Comparison study between bacteriological aetiology and outcome of VAT & VAP

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Nasr H. Kahlil

2017-01-01

Conclusion: From the study we concluded that VAT infection is as severe as VAP and it needs more attention to prevent its presence as, once present, it usually progress to VAP increasing mortality rate in ICU.

Crystallization and preliminary X-ray crystallographic analysis of two vascular apoptosis-inducing proteins (VAPs) from Crotalus atrox venom

International Nuclear Information System (INIS)

Igarashi, Tomoko; Oishi, Yuko; Araki, Satohiko; Mori, Hidezo; Takeda, Soichi

2006-01-01

Vascular apoptosis-inducing protein 1 (VAP1) and VAP2 from C. atrox venom were crystallized in variety of different crystal forms. Diffraction data sets were obtained to 2.5 and 2.15 Å resolution for VAP1 and VAP2, respectively. VAPs are haemorrhagic snake-venom toxins belonging to the reprolysin family of zinc metalloproteinases. In vitro, VAPs induce apoptosis specifically in cultured vascular endothelial cells. VAPs have a modular structure that bears structural homology to mammalian ADAMs (a disintegrin and metalloproteinases). VAP1 is a homodimer with a MW of 110 kDa in which the monomers are connected by a single disulfide bridge. VAP2 is homologous to VAP1 and exists as a monomer with a MW of 55 kDa. In the current study, several crystal forms of VAP1 and VAP2 were obtained using the vapour-diffusion method and diffraction data sets were collected using SPring-8 beamlines. The best crystals of VAP1 and VAP2 generated data sets to 2.5 and 2.15 Å resolution, respectively

APACHE II as an indicator of ventilator-associated pneumonia (VAP.

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Kelser de Souza Kock

2015-01-01

Full Text Available Background and objectives: strategies for risk stratification in severe pathologies are extremely important. The aim of this study was to analyze the accuracy of the APACHE II score as an indicator of Ventilator-Associated Pneumonia (VAP in ICU patient sat Hospital Nossa Senhora da Conceição (HNSC Tubarão-SC. Methods: It was conducted a prospective cohort study with 120 patients admitted between March and August 2013, being held APACHE II in the first 24 hours of mechanical ventilation (MV. Patients were followed until the following gout comes: discharge or death. It was also analyzed the cause of ICU admission, age, gender, days of mechanical ventilation, length of ICU and outcome. Results: The incidence of VAP was 31.8% (38/120. Two variables showed a relative riskin the development of VAP, APACHE II above average (RR = 1,62; IC 95% 1,03-2,55 and males (RR = 1,56; IC 95 % 1,18-2,08. The duration of mechanical ventilation (days above average18.4± 14.9(p =0.001, ICU stay (days above average 20.4± 15.3(p =0.003 presented the development of VAP. The accuracy of APACHE II in predicting VAP score >23, showed a sensitivity of 84% and specificity of 33%. Inrelation to death, two variables showed relative risk, age above average (RR=2.08; 95% CI =1.34 to 3.23 and ICU stay above average (RR=2.05; CI 95 =1.28 to 3.28%. Conclusion: The APACHE II score above or equal 23 might to indicate the risk of VAP. Keywords: Pneumonia, Ventilator-Associated, Intensive Care Units, APACHE. Prognosis

Analysis of ventilator associated pneumonia (VAP studies in Egyptian University Hospitals

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Amal Fathy

2013-01-01

Conclusion: It is important to establish large-scale multi center national studies to explore incidence of VAP, all possible risk factors (whether preventable or non preventable, causative organisms, and mortality due to VAP and its economic aspect.

Antibiotic susceptibility patterns of different bacteria isolated from patients with ventilator associated pneumonia (vap).

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Alqurashi, Abdulrahman M

2005-09-01

Ventilator associated pneumonia (VAP) is a frequent complication of mechanical ventilation (MV) and it is a leading cause of death in MV patients. The development of VAP has been demonstrated as being due to aspiration of oropharyngeal secretion, ventilator tubing condensate, or gastric contents that are colonized with pathogenic microorganisms. The aim of the present study is to isolate and identify bacteria that cause VAP and to study antibiotic susceptibility. This study was carried out on 95 patients who fulfilled the diagnostic criteria for VAP. Quantitative cultures of endotracheal aspirates (EA) using a cut-off point of 10(6) cfu/ml was done. The microbiological results revealed that gram negative bacilli were the most common bacterial agents responsible for VAP and accounted for 78.8% of all the causative agents. The most common isolated organisms were Klebsiella pnemouniae (30.9 %) followed by Pseudomonas aeruginosa (22.5%), Staphylococcus aureus (21.2%), Eschericia coli (12.8 %), Proteus spp. (9.8%), and Citrobacter spp. (2.8%). Blood cultures were positive in 25.9% of patients with Klebsiella pnemouniae in about 33.3%. From this study, it can be concluded that VAP is an important nosocomial infection. EA is a simple procedure to obtain respiratory samples and perform sensitivity testing in patients with VAP. Also, the commonest cause of VAP is gram negative bacilli.

Use of VAP3D software for production and manipulation of synthetic radiographies of anthropomorphic models

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Lima, Lindeval Fernandes de, E-mail: lindeval@dmat.ufrr.b [Universidade Federal de Roraima (DMAT/UFRR), Boa Vista, RR (Brazil). Dept. de Matematica; Centro Regional de Ciencias Nucleares (CRCN-NE/CNEN-PE), Recife, PE (Brazil); Vieira, Jose W. [Instituto Federal de Educacao, Ciencia e Tecnologia de Pernambuco (IFPE), Recife, PE (Brazil); Universidade de Pernambuco (EPP/UPE), Recife, PE (Brazil). Escola Politecnica de Pernambuco; Lima, Fernando R.A., E-mail: falima@cnen.gov.b [Centro Regional de Ciencias Nucleares (CRCN-NE/CNEN-PE), Recife, PE (Brazil); Leal Neto, Viriato [Universidade Federal de Pernambuco (DEN/UFPE), Recife, PE (Brazil). Dept. de Energia Nuclear

2011-07-01

The Grupo de Dosimetria Numerica has developed exposure computational models (ECM) involving a Monte Carlo code and voxel phantoms to simulate various situations of internal and external exposure to ionizing radiation. Most analyses of the produced results are presented in tables and graphics formats. An alternative to this traditional way of analyzing results is to save voxels of Regions of Interest (ROI) of the phantom irradiated with information like the location of the voxel and the energy deposited in it during the simulation. Such information can be saved to a text file and later turned into 3D objects. In this paper the VAP3D software has been used to read text files produced in simulations using the ECM of DEN (Nuclear Energy Dept. - UFPE), converting them into binary files of the type RAW, and visualize them. In order to reflect the radiosensitivity of the organs and tissues suggested by ICRP-60, for conversion of text file to binary, of the energy deposited values are multiplied by the weighting factor of the tissue to which the voxel belongs. The result of the multiplication is normalized to the interval [0, 255]. The files transformed are referred herein as synthetic radiographies. In VAP3D software, it is possible to generate stacks from theses radiographies in transverse, sagittal and coronal directions. In order to illustrate the production of synthetic radiographies, some images are presented in this paper, and dosimetric results are obtained from a variety of ROIs of the phantoms of DEN for radiological exams. (author)

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients.

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Gupta, A; Gupta, A; Singh, T K; Saxsena, A

2016-01-01

Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

OpenAIRE

A Gupta; A Gupta; T K Singh; A Saxsena

2016-01-01

Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

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A Gupta

2016-01-01

Full Text Available Ventilator associated pneumonia (VAP is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

VapC toxins drive cellular dormancy under uranium stress for the extreme thermoacidophile Metallosphaera prunae.

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Mukherjee, Arpan; Wheaton, Garrett H; Counts, James A; Ijeomah, Brenda; Desai, Jigar; Kelly, Robert M

2017-07-01

When abruptly exposed to toxic levels of hexavalent uranium, the extremely thermoacidophilic archaeon Metallosphaera prunae, originally isolated from an abandoned uranium mine, ceased to grow, and concomitantly exhibited heightened levels of cytosolic ribonuclease activity that corresponded to substantial degradation of cellular RNA. The M. prunae transcriptome during 'uranium-shock' implicated VapC toxins as possible causative agents of the observed RNA degradation. Identifiable VapC toxins and PIN-domain proteins encoded in the M. prunae genome were produced and characterized, three of which (VapC4, VapC7, VapC8) substantially degraded M. prunae rRNA in vitro. RNA cleavage specificity for these VapCs mapped to motifs within M. prunae rRNA. Furthermore, based on frequency of cleavage sequences, putative target mRNAs for these VapCs were identified; these were closely associated with translation, transcription, and replication. It is interesting to note that Metallosphaera sedula, a member of the same genus and which has a nearly identical genome sequence but not isolated from a uranium-rich biotope, showed no evidence of dormancy when exposed to this metal. M. prunae utilizes VapC toxins for post-transcriptional regulation under uranium stress to enter a cellular dormant state, thereby providing an adaptive response to what would otherwise be a deleterious environmental perturbation. © 2017 Society for Applied Microbiology and John Wiley & Sons Ltd.

Is the gram stain useful in the microbiologic diagnosis of VAP? A meta-analysis.

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O'Horo, John C; Thompson, Deb; Safdar, Nasia

2012-08-01

In a meta-analysis examining respiratory specimen Gram stain for diagnosis of ventilator-associated pneumonia, absence of bacteria on Gram stain had a high negative predictive value, but a positive Gram stain correlated poorly with organisms recovered in culture. Rapid and accurate diagnosis of ventilator-associated pneumonia (VAP) is a major challenge and no generally accepted gold standard exists for VAP diagnosis. We conducted a meta-analysis to examine the role of respiratory specimen Gram stain to diagnose VAP, and the correlation with final culture results. In 21 studies, pooled sensitivity of Gram stain for VAP was 0.79 (95% confidence interval [CI], .77-0.81; P Gram stain for a VAP prevalence of 20%-30% was 91%, suggesting that VAP is unlikely with a negative Gram stain but the positive predictive value of Gram stain was only 40%. Pooled kappa was 0.42 for gram-positive organisms and 0.34 for gram-negative organisms, suggesting fair concordance between organisms on Gram stain and recovery by culture. Therefore, a positive Gram stain should not be used to narrow anti-infective therapy until culture results become available.

Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children's critical care unit.

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Hill, Charlotte

2016-05-09

Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role.

ANTIBIOTIC SUSCEPTIBILITY PATTERNS OF DIFFERENT BACTERIA ISOLATED FROM PATIENTS WITH VENTILATOR ASSOCIATED PNEUMONIA (VAP)

OpenAIRE

Alqurashi, Abdulrahman M.

2005-01-01

Objective: Ventilator associated pneumonia (VAP) is a frequent complication of mechanical ventilation (MV) and it is a leading cause of death in MV patients. The development of VAP has been demonstrated as being due to aspiration of oropharyngeal secretion, ventilator tubing condensate, or gastric contents that are colonized with pathogenic microorganisms. The aim of the present study is to isolate and identify bacteria that cause VAP and to study antibiotic susceptibility. Material and Metho...

Structure of the virulence-associated protein VapD from the intracellular pathogen Rhodococcus equi

International Nuclear Information System (INIS)

Whittingham, Jean L.; Blagova, Elena V.; Finn, Ciaran E.; Luo, Haixia; Miranda-CasoLuengo, Raúl; Turkenburg, Johan P.; Leech, Andrew P.; Walton, Paul H.; Murzin, Alexey G.; Meijer, Wim G.; Wilkinson, Anthony J.

2014-01-01

VapD is one of a set of highly homologous virulence-associated proteins from the multi-host pathogen Rhodococcus equi. The crystal structure reveals an eight-stranded β-barrel with a novel fold and a glycine rich ‘bald’ surface. Rhodococcus equi is a multi-host pathogen that infects a range of animals as well as immune-compromised humans. Equine and porcine isolates harbour a virulence plasmid encoding a homologous family of virulence-associated proteins associated with the capacity of R. equi to divert the normal processes of endosomal maturation, enabling bacterial survival and proliferation in alveolar macrophages. To provide a basis for probing the function of the Vap proteins in virulence, the crystal structure of VapD was determined. VapD is a monomer as determined by multi-angle laser light scattering. The structure reveals an elliptical, compact eight-stranded β-barrel with a novel strand topology and pseudo-twofold symmetry, suggesting evolution from an ancestral dimer. Surface-associated octyl-β-d-glucoside molecules may provide clues to function. Circular-dichroism spectroscopic analysis suggests that the β-barrel structure is preceded by a natively disordered region at the N-terminus. Sequence comparisons indicate that the core folds of the other plasmid-encoded virulence-associated proteins from R. equi strains are similar to that of VapD. It is further shown that sequences encoding putative R. equi Vap-like proteins occur in diverse bacterial species. Finally, the functional implications of the structure are discussed in the light of the unique structural features of VapD and its partial structural similarity to other β-barrel proteins

Structure of the virulence-associated protein VapD from the intracellular pathogen Rhodococcus equi

Energy Technology Data Exchange (ETDEWEB)

Whittingham, Jean L.; Blagova, Elena V. [University of York, Heslington, York YO10 5DD (United Kingdom); Finn, Ciaran E.; Luo, Haixia; Miranda-CasoLuengo, Raúl [University College Dublin, Dublin (Ireland); Turkenburg, Johan P.; Leech, Andrew P.; Walton, Paul H. [University of York, Heslington, York YO10 5DD (United Kingdom); Murzin, Alexey G. [MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge CB2 0QH (United Kingdom); Meijer, Wim G. [University College Dublin, Dublin (Ireland); Wilkinson, Anthony J., E-mail: tony.wilkinson@york.ac.uk [University of York, Heslington, York YO10 5DD (United Kingdom)

2014-08-01

VapD is one of a set of highly homologous virulence-associated proteins from the multi-host pathogen Rhodococcus equi. The crystal structure reveals an eight-stranded β-barrel with a novel fold and a glycine rich ‘bald’ surface. Rhodococcus equi is a multi-host pathogen that infects a range of animals as well as immune-compromised humans. Equine and porcine isolates harbour a virulence plasmid encoding a homologous family of virulence-associated proteins associated with the capacity of R. equi to divert the normal processes of endosomal maturation, enabling bacterial survival and proliferation in alveolar macrophages. To provide a basis for probing the function of the Vap proteins in virulence, the crystal structure of VapD was determined. VapD is a monomer as determined by multi-angle laser light scattering. The structure reveals an elliptical, compact eight-stranded β-barrel with a novel strand topology and pseudo-twofold symmetry, suggesting evolution from an ancestral dimer. Surface-associated octyl-β-d-glucoside molecules may provide clues to function. Circular-dichroism spectroscopic analysis suggests that the β-barrel structure is preceded by a natively disordered region at the N-terminus. Sequence comparisons indicate that the core folds of the other plasmid-encoded virulence-associated proteins from R. equi strains are similar to that of VapD. It is further shown that sequences encoding putative R. equi Vap-like proteins occur in diverse bacterial species. Finally, the functional implications of the structure are discussed in the light of the unique structural features of VapD and its partial structural similarity to other β-barrel proteins.

Critical Analysis of the Factors Associated with Enteral Feeding in Preventing VAP: A Systematic Review

OpenAIRE

Yu-Chih Chen

2009-01-01

Ventilator-associated pneumonia (VAP) is a common cause of morbidity in critically ill patients. Appropriate enteral feeding is the most important factor associated with the prevention of VAP. However, the standardization of enteral feeding methods needs clarification. The purpose of this systematic review was to synthesize the factors associated with enteral feeding in order to prevent VAP and to describe the characteristics of these factors. A comprehensive search was undertaken involving a...

Ventilator-Associated Pneumonia (VAP in a Patient with Guillain-Barre Syndrome

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Anti Dharmayanti

2017-04-01

Full Text Available A 46-year-old man was admitted to ICU with a diagnosis at the time of admission of Guillain Barre Syndrome (GBS and sepsis due to suspected Ventilator-Associated Pneumoniae (VAP. Specimens for the following laboratory workup were inquired, i.e. complete blood count, culture and resistance workup using specimens obtained from the tip of suction pipe, urinalysis and urine culture, blood culture and resistance, procalcitonin and lactate levels. Neutrophilia was found along with increased procalcitonin and lactate levels, which supported the sepsis diagnosis. Moreover, the result of culture from suction pipe demonstrated colonies of Pseudomonas luteola MDRO, which might be originated from the oropharyngeal colonization of the patients due to poor oral hygiene and ineffective oral hygiene nursing; therefore, the colonies of the microorganism were swabbed away when obtaining the specimens. Ineffective oral hygiene nursing may have a potency to cause VAP and recurrent VAP.

Critical analysis of the factors associated with enteral feeding in preventing VAP: a systematic review.

Science.gov (United States)

Chen, Yu-Chih

2009-04-01

Ventilator-associated pneumonia (VAP) is a common cause of morbidity in critically ill patients. Appropriate enteral feeding is the most important factor associated with the prevention of VAP. However, the standardization of enteral feeding methods needs clarification. The purpose of this systematic review was to synthesize the factors associated with enteral feeding in order to prevent VAP and to describe the characteristics of these factors. A comprehensive search was undertaken involving all major databases from their inception to September 2008 using medical subject heading terms associated with enteral feeding in relation to VAP. The overall reference list of identified studies was audited, and eligible studies included randomized controlled trials, controlled before-and-after (pre-post) studies and meta-analyses. To generate the characteristics of the factors associated with VAP, the reported components of these trials were pinpointed and categorized. A total of 14 papers were found that had investigated the factors linking enteral feeding and VAP. For these, 11 were randomized controlled trials, 1 was a meta-analysis and 2 were case-controlled analyses. Twelve of these 14 studies were conducted at a single institute and 2 were conducted at multiple institutes. The sample sizes varied from 10 to 2,528 subjects. Three major issues were identified based on the purpose of study interventions, and these were the effects of feeding method (continuous vs. intermittent), feeding site on aspiration (gastric vs. small bowel), and the timing of enteral feeding (early vs. late). The evidence suggests that a correct choice of enteral feeding method can effectively reduce complications due to aspiration. Furthermore, intermittent enteral feeding and with a small residual volume feed can reduce gastroesophageal reflux, and increased total intake volume and early feeding can reduce ICU mortality. Nonetheless, the effects of these choices on preventing VAP still need further

Critical Analysis of the Factors Associated with Enteral Feeding in Preventing VAP: A Systematic Review

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Yu-Chih Chen

2009-04-01

Full Text Available Ventilator-associated pneumonia (VAP is a common cause of morbidity in critically ill patients. Appropriate enteral feeding is the most important factor associated with the prevention of VAP. However, the standardization of enteral feeding methods needs clarification. The purpose of this systematic review was to synthesize the factors associated with enteral feeding in order to prevent VAP and to describe the characteristics of these factors. A comprehensive search was undertaken involving all major databases from their inception to September 2008 using medical subject heading terms associated with enteral feeding in relation to VAP. The overall reference list of identified studies was audited, and eligible studies included randomized controlled trials, controlled before-and-after (pre–post studies and meta-analyses. To generate the characteristics of the factors associated with VAP, the reported components of these trials were pinpointed and categorized. A total of 14 papers were found that had investigated the factors linking enteral feeding and VAP. For these, 11 were randomized controlled trials, 1 was a meta-analysis and 2 were case-controlled analyses. Twelve of these 14 studies were conducted at a single institute and 2 were conducted at multiple institutes. The sample sizes varied from 10 to 2,528 subjects. Three major issues were identified based on the purpose of study interventions, and these were the effects of feeding method (continuous vs. intermittent, feeding site on aspiration (gastric vs. small bowel, and the timing of enteral feeding (early vs. late. The evidence suggests that a correct choice of enteral feeding method can effectively reduce complications due to aspiration. Furthermore, intermittent enteral feeding and with a small residual volume feed can reduce gastroesophageal reflux, and increased total intake volume and early feeding can reduce ICU mortality. Nonetheless, the effects of these choices on preventing VAP

Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle.

Science.gov (United States)

Zaydfudim, Victor; Dossett, Lesly A; Starmer, John M; Arbogast, Patrick G; Feurer, Irene D; Ray, Wayne A; May, Addison K; Pinson, C Wright

2009-07-01

Ventilator-associated pneumonia (VAP) causes significant morbidity and mortality in critically ill surgical patients. Recent studies suggest that the success of preventive measures is dependent on compliance with ventilator bundle parameters. Implementation of an electronic dashboard will improve compliance with the bundle parameters and reduce rates of VAP in our surgical intensive care unit (SICU). Time series analysis of VAP rates between January 2005 and July 2008, with dashboard implementation in July 2007. Multidisciplinary SICU at a tertiary-care referral center with a stable case mix during the study period. Patients admitted to the SICU between January 2005 and July 2008. Infection control data were used to establish rates of VAP and total ventilator days. For the time series analysis, VAP rates were calculated as quarterly VAP events per 1000 ventilator days. Ventilator bundle compliance was analyzed after dashboard implementation. Differences between expected and observed VAP rates based on time series analysis were used to estimate the effect of intervention. Average compliance with the ventilator bundle improved from 39% in August 2007 to 89% in July 2008 (P dashboard (P = .01). Quarterly VAP rates were significantly reduced in the November 2007 through January 2008 and February through April 2008 periods (P dashboard improved compliance with ventilator bundle measures and is associated with reduced rates of VAP in our SICU.

Respective impact of implementation of prevention strategies, colonization with multiresistant bacteria and antimicrobial use on the risk of early- and late-onset VAP: An analysis of the OUTCOMEREA network

OpenAIRE

Ibn Saied, Wafa; Souweine, Bertrand; Garrouste-Orgeas, Maité; Ruckly, Stéphane; Darmon, Michael; Bailly, Sébastien; Cohen, Yves; Azoulay, Elie; Schwebel, Carole; Radjou, Aguila; Kallel, Hatem; Adrie, Christophe; Dumenil, Anne-Sylvie; Argaud, Laurent; Marcotte, Guillaume

2017-01-01

International audience; Rationale: The impact of prevention strategies and risk factors for early-onset (EOP) versus late-onset (LOP) ventilator -associated pneumonia (VAP) are still debated.Objectives: To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies.Methods: 7,784 patients with mechanical ventilation (MV) for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997-2016). VAP occurring between...

VapD in Xylella fastidiosa Is a Thermostable Protein with Ribonuclease Activity.

Science.gov (United States)

Mendes, Juliano S; Santiago, André da S; Toledo, Marcelo A S; Rosselli-Murai, Luciana K; Favaro, Marianna T P; Santos, Clelton A; Horta, Maria Augusta C; Crucello, Aline; Beloti, Lilian L; Romero, Fabian; Tasic, Ljubica; de Souza, Alessandra A; de Souza, Anete P

2015-01-01

Xylella fastidiosa strain 9a5c is a gram-negative phytopathogen that is the causal agent of citrus variegated chlorosis (CVC), a disease that is responsible for economic losses in Brazilian agriculture. The most well-known mechanism of pathogenicity for this bacterial pathogen is xylem vessel occlusion, which results from bacterial movement and the formation of biofilms. The molecular mechanisms underlying the virulence caused by biofilm formation are unknown. Here, we provide evidence showing that virulence-associated protein D in X. fastidiosa (Xf-VapD) is a thermostable protein with ribonuclease activity. Moreover, protein expression analyses in two X. fastidiosa strains, including virulent (Xf9a5c) and nonpathogenic (XfJ1a12) strains, showed that Xf-VapD was expressed during all phases of development in both strains and that increased expression was observed in Xf9a5c during biofilm growth. This study is an important step toward characterizing and improving our understanding of the biological significance of Xf-VapD and its potential functions in the CVC pathosystem.

VapD in Xylella fastidiosa Is a Thermostable Protein with Ribonuclease Activity.

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Juliano S Mendes

Full Text Available Xylella fastidiosa strain 9a5c is a gram-negative phytopathogen that is the causal agent of citrus variegated chlorosis (CVC, a disease that is responsible for economic losses in Brazilian agriculture. The most well-known mechanism of pathogenicity for this bacterial pathogen is xylem vessel occlusion, which results from bacterial movement and the formation of biofilms. The molecular mechanisms underlying the virulence caused by biofilm formation are unknown. Here, we provide evidence showing that virulence-associated protein D in X. fastidiosa (Xf-VapD is a thermostable protein with ribonuclease activity. Moreover, protein expression analyses in two X. fastidiosa strains, including virulent (Xf9a5c and nonpathogenic (XfJ1a12 strains, showed that Xf-VapD was expressed during all phases of development in both strains and that increased expression was observed in Xf9a5c during biofilm growth. This study is an important step toward characterizing and improving our understanding of the biological significance of Xf-VapD and its potential functions in the CVC pathosystem.

Structure of Rhodococcus equi virulence-associated protein B (VapB) reveals an eight-stranded antiparallel β-barrel consisting of two Greek-key motifs

International Nuclear Information System (INIS)

Geerds, Christina; Wohlmann, Jens; Haas, Albert; Niemann, Hartmut H.

