current fluctuations in discrete-time Markov chains and continuous-time master equations. We prove that current fluctuations in the master equations are always more likely, due to random timings of transitions. This comparison leads to a mapping of the moments of a current between discrete and continuous time. We exploit this mapping to obtain uncertainty bounds. Our results reduce the quests for uncertainty bounds in discrete and continuous time to a single problem.

Charge Management in LISA Pathfinder: The Continuous Discharging Experiment

Science.gov (United States)

Ewing, Becca Elizabeth

2018-01-01

Test mass charging is a significant source of excess force and force noise in LISA Pathfinder (LPF). The planned design scheme for mitigation of charge induced force noise in LISA is a continuous discharge by UV light illumination. We report on analysis of a charge management experiment on-board LPF conducted during December 2016. We discuss the measurement of test mass charging noise with and without continuous UV illumination, in addition to the dynamic response in the continuous discharge scheme. Results of the continuous discharge system will be discussed for their application to operating LISA with lower test mass charge.

Large scale chromatographic separations using continuous displacement chromatography (CDC)

International Nuclear Information System (INIS)

Taniguchi, V.T.; Doty, A.W.; Byers, C.H.

1988-01-01

A process for large scale chromatographic separations using a continuous chromatography technique is described. The process combines the advantages of large scale batch fixed column displacement chromatography with conventional analytical or elution continuous annular chromatography (CAC) to enable large scale displacement chromatography to be performed on a continuous basis (CDC). Such large scale, continuous displacement chromatography separations have not been reported in the literature. The process is demonstrated with the ion exchange separation of a binary lanthanide (Nd/Pr) mixture. The process is, however, applicable to any displacement chromatography separation that can be performed using conventional batch, fixed column chromatography

Achieving continuous manufacturing: technologies and approaches for synthesis, workup, and isolation of drug substance. May 20-21, 2014 Continuous Manufacturing Symposium.

Science.gov (United States)

Baxendale, Ian R; Braatz, Richard D; Hodnett, Benjamin K; Jensen, Klavs F; Johnson, Martin D; Sharratt, Paul; Sherlock, Jon-Paul; Florence, Alastair J

2015-03-01

This whitepaper highlights current challenges and opportunities associated with continuous synthesis, workup, and crystallization of active pharmaceutical ingredients (drug substances). We describe the technologies and requirements at each stage and emphasize the different considerations for developing continuous processes compared with batch. In addition to the specific sequence of operations required to deliver the necessary chemical and physical transformations for continuous drug substance manufacture, consideration is also given to how adoption of continuous technologies may impact different manufacturing stages in development from discovery, process development, through scale-up and into full scale production. The impact of continuous manufacture on drug substance quality and the associated challenges for control and for process safety are also emphasized. In addition to the technology and operational considerations necessary for the adoption of continuous manufacturing (CM), this whitepaper also addresses the cultural, as well as skills and training, challenges that will need to be met by support from organizations in order to accommodate the new work flows. Specific action items for industry leaders are: Develop flow chemistry toolboxes, exploiting the advantages of flow processing and including highly selective chemistries that allow use of simple and effective continuous workup technologies. Availability of modular or plug and play type equipment especially for workup to assist in straightforward deployment in the laboratory. As with learning from other industries, standardization is highly desirable and will require cooperation across industry and academia to develop and implement. Implement and exploit process analytical technologies (PAT) for real-time dynamic control of continuous processes. Develop modeling and simulation techniques to support continuous process development and control. Progress is required in multiphase systems such as

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...

Idiopathic pulmonary fibrosis patient supported with extracorporeal membrane oxygenation for 403 days while waiting for a lung transplant: A case report

Directory of Open Access Journals (Sweden)

Nao Umei, M.D.