2014-01-01

The structure of VapB, a member of the Vap protein family that is involved in virulence of the bacterial pathogen R. equi, was determined by SAD phasing and reveals an eight-stranded antiparallel β-barrel similar to avidin, suggestive of a binding function. Made up of two Greek-key motifs, the topology of VapB is unusual or even unique. Members of the virulence-associated protein (Vap) family from the pathogen Rhodococcus equi regulate virulence in an unknown manner. They do not share recognizable sequence homology with any protein of known structure. VapB and VapA are normally associated with isolates from pigs and horses, respectively. To contribute to a molecular understanding of Vap function, the crystal structure of a protease-resistant VapB fragment was determined at 1.4 Å resolution. The structure was solved by SAD phasing employing the anomalous signal of one endogenous S atom and two bound Co ions with low occupancy. VapB is an eight-stranded antiparallel β-barrel with a single helix. Structural similarity to avidins suggests a potential binding function. Unlike other eight- or ten-stranded β-barrels found in avidins, bacterial outer membrane proteins, fatty-acid-binding proteins and lysozyme inhibitors, Vaps do not have a next-neighbour arrangement but consist of two Greek-key motifs with strand order 41238567, suggesting an unusual or even unique topology

Structure of Rhodococcus equi virulence-associated protein B (VapB) reveals an eight-stranded antiparallel β-barrel consisting of two Greek-key motifs

Energy Technology Data Exchange (ETDEWEB)

Geerds, Christina [Bielefeld University, Universitaetsstrasse 25, 33615 Bielefeld (Germany); Wohlmann, Jens; Haas, Albert [University of Bonn, Ulrich-Haberland Strasse 61a, 53121 Bonn (Germany); Niemann, Hartmut H., E-mail: hartmut.niemann@uni-bielefeld.de [Bielefeld University, Universitaetsstrasse 25, 33615 Bielefeld (Germany)

2014-06-18

The structure of VapB, a member of the Vap protein family that is involved in virulence of the bacterial pathogen R. equi, was determined by SAD phasing and reveals an eight-stranded antiparallel β-barrel similar to avidin, suggestive of a binding function. Made up of two Greek-key motifs, the topology of VapB is unusual or even unique. Members of the virulence-associated protein (Vap) family from the pathogen Rhodococcus equi regulate virulence in an unknown manner. They do not share recognizable sequence homology with any protein of known structure. VapB and VapA are normally associated with isolates from pigs and horses, respectively. To contribute to a molecular understanding of Vap function, the crystal structure of a protease-resistant VapB fragment was determined at 1.4 Å resolution. The structure was solved by SAD phasing employing the anomalous signal of one endogenous S atom and two bound Co ions with low occupancy. VapB is an eight-stranded antiparallel β-barrel with a single helix. Structural similarity to avidins suggests a potential binding function. Unlike other eight- or ten-stranded β-barrels found in avidins, bacterial outer membrane proteins, fatty-acid-binding proteins and lysozyme inhibitors, Vaps do not have a next-neighbour arrangement but consist of two Greek-key motifs with strand order 41238567, suggesting an unusual or even unique topology.

Analysis of non-typeable Haemophilous influenzae VapC1 mutations reveals structural features required for toxicity and flexibility in the active site.

Directory of Open Access Journals (Sweden)

Brooke Hamilton

Full Text Available Bacteria have evolved mechanisms that allow them to survive in the face of a variety of stresses including nutrient deprivation, antibiotic challenge and engulfment by predator cells. A switch to dormancy represents one strategy that reduces energy utilization and can render cells resistant to compounds that kill growing bacteria. These persister cells pose a problem during treatment of infections with antibiotics, and dormancy mechanisms may contribute to latent infections. Many bacteria encode toxin-antitoxin (TA gene pairs that play an important role in dormancy and the formation of persisters. VapBC gene pairs comprise the largest of the Type II TA systems in bacteria and they produce a VapC ribonuclease toxin whose activity is inhibited by the VapB antitoxin. Despite the importance of VapBC TA pairs in dormancy and persister formation, little information exists on the structural features of VapC proteins required for their toxic function in vivo. Studies reported here identified 17 single mutations that disrupt the function of VapC1 from non-typeable H. influenzae in vivo. 3-D modeling suggests that side chains affected by many of these mutations sit near the active site of the toxin protein. Phylogenetic comparisons and secondary mutagenesis indicate that VapC1 toxicity requires an alternative active site motif found in many proteobacteria. Expression of the antitoxin VapB1 counteracts the activity of VapC1 mutants partially defective for toxicity, indicating that the antitoxin binds these mutant proteins in vivo. These findings identify critical chemical features required for the biological function of VapC toxins and PIN-domain proteins.

Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study.

Science.gov (United States)

Koulenti, D; Tsigou, E; Rello, J

2017-11-01

We report on intensive care nosocomial pneumonia (NP) in Europe through a review of EU-VAP/CAP manuscripts: a prospective observational study, enrolling patients from 27 ICUs in nine European countries. From 2,436 eligible ICU patients, 827 cases presented NP, with 18.3 episodes of VAP per 1000 ventilator-days. Most common findings were worsening oxygenation, purulent respiratory secretions and temperature increase. At least three criteria from Clinical Pulmonary Infection score (CPIS) were present in 77.9 % of episodes, but only 0.2 % met six CPIS criteria. Diagnosis was confirmed mainly noninvasively (74.8 %), with half qualitative and quantitative cultures. The dominant isolate was S. aureus in Spain, France, Belgium and Ireland, P. aeruginosa in Italy and Portugal, Acinetobacter in Greece and Turkey, but Escherichia coli in Germany. NP resulted in 6 % higher mortality, longer ICU stay and duration of mechanical ventilation (12 and 10 days). COPD and age ≥45 years were not associated with higher VAP incidence but did correlate with increased mortality. Trauma had higher VAP incidence but lower mortality. Bacteremia (led by MRSA and Acinetobacter baumannii) was documented in 14.6 %, being associated with extra ICU stay and mortality. Vasopressors and ICUs with above 25 % prevalence of Potential Resistant Organisms (PRM) were independently associated with PRM, being documented in 50.7 % of patients with early-onset VAP without known risk factors. Most patients initially received combination therapy. Delay in appropriate antimicrobial choice significantly increased mortality, and LOS in survivors was six days longer (p < 0.05). In conclusion, NP management in Europe presents local differences and major shifts when compared to reports from North America, outcomes of randomized trials and general guidelines.

[The comparison of different bronchial aspirate culturing methods in patients with ventilator-associated pneumonia (VAP)].

Science.gov (United States)

Kowalczyk, Wojciech; Rybicki, Zbigniew; Tomaszewski, Dariusz; Truszczyński, Andrzej; Guzek, Aneta

2011-01-01

Although broncho-alveolar lavage (BAL) culture and protected specimen brush (PSB) are regarded as the most effective methods in the diagnosis of VAP, a simple endotracheal aspiration (EA) is frequently performed during routine care, because of its simplicity and low cost. We compared the effectiveness of EA with BAL and PSB in VAP patients. Sixty-one adult VAP patients, ventilated for longer than 48 h, were cultured with all three methods. Positive cultures were obtained from 63.9% of patients, with Acinetobacter baumannii being the most common pathogen. There was a high positive correlation between simple aspirates and BAL (k 0.817, CI 0.664-0.840, p aspirates and PSB (k 0.667, CI 0.483-0.871, p aspirate culturing, compared to BAL and PSB, it can be used successfully in most cases.

Knowledge of Pediatric Critical Care Nurses Regarding Evidence Based Guidelines for Prevention of Ventilator Associated Pneumonia (VAP)

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Ahmed, Gehan EL Nabawy; Abosamra, Omyma Mostafa

2015-01-01

Ventilator associated pneumonia (VAP) is a costly, preventable, and often fatal consequence of medical therapy that increases hospital and intensive care stays in mechanically ventilated patients. The prevention of VAP is primarily the responsibility of the bedside nurse whose knowledge, beliefs, and practices influence the health outcome of ICU…

Biomarkers kinetics in the assessment of ventilator-associated pneumonia response to antibiotics - results from the BioVAP study

NARCIS (Netherlands)

Póvoa, Pedro; Martin-Loeches, Ignacio; Ramirez, Paula; Bos, Lieuwe D.; Esperatti, Mariano; Silvestre, Joana; Gili, Gisela; Goma, Gemma; Berlanga, Eugenio; Espasa, Mateu; Gonçalves, Elsa; Torres, Antoni; Artigas, Antonio

2017-01-01

Purpose: Our aim was to evaluate the role of biomarker kinetics in the assessment of ventilator-associated pneumonia (VAP) response to antibiotics. Materials and methods: We performed a prospective, multicenter, observational study to evaluate in 37 microbiologically documented VAP, the kinetics of

VAP/VAT: video analytics platform and test bed for testing and deploying video analytics

Science.gov (United States)

Gorodnichy, Dmitry O.; Dubrofsky, Elan

2010-04-01

Deploying Video Analytics in operational environments is extremely challenging. This paper presents a methodological approach developed by the Video Surveillance and Biometrics Section (VSB) of the Science and Engineering Directorate (S&E) of the Canada Border Services Agency (CBSA) to resolve these problems. A three-phase approach to enable VA deployment within an operational agency is presented and the Video Analytics Platform and Testbed (VAP/VAT) developed by the VSB section is introduced. In addition to allowing the integration of third party and in-house built VA codes into an existing video surveillance infrastructure, VAP/VAT also allows the agency to conduct an unbiased performance evaluation of the cameras and VA software available on the market. VAP/VAT consists of two components: EventCapture, which serves to Automatically detect a "Visual Event", and EventBrowser, which serves to Display & Peruse of "Visual Details" captured at the "Visual Event". To deal with Open architecture as well as with Closed architecture cameras, two video-feed capture mechanisms have been developed within the EventCapture component: IPCamCapture and ScreenCapture.

Impact of VAP bundle adherence among ventilated critically ill patients and its effectiveness in adult ICU

Directory of Open Access Journals (Sweden)

Saad Rabie Samra

2017-01-01

Conclusion: The application of VAP bundle is a feasible reality that produces improvement in microbiological measures and nosocomal infection rates resulting in lowering mortality, shortened lengths of hospitalization and decreased medical care costs. However, education and periodic training remain a fundamental process of improving health services. VAPs were reduced by improving bundle compliance and ensuring the same standard of care to all ICU patients. Direct, on-site observation was a more accurate method of monitoring.

Respective impact of implementation of prevention strategies, colonization with multiresistant bacteria and antimicrobial use on the risk of early- and late-onset VAP: An analysis of the OUTCOMEREA network.

Directory of Open Access Journals (Sweden)

Wafa Ibn Saied

Full Text Available The impact of prevention strategies and risk factors for early-onset (EOP versus late-onset (LOP ventilator-associated pneumonia (VAP are still debated.To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies.7,784 patients with mechanical ventilation (MV for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997-2016. VAP occurring between the 3rd and 6th day of MV defined EOP, while those occurring after defined LOPs. We used a Fine and Gray subdistribution model to take the successful extubation into account as a competing event.Overall, 1,234 included patients developed VAP (EOP: 445 (36%; LOP: 789 (64%. Male gender was a risk factor for both EOP and LOP. Factors specifically associated with EOP were admission for respiratory distress, previous colonization with multidrug-resistant Pseudomonas aeruginosa, chest tube and enteral feeding within the first 2 days of MV. Antimicrobials administrated within the first 2 days of MV were all protective of EOP. ICU admission for COPD exacerbation or pneumonia were early risk factors for LOP, while imidazole and vancomycin use within the first 2 days of MV were protective factors. Late risk factors (between the 3rd and the 6th day of MV were the intra-hospital transport, PAO2-FIO2<200 mmHg, vasopressor use, and known colonization with methicillin-resistant Staphylococcus aureus. Among the antimicrobials administered between the 3rd and the 6th day, fluoroquinolones were the solely protective one.Contrarily to LOP, the risk of EOP decreased across the study time periods, concomitantly with an increase in the compliance with bundle of prevention measures.VAP risk factors are mostly different according to the pneumonia time of onset, which should lead to differentiated prevention strategies.

A mutation in human VAP-B--MSP domain, present in ALS patients, affects the interaction with other cellular proteins.

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Mitne-Neto, M; Ramos, C R R; Pimenta, D C; Luz, J S; Nishimura, A L; Gonzales, F A; Oliveira, C C; Zatz, M

2007-09-01

Amyotrophic Lateral Sclerosis (ALS) is the most common adult-onset Motor Neuron Disease (MND), characterized by motor neurons death in the cortex, brainstem and spinal cord. Ten loci linked to Familial ALS have been mapped. ALS8 is caused by a substitution of a proline by a serine in the Vesicle-Associated Membrane Protein-Associated protein-B/C (VAP-B/C). VAP-B belongs to a highly conserved family of proteins implicated in Endoplasmic Reticulum-Golgi and intra-Golgi transport and microtubules stabilization. Previous studies demonstrated that the P56S mutation disrupts the subcellular localization of VAP-B and that this position would be essential for Unfolded Protein Response (UPR) induced by VAP-B. In the present work we expressed and purified recombinant wild-type and P56S mutant VAP-B-MSP domain for the analysis of its interactions with other cellular proteins. Our findings suggest that the P56S mutation may lead to a less stable interaction of this endoplasmic reticulum protein with at least two other proteins: tubulin and GAPDH. These two proteins have been previously related to other forms of neurodegenerative diseases and are potential key points to understand ALS8 pathogenesis and other forms of MND. Understanding the role of these protein interactions may help the treatment of this devastating disease in the future.

Xylanase production from Thermomyces lanuginosus VAPS-24 using low cost agro-industrial residues via hybrid optimization tools and its potential use for saccharification.

Science.gov (United States)

Kumar, Vishal; Chhabra, Deepak; Shukla, Pratyoosh

2017-11-01

The xylanase production from Thermomyces lanuginosus VAPS-24 has been optimized using OFAT (One factor at a time) approach using agro-industrial substrates. Further, central composite design (CCD) has been employed to optimize various process parameters such as temperature (45-55°C), carbon source concentration (1.5-2.5%), fermentation time (72-120h) and production medium pH (6-8). Maximum xylanase yield after RSM optimization was approximately double (119.91±2.53UmL -1 ) than un-optimized conditions (61.09±0.91UmL -1 ). Several hybrid statistical tools such as Genetic Algorithm-Response Surface Methodology (GA-RSM), Artificial Neural Network (ANN), Genetic Algorithm-Artificial Neural Network (GA-ANN) were employed to obtain more optimized process parameters to maximize the xylanase production and observed an increase of 10.50% xylanase production (132.51±3.27UmL -1 ) as compared to RSM response (119.91±2.53UmL -1 ). The various pretreated and untreated agricultural residues were subjected to saccharification by using crude xylanase in which the pretreated rice straw yielded maximum fermentable sugars 126.89mgg -1 . Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparative Genomics of Rhodococcus equi Virulence Plasmids Indicates Host-Driven Evolution of the vap Pathogenicity Island.

Science.gov (United States)

MacArthur, Iain; Anastasi, Elisa; Alvarez, Sonsiray; Scortti, Mariela; Vázquez-Boland, José A

2017-05-01

The conjugative virulence plasmid is a key component of the Rhodococcus equi accessory genome essential for pathogenesis. Three host-associated virulence plasmid types have been identified the equine pVAPA and porcine pVAPB circular variants, and the linear pVAPN found in bovine (ruminant) isolates. We recently characterized the R. equi pangenome (Anastasi E, et al. 2016. Pangenome and phylogenomic analysis of the pathogenic actinobacterium Rhodococcus equi. Genome Biol Evol. 8:3140-3148.) and we report here the comparative analysis of the virulence plasmid genomes. Plasmids within each host-associated type were highly similar despite their diverse origins. Variation was accounted for by scattered single nucleotide polymorphisms and short nucleotide indels, while larger indels-mostly in the plasticity region near the vap pathogencity island (PAI)-defined plasmid genomic subtypes. Only one of the plasmids analyzed, of pVAPN type, was exceptionally divergent due to accumulation of indels in the housekeeping backbone. Each host-associated plasmid type carried a unique PAI differing in vap gene complement, suggesting animal host-specific evolution of the vap multigene family. Complete conservation of the vap PAI was observed within each host-associated plasmid type. Both diversity of host-associated plasmid types and clonality of specific chromosomal-plasmid genomic type combinations were observed within the same R. equi phylogenomic subclade. Our data indicate that the overall strong conservation of the R. equi host-associated virulence plasmids is the combined result of host-driven selection, lateral transfer between strains, and geographical spread due to international livestock exchanges. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

Pola Kuman Penyebab Ventilator Associated Pneumonia(VAP dan Sensitivitas Terhadap Antibiotik di RSAB Harapan Kita

Directory of Open Access Journals (Sweden)

Retno Widyaningsih

2016-11-01

Kesimpulan. Basil gram negatif aerob (79,5% merupakan mikroorganisme penyebab yang paling dominan. Ceftazidime, diikuti terhadap amikacin serta netilmicin masih mempunyai sensitivitas yang tinggi sehingga dapat dipakai sebagai terapi awal VAP.

Technology for Evolutionary Software Development (Technologies pour le developpement de logiciels evolutifs)

Science.gov (United States)

2003-06-01

experiences, there should be some common framework which speakers can aspire to. • Lack of common training programme [Evo] None of the speakers mentioned any...entation VAPS Formats: Realisation, implementation & Integration on the Flight Simulator VAPS For ats: ealisation, i ple entation & Integration on...final product. The methodology is supported by VAPS (Visual APplicationS) computer models, three-dimensional mock- ups and electronic drawings of the

Structural analysis of the active site architecture of the VapC toxin from Shigella flexneri

DEFF Research Database (Denmark)

Xu, Kehan; Dedic, Emil; Brodersen, Ditlev Egeskov

2016-01-01

The VapC toxin from the Shigella flexneri 2a virulence plasmid pMYSH6000 belongs to the PIN domain protein family, which is characterized by a conserved fold with low amino acid sequence conservation. The toxin is a bona fide Mg2+-dependent ribonuclease and has been shown to target initiator t...

Microalgal cultivation for value-added products: a critical enviro-economical assessment.

Science.gov (United States)

Kothari, Richa; Pandey, Arya; Ahmad, Shamshad; Kumar, Ashwani; Pathak, Vinayak V; Tyagi, V V

2017-08-01

The present review focuses on the cultivation of algal biomass for generating value-added products (VAP) and to assess their economic benefits and harmful environmental impact. Additionally, the impact of bioreactor designs on the yield of microalgal biomass for VAP is also considered. All these factors are discussed in relation to the impact of microalgae production on the bio-economy sector of commercial biotechnology.

Exploration of knowledge of, adherence to, attitude and barriers toward evidence-based guidelines (EBGs for prevention of ventilator-associated pneumonia (VAP in healthcare workers of pediatric cardiac intensive care units (PCICUs: A Quali-Quantitative survey

Directory of Open Access Journals (Sweden)

Leila Jahansefat

2016-09-01

Full Text Available Implementation of evidence-based guidelines (EBGs is an effective measure for prevention of ventilator-associated pneumonia (VAP. Appropriate knowledge, attitude and adherence of healthcare workers (HCWs to EBGs are necessary factors for implementation of EBGs. This study was conducted with objective of evaluation of knowledge, attitude, and adherence of HCWs to EBGs for prevention of VAP and exploration of the barriers of their implementation in clinical practice. Totally, a total number of 45 HCWs of two pediatric cardiac surgery ICU (PCICUs participated in this quali-quantitative survey. Knowledge, attitude and adherence of participants was evaluated by a validated multiple-choice questionnaire and barriers of implementation of EBGs was extracted from participants’ answer to an open-ended question of our self-made questionnaire. Knowledge of HCWs was poor and significantly different between nurse assistants (RAs, nurses (RNs, and physicians (MDs (respectively, 1.25±0.95, 4.53±1.73, and 5.54±2.01, P=0.001. Likewise, attit ude of HCWs is not positive and significantly different between NAs, RNs, and MDs (respectively, 32.96±2.42, 34.00±2.44, 36.81±4.35, P=0.003. The adherence of HCWs is not good and different between RAs, RNs, and MDs (respectively, 11.50±1.00, 13.13±1.83, and 17.18±6.06, P= 0.17. The Barriers of implementation of EBGs was categorized into four category of individual, organizational, social, and educational factors. Unsatisfying status of knowledge, attitude, and adherence of HCWs is a challenging concern of health-care system, especially in PICUs. In addition to these well-known factors, poor implementation of EBGs is related to many other barriers which should recognized and taken into consideration for designation of infection controlling programs.

The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study.

Science.gov (United States)

Eom, Joong Sik; Lee, Mi-Suk; Chun, Hee-Kyung; Choi, Hee Jung; Jung, Sun-Young; Kim, Yeon-Sook; Yoon, Seon Jin; Kwak, Yee Gyung; Oh, Gang-Bok; Jeon, Min-Hyok; Park, Sun-Young; Koo, Hyun-Sook; Ju, Young-Su; Lee, Jin Seo

2014-01-01

For prevention of ventilator-associated pneumonia (VAP), a bundle approach was applied to patients receiving mechanical ventilation in intensive care units. The incidence of VAP and the preventive efficacy of the VAP bundle were investigated. A quasi-experimental study was conducted in adult intensive care units of 6 university hospitals with similar VAP rates. We implemented the VAP bundle between March 2011 and June 2011, then compared the rate of VAP after implementation of the VAP bundle with the rate in the previous 8 months. Our ventilator bundle included head of bed elevation, peptic ulcer disease prophylaxis, deep venous thrombosis prophylaxis, and oral decontamination with chlorhexidine 0.12%. Continuous aspiration of subglottic secretions was an option. Implementation of the VAP bundle reduced the VAP rate from a mean of 4.08 cases per 1,000 ventilator-days to 1.16 cases per 1,000 ventilator-days. The incidence density ratio (rate) was 0.28 (95% confidence interval, 0.275-0.292). Implementing the appropriate VAP bundle significantly decreased the incidence of VAP in patients with mechanical ventilation. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

[Changes observed in three quality indicators after the implementation of improvement strategies in the respiratory intensive care unit].

Science.gov (United States)

Álvarez Maldonado, Pablo; Cueto Robledo, Guillermo; Cicero Sabido, Raúl

2015-04-01

To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). A prospective, comparative, longitudinal and interventional study was carried out. The RICU of Hospital General de México (Mexico). All patients admitted to the RICU from March 2012 to March 2013. An evidence-based bundle of interventions was implemented in order to reduce the ratios of three quality indicators: non-planned extubation (NPE), reintubation, and ventilator-associated pneumonia (VAP). NPE, reintubation and VAP ratios. A total of 232 patients were admitted, with a mean age of 49.5±17.8years; 119 (50.5%) were woman. The mean Simplified Acute Physiology Score (SAPS-3) was 49.8±17, and the mean Sequential Organ Failure Assessment (SOFA) score was 5.3±4.1. The mortality rate in the RICU was 38.7%. The standardized mortality ratio was 1.50 (95%CI: 1.20-1.84). An improved ratio was observed for reintubation and NPE indicators compared to the ratios of the previous 2011 cohort: 1.6% vs. 7% (P=.02) and 8.1 vs. 17 episodes per 1000 days of mechanical ventilation (P=.04), respectively. A worsened VAP ratio was observed: 18.4 vs. 15.1 episodes per 1000 days of mechanical ventilation (P=.5). Quality improvement is feasible with the identification of areas of opportunity and the implementation of strategies. Nevertheless, the implementation of a bundle of preventive measures in itself does not guarantee improvements. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Use of VAP3D software in the construction of pathological anthropomorphic phantoms for dosimetric evaluations; Uso do software VAP3D na construcao de fantomas antropomorficos patologicos para avaliacoes dosimetricas

Energy Technology Data Exchange (ETDEWEB)

Lima, Lindeval Fernandes de [Universidade Federal de Pernambuco (DEM/UFPE), Recife, PE (Brazil). Dept. de Engenharia Mecanica; Vieira, Jose Wilson [Instituto Federal de Educacao, Ciencia e Tecnologia de Pernambuco, Recife, PE (Brazil); Lima, Fernando R.A., E-mail: falima@cnen.gov.b [Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil)

2011-10-26

This paper performs a new type of dosimetric evaluation, where it was used a phantom of pathological voxels (representative phantom of sick person). The software VAP3D (Visualization and Analysis of Phantoms 3D) were used for, from a healthy phantom (phantom representative of healthy person), to introduce three dimensional regions to simulate tumors. It was used the Monte Carlo ESGnrc code to simulate the X ray photon transport, his interaction with matter and evaluation of absorbed dose in organs and tissues from thorax region of the healthy phantom and his pathological version. This is a computer model of typical exposure for programming the treatments in radiodiagnostic

Crystal Structure of the VapBC Toxin–Antitoxin Complex from Shigella flexneri Reveals a Hetero-Octameric DNA-Binding Assembly

DEFF Research Database (Denmark)

Dienemann, Christian; Bøggild, Andreas; Winther, Kristoffer S.

2011-01-01

the crystal structure of the intact Shigella flexneri VapBC TA complex, determined to 2.7 Å resolution. Both in solution and in the crystal structure, four molecules of each protein combine to form a large and globular hetero-octameric assembly with SpoVT/AbrB-type DNA-binding domains at each end and a total...

Model of OSBP-Mediated Cholesterol Supply to Aichi Virus RNA Replication Sites Involving Protein-Protein Interactions among Viral Proteins, ACBD3, OSBP, VAP-A/B, and SAC1.

Science.gov (United States)

Ishikawa-Sasaki, Kumiko; Nagashima, Shigeo; Taniguchi, Koki; Sasaki, Jun

2018-04-15

Positive-strand RNA viruses, including picornaviruses, utilize cellular machinery for genome replication. Previously, we reported that each of the 2B, 2BC, 2C, 3A, and 3AB proteins of Aichi virus (AiV), a picornavirus, forms a complex with the Golgi apparatus protein ACBD3 and phosphatidylinositol 4-kinase IIIβ (PI4KB) at viral RNA replication sites (replication organelles [ROs]), enhancing PI4KB-dependent phosphatidylinositol 4-phosphate (PI4P) production. Here, we demonstrate AiV hijacking of the cellular cholesterol transport system involving oxysterol-binding protein (OSBP), a PI4P-binding cholesterol transfer protein. AiV RNA replication was inhibited by silencing cellular proteins known to be components of this pathway, OSBP, the ER membrane proteins VAPA and VAPB (VAP-A/B), the PI4P-phosphatase SAC1, and PI-transfer protein β. OSBP, VAP-A/B, and SAC1 were present at RNA replication sites. We also found various previously unknown interactions among the AiV proteins (2B, 2BC, 2C, 3A, and 3AB), ACBD3, OSBP, VAP-A/B, and SAC1, and the interactions were suggested to be involved in recruiting the component proteins to AiV ROs. Importantly, the OSBP-2B interaction enabled PI4P-independent recruitment of OSBP to AiV ROs, indicating preferential recruitment of OSBP among PI4P-binding proteins. Protein-protein interaction-based OSBP recruitment has not been reported for other picornaviruses. Cholesterol was accumulated at AiV ROs, and inhibition of OSBP-mediated cholesterol transfer impaired cholesterol accumulation and AiV RNA replication. Electron microscopy showed that AiV-induced vesicle-like structures were close to ER membranes. Altogether, we conclude that AiV directly recruits the cholesterol transport machinery through protein-protein interactions, resulting in formation of membrane contact sites between the ER and AiV ROs and cholesterol supply to the ROs. IMPORTANCE Positive-strand RNA viruses utilize host pathways to modulate the lipid composition of

Improving the quality of the intensive care follow-up of ventilated patients during a national registration program.

Science.gov (United States)

Reper, P; Dicker, D; Damas, P; Huyghens, L; Haelterman, M

2017-07-01

The Belgian Public Health Organization is concerned with rates of hospital-acquired infections like ventilator-associated pneumonia (VAP). Implementing best practice guidelines for these nosocomial infections has variable success in the literature. This retrospective study was undertaken to see whether implementation of the evidence-based practices as a bundle was feasible, would influence compliance, and could reduce the rates of VAP. We utilized easily collectable data about regular care to rapidly assess whether interventions already in place were effectively successfully applied. This avoided cumbersome data collection and review. Retrospective compliance rates and VAP ratios were compared using z tests with P-values education campaigns, staff meetings, in-services, physician checklist, nurse checklist, charge nurse checklist implementation, systematic VAP bundle application, and systematic protocols for oral care and sedation protocols. Additionally, VAP ratio could be registered by the participating centers. A total of 10,211 intensive care unit (ICU) patients were included in the study which represents 66,817 ICU days under artificial ventilation with an endotracheal tube. The general compliance for VAP bundle raised from VAP was 61% in February 2012 and 74.16% in December 2012 (P education, and checklist implementation resulted in an increase in compliance for VAP bundle and a decrease in VAP ratio. This study confirms the applicability of best practice guidelines about regular care but results on VAP incidence have to be confirmed. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Strain-related acid production by oral streptococci

DEFF Research Database (Denmark)

de Soet, JJ; Nyvad, Bente; Kilian, Mogens

2000-01-01

Acid production, in particular at low pH, is thought to be an important ecological determinant in dental caries. The aim of the present study was to determine the acid producing capability at different pH levels of 47 streptococcal strains, representing 9 species, isolated from human dental plaque....... The bacteria were grown until mid log-phase under anaerobic conditions and acid production was measured in a pH-stat system at pH 7.0, 6.0, 5.5 and 5.0. At all pH values, the mean velocity of acid production (V(ap)) by Streptococcus mutans and S. sobrinus was significantly higher (p... that of the other oral streptococci, including S. mitis, S. oralis, S. gordonii, S. sanguis, S. intermedius, S. anginosus, S. constellatus, and S. vestibularis. However, the V(ap) of some strains of S. mitis biovar 1 and S. oralis, particularly at pH values of 7.0 and 6.0, exceeded that of some strains of S. mutans...

Molecular characterization of Rhodococcus equi isolates from horses in Poland: pVapA characteristics and plasmid new variant, 85-kb type V.

Science.gov (United States)

Witkowski, Lucjan; Rzewuska, Magdalena; Takai, Shinji; Chrobak-Chmiel, Dorota; Kizerwetter-Świda, Magdalena; Feret, Małgorzata; Gawryś, Marta; Witkowski, Maciej; Kita, Jerzy

2017-01-26

Rhodococcus equi is one of the most significant bacterial pathogens affecting foals up to 6 months of age worldwide. Rhodococcosis is present in Poland however information about molecular characterization of R. equi isolates is scarce. This study describes molecular characterization of Rhodococcus equi infection on 13 horse breeding farms in Poland between 2001 and 2012. Samples were collected by tracheobronchial aspiration from pneumonic foals or during necropsy. The R. equi isolates were genotyped by plasmid profiling and pulsed-field gel electrophoresis. Totally, 58 R. equi isolates were investigated. One isolate lost its plasmid. Among the 57 VapA-positive isolates, 48 contained 85-kb type I plasmid (82.8%), 8 contained 87-kb type I plasmid (13.8%). One isolate (1.7%) had a unique restriction cleavage pattern and the 2nd fragment of EcoRI digests of this plasmid DNA was about 2600 bases smaller than that of the 85 kb type I. This new plasmid variant was designated as the "85-kb type V". Among the 58 isolates typeable with VspI-PFGE, ten PFGE clusters were detected. The majority of foals were infected mostly with isolates of low genetic diversity. Most of clinical isolates of R. equi from foals in Poland contain pVapA 85-kb type I and 87-kb type I similarly to the other European countries and the United States. However, the new variant of pVapA 85-kb type V was identified. The chromosomal variability was detected among some of the investigated isolates and the presence of farm-specific isolates might be possible.

Ka-Band ARM Zenith Radar Corrections Value-Added Product

Energy Technology Data Exchange (ETDEWEB)

Johnson, Karen [Brookhaven National Lab. (BNL), Upton, NY (United States); Toto, Tami [Brookhaven National Lab. (BNL), Upton, NY (United States); Giangrande, Scott [Brookhaven National Lab. (BNL), Upton, NY (United States)

2017-10-15

The KAZRCOR Value -added Product (VAP) performs several corrections to the ingested KAZR moments and also creates a significant detection mask for each radar mode. The VAP computes gaseous attenuation as a function of time and radial distance from the radar antenna, based on ambient meteorological observations, and corrects observed reflectivities for that effect. KAZRCOR also dealiases mean Doppler velocities to correct velocities whose magnitudes exceed the radar’s Nyquist velocity. Input KAZR data fields are passed through into the KAZRCOR output files, in their native time and range coordinates. Complementary corrected reflectivity and velocity fields are provided, along with a mask of significant detections and a number of data quality flags. This report covers the KAZRCOR VAP as applied to the original KAZR radars and the upgraded KAZR2 radars. Currently there are two separate code bases for the different radar versions, but once KAZR and KAZR2 data formats are harmonized, only a single code base will be required.

Cloud Type Classification (cldtype) Value-Added Product

Energy Technology Data Exchange (ETDEWEB)

Flynn, Donna [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Shi, Yan [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Lim, K-S [Korean Atomic Energy Research Inst., Daejeon (South Korea); Riihimaki, Laura [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2017-08-15

The Cloud Type (cldtype) value-added product (VAP) provides an automated cloud type classification based on macrophysical quantities derived from vertically pointing lidar and radar. Up to 10 layers of clouds are classified into seven cloud types based on predetermined and site-specific thresholds of cloud top, base and thickness. Examples of thresholds for selected U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility sites are provided in Tables 1 and 2. Inputs for the cldtype VAP include lidar and radar cloud boundaries obtained from the Active Remotely Sensed Cloud Location (ARSCL) and Surface Meteorological Systems (MET) data. Rain rates from MET are used to determine when radar signal attenuation precludes accurate cloud detection. Temporal resolution and vertical resolution for cldtype are 1 minute and 30 m respectively and match the resolution of ARSCL. The cldtype classification is an initial step for further categorization of clouds. It was developed for use by the Shallow Cumulus VAP to identify potential periods of interest to the LASSO model and is intended to find clouds of interest for a variety of users.

Use of VAP3D software in the construction of pathological anthropomorphic phantoms for dosimetric evaluations

International Nuclear Information System (INIS)

Lima, Lindeval Fernandes de; Lima, Fernando R.A.

2011-01-01

This paper performs a new type of dosimetric evaluation, where it was used a phantom of pathological voxels (representative phantom of sick person). The software VAP3D (Visualization and Analysis of Phantoms 3D) were used for, from a healthy phantom (phantom representative of healthy person), to introduce three dimensional regions to simulate tumors. It was used the Monte Carlo ESGnrc code to simulate the X ray photon transport, his interaction with matter and evaluation of absorbed dose in organs and tissues from thorax region of the healthy phantom and his pathological version. This is a computer model of typical exposure for programming the treatments in radiodiagnostic

Lean Manufacturing Implementation: an Approach to Reduce Production Cost

Directory of Open Access Journals (Sweden)

Iraswari

2012-04-01

Full Text Available Abstract: Lean Manufacturing Implementation: An Approach To Reduce Production Cost. Opportunities to improve production processes and reduce production cost through the implementation of lean manufacturing in small medium garment manufacturing are presented in this research. This research shows that there is a possibility of decrease in production cost and increase in return on sales. Lean manufacturing implementation can eliminate waste in the production process. This is a set of techniques for identification and elimination of waste gathered from The Ford Production, Statistical Process Control and other techniques. Improvement of quality could be carried out while time and cost of production are being reduced.

Doppler Lidar Vertical Velocity Statistics Value-Added Product

Energy Technology Data Exchange (ETDEWEB)

Newsom, R. K. [DOE ARM Climate Research Facility, Washington, DC (United States); Sivaraman, C. [DOE ARM Climate Research Facility, Washington, DC (United States); Shippert, T. R. [DOE ARM Climate Research Facility, Washington, DC (United States); Riihimaki, L. D. [DOE ARM Climate Research Facility, Washington, DC (United States)

2015-07-01

Accurate height-resolved measurements of higher-order statistical moments of vertical velocity fluctuations are crucial for improved understanding of turbulent mixing and diffusion, convective initiation, and cloud life cycles. The Atmospheric Radiation Measurement (ARM) Climate Research Facility operates coherent Doppler lidar systems at several sites around the globe. These instruments provide measurements of clear-air vertical velocity profiles in the lower troposphere with a nominal temporal resolution of 1 sec and height resolution of 30 m. The purpose of the Doppler lidar vertical velocity statistics (DLWSTATS) value-added product (VAP) is to produce height- and time-resolved estimates of vertical velocity variance, skewness, and kurtosis from these raw measurements. The VAP also produces estimates of cloud properties, including cloud-base height (CBH), cloud frequency, cloud-base vertical velocity, and cloud-base updraft fraction.

Ventilator-associated pneumonia management in critical illness.

Science.gov (United States)

Albertos, Raquel; Caralt, Berta; Rello, Jordi

2011-03-01

Ventilator-associated pneumonia (VAP) is a frequent adverse event in the intensive care unit.We review recent publications about the management and prevention of VAP. The latest care bundles introduced standard interventions to facilitate implementation of evidence-based clinical guidelines and to improve the outcome of patients. Recent studies find that prevention management of ventilated patients decreases the risk of VAP. Enteral feeding, considered a risk factor for VAP, currently has been recommended, with appropriate administration, for all critical ill patients if no contraindications exist. In view of the recently available data, it can be concluded that the implementation of care bundles on the general management of ventilated patients in daily practice has reduced the VAP rates. The main pharmacological measures to prevent VAP are proper hands hygiene, high nurse-to-patient ratio, avoid unnecessary transfer of ventilated patients, use of noninvasive mechanical ventilation, shortening weaning period, avoid the use of nasal intubation, prevent bio-film deposition in endotracheal tube, aspiration of subglottic secretions, maintenance of adequate pressure of endotracheal cuffs, avoid manipulation of ventilator circuits, semi-recumbent position and adequate enteral feeding.In addition, updated guidelines incorporate more comprehensive diagnostic protocols to the evidence-based management of VAP.

Implementation of HACCP system in production of UHT milk

Directory of Open Access Journals (Sweden)

Irena Jeličić

2009-06-01

Full Text Available Regulation of the Croatian Food Law (NN 46/07 which demands implementation of food safety management system based on HACCP principles became mandatory at the January 01st 2009. According to that regulation all subjects in food production and retail sector including the dairy industry too are obligant to implement HACCP system in their production processes. In the process of HACCP implementation many problems occur which result in delaying the implementation, scarce performance of assigned monitoring actions and inadequate maintenance and improvement of the system. All of the latter mentioned problems disable proactive functioning and may lead to disturbance of food safety of the end product. The aim of this paper is to demonstrate the interpretation of each steps that have to be taken in the process of implementation of HACCP system in the production of UHT milk. Thereby many practical informations and examples have been gathered while reviewing the HACCP system in KIM d.d. Dairy industry, Karlovac, Croatia. This paper contains the examples of all indentified hazards, all assigned control actions, hazard analysis and critical control point determination for the process of UHT milk production in KIM d.d. Dairy industry, Karlovac. Furthermore, also examples and ideas for the traceability, verification and validation, product recall and withdrawal procedures are given.

[Ventilator associated pneumonia].

Science.gov (United States)

Bellani, S; Nesci, M; Celotto, S; Lampati, L; Lucchini, A

2003-04-01

Ventilator associated pneumonia (VAP) is a nosocomial lower respiratory tract infection that ensues in critically ill patients undergoing mechanical ventilation. The reported incidence of VAP varies between 9% and 68% with a mortality ranging between 33% and 71%. Two key factors are implicated in the pathogenesis of VAP: bacterial colonization of the upper digestive-respiratory tract and aspiration of oral secretions into the trachea. Preventive measurements are advocated to reduce the incidence of VAP, such as selective decontamination of the digestive tract (SDD), supraglottic aspiration and positioning. Prompt recognition and treatment of established VAP has also been demostrated to affect outcome. Therefore, the knowledge of risk factors associated with the development of VAP and the implementation of strategies to prevent, diagnose and treat VAP are mainstems in the nursing of mechanically ventilated patients.

Raman Lidar Profiles–Temperature (RLPROFTEMP) Value-Added Product

Energy Technology Data Exchange (ETDEWEB)

Newsom, RK; Sivaraman, C; McFarlane, SA

2012-10-31

The purpose of this document is to describe the Raman Lidar Profiles–Temperature (RLPROFTEMP) value-added product (VAP) and the procedures used to derive atmospheric temperature profiles from the raw RL measurements. Sections 2 and 4 describe the input and output variables, respectively. Section 3 discusses the theory behind the measurement and the details of the algorithm, including calibration and overlap correction.

Successful prevention of ventilator-associated pneumonia in an intensive care setting.

Science.gov (United States)

Marra, Alexandre R; Cal, Ruy Guilherme Rodrigues; Silva, Cláudia Vallone; Caserta, Raquel Afonso; Paes, Angela Tavares; Moura, Denis Faria; dos Santos, Oscar Fernando Pavão; Edmond, Michael B; Durão, Marcelino Souza

2009-10-01

Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings. Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU). A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From March 2001 to December 2002 (phase 1: P1), some Centers for Disease Control and Prevention (CDC) evidence-based practices were implemented. From January 2003 to December 2006 (P2), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, and, from January 2007 to September 2008 (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions. The incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P=.05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%. These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.

The LoTrach system: its role in the prevention of ventilator-associated pneumonia.

Science.gov (United States)

Fletcher, Andrew J W; Ruffell, Alison J; Young, Peter J

2008-01-01

To discuss the development of the LoTrach system in light of current evidence around the prevention of ventilator-associated pneumonia (VAP) and its practical application in the intensive care setting. VAP causes substantial morbidity and mortality in ventilated patients in the Intensive Care Unit (ICU), increases length of stay in ICU and is extremely costly. Strategies are needed to reduce the risk of VAP. We examine the need for an endotracheal tube (ETT) specifically designed for the critically-ill patient, the development of the LoTrach system from conception to production, and the role of the various components of the system in preventing VAP. Early issues in implementing this revolutionary equipment into ICU are explored and three case studies highlight advantages of this system. The LoTrach system has been designed to facilitate the provision of a number of evidence-based interventions that have been shown to reduce VAP. Pulmonary aspiration is ubiquitous with conventional cuffs but prevented by the cuff of the LoTrach system when held at a constant and safe pressure against the tracheal wall with a cuff pressure controller. Other aspects incorporated in the ETT are aimed at clearing the secretions from the subglottic space, preventing tube occlusion and accidental extubation, and avoiding damage to the airway. In this way the LoTrach system employs a multifactorial approach to the prevention of VAP and the cost savings from LoTrach rather than a standard ETT will be considerable because of an average 3 day reduction in ICU length of stay related to this. It thus has the potential to be a very useful tool in the ICU setting in the prevention of VAP.

Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients.

Science.gov (United States)

Parisi, Maria; Gerovasili, Vasiliki; Dimopoulos, Stavros; Kampisiouli, Efstathia; Goga, Christina; Perivolioti, Efstathia; Argyropoulou, Athina; Routsi, Christina; Tsiodras, Sotirios; Nanas, Serafeim

2016-10-01

Ventilator-associated pneumonia (VAP), one of the most common hospital-acquired infections, has a high mortality rate. To evaluate the incidence of VAP in a multidisciplinary intensive care unit and to examine the effects of the implementation of ventilator bundles and staff education on its incidence. A 24-month-long before/after study was conducted, divided into baseline, intervention, and postintervention periods. VAP incidence and rate, the microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit were recorded and compared between the periods. Of 1097 patients evaluated, 362 met the inclusion criteria. The baseline VAP rate was 21.6 per 1000 ventilator days. During the postintervention period, it decreased to 11.6 per 1000 ventilator days (P = .01). Length of stay in the intensive care unit decreased from 36 to 27 days (P = .04), and duration of mechanical ventilation decreased from 26 to 21 days (P = .06). VAP incidence was high in a general intensive care unit in a Greek hospital. However, implementation of a ventilator bundle and staff education has decreased both VAP incidence and length of stay in the unit. ©2016 American Association of Critical-Care Nurses.

Measures to prevent nosocomial infections during mechanical ventilation.

Science.gov (United States)

Ramirez, Paula; Bassi, Gianluigi L; Torres, Antonio

2012-02-01

Endotracheal intubation and mechanical ventilation are lifesaving measures in critically ill patients. However, these interventions increase the risk of respiratory infections, particularly ventilator-associated pneumonia (VAP). VAP constitutes a serious burden for the healthcare system and worsens the patient's outcomes; thus, several preventive strategies have been implemented. This communication reviews the current knowledge on VAP pathogenesis and the latest preventive measures. Pathogen-laden oropharyngeal secretions leak across the endotracheal tube (ETT) cuff; thus, a continuous control of the internal cuff pressure and cuffs made of polyurethane improve sealing effectiveness and associated risks of infections. Subglottic secretions aspiration prevents VAP, and the latest evidence demonstrated a reduction in the incidence of late-onset VAP. The role of ETT biofilm in the pathogenesis of VAP is not fully elucidated. Nevertheless, antimicrobial-coated ETTs have showed beneficial effects in VAP incidence. Recent experimental evidence has challenged the benefits associated with the use of the semirecumbent position; yet, these findings need to be corroborated in clinical trials. The latest results from trials testing the effects of selective digestive decontamination (SDD) showed beneficial effects on patients' outcomes, but concerns remain regarding the emergence of bacterial resistance, specifically upon digestive tract re-colonization. The use of oropharyngeal decontamination with antiseptics and the use of probiotics are potential alternatives to SDD. There is consistent evidence that strategies affecting the primary mechanisms of VAP pathogenesis efficiently reduce the occurrence of the disease. Preventive measures should be implemented grouped into bundles to improve overall efficacy.

A Conceptual Model for Production Leveling (Heijunka) Implementation in Batch Production Systems

OpenAIRE

De Araujo , Luciano Fonseca; De Queiroz , Abelardo Alves

2009-01-01

International audience; This paper explains an implementation model for a new method for Production Leveling designed for batch production system. The main structure of this model is grounded on three constructs: traditional framework for Operations Planning, Lean Manufacturing concepts for Production Leveling and case study guidelines. By combining the first and second construct, a framework for Production Leveling has been developed for batch production systems. Then, case study guidelines ...

Multidisciplinary approach to successful implementation of production information system (PRISM)

Energy Technology Data Exchange (ETDEWEB)

Shariff, M.R.; Gopalakrishnan, S.G.; Francis, N. [and others

1995-12-31

A company wide corporate and regional production database supporting all production areas was envisaged critical to the current expansion within Petronas Carigali Sdn Bhd (PCSB). A multi disciplinary project team was thus formed to analyze the requirements prior to developing, testing, implementing and training users. PCSB has currently evolved into a mature E & P company on par with other E & P companies within the region. This expansion necessitates a common Production Information System for the efficient dissemination of vital Production Information for Production Surveillance, Reservoir Management, Reserve Assessment, Special Studies and Standardized Group-wide Reporting. This paper will discuss all the phases involved in the project which includes Systems Requirement Study, Data Migration, System Development, System Implementation and Post-Implementation Plan.

A simplified prevention bundle with dual hand hygiene audit reduces early-onset ventilator-associated pneumonia in cardiovascular surgery units: An interrupted time-series analysis.

Directory of Open Access Journals (Sweden)

Kang-Cheng Su

Full Text Available To investigate the effect of a simplified prevention bundle with alcohol-based, dual hand hygiene (HH audit on the incidence of early-onset ventilation-associated pneumonia (VAP.This 3-year, quasi-experimental study with interrupted time-series analysis was conducted in two cardiovascular surgery intensive care units in a medical center. Unaware external HH audit (eHH performed by non-unit-based observers was a routine task before and after bundle implementation. Based on the realistic ICU settings, we implemented a 3-component bundle, which included: a compulsory education program, a knowing internal HH audit (iHH performed by unit-based observers, and a standardized oral care (OC protocol with 0.1% chlorhexidine gluconate. The study periods comprised 4 phases: 12-month pre-implementation phase 1 (eHH+/education-/iHH-/OC-, 3-month run-in phase 2 (eHH+/education+/iHH+/OC+, 15-month implementation phase 3 (eHH+/education+/iHH+/OC+, and 6-month post-implementation phase 4 (eHH+/education-/iHH+/OC-.A total of 2553 ventilator-days were observed. VAP incidences (events/1000 ventilator days in phase 1-4 were 39.1, 40.5, 15.9, and 20.4, respectively. VAP was significantly reduced by 59% in phase 3 (vs. phase 1, incidence rate ratio [IRR] 0.41, P = 0.002, but rebounded in phase 4. Moreover, VAP incidence was inversely correlated to compliance of OC (r2 = 0.531, P = 0.001 and eHH (r2 = 0.878, P < 0.001, but not applied for iHH, despite iHH compliance was higher than eHH compliance during phase 2 to 4. Compared to eHH, iHH provided more efficient and faster improvements for standard HH practice. The minimal compliances required for significant VAP reduction were 85% and 75% for OC and eHH (both P < 0.05, IRR 0.28 and 0.42, respectively.This simplified prevention bundle effectively reduces early-onset VAP incidence. An unaware HH compliance correlates with VAP incidence. A knowing HH audit provides better improvement in HH practice. Accordingly, we suggest

Development of a High Resolution Virulence Allelic Profiling (HReVAP) Approach Based on the Accessory Genome of Escherichia coli to Characterize Shiga-Toxin Producing E. coli (STEC)

Science.gov (United States)

Michelacci, Valeria; Orsini, Massimiliano; Knijn, Arnold; Delannoy, Sabine; Fach, Patrick; Caprioli, Alfredo; Morabito, Stefano

2016-01-01

Shiga-toxin producing Escherichia coli (STEC) strains possess a large accessory genome composed of virulence genes existing in multiple allelic variants, which sometimes segregate with specific STEC subpopulations. We analyzed the allelic variability of 91 virulence genes of STEC by Real Time PCR followed by melting curves analysis in 713 E. coli strains including 358 STEC. The 91 genes investigated were located on the locus of enterocyte effacement (LEE), OI-57, and OI-122 pathogenicity islands and displayed a total of 476 alleles in the study population. The combinations of the 91 alleles of each strain were termed allelic signatures and used to perform cluster analyses. We termed such an approach High Resolution Virulence Allelic Profiling (HReVAP) and used it to investigate the phylogeny of STEC of multiple serogroups. The dendrograms obtained identified groups of STEC segregating approximately with the serogroups and allowed the identification of subpopulations within the single groups. The study of the allelic signatures provided further evidence of the coevolution of the LEE and OI-122, reflecting the occurrence of their acquisition through a single event. The HReVAP analysis represents a sensitive tool for studying the evolution of LEE-positive STEC. PMID:26941726

Production Leveling (Heijunka) Implementation in a Batch Production System: A Case Study

OpenAIRE

Araujo , Luciano Fonseca; Queiroz , Abelardo Alves

2009-01-01

International audience; This paper presents a case study of an implementation of a new method for Production Leveling designed for batch production. It includes prioritizing criteria of products and level production plan. Moreover, it was applied on a subsidiary of a multinational enterprise located on Brazil, which manufacturing processes comprise batch production in a make-to-stock policy. Regarding a qualitative assessment, evidences show that the company had deficient practices related to...