Full Text Available According to the Extracorporeal Life Support Organization, the average duration of veno-venous extracorporeal membrane oxygenation (V-V ECMO in adults with acute respiratory failure is 10.5–13.5 days. Some patients on V-V ECMO may not recover in such a short period of time, and recently, there have been more reports of prolonged V-V ECMO. However, we do not know how long it is feasible to wait for native lung recovery or lung transplant (LTx with the use of ECMO. We describe a patient with acute exacerbation of idiopathic pulmonary fibrosis supported by ECMO for 403 days while waiting for a LTx. In this case, we kept the patient awake, and he was communicating frequently with his family. We changed the membrane oxygenator 23 times and the cannula 10 times without complication. However, we terminated the treatment on day 403 of ECMO because there was no access site for cannula insertion due to blockage by a venous thrombotic occlusion, making it impossible to continue this bridge to lung transplantation. It has become possible to maintain patients on ECMO for extended periods of time, but it is difficult to manage ECMO for more than one year without the development of a more durable lung support system. Keywords: Lung transplantation, Extracorporeal membrane oxygenation, Idiopathic pulmonary fibrosis

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.

Industrial variographic analysis for continuous sampling system validation

DEFF Research Database (Denmark)

Engström, Karin; Esbensen, Kim Harry

2017-01-01

Karin Engström, LKAB mining, Kiruna, Sweden, continues to present illuminative cases from process industry. Here she reveals more from her ongoing PhD project showing application of variographic characterisation for on-line continuous control of process sampling systems, including the one...

Continuous Flattening of a Regular Tetrahedron with Explicit Mappings

Directory of Open Access Journals (Sweden)

Jin-ichi Itoh

2012-01-01

Full Text Available We proved in [10] that each Platonic polyhedron P can be folded into a flat multilayered face of P by a continuous folding process of polyhedra. In this paper, we give explicit formulas of continuous functions for such a continuous flattening process in R³ for a regular tetrahedron.The article is published in the author’s wording.

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...

Semi-continuous detection of mercury in gases

Science.gov (United States)

Granite, Evan J [Wexford, PA; Pennline, Henry W [Bethel Park, PA

2011-12-06

A new method for the semi-continuous detection of heavy metals and metalloids including mercury in gaseous streams. The method entails mass measurement of heavy metal oxides and metalloid oxides with a surface acoustic wave (SAW) sensor having an uncoated substrate. An array of surface acoustic wave (SAW) sensors can be used where each sensor is for the semi-continuous emission monitoring of a particular heavy metal or metalloid.

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.

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.

Evidence of structurally continuous collagen fibrils in tendon

DEFF Research Database (Denmark)

Svensson, Rene B; Herchenhan, Andreas; Starborg, Tobias

2017-01-01

favor continuity. This study initially set out to trace the full length of individual fibrils in adult human tendons, using serial block face-scanning electron microscopy. But even with this advanced technique the required length could not be covered. Instead a statistical approach was used on a large...... volume of fibrils in shorter image stacks. Only a single end was observed after tracking 67.5 mm of combined fibril lengths, in support of fibril continuity. To shed more light on this observation, the full length of a short tendon (mouse stapedius, 125 μm) was investigated and continuity of individual...... fibrils was confirmed. In light of these results, possible mechanisms that could reconcile the opposing findings on fibril continuity are discussed. STATEMENT OF SIGNIFICANCE: Connective tissues hold all parts of the body together and are mostly constructed from thin threads of the protein collagen...

Orodispersible films: Product transfer from lab-scale to continuous manufacturing.

Science.gov (United States)

Thabet, Yasmin; Breitkreutz, Joerg

2018-01-15

Orodispersible films have been described as new beneficial dosage forms for special patient populations. Due to various production settings, different requirements on film formulations are required for non- continuous and continuous manufacturing. In this study, a continuous coating machine was qualified in regards of the process conditions for film compositions and their effects on the formed films. To investigate differences between both manufacturing processes, various film formulations of hydrochlorothiazide and hydroxypropylcellulose (HPC) or hydroxypropylmethycellulose (HPMC) as film formers were produced and the resulting films were characterized. The qualification of the continuously operating coating machine reveals no uniform heat distribution during drying. Coating solutions for continuous manufacturing should provide at least a dynamic viscosity of 1 Pa*s (wet film thickness of 500 μm, velocity of 15.9 cm/min). HPC films contain higher residuals of ethanol or acetone in bench-scale than in continuous production mode. Continuous production lead to lower drug content of the films. All continuously produced films disintegrate within less than 30 s. There are observed significant effects of the production process on the film characteristics. When transferring film manufacturing from lab-scale to continuous mode, film compositions, processing conditions and suitable characterization methods have to be carefully selected and adopted. Copyright © 2017 Elsevier B.V. All rights reserved.

Lapse in Institutional Animal Care and Use Committee Continuing Reviews.

Directory of Open Access Journals (Sweden)

Min-Fu Tsan

Full Text Available The United States federal animal welfare regulations and the Public Health Service Policy on Humane Care and Use of Laboratory Animals require that institutional animal care and use committees (IACUCs conduct continuing reviews of all animal research activities. However, little is known about the lapse rate of IACUC continuing reviews, and how frequently investigators continue research activities during the lapse. It is also not clear what factors may contribute to an institution's lapse in IACUC continuing reviews. As part of the quality assurance program, the Department of Veterans Affairs (VA has collected performance metric data for animal care and use programs since 2011. We analyzed IACUC continuing review performance data at 74-75 VA research facilities from 2011 through 2015. The IACUC continuing review lapse rates improved from 5.6% in 2011 to 2.7% in 2015. The rate of investigators continuing research activities during the lapse also decreased from 47.2% in 2012 to 7.4% in 2015. The type of IACUCs used and the size of animal research programs appeared to have no effect in facility's rates of lapse in IACUC continuing reviews. While approximately 80% of facilities reported no lapse in IACUC continuing reviews, approximately 14% of facilities had lapse rates of >10% each year. Some facilities appeared to be repeat offenders. Four facilities had IACUC lapse rates of >10% in at least 3 out of 5 years, suggesting a system problem in these facilities requiring remedial actions to improve their IACUC continuing review processes.

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...

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

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).…

Exact solutions of continuous states for Hartmann potential

International Nuclear Information System (INIS)

Chen Changyuan; Lu Falin; Sun Dongsheng

2004-01-01

In this Letter, we obtain the exact solutions of continuous states for the Hartmann potential. The normalized wave functions of continuous states on the 'k/2π scale' and the calculation formula of phase shifts are presented. Analytical properties of the scattering amplitude are discussed

Continuing education modules and the scholarship of engagement.

Science.gov (United States)

Mitchell, Jim

2010-01-01

Economic and political trends underscore the importance of engaged scholarship as evidence that colleges and universities are serving their constituencies. Set in a background of debate about pure versus applied social science this article describes a planned approach to continuing gerontological education grounded firmly in the principles of the scholarship of engagement. The description includes efforts to ascertain through a two-phase state-wide survey continuing education needs and preferred venue in a segment of the North Carolina aging services workforce. Subsequent surveys were used to define and prioritize modular continuing education topics suitable for web-based delivery.

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.

Continuous limit of discrete systems with long-range interaction

International Nuclear Information System (INIS)

Tarasov, Vasily E

2006-01-01

Discrete systems with long-range interactions are considered. Continuous medium models as continuous limit of discrete chain system are defined. Long-range interactions of chain elements that give the fractional equations for the medium model are discussed. The chain equations of motion with long-range interaction are mapped into the continuum equation with the Riesz fractional derivative. We formulate the consistent definition of continuous limit for the systems with long-range interactions. In this paper, we consider a wide class of long-range interactions that give fractional medium equations in the continuous limit. The power-law interaction is a special case of this class

Post-operative bilateral continuous ultrasound-guided transversus abdominis plane block versus continuous local anaesthetic wound infusion in patients undergoing abdominoplasty

Directory of Open Access Journals (Sweden)

Eman Ramadan Salama

2018-01-01

Full Text Available Background and Aims: Transversus abdominis plane (TAP block and continuous local anaesthetic wound infusion are used as part of multimodal analgesia to treat postoperative pain after lower abdominal surgeries. The aim of this randomised controlled study was to assess the efficacy of the two techniques and compare the two in patients undergoing abdominoplasty. Methods: Ninety female patients undergoing abdominoplasty were allocated to receive continuous wound infusion with saline (control group, GC, n = 30, continuous bilateral TAP block with 0.25% levobupivacaine (group GT, n = 30, or continuous wound infusion with 0.25% levobupivacaine (group GW, n = 30. The primary end-point was morphine requirement in the first 48 h. Numerical rating scale (NRS at rest and during movement, time to first morphine dose and time to first ambulation were recorded. Results: Morphine requirement in the first 48 h was significantly higher in GC than GW and GT (61.9 ± 12.8, 21.5 ± 9.5, and 18.9 ± 8.1 mg, respectively; P = 0.001, but GW and GT were comparable (P = 0.259. NRS was significantly higher in GC during movement in the first 24 h. GW and GT showed significantly longer time to first morphine dose (6.5 ± 1.7 and 8.9 ± 1.4 h, respectively, vs. 1.2 ± 0.3 h in GC and significantly shorter time to first ambulation (7.8 ± 3.1 and 6.9 ± 3.4 h, respectively, vs. 13.2 ± 4.9 h in GC (P = 0.001. Conclusion: Continuous bilateral ultrasound-guided TAP block and continuous local anaesthetic wound infusion significantly decreased total morphine consumption in the first 48 h compared to placebo; however, both treatment techniques were comparable.