Implementing standardized modules in the production architecture

DEFF Research Database (Denmark)

Gudmundsson, Agnar

implementation of modularization and platform-thinking. On a general level, the very concepts related to modularization, platform, platform-thinking, and so on are often far from clearly defined. This makes the use of existing knowledge difficult. Furthermore, a contingent view of modularization and platform......-thinking is much needed, as the concept cannot possible mean the same thing for Levi’s as for a Danish, medium-sized industrial firm. The study also uncovers a set of organizational factors inhibiting implementation all of which are related to the view of new product development applied in many organizations today....... Hence, as its final normative contribution the research of Agnar Gudmundsson calls for a new view of new product development to be developed....

Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia.

Science.gov (United States)

Ory, Jérôme; Mourgues, Charline; Raybaud, Evelyne; Chabanne, Russell; Jourdy, Jean Christophe; Belard, Fabien; Guérin, Renaud; Cosserant, Bernard; Faure, Jean Sébastien; Calvet, Laure; Pereira, Bruno; Guelon, Dominique; Traore, Ousmane; Gerbaud, Laurent

2018-06-01

Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP. In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…). A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program. Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable. NCT02400294.

Implementing new product development: A study of personal characteristics among managers

DEFF Research Database (Denmark)

Jespersen, Kristina Risom; Bysted, Rune

2016-01-01

Strategy implementation is an important aspect of innovation, as only 30% of planned strategies are matched by realised innovation outcomes. The present study investigates this in a setting of strategic implementation of New Product Development (NPD). In the implementation process, the managers...... strategic intentions create information overload in the NPD process, which decreases the new product novelty. In contrast, realisation of defensive strategic intentions makes experienced NPD managers focus on known NPD competences, thereby decreasing the new product novelty of NPD efforts. The study...

Effectiveness of a multidimensional approach for the prevention of ventilator-associated pneumonia in an adult intensive care unit in Cuba: findings of the International Nosocomial Infection Control Consortium (INICC).

Science.gov (United States)

Guanche-Garcell, Humberto; Morales-Pérez, Clara; Rosenthal, Victor D

2013-04-01

This study sought to assess the effect of the multidimensional approach developed by the International Nosocomial Infection Control Consortium (INICC) on the reduction of ventilator-associated pneumonia (VAP) rates in patients hospitalized in an adult intensive care unit (AICU) in an INICC member hospital in Havana, Cuba. We conducted a prospective surveillance pre-post study in AICU patients. The study was divided into two periods:baseline and intervention. During the baseline period, we conducted active prospective surveillance of VAP using the Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definition and INICC methods. During the intervention period, we implemented the INICC multidimensional approach for VAP, in addition to performing active surveillance. This multidimensional approach included the following measures: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback of VAP rates and performance feedback of infection control practices. The baseline rates of VAP were compared to the rates obtained after intervention, and we analyzed the impact of our interventions by Poisson regression. During the baseline period, we recorded 114 mechanical ventilator (MV) days, whereas we recorded 2350MV days during the intervention period. The baseline rate of VAP was 52.63 per 1000MV days and 15.32 per 1000MV days during the intervention. At the end of the study period, we achieved a 70% reduction in the rate of VAP (RR, 0.3; 95% CI, 0.12-0.7; P value, 0.003.). The implementation the INICC multidimensional approach for VAP was associated with a significant reduction in the VAP rate in the participating AICU of Cuba. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Implementing Product Platforms: A Case Study

DEFF Research Database (Denmark)

Nielsen, Ole Fiil; Mortensen, Niels Henrik

2006-01-01

The paper describes a case study dealing with the process of creating and implementing a product platform. The paper espessially deals with the fact that to obtain the benefits of platforms a permanent change in behaviour in product development must be ensured. This change in behaviour requires...... acceptance and approval from the organisation in general and the commitment from management to enforce agreed-upon decisions. The case study itself was performed in the Danish company LEGO Group. The case study had two objectives: To create a technical architecture and align this architecture...

Organic Aerosol Component (OACOMP) Value-Added Product Report

Energy Technology Data Exchange (ETDEWEB)

Fast, J; Zhang, Q; Tilp, A; Shippert, T; Parworth, C; Mei, F

2013-08-23

Significantly improved returns in their aerosol chemistry data can be achieved via the development of a value-added product (VAP) of deriving OA components, called Organic Aerosol Components (OACOMP). OACOMP is primarily based on multivariate analysis of the measured organic mass spectral matrix. The key outputs of OACOMP are the concentration time series and the mass spectra of OA factors that are associated with distinct sources, formation and evolution processes, and physicochemical properties.

Incidence and risk factors of ventilator associated pneumonia in a tertiary care hospital.

Science.gov (United States)

Charles, Mv Pravin; Easow, Joshy M; Joseph, Noyal M; Ravishankar, M; Kumar, Shailesh; Umadevi, Sivaraman

2013-01-01

Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia associated with increased morbidity and mortality. Knowledge about the incidence and risk factors is necessary to implement preventive measures to reduce mortality in these patients. A prospective study was conducted at a tertiary care teaching hospital for a period of 20 months from November 2009 to July 2011. Patients who were on mechanical ventilation (MV) for more than 48 hours were monitored at frequent intervals for development of VAP using clinical and microbiological criteria until discharge or death. Of the 76 patients, 18 (23.7%) developed VAP during their ICU stay. The incidence of VAP was 53.25 per 1,000 ventilator days. About 94% of VAP cases occurred within the first week of MV. Early-onset and late-onset VAP was observed in 72.2% and 27.8%, respectively. Univariate analysis showed chronic lung failure, H2 blockers usage, and supine head position were significant risk factors for VAP. Logistic regression revealed supine head position as an independent risk factor for VAP. VAP occurred in a sizeable number of patients on MV. Chronic lung failure, H2 blockers usage, and supine head position were the risk factors associated with VAP. Awareness about these risk factors can be used to inform simple and effective preventive measures.

Prevention of ventilator-associated pneumonia.

Science.gov (United States)

Li Bassi, Gianluigi; Senussi, Tarek; Aguilera Xiol, Eli

2017-04-01

Ventilator-associated pneumonia (VAP) is an iatrogenic disease. Here we appraise recent advancements in the development and testing of strategies to prevent VAP. We also provide recommendations on the most promising interventions that should be applied. In the last year, preventive bundles have consistently let to a reduction of VAP. A few trials on endotracheal tubes (ETTs) with novel cuffs failed to translate positive bench findings into clinical settings. In addition, meta-analyses confirmed the primary role of subglottic secretion aspiration in VAP prevention. A relatively new ETT, with an innovative cuff design, has been tested in clinical trials confirming potential value. Meta-analyses confirmed reduction of VAP with the use of chlorhexidine for oropharyngeal decontamination. However, prophylactic inhaled or oral antibiotics are ineffective. Finally, there is growing interest in orally ingested probiotics to prevent VAP. The results of ongoing studies on probiotics are much-awaited. In conclusion, in the past year, new evidence elucidated limitations of new ETT cuffs in the prevention of VAP; whereas, subglottic secretion aspiration proved consistent benefits. Modulation of oropharyngeal colonization with chlorhexidine decreases risks of VAP and should be widely implemented. Finally, preventive measures with proven preventive value should be grouped into bundles.

Sustained Reduction of Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle Compliance Dashboard.

Science.gov (United States)

Talbot, Thomas R; Carr, Devin; Parmley, C Lee; Martin, Barbara J; Gray, Barbara; Ambrose, Anna; Starmer, Jack

2015-11-01

The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned. To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications. DESIGN Before-and-after quasi-experimental study with interrupted time-series analysis. SETTING Academic medical center. In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients. The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (Pdashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.

Systematic model for lean product development implementation in an automotive related company

Directory of Open Access Journals (Sweden)

Daniel Osezua Aikhuele

2017-07-01

Full Text Available Lean product development is a major innovative business strategy that employs sets of practices to achieve an efficient, innovative and a sustainable product development. Despite the many benefits and high hopes in the lean strategy, many companies are still struggling, and unable to either achieve or sustain substantial positive results with their lean implementation efforts. However, as the first step towards addressing this issue, this paper seeks to propose a systematic model that considers the administrative and implementation limitations of lean thinking practices in the product development process. The model which is based on the integration of fuzzy Shannon’s entropy and Modified Technique for Order Preference by Similarity to the Ideal Solution (M-TOPSIS model for the lean product development practices implementation with respective to different criteria including management and leadership, financial capabilities, skills and expertise and organization culture, provides a guide or roadmap for product development managers on the lean implementation route.

Comparative study of 2 oral care protocols in intensive care units.

Science.gov (United States)

Ory, Jérôme; Raybaud, Evelyne; Chabanne, Russell; Cosserant, Bernard; Faure, Jean Sébastien; Guérin, Renaud; Calvet, Laure; Pereira, Bruno; Mourgues, Charline; Guelon, Dominique; Traore, Ousmane

2017-03-01

The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

VAP3D: a software for dosimetric analysis and visualization of phantons

International Nuclear Information System (INIS)

Lima, Lindeval Fernandes de; Lima, Fernando Roberto de Andrade

2011-01-01

The anthropomorphic models used in computational dosimetry of the ionizing radiation, usually called voxel phantom, are produced from image stacks CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) obtained from patient or volunteer scanning. These phantoms are the geometry to be radiated in the computing arrangements of exposure, using a Monte Carlo code, allowing the estimation of the energy deposited in each voxel of the virtual body. From these data collected in the simulation, it is possible to evaluate the average absorbed dose in various organs and tissues radiosensitive cataloged by the International Commission on Radiological Protection (ICRP). Therefore, a computational model of the exhibition is constituted primarily by the Monte Carlo code to simulate the transport, deposition and interaction of radiation and the phantom being irradiated. The construction of voxel phantoms requires computer skills like a transformation format of images, compression of 2D images for 3D image construction, quantization, resampling and image segmentation, among others. Hardly the computational dosimetry researcher finds all these skills into a single software and often this results in a decrease in the pace of their research or the use, sometimes inadequate, the alternative tools. This paper presents the VAP3D (Visualization and Analysis of Phantoms), a software developed with Qt/VTK with C++, in order to operationalize some of the tasks mentioned above. The current version has been based on DIP software (Digital Imaging Processing), containing the File menu, Conversions and tools, where the user interacts with the software. (author)

Design requirements for SRB production control system. Volume 4: Implementation

Science.gov (United States)

1981-01-01

The implementation plan which is presented was developed to provide the means for the successful implementation of the automated production control system. There are three factors which the implementation plan encompasses: detailed planning; phased implementation; and user involvement. The plan is detailed to the task level in terms of necessary activities as the system is developed, refined, installed, and tested. These tasks are scheduled, on a preliminary basis, over a two-and-one-half-year time frame.

Is Vitamin D Deficiency Related to Accumulation of Advanced Glycation End Products, Markers of Inflammation, and Oxidative Stress in Diabetic Subjects?

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K. Šebeková

2015-01-01

Full Text Available Objectives. In diabetes accumulated advanced glycation end products (AGEs are involved in the striking cardiovascular morbidity/mortality. We asked whether a hypovitaminosis D associates with an increased formation and toxicity of AGEs in diabetes. Methods. In 276 diabetics (160 M/116 F, age: 65.0±13.4; 43 type 1,T1DM, and 233 type 2 patients, T2DM and 121 nondiabetic controls (60 M/61 F; age: 58.6±15.5 years routine biochemistry, levels of 25-hydroxyvitamin D3 (25-(OHD, skin autofluorescence (SAF, plasma AGE-associated fluorescence (AGE-FL, Nε-(carboxymethyllysine (CML, soluble receptor for AGEs (sRAGE, soluble vascular adhesion protein-1 (sVAP-1, high sensitive C-reactive protein (hs-CRP, and renal function (eGFR were determined. Results. In the diabetics SAF and AGE-Fl were higher than those of the controls and correlated with age, duration of diabetes, and degree of renal impairment. In T2DM patients but not in T1DM the age-dependent rise of SAF directly correlated with hs-CRP and sVAP-1. 25-(OHD levels in diabetics and nondiabetics were lowered to a similar degree averaging 22.5 ng/mL. No relationship between 25-(OHD and studied markers except for sVAP-1 was observed in the diabetics. Conclusion. In diabetics hypovitaminosis D does not augment accumulation of AGEs and studied markers of microinflammation and oxidative stress except for sVAP-1.

The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated.

Science.gov (United States)

Muscedere, John; Sinuff, Tasnim; Heyland, Daren K; Dodek, Peter M; Keenan, Sean P; Wood, Gordon; Jiang, Xuran; Day, Andrew G; Laporta, Denny; Klompas, Michael

2013-11-01

Ventilator-associated conditions (VACs) and infection-related ventilator-associated complications (iVACs) are the Centers for Disease Control and Prevention's new surveillance paradigms for patients who are mechanically ventilated. Little is known regarding the clinical impact and preventability of VACs and iVACs and their relationship to ventilator-associated pneumonia (VAP). We evaluated these using data from a large, multicenter, quality-improvement initiative. We retrospectively applied definitions for VAC and iVAC to data from a prospective time series study in which VAP clinical practice guidelines were implemented in 11 North American ICUs. Each ICU enrolled 30 consecutive patients mechanically ventilated > 48 h during each of four study periods. Data on clinical outcomes and concordance with prevention recommendations were collected. VAC, iVAC, and VAP rates over time, the agreement (κ statistic) between definitions, associated morbidity/mortality, and independent risk factors for each were determined. Of 1,320 patients, 139 (10.5%) developed a VAC, 65 (4.9%) developed an iVAC, and 148 (11.2%) developed VAP. The agreement between VAP and VAC was 0.18, and between VAP and iVAC it was 0.19. Patients who developed a VAC or iVAC had significantly more ventilator days, hospital days, and antibiotic days and higher hospital mortality than patients who had neither of these conditions. Increased concordance with VAP prevention guidelines during the study was associated with decreased VAP and VAC rates but no change in iVAC rates. VACs and iVACs are associated with significant morbidity and mortality. Although the agreement between VAC, iVAC, and VAP is poor, a higher adoption of measures to prevent VAP was associated with lower VAP and VAC rates.

A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention.

Science.gov (United States)

Gadani, Hina; Vyas, Arun; Kar, Akhya Kumar

2010-11-01

Ventilator-associated pneumonia (VAP) is a major cause of hospital morbidity and mortality despite recent advances in diagnosis and accuracy of management. However, as taught in medical science, prevention is better than cure is probably more appropriate as concerned to VAP because of the fact that it is a well preventable disease and a proper approach decreases the hospital stay, cost, morbidity and mortality. The aim of the study is to critically review the incidence and outcome, identify various risk factors and conclude specific measures that should be undertaken to prevent VAP. We studied 100 patients randomly, kept on ventilatory support for more than 48 h. After excluding those who developed pneumonia within 48 h, VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. After evaluating, the data were subjected to univariate analysis using the chi-square test. The level of significance was set at Ppatients developed VAP. The risk factor significantly associated with VAP in our study was found to be duration of ventilator support, reintubation, supine position, advanced age and altered consciousness. Declining ratio of partial pressure to inspired fraction of oxygen (PaO(2)/FiO(2) ratio) was found to be the earliest indicator of VAP. The most common organism isolated in our institution was Pseudomonas. The incidence of early-onset VAP (within 96 h) was found to be 27% while the late-onset type (>96 h) was 73%. Late-onset VAP had poor prognosis in terms of mortality (66%) as compared to the early-onset type (20%). The mortality of patients of the non-VAP group was found to be 41% while that of VAP patients was 54%. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Above all, everyone of the critical care unit should understand the factors that place the patients at risk

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT).

Science.gov (United States)

Torres, Antoni; Niederman, Michael S; Chastre, Jean; Ewig, Santiago; Fernandez-Vandellos, Patricia; Hanberger, Hakan; Kollef, Marin; Li Bassi, Gianluigi; Luna, Carlos M; Martin-Loeches, Ignacio; Paiva, J Artur; Read, Robert C; Rigau, David; Timsit, Jean François; Welte, Tobias; Wunderink, Richard

2017-09-01

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention. Copyright ©ERS 2017.

AREAS FOR INNOVATIVE PRODUCTS IMPLEMENTATION IN THE INSURANCE MARKET OF UKRAINE

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Diana Tretiak

2017-11-01

Full Text Available The aim of the article is to assess the prospects for the implementation of the investment life insurance in Ukraine. The study analysed the experience of foreign countries in the investment life insurance market development. Also, an analysis of existing definitions for the "unit-linked" term is carried out; the result is the conclusion that they are limited to only a descriptive characteristic that relates to a particular aspect of the product. Upon that, a comprehensive definition is absent at all now. Methods. The study is based on a comparison of "unitlinked" products with the traditional life insurance, which exist in the world practice. Practical importance. Increase in the inflow of long-term resources in the Ukrainian economy through the implementation of an innovative unitlinked product. Transformation of the life insurance industry into the high-margin business sphere in Ukraine. Importance/originality. A technique of constructing an innovative unit-linked product depending on the specifics of the domestic insurance market performance is developed. Results. The article considers in depth the specific features of unit-linked products, which distinguish this life insurance type from the classic accumulative insurance. In addition, it highlights other important characteristics such as a high level of flexibility and transparency of all the components. Also, the advantages and disadvantages of unit-linked products are considered as compared to alternative products, its classification is held for the selected parameter group. The estimations of the unit-linked product development prospects, as well as its influence on the growth of the insurance market, are made. The study justifies the legislative consolidation of the investment life insurance along with a number of expansionary measures successfully implemented in Eastern European countries, which are similar to Ukraine. The result within the framework of this direction is the

A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention

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Hina Gadani

2010-01-01

Full Text Available Ventilator-associated pneumonia (VAP is a major cause of hospital morbidity and mortality despite recent advances in diagnosis and accuracy of management. However, as taught in medical science, prevention is better than cure is probably more appropriate as concerned to VAP because of the fact that it is a well preventable disease and a proper approach decreases the hospital stay, cost, morbidity and mortality. The aim of the study is to critically review the incidence and outcome, identify various risk factors and conclude specific measures that should be undertaken to prevent VAP. We studied 100 patients randomly, kept on ventilatory support for more than 48 h. After excluding those who developed pneumonia within 48 h, VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. After evaluating, the data were subjected to univariate analysis using the chi-square test. The level of significance was set at P96 h was 73%. Late-onset VAP had poor prognosis in terms of mortality (66% as compared to the early-onset type (20%. The mortality of patients of the non-VAP group was found to be 41% while that of VAP patients was 54%. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Above all, everyone of the critical care unit should understand the factors that place the patients at risk of VAP and utmost importance must be given to prevent VAP.

Expected and Realized Costs and Benefits from Implementing Product Configuration Systems

DEFF Research Database (Denmark)

Edwards, Kasper

2010-01-01

Product configuration systems (PCS) are a technology well suited for mass customization and support the task of configuring the product to the individual customer’s needs. PCS are at the same time complex software systems that may be tailored to solve a variety of problems for a firm, e.......g. supporting the quotation process or validating the structure of a product. This paper reports findings from a study of 12 Danish firms, which at the time of the study have implemented or are in the process of implementing product configuration systems. 12 costs and 12 benefits are identified in literature...... organization. It is observed that product configuration projects are treated as simple technical projects although they should be regarded as organizational change projects....

Nosocomial pneumonia in the ICU: a prospective cohort study.

Science.gov (United States)

Hyllienmark, Petra; Gårdlund, Bengt; Persson, Jan-Olov; Ekdahl, Karl

2007-01-01

Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection among patients requiring mechanical ventilation. A prospective surveillance programme of all patients has been implemented at the ICU, Karolinska University Hospital, Sweden since 2001. Within this programme, incidence and risk factors for ICU-acquired pneumonia and associated death over a 2-y period have been studied. Of 329 patients enrolled in the study, 221 required mechanical ventilation. 33 of 221 patients (15%) developed VAP, corresponding to a rate of 29 VAP/1000 ventilator d. Risk factors for VAP were aspiration (hazard ratio 3.79; 95% CI 1.48-9.68), recent surgery (HR 3.58; 95% CI 1.15-11.10) and trauma (HR 3.00; 95% CI 1.03-8.71). 11 patients of 33 (33%) with VAP died within 28 d compared to 46 of 288 (16%) without ICU-acquired pneumonia (odds ratio 2.73; 95% CI 0.97-7.63). We conclude that: 1) incidence of VAP was 15% and the most important risk factor was aspiration; 2) APACHE II score > or = 20 is a stronger predictor for poor outcome than VAP; 3) a minority of patients with APACHE II score > or = 20 develop VAP; and 4) continuous surveillance programmes are feasible and provide valuable data for improvement of quality of care.

Improved Correction of IR Loss in Diffuse Shortwave Measurements: An ARM Value-Added Product

Energy Technology Data Exchange (ETDEWEB)

Younkin, K; Long, CN

2003-11-01

Simple single black detector pyranometers, such as the Eppley Precision Spectral Pyranometer (PSP) used by the Atmospheric Radiation Measurement (ARM) Program, are known to lose energy via infrared (IR) emission to the sky. This is especially a problem when making clear-sky diffuse shortwave (SW) measurements, which are inherently of low magnitude and suffer the greatest IR loss. Dutton et al. (2001) proposed a technique using information from collocated pyrgeometers to help compensate for this IR loss. The technique uses an empirically derived relationship between the pyrgeometer detector data (and alternatively the detector data plus the difference between the pyrgeometer case and dome temperatures) and the nighttime pyranometer IR loss data. This relationship is then used to apply a correction to the diffuse SW data during daylight hours. We developed an ARM value-added product (VAP) called the SW DIFF CORR 1DUTT VAP to apply the Dutton et al. correction technique to ARM PSP diffuse SW measurements.

Economic Analysis of a Pediatric Ventilator-Associated Pneumonia Prevention Initiative in Nicaragua

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Edward I. Broughton

2012-01-01

Full Text Available We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP prevalence in pediatric intensive care units (PICUs at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention required only modest effectiveness to be cost-neutral and has potential to generate substantial cost savings argues for implementation of VAP prevention strategies in low-income countries like Nicaragua on a broader scale.

Accounting in the Context of the Implementation of Production Sharing Agreements

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Orlova Valentina K.

2018-03-01

Full Text Available The aim of the article is to study the problems of accounting in the context of the implementation of production sharing agreements (PSAs concerning development of proposals for their solution. Therefore, the main tasks considered are the assessment of the legal framework for regulation of accounting in the context of the implementation of production sharing agreements in accordance with the current legislation, a critical analysis of the unsettled provisions of the current legislation acts for the practical need, to generate information on specific accounting objects for management purposes. The ways of their solving based on the methodology for the accounting of PSAs are suggested. The methodology and scientific approaches of the research imply general scientific and specific research methods associated with complex processes of the functioning of the system for managing business entities in languages of the PSA implementation. There proposed a scheme for accounting in the context of the PSA implementation, which allows introducing in the accounting system objects that are new and characteristic only for the PSA. The practical significance is that the obtained results make it possible to separate compensation costs, single social contribution, which is necessary for determining the object of taxation in the context of PSA; to generate information on compensation costs, which is necessary when dividing the products into compensatory and profitable ones, which allows to reflect in the accounting the division of finished products into compensatory, profitable for the investor and profitable for the state. The originality and value of the authors’ development contributes to the formation of reliable information about management objects in the PSA between enterprises and the state, with clear allocation of compensation costs, compensatory products, profitable products for the state and profitable products for the investor in separate accounts.

Impact evaluation of productive use—An implementation guideline for electrification projects

International Nuclear Information System (INIS)

Bensch, Gunther; Peters, Jörg; Schmidt, Christoph M.

2012-01-01

There is a consensus in the international community that rural electrification and, in particular, the productive use of electricity contributes to poverty alleviation. At the same time, efforts to evaluate the impacts of development projects have increased substantially. This paper provides a hands-on guide for designing evaluation studies regarding the impacts of productive electricity usage. Complementary to the existing literature on evaluation methods, this guide familiarizes project managers with the concrete steps that have to be undertaken to plan and implement an evaluation. The guide comprises three modules based on enterprise surveys and on anecdotal case studies. For each module, the implementation is described on a step-by-step basis including conceptual issues as well as logistics and methodological questions. - Highlights: ► Hands-on evaluation guideline for development project managers. ► Step-by-step procedure on how to implement evaluation. ► Impacts of productive electricity use.