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...

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.

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

The Praxis Teacher from Continuing Training

Directory of Open Access Journals (Sweden)

Yuraima Margelis Matos

2017-05-01

Full Text Available Related with the demands and policies that the Venezuelan system is setting, it´s necessary to make emphasis in the need for continuing formation of teachers in order to optimize their educational practice; even more when teachers now day have to be in constant process of formation and transformation. It´s necessary to mention that this study is part of a macro research that has been done in the U.E.B. The Paramito, Merida State, which presents one of its research purposes: to reveal through the voices of teachers conception of teaching practice from continuing training they receive. Methodologically it was addressed from the qualitative paradigm directed by the Participatory Action, which emerged from a diagnosis made and led to describe a phase research study. In this case they were made work tables, where dialogue prevailed between the actors involved, emerging categories such as were made: practice and experience for action, sharing knowledge, professional skills, which when put into practice can optimize the educational process in the as they strengthen the continuing education of teachers and thus a better quality education.

Continuous Improvement Implementation in the Nottingham University Hospitals NHS Trust: A Case Study of a Continuous Improvement Programme & Project

OpenAIRE

Velzen, Jeena

2012-01-01

This paper aims at identifying the extent to which the Nottingham University Hospitals NHS Trust has fulfilled literature requirements for successful continuous improvement as exemplified by its Better for You programme and chemotherapy service improvement project. Both the theory and ideals of the continuous improvement programme, along with the actualization of these philosophies and methodologies in the context of the particular project,were compared against a framework for the enabling...

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

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...

Automatic continuous dew point measurement in combustion gases

Energy Technology Data Exchange (ETDEWEB)

Fehler, D.

1986-08-01

Low exhaust temperatures serve to minimize energy consumption in combustion systems. This requires accurate, continuous measurement of exhaust condensation. An automatic dew point meter for continuous operation is described. The principle of measurement, the design of the measuring system, and practical aspects of operation are discussed.

The continuity-creativity debate : the case of Revival

Directory of Open Access Journals (Sweden)

Jean Besson

1996-07-01

Full Text Available Argues that the attempts to polarize the debate around Caribbean culture into an African continuity versus a creole creativity position is misplaced. The authors use Revivalism as an example of both continuity in African-derived Myalim and an on-going process of re-creation.

Institutional Continuity and Distance Learning: A Symbiotic Relationship

Science.gov (United States)

Bates, Rodger

2013-01-01

Universities and colleges have been developing institutional continuity plans to protect their ability to function within an environment of increasing uncertainties caused by natural and man-made disasters and events. Within the academic context, distance learning strategies have emerged as critical components for program continuity. This research…

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.

Continuing Professional Development in Context: Teachers' Continuing Professional Development Culture in Germany and Sweden

Science.gov (United States)

Wermke, Wieland

2011-01-01

This article investigates the continuing professional development (CPD) culture of teachers, and asks how it is influenced by properties of the school system. It reports the results of a questionnaire study with 418 secondary teachers from Sweden and Germany. The results show highly significant differences between Swedish and German teachers'…

RFID Continuance Usage Intention in Health Care Industry.