STUDY OF THE ISOLATES OF SUSPECTED VAP, PREVALENCE OF THE DIFFERENT ORGANISMS AND MIC PATTERNS IN A TERTIARY CARE HOSPITAL

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Swagnik Roy

2017-01-01

Full Text Available BACKGROUND The development of nosocomial infections mostly ventilator-associated pneumonia due to prolonged stay in the ICUs varies grossly in different outcomes including increased morbidity and mortality. The American Thoracic Society (ATS guidelines recommend that quantitative cultures can be performed on ETA or samples collected either bronchoscopically or nonbronchosopically. 1 More importantly, recent small trials have repeatedly shown that there is no advantage of bronchoscopic cultures over quantitative endotracheal aspirate. 2,3,4 Detection of causative organisms and their antibiotic MIC determination is absolutely necessary to initiate the specific antibiotic with appropriate dose thereby reducing the adverse effects of inadequate antibiotic treatment on the patient prognosis. MATERIALS AND METHODS The prospective study was carried out during the period from August 2012 to January 2015 in Department of Microbiology from the samples those were received as a routine culture from VAP suspected patients from the ICU. There were 373 samples from which 123 were culture positives. Inclusion criteria were all the patients 18 years and more age group who were intubated in mechanical ventilator and others were excluded in the study. Clinical Pulmonary Infection Score (CPIS was given to each patient included in the study on daily basis. CPIS of greater than six was used as diagnostic criteria for VAP. 5 Clinically diagnosed ventilator-associated pneumonia were observed and clinical parameters were recorded from their medical records and bedside charts. All patients with clinical and radiological signs suggestive of pneumonia on admission. Endotracheal aspirate was collected by using a 22-inch Romsons suction catheter. Chest vibration or percussion for 10 mins. was used. Only 1 ETA sample was collected from each patient and was immediately taken to the laboratory for processing. RESULTS Klebsiella pneumonia was isolated 39.02%, Pseudomonas

Implementation of HACCP system in production of Paški cheese

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Šime Gligora

2007-06-01

Full Text Available Since August 2006 all participants in Republic of Croatia dealing with the food have an obligation to introduce Hazard Analysis of Critical Control Point (HACCP system. Therefore, all producers of dairy products, as well as registered producers of Paški cheese have to implement HACCP system in their facilities. The aim of this work is to describe implementation and use of HACCP system in «Sirena - mala sirana» which is a small-scale cheese factory situated in a place Kolan on the island of Pag. For this reason, EU and Croatian legislative related to HACCP system is firstly described. After that, procedure of certification is presented, as well as prerequisite programsof the system which are the base for successful implementation of the HACCP system. Furthermore, appliance of HACCP in Paški cheese production through system’s documentation is described. Flow diagram is presented, analysis of hazardous and determination of critical control points is described trough defined production processes. Next, control, monitoring and corrective measures for production processes are described. Finally, HACCP plan and Standard Sanitation Operative Procedures (SSOP are presented. Besides that, traceability system and training plan are shown, as well as all required record lists and other documentation for HACCP system. With implementation of the HACCP system in «Sirena» cheese facility, general hygiene was improved as well as hygiene of equipment and personnel. Risk of product contamination is reduced to a minimum level. With effective management of control measures and records, quality of produced Paški cheese was also improved

Compliance with the standards for prevention of ventilator-associated pneumonia by nurses in the intensive care units

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Saiede Masomeh Tabaeian

2017-01-01

Full Text Available Introduction: Ventilator-associated pneumonia (VAP is the most common infection in the intensive care unit, and has many side effects such as increased mortality, increased length of hospital stay, and increased health costs. This study aimed to evaluate the compliance with the standards for prevention of VAP by nurses in the intensive care units. Materials and Methods: In this descriptive cross-sectional study, 120 nurses in 11 intensive care units of hospitals affiliated to Isfahan university of Medical Sciences, Iran, were assessed for 4 months from July to October 2014. The implementation of all measures for the prevention of VAP was investigated through observation and using a checklist. Results: The mean compliance with the standards for the prevention of VAP in the intensive care unit by the nurses was 56.32%; analysis of variance test showed significant difference between the hospitals (P < 0.001. Disposable ventilator circuit was performed for all patients; however, reviewing the patient readiness for separation from the ventilator was not conducted on a daily basis. Conclusions: Compliance with the standards for the prevention of VAP in the intensive care units was relatively acceptable; however, it still requires serious attention by the officials with training and sensitization of nurses in implementing preventive measures, especially through the provision of clinical guidelines and related protocols.

Implementation of success factors in new product development: The missing link

DEFF Research Database (Denmark)

Jensen, Bjarne; Harmsen, Hanne

2001-01-01

This paper addresses companies' lack of implementation of success factors in new product development. Drawing on theory in the competence perspective and an exploratory empirical study, the paper points to two major areas that have not been covered by previous studies on new product development s...... success factors. The two areas are knowledge and skills of individual employees, values and norms and it is suggested that increased understanding of these two areas hold potential in making identified success factors more accessible to companies.......This paper addresses companies' lack of implementation of success factors in new product development. Drawing on theory in the competence perspective and an exploratory empirical study, the paper points to two major areas that have not been covered by previous studies on new product development...

Staff perceptions of a Productive Community Services implementation: A qualitative interview study.

Science.gov (United States)

Bradley, Dominique Kim Frances; Griffin, Murray

2015-06-01

The Productive Series is a collection of change programmes designed by the English National Health Service (NHS) Institute for Innovation and Improvement to help frontline healthcare staff improve quality and reduce wasted time, so that this time can be reinvested into time spent with patients. The programmes have been implemented in at least 14 countries around the world. This study examines an implementation of the Productive Community Services programme that took place in a Community healthcare organisation in England from July 2010 to March 2012. To explore staff members' perceptions of a Productive Community Services implementation. Cross-sectional interview. Community Healthcare Organisation in East Anglia, England. 45 participants were recruited using purposive, snowballing and opportunistic sampling methods to represent five main types of staff group in the organisation; clinical team members, administrative team members, service managers/team leaders, senior managers and software support staff. Team members were recruited on the basis that they had submitted data for at least one Productive Community Services module. Semi-structured individual and group interviews were carried out after the programme concluded and analysed using thematic analysis. This report focuses on six of the themes identified. The analysis found that communication was not always effective, and there was a lack of awareness, knowledge and understanding of the programme. Many staff did not find the Productive Community Services work relevant, and although certain improvements were sustained, suboptimal practices crept back. Although negative outcomes were reported, such as the programme taking time away from patients initially, many benefits were described including improved stock control and work environments, and better use of the Electronic Patient Record system. One of the themes identified highlighted the positive perceptions of the programme, however a focus on five other themes

Cultural Aspects when Implementing Lean Production and Lean Product Development – Experiences from a Swedish Perspective

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Promporn Wangwacharakul

2014-07-01

Full Text Available Lean principles and methods, originating in a Japanese cultural context, have spread to a large number of companies throughout the world. The aim of this case study research is to identify and compare national cultural aspects that influence Lean Production and Lean Product Development implementation in Swedish companies. Data were collected through questionnaires, interviews and an industrial workshop with Swedish Lean practitioners. The study shows that some sub-areas in Lean, such as value definition, control systems, leadership, team development, knowledge management, and strategies, are highly dependent on contextual factors related to human, cultural and organizational aspects. These are related to the national culture and should be considered to a higher extent for successful sustainable implementation of Lean in different cultural contexts. As for implementing Lean in Sweden, national cultural characteristics, such as individualism, autonomy and supportive management style fit well with Lean thinking.

Intranet of the future: functional study, comparison of products and practical implementation

OpenAIRE

Bertran Ribalaygua, Ignasi

2010-01-01

Future intranet: functional study, comparison of products and practical implementation 1. Introduction The project has fulfilled three goals: 1) To perform a study of the functionalities which have to be covered in a modern intranet (web 2.0, unified communication, collaboration, etc) 2) To perform a comparison of tools of the market which can be used to implement intranets (commercial and open source products) 3) To test three of these tools (Oracle WebCenter, Liferay Portal and Microsoft Sh...

Low-Cost Rapid Usability Testing: Its Application in Both Product Development and System Implementation.

Science.gov (United States)

Kushniruk, Andre; Borycki, Elizabeth

2017-01-01

In recent years there has been considerable discussion around the need for certification and regulation of healthcare information technology (IT). In particular, the usability of the products being developed needs to be evaluated. This has included the application of standards designed to ensure the process of system development is user-centered and takes usability into consideration while a product is being developed. In addition to this, in healthcare, organizations in the United States and Europe have also addressed the need and requirement for product certification. However, despite these efforts there are continued reports of unusable and unsafe implementations. In this paper we discuss the need to not only include (and require) usability testing in the one-time development process of health IT products (such as EHRs), but we also argue for the need to additionally develop specific usability standards and requirements for usability testing during the implementation of vendor products (i.e. post product development) in healthcare settings. It is further argued that health IT products that may have been certified regarding their development process will still require application of usability testing in the process of implementing them in real hospital settings in order to ensure usability and safety. This is needed in order to ensure that the final result of both product development and implementation processes take into account and apply the latest usability principles and methods.

Examining the Extent of Environmental Compliance Requirements on Mechatronic Products and Their Implementation through Product Lifecycle Management

Science.gov (United States)

Jovanovic, Vukica

2010-01-01

The present mixed-methods study examined the opinions of industry practitioners related to the implementation of environmental compliance requirements into design and manufacturing processes of mechatronic and electromechanical products. It focused on the environmental standards for mechatronic and electromechanical products and how Product…

21 CFR 111.55 - What are the requirements to implement a production and process control system?

Science.gov (United States)

2010-04-01

... production and process control system? 111.55 Section 111.55 Food and Drugs FOOD AND DRUG ADMINISTRATION... to Establish a Production and Process Control System § 111.55 What are the requirements to implement a production and process control system? You must implement a system of production and process...

IMPLEMENTATION OF CONTROL CARDS AND SUPPORTING METHOD IN PRODUCTION ENGINEERING

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Anna WOLNOWSKA

2012-10-01

Full Text Available In the article there were presented chosen method associated with statistical control of production processes. Mainly focused on control cards and Pareto‐Lorenz analysis. Showed method were implemented to analysis production process stability of hearing aids in X company (the brand name don’t give because date of production is secret. Researches were made few months after new assembly lines starts‐up. Main aim of researches was defects types identification occurred in production process and determine the scale of effect. Finally received results were satisfactory, i.e. despite of occurred errors, control cards analysis showed that production process of BTE‐type (Behind‐The‐Ear hearing aids was stable.

Implementation of quality by design toward processing of food products.

Science.gov (United States)

Rathore, Anurag S; Kapoor, Gautam

2017-05-28

Quality by design (QbD) is a systematic approach that begins with predefined objectives and emphasizes product and process understanding and process control. It is an approach based on principles of sound science and quality risk management. As the food processing industry continues to embrace the idea of in-line, online, and/or at-line sensors and real-time characterization for process monitoring and control, the existing gaps with regard to our ability to monitor multiple parameters/variables associated with the manufacturing process will be alleviated over time. Investments made for development of tools and approaches that facilitate high-throughput analytical and process development, process analytical technology, design of experiments, risk analysis, knowledge management, and enhancement of process/product understanding would pave way for operational and economic benefits later in the commercialization process and across other product pipelines. This article aims to achieve two major objectives. First, to review the progress that has been made in the recent years on the topic of QbD implementation in processing of food products and second, present a case study that illustrates benefits of such QbD implementation.

Developing a new national approach to surveillance for ventilator-associated events: executive summary.

Science.gov (United States)

Magill, Shelley S; Klompas, Michael; Balk, Robert; Burns, Suzanne M; Deutschman, Clifford S; Diekema, Daniel; Fridkin, Scott; Greene, Linda; Guh, Alice; Gutterman, David; Hammer, Beth; Henderson, David; Hess, Dean R; Hill, Nicholas S; Horan, Teresa; Kollef, Marin; Levy, Mitchell; Septimus, Edward; VanAntwerpen, Carole; Wright, Don; Lipsett, Pamela

2013-11-01

In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1). The charges to the Working Group were to (1) critically review a draft, streamlined VAP surveillance definition developed for use in adult patients; (2) suggest modifications to enhance the reliability and credibility of the surveillance definition within the critical care and infection prevention communities; and (3) propose a final adult surveillance definition algorithm to be implemented in the CDC's National Healthcare Safety Network (NHSN), taking into consideration the potential future use of the definition algorithm in public reporting, interfacility comparisons, and pay-for-reporting and pay-for-performance programs. Published by Mosby, Inc.

Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements

Directory of Open Access Journals (Sweden)

Holly Keyt

2014-01-01

Full Text Available Ventilator-associated pneumonia (VAP is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.

Experiences from Implementation of Lean Production: Standardization versus Self-management: A Swedish Case Study

Directory of Open Access Journals (Sweden)

Margareta Oudhuis

2013-01-01

Full Text Available In this article, we discuss important aspects of the perceived problematic relationship between self-management and standardization. The article presents data from three case studies conducted within manufacturing companies in Sweden, where the popularity of lean production has led to a renaissance for short-cycle and standardized assembly work in settings that traditionally have made use of sociotechnical production design. The data suggest that the implementation has not contributed to an increased commitment, smooth operations, and capacity for change and innovation. Despite these not so positive results, it is argued that it is possible to combine self-management principles with lean production and standardization if 1 the implementation of lean is done with a contextual sensitivity, 2 a balance is reached between the use of standards on the one hand and work enrichment on the other, and 3 a feeling of ownership as regards both implementation and production process is upheld among the product on personnel.

Knowledge co-production and boundary work to promote implementation of conservation plans.

Science.gov (United States)

Nel, Jeanne L; Roux, Dirk J; Driver, Amanda; Hill, Liesl; Maherry, Ashton C; Snaddon, Kate; Petersen, Chantel R; Smith-Adao, Lindie B; Van Deventer, Heidi; Reyers, Belinda

2016-02-01

Knowledge co-production and boundary work offer planners a new frame for critically designing a social process that fosters collaborative implementation of resulting plans. Knowledge co-production involves stakeholders from diverse knowledge systems working iteratively toward common vision and action. Boundary work is a means of creating permeable knowledge boundaries that satisfy the needs of multiple social groups while guarding the functional integrity of contributing knowledge systems. Resulting products are boundary objects of mutual interest that maintain coherence across all knowledge boundaries. We examined how knowledge co-production and boundary work can bridge the gap between planning and implementation and promote cross-sectoral cooperation. We applied these concepts to well-established stages in regional conservation planning within a national scale conservation planning project aimed at identifying areas for conserving rivers and wetlands of South Africa and developing an institutional environment for promoting their conservation. Knowledge co-production occurred iteratively over 4 years in interactive stake-holder workshops that included co-development of national freshwater conservation goals and spatial data on freshwater biodiversity and local conservation feasibility; translation of goals into quantitative inputs that were used in Marxan to select draft priority conservation areas; review of draft priority areas; and packaging of resulting map products into an atlas and implementation manual to promote application of the priority area maps in 37 different decision-making contexts. Knowledge co-production stimulated dialogue and negotiation and built capacity for multi-scale implementation beyond the project. The resulting maps and information integrated diverse knowledge types of over 450 stakeholders and represented >1000 years of collective experience. The maps provided a consistent national source of information on priority conservation areas

Development and implementation strategy for the of product configuration systems in engineer-to-order companies

DEFF Research Database (Denmark)

Kristjansdottir, Katrin; Shafiee, Sara; Hvam, Lars

2016-01-01

This paper will address how to develop a strategy when developing and implementing product configuration systems (PCSs) in engineer-to-order (ETO) companies. PCSs are often gradually implemented especially where there are complex products and processes in order to break down the overall project...... and reduce risk. This highlights the importance of having an overall strategy to guide the long-term development and implementation of PCSs In this paper, guideline for making the strategy are provided and supplemented with examples based on a case study. The guideline includes the main objectives...... for the development and implementation process, PCSs to be used to support the sales and /or the engineering processes, more uniform IT support for making product configurations, combining output from different PCSs and finally integrations that includes both internal and external IT systems. Based...

Impact on cost accuracy and profitability from implementing product configuration system – A case-study

DEFF Research Database (Denmark)

Myrodia, Anna; Kristjansdottir, Katrin; Hvam, Lars

2015-01-01

This article aims at analyzing the impacts from implementing a product configuration system (PCS) on company profitability and improved cost estimations in the sales phase. Companies that have implemented PCSs have achieved substantial benefits in terms of being more in control of their product...... assortment, making the right decisions in the sales phase and increased sales of optimal products. Those benefits should have direct impact on improved profitability in terms of increased contribution ratios and more accurate cost estimations used to determine the price in the budgetary quotations...... and accuracy of the cost estimation in the sales phase can be achieved from implementing a PCS....

Prevention and diagnosis of ventilator-associated pneumonia: a survey on current practices in Southern Spanish ICUs.

Science.gov (United States)

Sierra, Rafael; Benítez, Encarnación; León, Cristóbal; Rello, Jordi

2005-09-01

To assess the implementation of selected ventilator-associated pneumonia (VAP) prevention strategies, and to learn how VAP is diagnosed in the ICUs of Southern Spain. Multicentric survey. The ICUs of 32 hospitals of the public health-care system of Southern Spain. Directors of ICUs. None. Twenty-eight ICUs (87.5%) returned completed questionnaires. Ventilator circuits were changed every 72 h or longer in 75% of ICUs. Use of heat and moisture exchangers and open endotracheal suction systems were reported in 96% of ICUs. Subglottic secretion drainage was never used, and 57% of ICUs checked endotracheal tube cuff pressure at least daily. Semi-recumbent position was common (93%), and 67.5% of ICUs used frequently noninvasive ventilation. Continuous enteral feeding was reported in all ICUs. Sedative infusions were usually interrupted every day in 11% of ICUs. Seventy-five percent of ICUs had specific guidelines for antibiotic therapy of VAP, but rotation of antibiotics was uncommon (11%). Twenty-nine percent of ICUs diagnosed VAP without microbiological confirmation. The most used technique for microbiologic diagnosis was qualitative culture of endotracheal aspirates (42.8%). The centers with a larger structural complexity reported using VAP therapy guidelines more frequently than the smaller centers, but they did not utilized bronchoscopic techniques for diagnosing VAP. Common prevention and diagnostic procedures in clinical practice, including large teaching institutions, significantly differed from evidence-based recommendations and reports by research groups of excellence. In addition, our study suggests that clinical practice for preventing and diagnosing VAP is variable and many opportunities exist to improve the care of patients receiving mechanical ventilation.

Designing Conservation Corridors in Production Landscapes: Assessment Methods, Implementation Issues, and Lessons Learned

Directory of Open Access Journals (Sweden)

Amanda T. Lombard

2010-09-01

Full Text Available Designing broad-scale conservation corridors has become increasingly common as a way of conducting an assessment for achieving targets for the representation and persistence of nature. However, since many of these corridors must traverse agricultural and other production landscapes, planning and implementation are not trivial tasks. Most approaches to conservation assessments in the dynamic world of production landscapes are data-intensive and analytically complex. However, in the real world, donor and other external requirements impose time and budget constraints, and dictate strong stakeholder involvement in the entire planning process. In order to accommodate this, assessments must be rapid, cheap, and the approach and products must be comprehensible and acceptable to stakeholders. Here we describe such an assessment aimed at identifying and implementing a network of conservation corridors in the Gouritz Initiative project domain of South Africa's Cape Floristic Region hotspot. We used empirical data and expert knowledge to identify a corridor network hypothesized to sustain key ecological and evolutionary processes. We also consulted experts to provide a spatially explicit assessment of the opportunity costs of conservation associated with agriculture, the predominant land use in the region. We used these products to identify categories of land requiring different actions and instruments to achieve conservation goals, thereby moving from the "where" to the "how" of conservation. This information was then fed into the collaborative strategy development process for the Gouritz Initiative. Our discussion emphasizes the lessons that we learnt from undertaking this assessment, particularly lessons regarding the implementation of the planning products. We conclude that at the outset of any planning project, a consensus on the vision must be achieved, a detailed social assessment of appropriate institutions must be undertaken, and a learning

Environmental and Social Management System Implementation Handbook : Crop Production

OpenAIRE

International Finance Corporation

2014-01-01

This Handbook is intended to be a practical guide to help companies in the crop production industry develop and implement an environmental and social management system, which should help to improve overall operations. If a company has existing management systems for quality or health and safety, this Handbook will help to expand them to include environmental and social performance. Sectio...

Reductions in employee productivity impairment observed after implementation of web-based worksite health promotion programs.

Science.gov (United States)

Silberman, Jordan; Schwartz, Steven; Giuseffi, Danielle L; Wang, Chun; Nevedal, Dana; Bedrosian, Richard

2011-12-01

To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

Implementing a Brand Strategy for a New Product: Releasing a New Product in a Multinational Company

OpenAIRE

Alexandra ION

2011-01-01

The present paper focuses on the issue of using marketing intruments (like innovation, creativity, revitalization) in multinational companies like Coca Cola. The research is about identifying the right options and marketing strategies, for implementing a new and healthy product on the market, and studying the consumer behavior, regarding the subject. In conclusion, this product could be a chance for this company to improve image and to take benefit by increasing the number of consumers.

Implementing Cleaner Production as an Environmental Management Efforts in Small Industries of Cassava Chips

Directory of Open Access Journals (Sweden)

Rahmadyanti Erina

2016-01-01

Full Text Available Small and Medium Enterprises (SMEs is one of the major driving factors for Indonesian economy, especially in food processing industries. The cassava-based industry is one type of food and beverage industry with chips as its major product. The limitations of knowledge caused their activities to only aim at pursuing economic benefits and ignoring the environmental balance. The most appropriate preventive method used, according to the characteristics of SMEs in Indonesia, is Cleaner Production. This study aims to reduce the risk of environmental pollution caused by the waste production of small chips industries by implementing cleaner production. The method used in this study is quick scanning by analyzing mass balance, energy, and utilities that aim to find an inefficient process to minimize losses. Implementation of cleaner production may include good housekeeping, reducing, and reusing. Based on the assessment of alternative eligibility criteria, the equipment modifications are the main factor in implementing cleaner production that drives the profits by providing efficiency of cutting as much as 80 percent and optimizes the profits into 57.62 kg in a month or 691.44 kg in a year. If the price of cassava chips is IDR 40,000 in a kg, then it would save IDR 27,657,600 in a year.

The opportunity cost of not utilising the woody invasive alien plant species in the Kouga, Krom and Baviaans catchments in South Africa

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Thulile Vundla

2016-12-01

Full Text Available This study estimates the opportunity costs of using woody invasive alien plants (IAPs for value-added products by estimating the net economic return from the value-added industries in South Africa. By 2008, IAPs were estimated at the national level to cover an area of 1 813 million condensed hectares in South Africa. A market has formed around their use for value-added products (VAP like charcoal, firewood and timber in the Kouga, Kromme and Baviaans River catchments in the Eastern Cape province of South Africa. The net economic return from these value-added industries was estimated for the purpose of several management scenarios, and was then used to estimate the opportunity costs if they were not used. A system dynamics model was used to value and analyse the Net Present Value of clearing in the study area and to estimate the opportunity cost of the non-use of VAP. The study showed that the inclusion of VAPs in the project would yield higher net present values for clearing. The findings from this study suggest that a cofinance option of the total economic returns from VAP for clearing costs is the best management scenario for reducing the costs of clearing and maximising the net economic returns from clearing. The net economic returns of VAPs by 2030 are estimated at R23 million without the co-finance option and R26 million with the option. The cumulative net income from VAPs with co-financing over the period of valuation is estimated to be R609 million.

Implementation of Green New Product Development Among SMEs: Barriers and Critical Success Factors

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Abu Noor Hidayah

2018-01-01

Full Text Available Green New Product Development (GNPD is very important due to environmental issues increasing. GNPD is defined as creating, designing and develop ecological product which could help in protecting the environment. Small and medium enterprise (SME firms is one of the contributor to the environmental issues but they could not afford to implement GNPD because there are several obstacles which prevent the successful of GNPD implementation. The objective of this paper are to identify the critical success factors and to determine the obstacles of GNPD implementation among SMEs. The method used in this study is conceptual review of previous literature in green and NPD area of research. The result finding of this paper consist of 9 critical success factors and 12 obstacles. All the critical success factors and obstacles will be grouped. The finding of this study could be a source and fundamental guideline for future study in developing framework for GNPD implementation especially for manufacturing SMEs in Malaysia. Besides that, the result of this study could help organization especially SMEs’s owner and manager in assessing their initiative to implement GNPD in organization.

National survey of practices to prevent health care-associated infections in Thailand: The role of prevention bundles.

Science.gov (United States)

Apisarnthanarak, Anucha; Ratz, David; Greene, M Todd; Khawcharoenporn, Thana; Weber, David J; Saint, Sanjay

2017-07-01

We evaluated the practices used in Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). From January 1, 2014-November 30, 2014, we surveyed all Thai hospitals with an intensive care unit and at least 250 beds. The use of prevention practices for CAUTI, CLABSI, and VAP was assessed. High compliance (≥75%) with all components of the CLABSI and VAP prevention bundles were determined. CAUTI, CLABSI, and VAP infection rates before and after implementing infection control practices are reported. Multivariable regression was used to examine associations between infection prevention bundle compliance and infection rate changes. Out of 245 eligible hospitals, 212 (86.5%) responded. A total of 120 (56.6%) and 115 hospitals (54.2%) reported ≥75% compliance for all components of the CLABSI and VAP prevention bundles, respectively, and 91 hospitals (42.9%) reported using ≥ 4 recommended CAUTI-prevention practices. High compliance with all of the CLABSI and VAP bundle components was associated with significant infection rate reductions (CLABSI, 38.3%; P Hospitals regularly using ≥ 4 CAUTI-prevention practices did not have greater reductions in CAUTI (0.02%; P = .99). Compliance with practices to prevent hospital infections was suboptimal. Policies and interventions promoting bundled approaches may help reduce hospital infections for Thai hospitals. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

A study on the implementation of the performance of electrical products standards

Energy Technology Data Exchange (ETDEWEB)

Berkowitz, M A

1984-03-01

The Steering Committee on Electrical Products (SCOPEP) has developed a number of performance standards for selected electrical products and product attributes, under the direction of the Canadian Standards Association. Although the development of these standards shows that a successful standards writing process is in place, the initiation and implementation has been achieved by one or more stakeholder groups spearheading the requirement for the standard. As a result, SCOPEP has been unable to achieve its full potential in its role of developing peformance standards for electrical products. A study was undertaken with the aim of developing a strategic plan for SCOPEP which would be supported by marketing and other strategies. The major elements of the strategy include: selecting those products for which the benefits of a standards program significantly outweigh the costs; agreeing on the use of a framework which rigorously evaluates the cost-benefits of developing performance standards; producing a critical mass of products through the selection process so that revenues from label fees will ultimately balance program costs and support a full time SCOPEP secretariat; aggressively marketing the standards in all sectors, using a balanced push-and-pull strategy; and developing a protagonist attitude so that standards programs implemented are credible to all SCOPEP stakeholders. Detailed cost-benefit tables are appended. 11 figs., 18 tabs.

Implementation of hazard analysis and critical control point (HACCP) in dried anchovy production process

Science.gov (United States)

Citraresmi, A. D. P.; Wahyuni, E. E.

2018-03-01

The aim of this study was to inspect the implementation of Hazard Analysis and Critical Control Point (HACCP) for identification and prevention of potential hazards in the production process of dried anchovy at PT. Kelola Mina Laut (KML), Lobuk unit, Sumenep. Cold storage process is needed in each anchovy processing step in order to maintain its physical and chemical condition. In addition, the implementation of quality assurance system should be undertaken to maintain product quality. The research was conducted using a survey method, by following the whole process of making anchovy from the receiving raw materials to the packaging of final product. The method of data analysis used was descriptive analysis method. Implementation of HACCP at PT. KML, Lobuk unit, Sumenep was conducted by applying Pre Requisite Programs (PRP) and preparation stage consisting of 5 initial stages and 7 principles of HACCP. The results showed that CCP was found in boiling process flow with significant hazard of Listeria monocytogenesis bacteria and final sorting process with significant hazard of foreign material contamination in the product. Actions taken were controlling boiling temperature of 100 – 105°C for 3 - 5 minutes and training for sorting process employees.

A framework for risk assessment on lean production implementation

Directory of Open Access Journals (Sweden)

Giuliano Almeida Marodin

2014-02-01

Full Text Available The organizational and technical complexity of implementing the lean principles and practices can become an extensively time consuming journey with few benefits. We argue that risk assessment can aid on the understanding and management of the major difficulties on the Lean production implementation (LPI. Thus, this paper proposes a framework for risk assessment on the LPI process. The literature review permitted to adapt the risk assessment steps to the characteristics of the LPI and develop data collection and analysis procedures for each step. The Sociotechnical systems (STS theory was brought in to improve the understanding of the context’s characteristics on the proposed framework because it has a major influence on the LPI. The framework was has five steps: (a defining the unit of analysis; (b describing the context; (c risk identification; (d risk analysis; and (e risk relationships modeling.

Electronic implementation of a novel surveillance paradigm for ventilator-associated events. Feasibility and validation

NARCIS (Netherlands)

Klein Klouwenberg, Peter M. C.; van Mourik, Maaike S. M.; Ong, David S. Y.; Horn, Janneke; Schultz, Marcus J.; Cremer, Olaf L.; Bonten, Marc J. M.

2014-01-01

Accurate surveillance of ventilator-associated pneumonia (VAP) is hampered by subjective diagnostic criteria. A novel surveillance paradigm for ventilator-associated events (VAEs) was introduced. To determine the validity of surveillance using the new VAE algorithm. Prospective cohort study in two

TIME MANAGEMENT AND ITS IMPLEMENTATION AT PRODUCTION COMPANIES

Directory of Open Access Journals (Sweden)

Yurii Safonov

2017-11-01

Full Text Available The purpose and objectives. Time management is still not a very popular element in many enterprises, while its implementation significantly increases staff productivity and, ultimately, the effectiveness of the company. For this reason, the purpose of the article is to promote time management in a business environment by providing specific tools, principles, methods and systems, and to show its importance to the company and describe the influence of time management for the enterprise. Methods. The study used a generalization, systematization, empirical research, systematic and logical approach to the development of theoretical and methodological provisions for instrumental support management performance of the industrial enterprise. Results. Time management is one of the most important strategic tools of the modern manager. It can help both existing companies and companies that are just launched (the project. Practical implications. The current goal of time management as a mechanism to improve the efficiency of the company. Value/originality. To implement it, the company offered a popular time management system, allowing the company to increase the effectiveness of its activities.

A lean production control system for high-variety/low-volume environments : a case study implementation

NARCIS (Netherlands)

Slomp, J.; Bokhorst, J.A.C.; Germs, R.

2009-01-01

Due to the success of lean manufacturing, many companies are interested in implementing a lean production control system. Lean production control principles include the levelling of production, the use of pull mechanisms and takt time control. These principles have mainly been applied in high volume

Multicentre randomised controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol.

Science.gov (United States)

Marjanovic, Nicolas; Frasca, Denis; Asehnoune, Karim; Paugam, Catherine; Lasocki, Sigismond; Ichai, Carole; Lefrant, Jean-Yves; Leone, Marc; Dahyot-Fizelier, Claire; Pottecher, Julien; Falcon, Dominique; Veber, Benoit; Constantin, Jean-Michel; Seguin, Sabrina; Guénézan, Jérémy; Mimoz, Olivier

2017-08-07

Severe trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated infections, including ventilator-associated pneumonia (VAP). Preventing underinflation of the tracheal cuff is recommended to reduce microaspiration, which plays a major role in the pathogenesis of VAP. Automatic devices facilitate the regulation of tracheal cuff pressure, and their implementation has the potential to reduce VAP. The objective of this work is to determine whether continuous regulation of tracheal cuff pressure using a pneumatic device reduces the incidence of VAP compared with intermittent control in severe trauma patients. This multicentre randomised controlled and open-label trial will include patients suffering from severe trauma who are admitted within the first 24 hours, who require invasive mechanical ventilation to longer than 48 hours. Their tracheal cuff pressure will be monitored either once every 8 hours (control group) or continuously using a pneumatic device (intervention group). The primary end point is the proportion of patients that develop VAP in the intensive care unit (ICU) at day 28. The secondary end points include the proportion of patients that develop VAP in the ICU, early (≤7 days) or late (>7 days) VAP, time until the first VAP diagnosis, the number of ventilator-free days and antibiotic-free days, the length of stay in the ICU, the proportion of patients with ventilator-associated events and that die during their ICU stay. This protocol has been approved by the ethics committee of Poitiers University Hospital, and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Clinical Trials NCT02534974. © Article author(s) (or

Implementation of Total Productive Maintenance (TPM to Improve Sheeter Machine Performance

Directory of Open Access Journals (Sweden)

Candra Nofri Eka

2017-01-01

Full Text Available This paper purpose is an evaluation of TPM implementation, as a case study at sheeter machine cut size line 5 finishing department, PT RAPP, Indonesia. Research methodology collected the Overall Equipment Effectiveness (OEE data of sheeter machine and computed its scores. Then, OEE analysis big losses, statistical analysis using SPSS 20 and focused maintenance evaluation of TPM were performed. The data collected to machine sheeter’s production for 10 months (January-October 2016. The data analyses was resulted the OEE average score of 82.75%. This score was still below the world class OEE (85% and the company target (90%. Based the big losses of OEE analysis was obtained the reduce speed losses, which most significant losses of OEE scores. The reduce speed losses value was 44.79% of total losses during the research period. The high score of these losses due to decreasing of machine production speed by operators, which intended to improve the quality of resulting products. The OEE scores statistical analysis was found breakdown losses and reduces speed losses, which significantly affected to OEE scores. Implementations of focused maintenance of TPM in the case study may need to improve because there were still occurred un-expecting losses during the research period.

Implementation of a departmental picture archiving and communication system: a productivity and cost analysis.

Science.gov (United States)

Macyszyn, Luke; Lega, Brad; Bohman, Leif-Erik; Latefi, Ahmad; Smith, Michelle J; Malhotra, Neil R; Welch, William; Grady, Sean M

2013-09-01

Digital radiology enhances productivity and results in long-term cost savings. However, the viewing, storage, and sharing of outside imaging studies on compact discs at ambulatory offices and hospitals pose a number of unique challenges to a surgeon's efficiency and clinical workflow. To improve the efficiency and clinical workflow of an academic neurosurgical practice when evaluating patients with outside radiological studies. Open-source software and commercial hardware were used to design and implement a departmental picture archiving and communications system (PACS). The implementation of a departmental PACS system significantly improved productivity and enhanced collaboration in a variety of clinical settings. Using published data on the rate of information technology problems associated with outside studies on compact discs, this system produced a cost savings ranging from $6250 to $33600 and from $43200 to $72000 for 2 cohorts, urgent transfer and spine clinic patients, respectively, therefore justifying the costs of the system in less than a year. The implementation of a departmental PACS system using open-source software is straightforward and cost-effective and results in significant gains in surgeon productivity when evaluating patients with outside imaging studies.

Implementation of unused production factors in agriculture by means of dynamic optimization models with random constraints

Directory of Open Access Journals (Sweden)

Jadwiga Zaród

2011-01-01

Full Text Available The farms of Western Pomerania province possess a large surplus of manpower. The dynamic optimization models with random constraints served the investigation of the possibilities of implementation of the unused man-hours. Those models regarded four successive years 2003-2006. The solution proceeded in two steps. The first step let us construct the assumption of the surplus or the deficiency of production factors. In the next step additional variables regarding the lease of arable grounds were introduced while the unused man-hours were implemented with various probability. The optimal solutions indicated the area of particular crops, the quantity of livestock and the farm income dependent on the use of the existing employment. This study aims at the presentation of the possibility of implementation of unused man-hours in farms dealing solely with the crop production and also the production of crop and livestock.

Perspectives on Resource Recovery from Bio-Based Production Processes: From Concept to Implementation

DEFF Research Database (Denmark)

S.B.A. Udugama, Isuru; Mansouri, Seyed Soheil; Mitic, Aleksandar

2017-01-01

Recovering valuable compounds from waste streams of bio-based production processes is in line with the circular economy paradigm, and is achievable by implementing “simple-to-use” and well-established process separation technologies. Such solutions are acceptable from industrial, economic...... and environmental points of view, implying relatively easy future implementation on pilot- and full-scale levels in the bio-based industry. Reviewing such technologies is therefore the focus here. Considerations about technology readiness level (TRL) and Net Present Value (NPV) are included in the review, since TRL...... and NPV contribute significantly to the techno-economic evaluation of future and promising process solutions. Based on the present review, a qualitative guideline for resource recovery from bio-based production processes is proposed. Finally, future approaches and perspectives toward identification...

IMPLEMENTING THE 5S METHOD IN THE PRODUCTION SYSTEM OF DACIA & RENAULT

Directory of Open Access Journals (Sweden)

Marin CIOBANU

2014-11-01

Full Text Available The aim of this paper is to demonstrate the usefulness of the 5S method in addressing the issues of continuous improvement of productivity and quality of work. There are presented the 5 steps, techniques and the adjacent tools. Solutions implemented in the production system Dacia & Renault are indicated. This article provides a practical framework. The 5S method follows the Deming PDCA cycle which constitutes the starting point of the SDCA cycle of continuous improvement of the company's activities in order to obtain excellence. The implementing time of the method depends on the resources and materials allocated. Deployment of 5S is achieved by a scheme of "3+2": the first 3S are tangible and immediate actions, the last 2S appeal to specific management actions. The efficacy of their own workplace in total autonomy creates comfort in the work environment and gives personal benefits to workers.

Genetic polymorphisms within tumor necrosis factor gene promoter region: a role for susceptibility to ventilator-associated pneumonia.

Science.gov (United States)

Kotsaki, Antigoni; Raftogiannis, Maria; Routsi, Christina; Baziaka, Fotini; Kotanidou, Anastasia; Antonopoulou, Anastasia; Orfanos, Stylianos E; Katsenos, Chrisostomos; Koutoukas, Pantelis; Plachouras, Diamantis; Mandragos, Konstantinos; Giamarellos-Bourboulis, Evangelos J

2012-08-01

Debatable findings exist among various studies regarding the impact of single nucleotide polymorphisms (SNPs) within the promoter region of the tumor necrosis factor (TNF) gene for susceptibility to infections. Their impact was investigated in a cohort of mechanically ventilated patients who developed ventilator-associated pneumonia (VAP). Two-hundred and thirteen mechanically ventilated patients who developed VAP were enrolled. Genomic DNA was extracted and SNPs at the -376, -308 and -238 position of the promoter region of the TNF gene were assessed by restriction fragment length polymorphisms. Monocytes were isolated from 47 patients when they developed sepsis and stimulated by bacterial endotoxin for the production of TNFα and of interleukin-6 (IL-6). Patients were divided into two groups; 166 patients bearing only wild-type alleles of all three studied polymorphisms; and 47 patients carrying at least one A allele of the three studied SNPs. Time between start of mechanical ventilation and advent of VAP was significantly shorter in the second group than in the first group (log-rank: 4.416, p: 0.041). When VAP supervened, disease severity did not differ between groups. Stimulation of TNFα and of IL-6 was much greater by monocytes for patients carrying A alleles. Carriage of at least one A allele of the three studied SNPs at the promoter region of the TNF-gene is associated with shorter time to development of VAP but it is not associated with disease severity. Findings may be related with a role of the studied SNPs in the production of pro-inflammatory cytokines. Copyright © 2012 Elsevier Ltd. All rights reserved.

Lean Manufacturing Implementation for Multinational Companies with Production Subsidiary in Brazil: Development of A Roadmap

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L. Goehnera,

2016-06-01

Full Text Available Foreign multinational companies with a production subsidiary in Brazil are in general recognized as high-level productive companies; however, their productivity potential is mostly not fully achieved. Lean Manufacturing (LM has been proved as a valuable aid to achieve competitiveness in the long run. Regarding the rising importance of successfully implementing LM at multinationals in Brazil and an apparent lack of discussion regarding LM in Brazil this paper aims to propose a comprehensive implementation roadmap, which enables a multinational on a basis of a systematic approach, to achieve an advanced sustainable LM system in a practical manner. The insights of literature and case studies are combined to develop the roadmap. The roadmap was developed so that both companies, those, which have not started yet their journey towards LM, as well as those that have taken already the first steps can use the roadmap. However, the roadmap was built on a broad empirical basis. It should be noticed that it is impossible to consider all factors influencing the LMI at multinationals operating in Brazil in a real world setting. As a result, the roadmap should not be regarded as a ready implementation plan, which has to be strictly followed. Instead, it should be seen as a guideline, which helps a multinational to develop its own, detailed and fitted plan for successfully implementing LM and establishing a learning organization.

Vascular adhesion protein-1 is elevated in primary sclerosing cholangitis, is predictive of clinical outcome and facilitates recruitment of gut-tropic lymphocytes to liver in a substrate-dependent manner.

Science.gov (United States)

Trivedi, Palak J; Tickle, Joseph; Vesterhus, Mette Nåmdal; Eddowes, Peter J; Bruns, Tony; Vainio, Jani; Parker, Richard; Smith, David; Liaskou, Evaggelia; Thorbjørnsen, Liv Wenche; Hirschfield, Gideon M; Auvinen, Kaisa; Hubscher, Stefan G; Salmi, Marko; Adams, David H; Weston, Chris J

2018-06-01

Primary sclerosing cholangitis (PSC) is the classical hepatobiliary manifestation of IBD. This clinical association is linked pathologically to the recruitment of mucosal T cells to the liver, via vascular adhesion protein (VAP)-1-dependent enzyme activity. Our aim was to examine the expression, function and enzymatic activation of the ectoenzyme VAP-1 in patients with PSC. We examined VAP-1 expression in patients with PSC, correlated levels with clinical characteristics and determined the functional consequences of enzyme activation by specific enzyme substrates on hepatic endothelium. The intrahepatic enzyme activity of VAP-1 was elevated in PSC versus immune-mediated disease controls and non-diseased liver (pgut-tropic α4β7 + lymphocytes to hepatic endothelial cells in vitro under flow was attenuated by 50% following administration of the VAP-1 inhibitor semicarbazide (pgut bacteria-was the most efficient (yielded the highest enzymatic rate) and efficacious in its ability to induce expression of functional mucosal addressin cell adhesion molecule-1 on hepatic endothelium. In a prospectively evaluated patient cohort with PSC, elevated serum soluble (s)VAP-1 levels predicted poorer transplant-free survival for patients, independently (HR: 3.85, p=0.003) and additively (HR: 2.02, p=0.012) of the presence of liver cirrhosis. VAP-1 expression is increased in PSC, facilitates adhesion of gut-tropic lymphocytes to liver endothelium in a substrate-dependent manner, and elevated levels of its circulating form predict clinical outcome in patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia.

Science.gov (United States)

Conway Morris, Andrew; Gadsby, Naomi; McKenna, James P; Hellyer, Thomas P; Dark, Paul; Singh, Suveer; Walsh, Timothy S; McAuley, Danny F; Templeton, Kate; Simpson, A John; McMullan, Ronan

2017-11-01

Ventilator-associated pneumonia (VAP) remains a challenge to intensive care units, with secure diagnosis relying on microbiological cultures that take up to 72 hours to provide a result. We sought to derive and validate a novel, real-time 16S rRNA gene PCR for rapid exclusion of VAP. Bronchoalveolar lavage (BAL) was obtained from two independent cohorts of patients with suspected VAP. Patients were recruited in a 2-centre derivation cohort and a 12-centre confirmation cohort. Confirmed VAP was defined as growth of >10 4 colony forming units/ml on semiquantitative culture and compared with a 16S PCR assay. Samples were tested from 67 patients in the derivation cohort, 10 (15%) of whom had confirmed VAP. Using cycles to cross threshold (C t ) values as the result of the 16S PCR test, the area under the receiver operating characteristic (ROC) curve (AUROC) was 0.94 (95% CI 0.86 to 1.0, p<0.0001). Samples from 92 patients were available from the confirmation cohort, 26 (28%) of whom had confirmed VAP. The AUROC for C t in this cohort was 0.89 (95% CI 0.83 to 0.95, p<0.0001). This study has derived and assessed the diagnostic accuracy of a novel application for 16S PCR. This suggests that 16S PCR in BAL could be used as a rapid test in suspected VAP and may allow better stewardship of antibiotics. VAPRAPID trial ref NCT01972425. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

ARM Cloud Radar Simulator Package for Global Climate Models Value-Added Product

Energy Technology Data Exchange (ETDEWEB)

Zhang, Yuying [North Carolina State Univ., Raleigh, NC (United States); Xie, Shaocheng [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2017-05-01

It has been challenging to directly compare U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility ground-based cloud radar measurements with climate model output because of limitations or features of the observing processes and the spatial gap between model and the single-point measurements. To facilitate the use of ARM radar data in numerical models, an ARM cloud radar simulator was developed to converts model data into pseudo-ARM cloud radar observations that mimic the instrument view of a narrow atmospheric column (as compared to a large global climate model [GCM] grid-cell), thus allowing meaningful comparison between model output and ARM cloud observations. The ARM cloud radar simulator value-added product (VAP) was developed based on the CloudSat simulator contained in the community satellite simulator package, the Cloud Feedback Model Intercomparison Project (CFMIP) Observation Simulator Package (COSP) (Bodas-Salcedo et al., 2011), which has been widely used in climate model evaluation with satellite data (Klein et al., 2013, Zhang et al., 2010). The essential part of the CloudSat simulator is the QuickBeam radar simulator that is used to produce CloudSat-like radar reflectivity, but is capable of simulating reflectivity for other radars (Marchand et al., 2009; Haynes et al., 2007). Adapting QuickBeam to the ARM cloud radar simulator within COSP required two primary changes: one was to set the frequency to 35 GHz for the ARM Ka-band cloud radar, as opposed to 94 GHz used for the CloudSat W-band radar, and the second was to invert the view from the ground to space so as to attenuate the beam correctly. In addition, the ARM cloud radar simulator uses a finer vertical resolution (100 m compared to 500 m for CloudSat) to resolve the more detailed structure of clouds captured by the ARM radars. The ARM simulator has been developed following the COSP workflow (Figure 1) and using the capabilities available in COSP

THE EFFECT OF IMPLEMENTATION MAINTENANCE CARDS IN PERFORMANCE OF MACHINES IN SELECTED PRODUCTION COMPANY

Directory of Open Access Journals (Sweden)

Michał ZASADZIEŃ

2015-10-01

Full Text Available Intelligent development should become an inherent part of the policy of each enterprise which wants to develop and maintain its position on the competitive market. The article presents investigations related to the implementation of one of Total Productive Maintenance system elements. Reasons for introducing a new procedure for circulating information about machine inspections and overhauls planned, the major element of which are work sheets for key machines taking part in the production process, have been presented. The effectiveness of the new procedure was subjected to analysis by comparing particular machines’ work times and downtimes before and after the implementation of new procedures. The conducted research revealed an increased effectiveness of machines’ work, which resulted from shortened down-times, especially the duration of a failure.

Promotion and regional development. Implementation of regional productive development agencies. The case of Maule region, Chile

Directory of Open Access Journals (Sweden)

Enrique Yamil Alul González

2010-12-01

Full Text Available The Regional Productive Development Agencies implemented in Chile in 2006, were developed as a way to answer the longing desire to territorially decentralize, and that the own Regions be whom define their future. The Agencies have the responsibility to develop innovation and productive development Agendas in participative processes, which means with public, academic and private actors. Also, the Agencies have the mission to implement Competitive Improvement Plans-PMC (clusters in prioritized economic sectors by the own region. These PMC are leaded by private actors in each sector.

78 FR 26301 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Consumer Products and...

Science.gov (United States)

2013-05-06

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA-R05-OAR-2010-0394; EPA-R05-OAR-2012-0786; FRL-9786-1] Approval and Promulgation of Air Quality Implementation Plans; Illinois; Consumer Products and... consumer products categories into the State's SIP. Finally, EPA is proposing to approve language to clarify...

Reconciling irrigated food production with environmental flows for Sustainable Development Goals implementation.

Science.gov (United States)

Jägermeyr, Jonas; Pastor, Amandine; Biemans, Hester; Gerten, Dieter

2017-07-19

Safeguarding river ecosystems is a precondition for attaining the UN Sustainable Development Goals (SDGs) related to water and the environment, while rigid implementation of such policies may hamper achievement of food security. River ecosystems provide life-supporting functions that depend on maintaining environmental flow requirements (EFRs). Here we establish gridded process-based estimates of EFRs and their violation through human water withdrawals. Results indicate that 41% of current global irrigation water use (997 km 3 per year) occurs at the expense of EFRs. If these volumes were to be reallocated to the ecosystems, half of globally irrigated cropland would face production losses of ≥10%, with losses of ∼20-30% of total country production especially in Central and South Asia. However, we explicitly show that improvement of irrigation practices can widely compensate for such losses on a sustainable basis. Integration with rainwater management can even achieve a 10% global net gain. Such management interventions are highlighted to act as a pivotal target in supporting the implementation of the ambitious and seemingly conflicting SDG agenda.

Reconciling irrigated food production with environmental flows for Sustainable Development Goals implementation

Science.gov (United States)

Jägermeyr, Jonas; Pastor, Amandine; Biemans, Hester; Gerten, Dieter

2017-07-01

Safeguarding river ecosystems is a precondition for attaining the UN Sustainable Development Goals (SDGs) related to water and the environment, while rigid implementation of such policies may hamper achievement of food security. River ecosystems provide life-supporting functions that depend on maintaining environmental flow requirements (EFRs). Here we establish gridded process-based estimates of EFRs and their violation through human water withdrawals. Results indicate that 41% of current global irrigation water use (997 km3 per year) occurs at the expense of EFRs. If these volumes were to be reallocated to the ecosystems, half of globally irrigated cropland would face production losses of >=10%, with losses of ~20-30% of total country production especially in Central and South Asia. However, we explicitly show that improvement of irrigation practices can widely compensate for such losses on a sustainable basis. Integration with rainwater management can even achieve a 10% global net gain. Such management interventions are highlighted to act as a pivotal target in supporting the implementation of the ambitious and seemingly conflicting SDG agenda.

Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance.

Science.gov (United States)

Almuneef, Maha; Memish, Ziad A; Balkhy, Hanan H; Alalem, Hala; Abutaleb, Abdulrahman

2004-09-01

To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients. This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions. Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP. The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.