Science.gov (United States)

Iranmanesh, Mohammad; Zailani, Suhaiza; Nikbin, Davoud

Radio-frequency identification (RFID) has been proved to be an effective tool both for improving operational efficiency and for gaining competitive advantage in the health care industry despite its relatively low-usage rate in hospitals. The sustained use of RFID by health care professionals will promote its development in the long term. This study evaluates the acceptance continuance of RFID among health care professionals through technology continuance theory (TCT). Data were collected from 178 medical professionals in Malaysia and were then analyzed using the partial least squares technique. The analysis showed that the TCT model provided not only a thorough understanding of the continuance behavior of health care professionals toward RFID but also the attitudes, satisfaction, and perceived usefulness of professionals toward it. The results of this study are expected to assist policy makers and managers in the health care industry in implementing the RFID technology in hospitals by understanding the determinants of continuance of RFID usage intention.

Continuity of care: betrayed values or misplaced nostalgia.

Science.gov (United States)

Roland, Martin

2012-10-01

Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to get continuity of care. This is despite most patients being clear that they want to see a regular doctor, and professional bodies in primary care consistently promoting continuity as a core value. General practitioners need to decide whether continuity of care matters. If it does, then they need to take a lead in ensuring that care is organised so that patients who want to see a regular doctor are able to do so. Suggestions are included for how contemporary practice can be organised to promote this traditional but still highly relevant value.

Continuity of care: betrayed values or misplaced nostalgia?

Directory of Open Access Journals (Sweden)

Martin Roland

2012-10-01

Full Text Available Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to get continuity of care. This is despite most patients being clear that they want to see a regular doctor, and professional bodies in primary care consistently promoting continuity as a core value. General practitioners need to decide whether continuity of care matters. If it does, then they need to take a lead in ensuring that care is organised so that patients who want to see a regular doctor are able to do so. Suggestions are included for how contemporary practice can be organised to promote this traditional but still highly relevant value.

Toward continuous-wave operation of organic semiconductor lasers

Science.gov (United States)

Sandanayaka, Atula S. D.; Matsushima, Toshinori; Bencheikh, Fatima; Yoshida, Kou; Inoue, Munetomo; Fujihara, Takashi; Goushi, Kenichi; Ribierre, Jean-Charles; Adachi, Chihaya

2017-01-01

The demonstration of continuous-wave lasing from organic semiconductor films is highly desirable for practical applications in the areas of spectroscopy, data communication, and sensing, but it still remains a challenging objective. We report low-threshold surface-emitting organic distributed feedback lasers operating in the quasi–continuous-wave regime at 80 MHz as well as under long-pulse photoexcitation of 30 ms. This outstanding performance was achieved using an organic semiconductor thin film with high optical gain, high photoluminescence quantum yield, and no triplet absorption losses at the lasing wavelength combined with a mixed-order distributed feedback grating to achieve a low lasing threshold. A simple encapsulation technique greatly reduced the laser-induced thermal degradation and suppressed the ablation of the gain medium otherwise taking place under intense continuous-wave photoexcitation. Overall, this study provides evidence that the development of a continuous-wave organic semiconductor laser technology is possible via the engineering of the gain medium and the device architecture. PMID:28508042

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...

The true value and return on investment of business continuity.

Science.gov (United States)

Phelps, Regina

2018-01-01

The phrase return on investment (ROI) is commonly heard when groups or organisations attempt to demonstrate the value of a particular activity. 'Is it good for us?', 'Is it worth the investment?' and 'Should we continue to fund the endeavour?' are all valid and important questions. The challenge for business continuity professionals is to address the question, 'What is the ROI of business continuity?' in ways that will be meaningful to the person wielding the budget stick. In the 'olden days', colleagues would point to their business impact analysis, with pie charts and bar graphs showing the cost of business downtime if an event occurred. They would sit back and say, 'See? We provide ROI because we addressed The Bad Thing!'. But is that really the best that continuity professionals can do? This paper peels back the question of ROI and addresses the value proposition of business continuity. The goal is to broaden the conversation, by instead of talking about how much money business continuity efforts will save the company, and instead to focus on the value that business continuity provides every day.

The Role of Motivation in Continuing Education for Pharmacists

OpenAIRE

Tjin a Tsoi, Sharon

2017-01-01

Healthcare professionals, including pharmacists, need to continuously update their knowledge and are, therefore, expected to participate in Continuing Education (CE) and Continuous Professional Development (CPD) activities on a regular basis. Lack of intrinsic (or autonomous) motivation appears to be an important barrier for engaging in high quality learning and can have consequences for poor performance and patient safety. This thesis aims to enhance our understanding of pharmacists’ motivat...