Mistletoe lectin is not the only cytotoxic component in fermented preparations of Viscum album from white fir (Abies pectinata

Directory of Open Access Journals (Sweden)

Ramos Mac

2007-05-01

Full Text Available Abstract Background Preparations of mistletoe (Viscum album are the form of cancer treatment that is most frequently used in the complementary medicine. Previous work has shown that these preparations are able to exert cytotoxic effects on carcinoma cells, the extent of which might be influenced by the host tree species and by the content of mistletoe lectin. Methods Using colorimetric assays, we have now compared the cytotoxic effects of Viscum album preparations (VAPs obtained from mistletoe growing on oak (Quercus robur and Q. petraea, VAP-Qu, apple tree (Malus domestica,, VAP-M, pine (Pinus sylvestris, VAP-P or white fir (Abies pectinata, VAP-A, on the in vitro growth of breast and bladder carcinoma cell lines. While MFM-223, KPL-1, MCF-7 and HCC-1937 were the breast carcinoma cell lines chosen, the panel of tested bladder carcinoma cells comprised the T-24, TCC-SUP, UM-UC-3 and J-82 cell lines. Results Each of the VAPs inhibited cell growth, but the extent of this inhibition differed with the preparation and with the cell line. The concentrations of VAP-Qu, VAP-M and VAP-A which led to a 50 % reduction of cell growth (IC50 varied between 0.6 and 0.03 mg/ml. Higher concentrations of VAP-P were required to obtain a comparable effect. Purified mistletoe lectin I (MLI led to an inhibition of breast carcinoma cell growth at concentrations lower than those of VAPs, but the sensitivity towards purified MLI did not parallel that towards VAPs. Bladder carcinoma cells were in most cases more sensitive to VAPs treatment than breast carcinoma cells. The total mistletoe lectin content was very high in VAP-Qu (54 ng/mg extract, intermediate in VAP-M (25 ng/mg extract, and very low in VAP-P (1.3 ng/mg extract and in VAP-A (1 ng/mg extract. As to be expected from the low content of mistletoe lectin, VAP-P led to relatively weak cytotoxic effects. Most remarkably, however, the lectin-poor VAP-A revealed a cytotoxic effect comparable to, or even stronger

THE FACTORS AFFECTING ON THE SUCCESS OF IMPLEMENTING TOTAL PRODUCTIVE MAINTENANCE IN THE MANUFACTURING COMPANY (NS BLUESCOPE VIETNAM)

OpenAIRE

Pham Van Tai (PhD)*, Dean of International Trade, College of Foreign Economic Relations Phan Cao Huy (MBA), Technical Manager, Bosch Vietnam

2017-01-01

The competition in business environment becomes more strictly, manufacturers must introduce lots of new products on the high quality level with suitable price. Thus, new technologies have been applied, manufacturing systems become more complex. Therefore, a new strategy for maintenance such as Total productive maintenance (TPM) becomes really necessary. Many organizations have implemented TPM to increase the effectiveness of manufacturing system. However, implementation of TPM still meets a l...

Deep Learning Object-Recognition in a Design-to-Robotic-Production and -Operation Implementation

NARCIS (Netherlands)

Liu Cheng, A.; Bier, H.H.; Mostafavi, S.S.

2017-01-01

This paper presents a new instance in a series of discrete proof-of-concept implementations of comprehensively intelligent built-environments based on Design-to-Robotic-Production and -Operation (D2RP&O) principles developed at Delft University of Technology (TUD). With respect to D2RP, the

Scaling-up vaccine production: implementation aspects of a biomass growth observer and controller

NARCIS (Netherlands)

Soons, Z.I.T.A.; IJssel, van den J.; Pol, van der L.A.; Straten, van G.; Boxtel, van A.J.B.

2009-01-01

Abstract This study considers two aspects of the implementation of a biomass growth observer and specific growth rate controller in scale-up from small- to pilot-scale bioreactors towards a feasible bulk production process for whole-cell vaccine against whooping cough. The first is the calculation

[Comparision of risk factors and pathogens in patients with early- and late-onset ventilator-associated pneumonia in intensive care unit].

Science.gov (United States)

Liang, Y J; Li, Z L; Wang, L; Liu, B Y; Ding, R Y; Ma, X C

2017-10-01

Objective: To compare risk factors and bacterial etiology in patients with early-onset versus late-onset ventilator-associated pneumonia (VAP) in intensive care unit (ICU). Methods: This prospective cohort study enrolled mechanically ventilated patients hospitalized for more than 48 hours in the first affiliated hospital, China Medical University from Jan 2012 to Jun 2016. Subjects were classified by ventilator status: early-onset VAP (VAP) or late-onset VAP (≥ 5 d ventilation, L-VAP). Potential risk factors and pathogen were evaluated. Results: A total of 4 179 patients in adult ICU were screened, 3 989 (95.5%) of whom were mechanically ventilated, 962 patients with mechanical ventilation time ≥ 48 h. VAP developed in 142 patients. E-VAP and L-VAP had different potential risk factors based on statistical analysis.Independent risk factors for E-VAP included male ( OR =1.825, 95% CI 1.006-3.310), chronic obstructive pulmonary disease (COPD; OR =3.746, 95% CI 1.795-7.818), emergency intubation ( OR =1.932, 95% CI 1.139-3.276), aspiration ( OR =3.324, 95% CI 1.359-8.130). Whereas independent risk factors for L-VAP were coma ( OR =2.335, 95% CI 1.300-4.194), renal dysfunction ( OR =0.524, 95% CI 0.290-0.947), emergency intubation ( OR =2.184, 95% CI 1.334-3.574). Mortality in E-VAP and L-VAP group were both higher than the non-VAP group[30.2%(19/63)vs 19.8%(162/820), P =0.044; 29.1%(23/79) vs 19.8%(162/820), P =0.046]. The pathogens isolated from early-onset versus late-onset VAP were not significantly different between groups, which the most common ones were acinetobacter baumannii, pseudomonas aeruginosa and klebsiella pneumoniae. Conclusion: E-VAP and L-VAP have different risk factors, however related pathogens are similar. Different specific preventive strategies are suggested based on different onset of VAP.

Implementation plan for the new production reactor capacity environmental impact statement

International Nuclear Information System (INIS)

1989-12-01

The US Department of Energy (DOE) proposed to site, construct, and operate new production reactor (NPR) capacity intended primarily to produce tritium and secondarily to produce plutonium for the US nuclear weapons program. DOE studies show that this new capacity is needed to ensure reliable maintenance of the nation's nuclear weapons stockpile. It also is essential that these necessary nuclear materials be produced in a safe and environmentally sound manner. The DOE has determined that this proposed action constitutes a major federal action that may significantly affect the quality of the human environment; therefore, the DOE will prepare an environmental impact statement (EIS) to assess the potential impacts of the proposed action and reasonable alternatives on the human and natural environment. The EIS will be prepared in accordance with the National Environmental Policy Act of 1969, as implemented in regulations promulgated by the Council on Environmental Quality (CEQ). This EIS implementation plan (IP) includes a description of the proposed action, descriptions of alternatives, a summary of EIS assumptions, a list of environmental issues to be considered in the EIS (including those identified during public scoping activities), a list of proposed agency consultations, a schedule for EIS preparation and related activities, and an annotated outline for the EIS. It is the Department's intent that the EIS on the NPR capacity will serve as the programmatic National Environmental Policy Act (NEPA) review of modernization of DOE defense nuclear materials production of tritium and plutonium. The Department is currently developing a NEPA compliance strategy for modernization of the remainder of the nuclear weapons production complex, which will reference the EIS on NPR capacity. 7 refs., 8 tabs

Implementation of a system of social accounting in the cooperative of agricultural production “Camilo Cienfuegos” and in the basic unit of cooperative production “Julian Alemán". Main results

Directory of Open Access Journals (Sweden)

Yamira Mirabal González

2014-12-01

• To determine the results of the implementation of the System of Social Accounting in the Cooperative of Agricultural Production “Camilo Cienfuegos” and in the Basic Unit of Cooperative Production “Julián Alemán”.    The main results of the investigation are centered in: Characterization of the administration of the Cooperative of Agricultural Production “Camilo Cienfuegos” and of the Basic Unit of Cooperative Production “Julián Alemán”, evaluation of the level of execution of a group of premises that you/they allow the implementation of the system and the results of the implementation of the System of Social Accounting in both cooperatives.

Implementation of production function of labor law as a means of achieving the social stability in Russia

Directory of Open Access Journals (Sweden)

Tatyana Aleksandrovna Izbiyenova

2015-09-01

Full Text Available Objective to determine the role and importance of the production function in the Russian labor law under modern conditions. Methods general comparative analysis abstraction analysis synthesis and speciallegal methods method of comparative law analysis technicallegal method etc.. Results the study proved the necessity of amendment in the civil law in terms of giving workers39 representatives the right to participate in the work of collective bodies of legal entities. The existing approaches to the formation of the management bodies do not allow to discuss the possibility of successful implementation of the production function of labour law. Scientific novelty for the first time by the examples of industrial democracy implementation in some foreign countries and in the Russian Federation the role and significance of industrial democracy was studied as the form of implementation of the production function of labour law. Practical significance the main provisions and conclusions of the article can be used in research activities when considering the functions of the Russian labour law and also in standardsetting activities for the improvement of normative legal acts. nbsp

Use of vascular access ports in femoral veins of dogs and cats with cancer.

Science.gov (United States)

Cahalane, Alane Kosanovich; Rassnick, Kenneth M; Flanders, James A

2007-11-01

To evaluate long-term function of vascular access ports (VAPs) implanted in the femoral vein of dogs and cats undergoing cancer treatment. Prospective clinical study. 3 dogs and 6 cats treated via chemotherapy or radiation. VAPs were surgically implanted in the left femoral vein of 3 dogs and 6 cats over a 1-year period. Injection port location was alternated to either a caudal thoracic or ilial location in each patient. Duration of VAP function, ease of infusion, and ease of aspiration through the VAPs were recorded, and associated complications were assessed at each VAP use. Client satisfaction with VAP placement was evaluated by use of a questionnaire. Primary uses of the VAPs included blood sampling and delivering sedative or chemotherapeutic drugs. Median duration of successful infusion was 147 days (range, 60 to 370 days), and median duration of successful aspiration was 117 days (range, 10 to 271 days). The frequency of signs of VAP-related discomfort was low (7% of patient observations). Clients were satisfied with their decision to use VAPs. Complications included partial (n = 7) or complete (2) VAP occlusion, port migration (1), and presumptive infection (1). Results suggested that VAP implantation into the femoral vein provides an acceptable means of chronic venous access in dogs and cats undergoing cancer treatment.

A comprehensive review of the implementation of hazard analysis critical control point (HACCP) to the production of flour and flour-based products.

Science.gov (United States)

Arvanitoyannis, Ioannis S; Traikou, Athina

2005-01-01

The production of flour and semolina and their ensuing products, such as bread, cake, spaghetti, noodles, and corn flakes, is of major importance, because these products constitute some of the main ingredients of the human diet. The Hazard Analysis Critical Control Point (HACCP) system aims at ensuring the safety of these products. HACCP has been implemented within the frame of this study on various products of both Asian and European origin; the hazards, critical control limits (CCLs), observation practices, and corrective actions have been summarized in comprehensive tables. Furthermore, the various production steps, packaging included, were thoroughly analyzed, and reference was made to both the traditional and new methodologies in an attempt to pinpoint the occurring differences (advantages and disadvantages) per process.

Surface inspection of flat products by means of texture analysis: on-line implementation using neural networks

Science.gov (United States)

Fernandez, Carlos; Platero, Carlos; Campoy, Pascual; Aracil, Rafael

1994-11-01

This paper describes some texture-based techniques that can be applied to quality assessment of flat products continuously produced (metal strips, wooden surfaces, cork, textile products, ...). Since the most difficult task is that of inspecting for product appearance, human-like inspection ability is required. A common feature to all these products is the presence of non- deterministic texture on their surfaces. Two main subjects are discussed: statistical techniques for both surface finishing determination and surface defect analysis as well as real-time implementation for on-line inspection in high-speed applications. For surface finishing determination a Gray Level Difference technique is presented to perform over low resolution images, that is, no-zoomed images. Defect analysis is performed by means of statistical texture analysis over defective portions of the surface. On-line implementation is accomplished by means of neural networks. When a defect arises, textural analysis is applied which result in a data-vector, acting as input of a neural net, previously trained in a supervised way. This approach tries to reach on-line performance in automated visual inspection applications when texture is presented in flat product surfaces.

Implementation effect of productive 4-stage field orientation on the student technopreneur skill in vocational schools

Science.gov (United States)

Ismail, Edy; Samsudi, Widjanarko, Dwi; Joyce, Peter; Stearns, Roman

2018-03-01

This model integrates project base learning by creating a product based on environmental needs. The Produktif Orientasi Lapangan 4 Tahap (POL4T) combines technical skills and entrepreneurial elements together in the learning process. This study is to implement the result of technopreneurship learning model development which is environment-oriented by combining technology and entrepreneurship components on Machining Skill Program. This study applies research and development design by optimizing experimental subject. Data were obtained from questionnaires, learning material validation, interpersonal, intrapersonal observation forms, skills, product, teachers and students' responses, and cognitive tasks. Expert validation and t-test calculation are applied to see how effective POL4T learning model. The result of the study is in the form of 4 steps learning model to enhance interpersonal and intrapersonal attitudes, develop practical products which orient to society and appropriate technology so that the products can have high selling value. The model is effective based on the students' post test result, which is better than the pre-test. The product obtained from POL4T model is proven to be better than the productive learning. POL4T model is recommended to be implemented for XI grade students. This is can develop entrepreneurial attitudes that are environment oriented, community needs and technical competencies students.

Models and methods for design and implementation of computer based control and monitoring systems for production cells

DEFF Research Database (Denmark)

Lynggaard, Hans Jørgen Birk

This dissertation is concerned with the engineering, i.e. the designing and making, of industrial cell control systems. The focus is on automated robot welding cells in the shipbuilding industry. The industrial research project defines models and methods for design and implementation of computer...... through the implementation of two cell control systems for robot welding cells in production at Odense Steel Shipyard.It is concluded that cell control technology provides for increased performance in production systems, and that the Cell Control Engineering concept reduces the effort for providing high...... quality and high functionality cell control solutions for the industry....

Bundles to prevent ventilator-associated pneumonia: how valuable are they?

Science.gov (United States)

Wip, Charity; Napolitano, Lena

2009-04-01

To review the value of care bundles to prevent ventilator-associated pneumonia (VAP). The Ventilator Bundle contains four components, elevation of the head of the bed to 30-45 degrees, daily 'sedation vacation' and daily assessment of readiness to extubate, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis, aimed to improve outcome in mechanically ventilated patients, but not all are associated with VAP prevention. Daily spontaneous awakening and breathing trials are associated with early liberation from mechanical ventilation and VAP reduction. Although a small prospective, randomized clinical study documented that the semirecumbent position was associated with a significant reduction in VAP, more recent studies have documented that the semirecumbent position is difficult to maintain in mechanically ventilated patients and may not impact VAP reduction. Prophylaxis for peptic ulcer disease and deep venous thrombosis do not directly impact VAP reduction. Other methods to reduce VAP, such as oral care and hygiene, chlorhexidine in the posterior pharynx, and specialized endotracheal tubes (continuous aspiration of subglottic secretions, silver-coated), should be considered for inclusion in a revised Ventilator Bundle more specifically aimed at VAP prevention. The Ventilator Bundle is an effective method to reduce VAP rates in ICUs. The ventilator bundle should be modified and expanded to include specific processes of care that have been definitively demonstrated to be effective in VAP reduction or a specific VAP bundle created to focus on VAP prevention.

Ventilator associated pneumonia: perspectives on the burden of illness.

Science.gov (United States)

Cook, D

2000-01-01

The objective of this narrative review is to summarize selected current concepts and clinical evidence regarding the burden of illness of VAP, including its epidemiology, diagnosis, attributable mortality and risk factors. Studies were identified through MEDLINE, EMBASE, bibliographies of primary and review articles and personal files. While cross sectional studies inform us about VAP prevalence, longitudinal studies inform us of the cumulative risk and conditional risk of developing VAP. Reported VAP rates are modulated by factors related to case mix, causative microorganisms, interventions that influence risk over time, and VAP definitions employed. Population-specific and organism-specific VAP rates are needed to avoid misleading benchmarking between different ICUs, and to minimize inappropriate between-study comparisons. Observational studies have shown that invasive sampling techniques versus non-invasive approaches to diagnose VAP facilitates more targeted antibiotic treatment; however, the influence of the diagnostic method on endpoints such as mortality is less clear. VAP is associated with approximately a 4 day increase in length of ICU stay and an attributable mortality of approximately 20-30%. Fixed VAP risk factors include underlying cardiorespiratory disease, neurologic injury and trauma. Modifiable VAP risk factors include supine body position, witnessed aspiration, paralytic agents and antibiotic exposure. If modifiable risk factors tested in randomized trials lower VAP rates, such as semirecumbency versus supine positioning, these represent effective VAP prevention strategies. Ventilator-associated pneumonia is a major morbid outcome among critically ill patients. Studies evaluating more effective prevention and treatment strategies are needed.

SPIE Smart Structures Product Implementation Award: a review of the first ten years

Science.gov (United States)

Anderson, Eric H.; Sater, Janet M.

2007-04-01

The research field of smart materials and structures has been a distinct entity for two decades. Over the past ten years, the SPIE Industrial and Commercial Applications Conference has presented a Smart Structures Product Implementation Award at its annual symposium. This paper revisits the nine winning entries to date (1998-2007) and updates their status. The paper begins with a brief description of the original and current intent of the award and follows with a short overview of the evolution of smart structures, from research to products. The winning teams and their respective products are then described. The current status of the products is discussed based on publicly available information and input from the respective companies. Note however that it is not the purpose of the paper to rank the product winners in terms of success or sales. The paper concludes with an assessment of the larger trends in productization of smart structures technologies. The application "form" for the award as well as the evaluation criteria and suggestions for improving award application packages can be found in the appendix.

An Analysis of the Impact of AHLTA Implementation on Provider Productivity at Naval Hospital Jacksonville, FL

Science.gov (United States)

2007-08-29

International Journal of Production Economics (Anonymous, 2007), organizations feel pressure from stakeholders to...curves may lead to decreased output. During implementation AHLTA utilization may decrease, an article published by the International Journal of Production Economics (2007...and other military-unique factors as the most significant differences between the groups. Limitations According to the International Journal of

Increased constituent ratios of Klebsiella sp., Acinetobacter sp., and Streptococcus sp. and a decrease in microflora diversity may be indicators of ventilator-associated pneumonia: a prospective study in the respiratory tracts of neonates.

Directory of Open Access Journals (Sweden)

Wei Lu

Full Text Available Ventilator-associated pneumonia (VAP is a common complication and cause of death in neonates on mechanical ventilation. However, it is difficult to define the causes of VAP. To understand the causes of VAP, we undertook a prospective study based on the diversity of the microflora in VAP. The experimental group consisted of newborns who suffered from respiratory distress syndrome (RDS and VAP, while the control group suffered from RDS without VAP. Sputa were collected within 1, 3, and 5 days of ventilation and were divided into six groups. DNA was extracted from the samples, and the 16S rDNA was PCR amplified, separated using denaturing gradient gel electrophoresis (DGGE, cloned and sequenced. The resulting sequences were compared using BLAST. The DGGE pictures were measured, and the richness, Shannon-Wiener index, and cluster maps were analyzed. No differences were found regarding the constituent ratio of any genus between the Non-VAP and VAP group within 1 day after intubation. After 1 to 3 days, the constituent ratios of Klebsiella sp., Acinetobacter sp., and Streptococcus sp. in the VAP group were higher than those in the Non-VAP group, and the ratios of Serratia sp. and Achromobacter sp. were lower. After 3 to 5 days, the ratios of Klebsiella sp., Acinetobacter sp., Serratia sp., and Achromobacter sp. were lower than those in the Non-VAP group. The richness and Shannon-Wiener index of the Non-VAP group were higher than those of the VAP group from 1 to 3 days after intubation, while no differences were found within 1 day and from 3 to 5 days. We conclude that during the first three days of intubation, the microflora diversity in the lower respiratory tract was reduced due to VAP, and the greater constituent ratios of Klebsiella sp., Acinetobacter sp., and Streptococcus sp. in the sputum may be indicators of VAP.

Ventilator-associated pneumonia in surgical emergency intensive care unit.

Science.gov (United States)

Ertugrul, Bulent M; Yildirim, Ayse; Ay, Pinar; Oncu, Serkan; Cagatay, Atahan; Cakar, Nahit; Ertekin, Cemalettin; Ozsut, Halit; Eraksoy, Haluk; Calangu, Semra

2006-01-01

To investigate the incidence, risk factors and the etiology of ventilator-associated pneumonia (VAP) in surgical emergency intensive care unit (ICU) patients. We conducted this prospective cohort study in the surgical emergency ICU of Istanbul Medical Faculty between December 1999 and May 2001. We included 100 mechanically ventilated patients in this study. We diagnosed VAP according to the current diagnostic criteria. We identified the etiology of VAP cases by both quantitative cultures of endotracheal aspiration and blood cultures. To analyze the predisposing factors for the development of VAP, we recorded the following variables: age, gender, acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma scale (GCS), sequential organ failure assessment (SOFA) score, serum albumin level, duration of mechanical ventilation (MV) prior to the development of VAP, and underlying diseases. We determined the VAP incidence rate as 28%. We found the APACHE II score and the duration of MV to be statistically significant variables for the development of VAP. There were no significant differences regarding age, gender, GCS, SOFA score, albumin level, or underlying diseases for the development of VAP. The isolated bacteria among VAP cases were as follows: Staphylococcus aureus (n=12, 43%), Acinetobacter spp. (n=6, 21%), coagulase-negative Staphylococci (n=4, 15%), Pseudomonas aeruginosa (n=3, 10.7%) and Klebsiella pneumoniae (n=3, 10.7%). Ventilator-associated pneumonia is a common infection, and certain interventions might affect the incidence of VAP. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to minimize the risk of VAP.

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

Science.gov (United States)

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

Production cell implementation in the facade execution: a construction case study

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Renato Nunes Mariz

2014-05-01

Full Text Available The construction industry is an environment with much waste. An alternative that could minimize this problem is Lean Thinking, as it focuses on eliminating waste. A widely used tool in lean manufacturing is the production cell, whose main goal is to keep production in continuo flow. In the construction context, the applications of this tool are still incipient, arousing the interest to be further investigated. The aim of this study is to analyze how a production cell was applied in a facade service execution and evaluate this result. We used the case study method in a contractor with experience in facades execution. We collected qualitative data (in situ observations and interviews with employees and quantitative (time and cost data supplied by the contractor. After the data were analyzed (before and after cell implementation Through analysis and literature review we decided to follow those steps: a methods b materials c people d equipments and machines. The results point out improvement in the employee relationship with the administration, increased employee commitment, cost savings with direct labor and increase the pay received by employees. This paper contributes to expanding the use of this tool (production cell in the construction and shows that through this application, many benefits can be achieved.

Evaluation of the New Centers for Disease Control and Prevention Ventilator-Associated Event Module and Criteria in Critically Ill Children in Greece.

Science.gov (United States)

Iosifidis, Elias; Chochliourou, Elpis; Violaki, Asimenia; Chorafa, Elisavet; Psachna, Stavroula; Roumpou, Afroditi; Sdougka, Maria; Roilides, Emmanuel

2016-10-01

OBJECTIVE To evaluate the new adult Centers for Disease Control and Prevention (CDC) ventilator-associated event (VAE) module in critically ill children and compare with the traditionally used CDC definition for ventilator-associated pneumonia (VAP). DESIGN Retrospective observational study of mechanically ventilated children in a pediatric intensive care unit in Greece January 1-December 31, 2011. METHODS Assessment of new adult CDC VAE module including 3 definition tiers: ventilator-associated condition (VAC), infection-related VAC, and possible/probable ventilator-associated pneumonia (VAE-VAP); comparison with traditional CDC criteria for clinically defined pneumonia in mechanically ventilated children (PNEU-VAP). We recorded Pediatric Risk of Mortality score at admission (PRISM III), number of ventilator-days, and outcome. RESULTS Among 119 patients with mechanical ventilation (median [range] number of ventilator-days, 7 [1-183]), 19 patients experienced VAC. Criteria for VAE-VAP were fulfilled in 12 of 19 patients with VAC (63%). Children with either VAC or VAE-VAP were on ventilation more days than patients without these conditions (16.5 vs 5 d, P=.0006 and 18 vs 5 d, PVAC (31.6%), than the patients without new VAE-VAP (14%, P=.007) or VAC (15%, P=.1), respectively. No significant association was found between PNEU-VAP and death. Incidences of PNEU-VAP and VAE-VAP were similar, but the agreement was poor. CONCLUSIONS VAE-VAP and PNEU-VAP found similar prevalence in critically ill children but with poor agreement. However, excess of death was significantly associated only with VAE-VAP. Infect Control Hosp Epidemiol 2016:1-5.

Perfil de suscetibilidade antimicrobiana e presença do gene vapA em Rhodococcus equi de origem humana, ambiental e equina

Directory of Open Access Journals (Sweden)

Lilian Kolling Girardini

2013-06-01

Full Text Available Rhodococcus equi é um micro-organismo intracelular facultativo, agente etiológico da rodococose, uma importante enfermidade que acomete principalmente potros com menos de seis meses de idade, causando a morte geralmente em decorrência de lesões pulmonares. Este agente também tem potencial zoonótico e emergiu como um patógeno oportunista no mundo, acometendo humanos imunocomprometidos, especialmente os transplantados e infectados pelo vírus da imunodeficiência humana (HIV. Entretanto, infecções por R. equi em hospedeiros hígidos tem sido relatadas, principalmente em crianças e idosos. Estudos tem mostrado um nível crescente na resistência de isolados de R. equi em relação aos antimicrobianos comumente utilizados no tratamento de animais e seres humanos infectados por este agente. A virulência deste pode estar associada a fatores como a cápsula de polissacarídeo, fosfolipase C e à enzima colesterol oxidase (fator equi. No entanto, uma proteína localizada em um plasmídeo, designada vapA, é essencial para a sobrevivência e replicação do agente em macrófagos. Com isso, os objetivos deste estudo foram avaliar o perfil de suscetibilidade de isolados de R. equi de diferentes fontes em relação aos antimicrobianos mais comumente utilizados na terapêutica animal e humana, bem como verificar a associação entre a presença do gene vapA e o índice de resistência múltipla aos antimicrobianos (IRMA. Neste estudo, 67 isolados brasileiros de R. qui de diferentes fontes foram analisados: 30 provenientes de amostras clínicas de equinos, sete de humanos e 30 ambientais (seis do solo e 24 de fezes de equinos. Para avaliar o perfil de suscetibilidade dos isolados utilizou-se o método de disco difusão, sendo testadas 16 drogas de diferentes classes de antimicrobianos. As amostras clínicas de equinos apresentaram as maiores taxas de resistência à penicilina (86,7% e lincomicina (30%. Além disso, foram também resistentes a

Implementation of Releasing Time to Care - the productive ward.