NONLINEAR PLANT PIECEWISE-CONTINUOUS MODEL MATRIX PARAMETERS ESTIMATION

Directory of Open Access Journals (Sweden)

Roman L. Leibov

2017-09-01

Full Text Available This paper presents a nonlinear plant piecewise-continuous model matrix parameters estimation technique using nonlinear model time responses and random search method. One of piecewise-continuous model application areas is defined. The results of proposed approach application for aircraft turbofan engine piecewisecontinuous model formation are presented

27 CFR 478.60 - Certain continuances of business.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Certain continuances of business. 478.60 Section 478.60 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO... Licenses § 478.60 Certain continuances of business. A licensee who furnishes his license to the Chief...

Is the Marketing Concept Adequate for Continuing Education?

Science.gov (United States)

Rittenburg, Terri L.

1984-01-01

Because educators have a social responsibility to those they teach, the marketing concept may not be adequate as a philosophy for continuing education. In attempting to broaden the audience for continuing education, educators should consider a societal marketing concept to meet the needs of the educationally disadvantaged. (SK)

77 FR 27538 - Aviation Rulemaking Advisory Committee-Continuing a Task

Science.gov (United States)

2012-05-10

... Committee--Continuing a Task AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of continuing a task assignment for the Aviation Rulemaking Advisory Committee (ARAC). SUMMARY: The FAA assigned the Aviation Rulemaking Advisory Committee (ARAC) a continuing task to provide advice and...

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...

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

THE ROMANIAN GEOGRAPHY TEACHERS’ OPINIONS ON CONTINUOUS TRAINING

Directory of Open Access Journals (Sweden)

ANCA LIANA GALE

2017-02-01

Full Text Available In the first part of the paper, we present the legislation from Romania and the methodologies related to the continuous training of teachers. In order to know the teachers’ opinions about their professional development, about the programes, courses and other training activities in which they were involved and about their needs for continuous training as geography teachers, a questionnaire was applied, and was completed by 170 teachers. The results were analysed and interpreted. These views are important because, based on them, decisions can be made concerning the teachers’ continuous training at both ministry level, as well as at the level of various institutions involved in such activities.

Integral-Value Models for Outcomes over Continuous Time

DEFF Research Database (Denmark)

Harvey, Charles M.; Østerdal, Lars Peter

Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions on prefere...... on preferences between real- or vector-valued outcomes over continuous time are satisfied if and only if the preferences are represented by a value function having an integral form......Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions...

Continuous-Variable Quantum Computation of Oracle Decision Problems

Science.gov (United States)

Adcock, Mark R. A.

Quantum information processing is appealing due its ability to solve certain problems quantitatively faster than classical information processing. Most quantum algorithms have been studied in discretely parameterized systems, but many quantum systems are continuously parameterized. The field of quantum optics in particular has sophisticated techniques for manipulating continuously parameterized quantum states of light, but the lack of a code-state formalism has hindered the study of quantum algorithms in these systems. To address this situation, a code-state formalism for the solution of oracle decision problems in continuously-parameterized quantum systems is developed. Quantum information processing is appealing due its ability to solve certain problems quantitatively faster than classical information processing. Most quantum algorithms have been studied in discretely parameterized systems, but many quantum systems are continuously parameterized. The field of quantum optics in particular has sophisticated techniques for manipulating continuously parameterized quantum states of light, but the lack of a code-state formalism has hindered the study of quantum algorithms in these systems. To address this situation, a code-state formalism for the solution of oracle decision problems in continuously-parameterized quantum systems is developed. In the infinite-dimensional case, we study continuous-variable quantum algorithms for the solution of the Deutsch--Jozsa oracle decision problem implemented within a single harmonic-oscillator. Orthogonal states are used as the computational bases, and we show that, contrary to a previous claim in the literature, this implementation of quantum information processing has limitations due to a position-momentum trade-off of the Fourier transform. We further demonstrate that orthogonal encoding bases are not unique, and using the coherent states of the harmonic oscillator as the computational bases, our formalism enables quantifying

Modeling Suspension and Continuation of a Process

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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.

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...

L’ontologie des Indivisibles et la structure du continu selon Gautier Burley The ontology of Indivisibles and the structure of continuity according to Walter Burley

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Alice Lamy

2011-12-01

Full Text Available Pour Aristote, sous le rapport de sa composition en parties, le continu est divisible mais sous le rapport de ses limites (point, ligne, surface et profondeur, le continu est indivisible. Walter Burley, comme ses contemporains, a commenté la coexistence problématique de la divisibilité et de l’indivisibilité dans la structure du continu. Bien plus, aux prises avec sa célèbre polémique contre son adversaire Guillaume d’Ockham à propos de l’ontologie de la catégorie de quantité, il admet une structure du continu originale qui semble contenir à la fois des intervalles ou parties divisibles et des points ou indivisibles.For Aristote, concerning its composition in parts, the continuous is divisible but concerning its limits (point, line, surface and depth, the continuous is indivisible. Walter Burley, as his contemporaries, commented on the problematic coexistence of the divisibility and the indivisibility in the structure of the continuous. Much more, battling against his opponent Wilhelm of Ockham about the ontology of the category of quantity, he admits an original structure of continuous who seems to contain at the same time intervals or divisible parts and indivisible points.

The Relationship Between Continuous Identity Disturbances, Negative Mood, and Suicidal Ideation.

Science.gov (United States)

Sokol, Yosef; Eisenheim, Edouard

To examine the relationship between continuous identity and a measure of depression, anxiety, and stress as well as suicidal ideation using 2 validated measures of continuous identity. A total of 246 subjects recruited from the Amazon Mechanical Turk subject pool who completed a full survey in November 2014 were included in the analyses. Stress, anxiety, and depression severity were measured using the Depression, Anxiety, and Stress Scale. Continuous identity was measured with the Venn continuous identity task and the me/not me continuous identity task. Multiple regression analyses revealed continuous identity disturbances were significantly associated with depressed mood (R (2) = 0.37, P Continuous identity also predicted suicide severity, even after controlling for demographic factors, negative life events, and depressed mood. Additionally, predictive discriminant analysis revealed continuous identity, depression severity, and negative life events correctly classified 74.1% of participants into high and low suicide risk groups. Lack of continuous identity predicted both depression and suicidality severity. Integration of perceived identities may be a worthwhile goal for behavioral interventions aimed at reducing depressed mood and suicidality.

Semi-continuous anaerobic treatment of fresh leachate from ...

African Journals Online (AJOL)

A semi-continuous leachate treatment process was developed in the present study. The fresh leachate was obtained from a municipal solid waste transfer station and palm oil mill effluent (POME) sludge was used as sources of anaerobic microbial complex. The semi-continuous treatment of leachate was operated in two ...

Simulation-Based Prediction of Equivalent Continuous Noises during Construction Processes.

Science.gov (United States)

Zhang, Hong; Pei, Yun

2016-08-12

Quantitative prediction of construction noise is crucial to evaluate construction plans to help make decisions to address noise levels. Considering limitations of existing methods for measuring or predicting the construction noise and particularly the equivalent continuous noise level over a period of time, this paper presents a discrete-event simulation method for predicting the construction noise in terms of equivalent continuous level. The noise-calculating models regarding synchronization, propagation and equivalent continuous level are presented. The simulation framework for modeling the noise-affected factors and calculating the equivalent continuous noise by incorporating the noise-calculating models into simulation strategy is proposed. An application study is presented to demonstrate and justify the proposed simulation method in predicting the equivalent continuous noise during construction. The study contributes to provision of a simulation methodology to quantitatively predict the equivalent continuous noise of construction by considering the relevant uncertainties, dynamics and interactions.

Continuous hydroponic wheat production using a recirculating system

Science.gov (United States)

Mackowiak, C. L.; Owens, L. P.; Hinkle, C. R.; Prince, R. P.

1989-01-01

Continuous crop production, where plants of various ages are growing simultaneously in a single recirculating nutrient solution, is a possible alternative to batch production in a Controlled Ecological Life Support System. A study was conducted at John F. Kennedy Space Center where 8 trays (0.24 sq m per tray) of Triticum aestivum L. Yecora Rojo were grown simultaneously in a growth chamber at 23 C, 65 percent relative humidity, 1000 ppm CO2, continuous light, with a continuous flow, thin film nutrient delivery system. The same modified Hoagland nutrient solution was recirculated through the plant trays from an 80 L reservoir throughout the study. It was maintained by periodic addition of water and nutrients based on chemical analyses of the solution. The study was conducted for 216 days, during which 24 trays of wheat were consecutively planted (one every 9 days), 16 of which were grown to maturity and harvested. The remaining 8 trays were harvested on day 216. Grain yields averaged 520 g m(exp -2), and had an average edible biomass of 32 percent. Consecutive yields were unaffected by nutrient solution age. It was concluded that continual wheat production will work in this system over an extended period of time. Certain micronutrient deficiencies and toxicities posed problems and must be addressed in future continuous production systems.

40 CFR Table 10 to Subpart Wwww of... - Data Requirements for New and Existing Continuous Lamination Lines and Continuous Casting Lines...

Science.gov (United States)

2010-07-01

... Continuous Lamination Lines and Continuous Casting Lines Complying With a Percent Reduction Limit on a Per... SOURCE CATEGORIES National Emissions Standards for Hazardous Air Pollutants: Reinforced Plastic... Reduction Limit on a Per Line Basis As required in § 63.5865(a), in order to comply with a percent reduction...

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.

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.

Continuity and Change in Disaster Education in Japan

Science.gov (United States)

Kitagawa, Kaori

2015-01-01

This article aims to describe post-war continuity and change in disaster education in Japan. Preparedness for natural disasters has been a continuous agenda in Japan for geographical and meteorological reasons, and disaster education has been practised in both formal and informal settings. Post-war disaster management and education have taken a…

Patient perspectives on continuity of care: adaption and preliminary psychometric assessment of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ-N

Directory of Open Access Journals (Sweden)

Øystein Hetlevik

2017-11-01

Full Text Available Abstract Background Continuity of care is regarded as a core quality element in healthcare. Continuity can be related to one or more specific caregivers but also applies to collaboration within a team or across boundaries of healthcare. Measuring continuity is important to identify problems and evaluate quality improvement of interventions. This study aimed to assess the feasibility and psychometric properties of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ. Methods The NCQ was developed in The Netherlands. It measures patients’ experienced continuity of care across multiple care settings and as a multidimensional concept regardless of morbidity. The NCQ comprises 28 items categorised into three subscales; two personal continuity scales, “care giver knows me” and “shows commitment”, asked regarding the patient’s general practitioner (GP and the most important specialist; and one “team/cross boundary continuity” scale, asked regarding primary care, specialised care and cooperation between GP and specialist, with a total of seven factors. The NCQ was translated and adapted to Norwegian (NCQ-N and distributed among patients referred to somatic rehabilitation (N = 984, response rate 34.5%. Confirmatory factor analyses (CFA, Cronbach’s alpha, intra-class correlation (ICC and Bland–Altman plots were used to assess psychometric properties. Results All patients (N = 375 who had responded to all parts of the NCQ-N were included in CFA. The CFA fit indices (CFI 0.941, RMSEA 0.064 (95% CI 0.059–0.070, SRMR 0.041 support a seven-factor structure in the NCQ-N based on the three subscales of the original NCQ. Cronbach’s alpha showed internal consistency (0.84–0.97, and was highest for the team/cross-boundary subscales. The NCQ-N showed overall high reliability with ICC 0.84–91 for personal continuity factors and 0.67–0.91 for team factors, with the lowest score for team continuity within primary care

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...

a Continuous-Time Positive Linear System

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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.

Development of a continuous duty cryopump

International Nuclear Information System (INIS)

Sedgley, D.W.; Batger, T.H.; Call, W.R.

1986-06-01

The continuous output of large quantities of gases at low pressure from fusion reactors, principally helium and hydrogen isotopes, dictates the need for a high speed pumping system that operates continuously, efficiently, and automatically. A liquid helium-cooled cryopump operated by a microprocessor controller can meet these requirements. The prototype system described herein features a single cryopump with three distinct pumping units: two units for pumping the vacuum chamber arranged so that one unit is closed for regenerating while the other is pumping the chamber (100% redundancy); and a collector pump, which is a high speed cryopump for receiving the regenerated gas. The unit pumps deuterium but can be changed readily to a sorption pump for helium service

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

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...

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.