Science.gov (United States)

Wilson, Gwyneth

2009-07-01

This paper describes the implementation of the NHS Institute for Innovation and Improvement Productive Ward - releasing time to care programme. It will discuss the benefits and key successes and provides advice for those wishing to implement the programme. In Lord Darzi's Next Stage Review, he advocates an ambitious vision of patient centred - clinician led, locally driven NHS. The Releasing Time to Care programme is a unique opportunity for everyone working within the NHS to improve effectiveness, safety and reliability of the services we provide. Whilst being situated within a National Health Service policy environment learning from this work can be translated nationally and internationally, as the principles underpin the provision of high quality care. Evaluation is currently in relation to each of the 15 modules rather than as the programme as a whole. It uses various methods including audit, observation, activity follow through, satisfaction surveys and process mapping. Each month data is colated for each of the 11 metrics which has shown a reduction in falls, drug administration errors and improvement in the recording of patient observations. One of the key issues is that an essential component for the success of the programme lies in the tangible support of the Trust Board/Board of Directors. Evidence shows that this programme improves patient satisfaction as it enables the provision of an increase in direct patient care by staff and subsequently improved clinical and safety outcomes. Ward Sister/Charge Nurse development includes Leadership, Project management and Lean Methodology techniques. The Releasing Time to Care programme is a key component of the Next Stage Review. It will create productive organisations by being a catalyst for the transformation of Trust services, enabling staff to spend more time caring for patients and users. This release in time will result in better outcomes and subsequent improvement with patient and staff satisfaction and

Work efficiency improvement of >90% after implementation of an annual inpatient blood products administration consent form.

Science.gov (United States)

Lindsay, Holly; Bhar, Saleh; Bonifant, Challice; Sartain, Sarah; Whittle, Sarah B; Lee-Kim, Youngna; Shah, Mona D

2018-01-01

Paediatric haematology, oncology and bone marrow transplant (BMT) patients frequently require transfusion of blood products. Our institution required a new transfusion consent be obtained every admission. The objectives of this project were to: revise inpatient blood products consent form to be valid for 1 year, decrease provider time spent consenting from 15 to improve provider frustration with the consent process. Over 6 months, we determined the average number of hospitalisations requiring transfusions in a random sampling of haematology/oncology/BMT inpatients. We surveyed nurses and providers regarding frustration levels and contact required regarding consents. Four and 12 months after implementation of the annual consent, providers and nurses were resurveyed, and new inpatient cohorts were assessed. Comparison of preintervention and postintervention time data allowed calculation of provider time reduction, a surrogate measure of improved work efficiency. Prior to the annual consent, >33 hours were spent over 6 months obtaining consent on 40 patients, with >19 hours spent obtaining consent when no transfusions were administered during admission. Twelve months after annual consent implementation, 97.5% (39/40) of analysed patients had a completed annual blood products transfusion consent and provider work efficiency had improved by 94.6% (>30 hours). Although several surveyed variables improved following annual consent implementation, provider frustration with consent process remained 6 out of a max score of 10, the same level as prior to the intervention. Development of an annual inpatient blood products consent form decreased provider time from 15 to 90%.

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies.

Science.gov (United States)

Nora, David; Póvoa, Pedro

2017-11-01

Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability.

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

OpenAIRE

Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis

2007-01-01

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is as...

Implementation of electroweak corrections in the POWHEG BOX: single W production

CERN Document Server

Barzè, L; Nason, P; Nicrosini, O; Piccinini, F

2012-01-01

We present a fully consistent implementation of electroweak and strong radiative corrections to single W hadroproduction in the POWHEG BOX framework, treating soft and collinear photon emissions on the same ground as coloured parton emissions. This framework can be easily extended to more complex electroweak processes. We describe how next-to-leading order (NLO) electroweak corrections are combined with the NLO QCD calculation, and show how they are interfaced to QCD and QED shower Monte Carlo. The resulting tool fills a gap in the literature and allows to study comprehensively the interplay of QCD and electroweak effects to W production using a single computational framework. Numerical comparisons with the predictions of the electroweak generator HORACE, as well as with existing results on the combination of electroweak and QCD corrections to W production, are shown for the LHC energies, to validate the reliability and accuracy of the approach

Assessment of Critical Care Provider's Application of Preventive Measures for Ventilator-Associated Pneumonia in Intensive Care Units.

Science.gov (United States)

Bagheri-Nesami, Masoumeh; Amiri-Abchuyeh, Maryam; Gholipour-Baradari, Afshin; Yazdani-Cherati, Jamshid; Nikkhah, Attieh

2015-08-01

The implementation of guidelines for the prevention of Ventilator-associated pneumonia has been shown to have a significant effect in reducing the incidence of VAP. The aim of the present study was to evaluate the implementation of the preventive strategies for VAP in ICUs of university hospitals of Sari, Iran. This cross-sectional study was carried out in 600 beds/day in the ICUs of university hospitals of Sari from April to June 2012. Sampling was done by availability technique in patients receiving mechanical ventilation in the ICU. The implementation of the preventive measures was assessed by a standard checklist with previously approved validity and reliability. The percentage of implementing each of the measures was as follows: sterile suction, 88.44%; semi-recumbent position, 76.8%; oral hygiene, 58.45%; using heat and moisture exchanges (HMEs), 58%; controlling cuff pressure, 46.8%; hand hygiene, 32.8%; using anti-coagulants, 26.8% and physiotherapy, 25.5%. Closed suction system, continuous drainage of subglottic secretions and kinetic beds were not used at all. The overall mean percentage of implementing preventive measures was low and required designing integrated guidelines by considering the conditions of the ICUs in each country, as well as educating and encouraging the staffs to use the recommended guidelines.

Total Productive Maintenance And Role Of Interpretive Structural Modeling And Structural Equation Modeling In Analyzing Barriers In Its Implementation A Literature Review

OpenAIRE

Prasanth S. Poduval; Dr. Jagathy Raj V. P.; Dr. V. R. Pramod

2015-01-01

Abstract - The aim of the authors is to present a review of literature of Total Productive Maintenance and the barriers in implementation of Total Productive Maintenance TPM. The paper begins with a brief description of TPM and the barriers in implementation of TPM. Interpretive Structural Modeling ISM and its role in analyzing the barriers in TPM implementation is explained in brief. Applications of ISM in analyzing issues in various fields are highlighted with special emphasis on TPM. T...

Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score.

Science.gov (United States)

Jung, Boris; Embriaco, Nathalie; Roux, François; Forel, Jean-Marie; Demory, Didier; Allardet-Servent, Jérôme; Jaber, Samir; La Scola, Bernard; Papazian, Laurent

2010-05-01

Early and adequate treatment of ventilator-associated pneumonia (VAP) is mandatory to improve the outcome. The aim of this study was to evaluate, in medical ICU patients, the respective and combined impact of the Clinical Pulmonary Infection Score (CPIS), broncho-alveolar lavage (BAL) gram staining, endotracheal aspirate and a biomarker (procalcitonin) for the early diagnosis of VAP. Prospective, observational study A medical intensive care unit in a teaching hospital. Over an 8-month period, we prospectively included 57 patients suspected of having 86 episodes of VAP. The day of suspicion, a BAL as well as alveolar and serum procalcitonin determinations and evaluation of CPIS were performed. Of 86 BAL performed, 48 were considered positive (cutoff of 10(4) cfu ml(-1)). We found no differences in alveolar or serum procalcitonin between VAP and non-VAP patients. Including procalcitonin in the CPIS score did not increase its accuracy (55%) for the diagnosis of VAP. The best tests to predict VAP were modified CPIS (threshold at 6) combined with microbiological data. Indeed, both routinely twice weekly performed endotracheal aspiration at a threshold of 10(5) cfu ml(-1) and BAL gram staining improved pre-test diagnostic accuracy of VAP (77 and 66%, respectively). This study showed that alveolar procalcitonin performed by BAL does not help the clinician to identify VAP. It confirmed that serum procalcitonin is not an accurate marker of VAP. In contrast, microbiological resources available at the time of VAP suspicion (BAL gram staining, last available endotracheal aspirate) combined or not with CPIS are helpful in distinguishing VAP diagnosed by BAL from patients with a negative BAL.

Study of Characteristics, risk factors and outcome for Ventilator Associated Pneumonia in Neonatal Intensive Care Unit patient

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Mehdi Moradi

2013-09-01

Full Text Available Background: Ventilator Associated Pneumonia (VAP, developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates.Methods: Neonates admitted to neonatal intensive care unit (NICU, over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death.Results: Thirty eight patients were enrolled (58% were boys and 42% were girls. 42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni (43%. On multiple regression analysis, duration of mechanical ventilation was associated with VAP (P=0.00. Patients with VAP had greater need for mechanical ventilation (18.7 vs 6 median days, longer NICU length of stay (39 vs 21.5 median days and higher total median hospital costs (79.5 vs 52 million rials than those without VAP. The mortality rate was not different between two groups.Conclusion: In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn’t increase mortality in patients.

17 CFR 39.4 - Procedures for implementing derivatives clearing organization rules and clearing new products.

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Procedures for implementing derivatives clearing organization rules and clearing new products. 39.4 Section 39.4 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION DERIVATIVES CLEARING ORGANIZATIONS § 39.4 Procedures for...

The influence of ERP implementation on the division of power at the production-sales interface

NARCIS (Netherlands)

de Vries, J.; Boonstra, A.

2012-01-01

Purpose - The purpose of this paper is to develop and validate a model that demonstrates the influence of enterprise resource planning (ERP) implementation on the power and interests of actors at the production-sales interface, and vice versa. Design/methodology/approach - An empirical in-depth

[Effect of continuous aspiration of subglottic secretions on the prevention of ventilator-associated pneumonia in mechanically ventilated patients: a prospective, randomized, controlled clinical trial].

Science.gov (United States)

Yang, Cong-shan; Qiu, Hai-bo; Zhu, Yan-ping; Huang, Ying-zi; Xu, Xiao-ting; Gao, Liang

2008-08-01

To evaluate the effect of continuous aspiration of subglottic secretions (CASS) on the prevention of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Patients ventilated mechanically at the ICU from October, 2004 to April, 2006 were randomly divided into 2 groups: one group received CASS and the other did not (NASS group). CASS was performed immediately after admission for patients in the CASS group. The diagnosis of VAP was made based on clinical presentations, and the evaluation of VAP was done using simplified version of the clinical pulmonary infection score (CPIS). The general status of the patients, days of ventilated treatment, the volume of daily aspirated subglottic secretions, the morbidity and timing of VAP, days of stay in ICU and mortality within 28 days of hospitalization were recorded. One hundred and one patients were included in the study. There were 48 patients in the CASS group who were treated with mechanical ventilation more than 48 hours, and 43 patients in the NASS group. There was no significant difference in the general status of the patients and days of ventilation between 2 groups with the averaged score of APACHE II being 20.8 +/- 6.1. The average of CPIS was of 5.6 +/- 1.0 when VAP was diagnosed. The mean volume of aspirated subglottic secretions within the first 24 hours in the CASS group (n = 48) was (27.2 +/- 21.2) ml. The morbidity of VAP in the CASS and the NASS groups was 25.0% and 46.5% respectively (P = 0.032), and the length of time before the onset of VAP in these 2 groups was (7.3 +/- 4.2) days and (5.1 +/- 3.0) days respectively (P = 0.100). There was a significant increase in the percentage of gram-positive cocci from the lower respiratory tracts in the NASS group compared with that in the CASS group (P = 0.004). In the CASS group, the volume of the first daily aspirated subglottic secretions in patients with VAP was significantly less than that in patients without VAP (P = 0.006). The morbidity of

Discussion after implementation of possible ergonomics contributions in production lines automation project

OpenAIRE

José Adriano Canton; Andrea Regina Martins Fontes; Isaías Torres

2016-01-01

This paper addresses the issue of work spaces designed based on Activity-Centered Ergonomics. The aim was to reflect on the role of Ergonomics in the design of productive situations in order to anticipate and mitigate the emergence of new constraints. This study was developed using a case study from the packaging industry, where an automated line was implemented to mitigate the injuries suffered as result of the manual system. This article was based on the results of an Ergonomic Work Analysi...

APPROACHES TO IMPLEMENTATION OF AN INTEGRATED MANAGEMENT SYSTEM IN THE PHARMACEUTICAL INDUSTRY. GALENICAL PHARMACEUTICAL PRODUCTION

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Ershova Elena Vladimirovna

2015-10-01

Full Text Available This article reviews the issues associated with development of an integrated quality management system and its implementation into a galenical pharmaceutical company. Recently, the Russian pharmaceutical industry has been developing extensively: pharmaceutical clusters are being formed, new and innovative technologies are being developed. For the enterprises producing galenical pharmaceutical products, which feature low prices and a high level of competition, development and implementation of management systems is a way to prove their competitiveness. The purpose of this article is to review the architecture and the key elements of integrated management systems for pharmaceutical enterprises, develop an integrated management system in terms of the upcoming revision of ISO 9001:2015, as well as to describe the benefits of implementation of such systems. The presented approach is the result of an educational project implemented within the framework of the MBA programme in "Master of Business Administration (MBA" in the Federal State Budgetary Educational Institution of Continuing Professional Education Pastukhov State Academy of Industrial Management.

Management of barriers to lean production implementation: a study in the automotive sector

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Filipe de Almeida Copetti

2016-03-01

Full Text Available During the process of lean production (LP implementation it is common to arise barriers depending on the context in which the application occurs. This study aims to perfect a method of management the barriers to the implementation of LP developed in a previous study. The improvements were developed by applying the method in the assembly area of bumpers in a car manufacturer. Data collection involved thirteen interviews, participant observation for six months and analysis of LP-related documents. Among the main improvements over the original version of the method, it can be highlighted the addition of thirteen barriers in the list of barriers already identified in the literature, and also the identification of contextual characteristics that can facilitate or hinder the application of the method.

Diagnostic Performance of Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Ventilator-Associated Pneumonia of Patients with Ischemic Stroke.

Science.gov (United States)

Yu, Yuetian; Zhu, Cheng; Liu, Chunyan; Gao, Yuan; Yin, Rong; Cao, Jianguo

2017-01-01

Objective . To investigate the effect of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in serum, bronchoalveolar lavage fluid (BALF), endotracheal aspiration (ETA), and exhaled breath condensate (EBC) samples as early biomarkers for the diagnosis of ventilator-associated pneumonia (VAP) in patients with ischemic stroke. Methods . One hundred and thirty-two patients with clinically suspected VAP were enrolled in this study. Bronchoscopy was performed on the day of clinically suspected VAP. sTREM-1 levels in serum, BALF, ETA, and EBC were measured. VAP was diagnosed by quantitative cultures of BALF (≥10 4  cfu/mL). Results . VAP was confirmed in 76 (57.58%) cases. Patients with VAP showed significantly higher sTREM-1 in BALF [32.35 (IQR, 30.08-41.72) versus 18.92 (11.89-31.72)] pg/mL and in EBC [1.57 (IQR, 1.02-2.61) versus 0.41 (0.19-1.61)] pg/mL than patients without VAP. The area under the curve was 0.813 ( p VAP.

Development and implementation of an herbal and natural product elective in undergraduate medical education.

Science.gov (United States)

Karpa, Kelly

2012-05-22

Medical students have consistently expressed interest in learning about alternative healing modalities, especially herbal and natural products. To fill this void in medical education at our institution, a novel elective was developed and implemented for fourth year medical students. This herbal/natural product course uses guest lecturers, classroom presentations, and active learning mechanisms that include experiential rotations, case-based learning, and team-based learning to increase student knowledge of herbal/natural product safety and efficacy. Knowledge outcomes were evaluated via administration of a pre- and post-course test (paired student t-test). End-of-course evaluations (Likert-type questions and narrative responses) were used to assess student opinion of knowledge and skills imparted by the elective and overall course content (mean, standard deviation). Over three academic years, 23 students have enrolled in this elective. More than 60% of participants have been female and nearly half of the students (43%) have pursued residencies in primary care. Completion of the course significantly increased student knowledge of common herbal/natural product mechanisms, uses, adverse effects, and drug-interactions as determined by a pre- and post-course knowledge assessment (45%±10% versus 78%±6%; pvariety of activities to which they were exposed and the open classroom discussions that resulted. While students tended to view some alternative medical systems with skepticism, they still believed it was valuable to learn what these modalities encompass. Development and implementation of a herbal/natural product elective that engages undergraduate medical students through active learning mechanisms and critical analysis of the literature has proven effective in increasing knowledge outcomes and is deemed to be a valuable curricular addition by student participants. In the future, it will be of interest to explore mechanisms for expanding the course to reach a larger

Alternative approaches to ventilator-associated pneumonia prevention.

Science.gov (United States)

Berra, L; Sampson, J; Fumagalli, J; Panigada, M; Kolobow, T

2011-03-01

Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. Ideally, the elimination of the mechanisms responsible for aspiration would decrease the incidence of VAP. Several preventive measures have been tested in clinical trials with little success.Here we present the results of our efforts to develop novel approaches for the prevention of VAP. Specifically, we found that keeping ventilated patients in a lateral position, which eliminates gravitational forces, is feasible and possibly advantageous. Additionally, several novel medical devices have been recently developed to prevent bacterial biofilm formation from the ETT and breathing tubing. These devices include coated ETTs, mucus shavers and mucus slurpers. Prevention of ETT bacterial colonization showed decreased bacterial colonization of the respiratory circuit and of the lower respiratory tract in laboratory studies and clinical trials. Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented.

Developing a new, national approach to surveillance for ventilator-associated events*.

Science.gov (United States)

Magill, Shelley S; Klompas, Michael; Balk, Robert; Burns, Suzanne M; Deutschman, Clifford S; Diekema, Daniel; Fridkin, Scott; Greene, Linda; Guh, Alice; Gutterman, David; Hammer, Beth; Henderson, David; Hess, Dean; Hill, Nicholas S; Horan, Teresa; Kollef, Marin; Levy, Mitchell; Septimus, Edward; VanAntwerpen, Carole; Wright, Don; Lipsett, Pamela

2013-11-01

To develop and implement an objective, reliable approach to surveillance for ventilator-associated events in adult patients. The Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group in September 2011. Working Group members included representatives of stakeholder societies and organizations and federal partners. The Working Group finalized a three-tier, adult surveillance definition algorithm for ventilator-associated events. The algorithm uses objective, readily available data elements and can identify a broad range of conditions and complications occurring in mechanically ventilated adult patients, including but not limited to VAP. The first tier definition, ventilator-associated condition (VAC), identifies patients with a period of sustained respiratory deterioration following a sustained period of stability or improvement on the ventilator, defined by changes in the daily minimum fraction of inspired oxygen or positive end-expiratory pressure. The second tier definition, infection-related ventilator-associated complication (IVAC), requires that patients with VAC also have an abnormal temperature or white blood cell count, and be started on a new antimicrobial agent. The third tier definitions, possible and probable VAP, require that patients with IVAC also have laboratory and/or microbiological evidence of respiratory infection. Ventilator-associated events surveillance was implemented in January 2013 in the CDC's National Healthcare Safety Network. Modifications to improve surveillance may be made as additional data become available and users gain experience with the new definitions.

Gastropulmonary Route of Infection and the Prevalence of Microaspiration in the Elderly Patients with Ventilator-Associated Pneumonia Verified by Molecular Microbiology-GM-PFGE.

Science.gov (United States)

Liu, Qing-hua; Zhang, Jing; Lin, Dian-jie; Mou, Xiao-yan; He, Li-xian; Qu, Jie-ming; Li, Hua-yin; Hu, Bi-jie; Zhu, Ying-min; Zhu, Du-ming; Gao, Xiao-dong

2015-04-01

Gastropulmonary route of infection was considered to be an important mechanism of ventilator-associated pneumonia (VAP). However there is little evidence to support this assumption. Moreover, the prevalence of microaspiration in elderly ventilated patients was not well understood. To confirm gastropulmonary infection route and investigate the prevalence of microaspiration in elderly ventilated patients using genome macrorestriction-pulsed field gel electrophoresis (GM-PFGE). Patients over 60 years old, expected to receive mechanical ventilation longer than 48 h, were prospectively enrolled from October 2009 to January 2012. Clinical data were collected and recorded until they died, developed pneumonia, or were extubated. Samples from gastric fluid, subglottic secretion and lower respiratory tract (LRT) were collected during the follow-up for microbiological examination. To evaluate the homogeneity, GM-PFGE was performed on strains responsible for VAP that had the same biochemical phenotype as those isolated from gastric juice and subglottic secretions sequentially. Among 44 VAP patients, 76 strains were isolated from LRT and considered responsible for VAP. Twenty-two isolates had the same biochemical phenotype with the corresponding gastric isolates. The homology was further confirmed using GM-PFGE in 12 episodes of VAP. Nearly 30% of VAPs were caused by microaspiration based on the analysis of bacterial phenotype or GM-PFGE. In addition, 58.3% patients with gastric colonization developed VAP, especially late-onset VAP (LOP). Gastropulmonary infection route exists in VAP especially LOP in elderly ventilated patients. It is one of the important mechanisms in the development of VAP.

Implementing the Prepaid Smart Meter System for Irrigated Groundwater Production in Northern China: Status and Problems

Directory of Open Access Journals (Sweden)

Xiaowei Wang

2017-05-01

Full Text Available To reduce the gap between groundwater demand and supply caused by agricultural groundwater over-exploitation, the Prepaid Smart Meter System (PSMS is being strongly implemented by the Chinese government in northern China. This study reports the analysis and results of PSMS field surveys in six typical provinces in northern China as well as domestic literature reviews. Based on the architecture and implementation policies of the system, the implementation differences between areas and the influencing factors were analyzed, particularly the acknowledgment of farmers, the installation proportion of tube wells, the social benefits. Great achievements have been gained in the implementation, and the management targets have been achieved, including accurately metering overall irrigation groundwater production, assisting in the total amount control and quota management, reducing groundwater exploitation, and improving water use efficiency. However, shortcomings remain in the implementation process, such as single initial investment channels, imperfect policy system construction, a lack of retrieving and analyzing data, and the unbalanced development between areas. Countermeasures and suggestions for these problems are discussed in this article.

Aspiration and the risk of ventilator-associated pneumonia.

Science.gov (United States)

Parker, Chris M; Heyland, Daren K

2004-12-01

Ventilator-associated pneumonia (VAP) is a major concern in the intensive care unit. It is estimated that the risk of developing VAP may be as high as 1% per ventilated day, and the attributable mortality approaches 50% in some series. A growing body of evidence implicates the role of microaspiration of contaminated oropharyngeal and perhaps gastroesophageal secretions into the airways as an integral step in the pathogenesis of VAP. In patients who have been intubated and mechanically ventilated for >72 hours, the majority of VAP is caused by enteric gram-negative organisms, presumably of gastrointestinal origin. As a result, strategies designed to minimize the risk of these contaminated secretions into the normally sterile airways are of paramount importance in terms of VAP prevention. This review highlights the important etiological role of the gut in the development of VAP and also discusses the evidence behind interventions that may modulate the risk of both aspiration and subsequent VAP.

Scaling-up vaccine production: implementation aspects of a biomass growth observer and controller

OpenAIRE

Soons, Z.I.T.A.; IJssel, van den, J.; Pol, van der, L.A.; Straten, van, G.; Boxtel, van, A.J.B.

2009-01-01

Abstract This study considers two aspects of the implementation of a biomass growth observer and specific growth rate controller in scale-up from small- to pilot-scale bioreactors towards a feasible bulk production process for whole-cell vaccine against whooping cough. The first is the calculation of the oxygen uptake rate, the starting point for online monitoring and control of biomass growth, taking into account the dynamics in the gas-phase. Mixing effects and delays are caused by amongst ...

Blockade of vascular adhesion protein-1 inhibits lymphocyte infiltration in rat liver allograft rejection.

Science.gov (United States)

Martelius, Timi; Salaspuro, Ville; Salmi, Marko; Krogerus, Leena; Höckerstedt, Krister; Jalkanen, Sirpa; Lautenschlager, Irmeli

2004-12-01

Vascular adhesion protein-1 (VAP-1) has been shown to mediate lymphocyte adhesion to endothelia at sites of inflammation, but its functional role in vivo has not been tested in any rodent model. Here we report the effects of VAP-1 blockade on rat liver allograft rejection. BN recipients of PVG liver allografts (known to develop acute rejection by day 7) were treated with 2 mg/kg anti-VAP-1 (a new anti-rat VAP-1 mAb 174-5) or isotype-matched irrelevant antibody (NS1) every other day (n = 6/group) and one group with anti-VAP-1 2 mg/kg daily (n = 7). On day 7, samples were collected for transplant aspiration cytology, histology, and immunohistochemistry. Lymphocyte infiltration to the graft was clearly affected by VAP-blockade. The total inflammation, mainly the number of active lymphoid cells, in transplant aspiration cytology was significantly decreased in animals treated with anti-VAP-1 (4.7 +/- 1.0 and 2.4 +/- 1.0 corrected increment units, respectively) compared to control (6.6 +/- 1.0) (P VAP-1 plays an important role in lymphocyte infiltration to sites of inflammation, and, in particular, liver allograft rejection.

Improved production operating efficiencies through automation: Wascana Energy`s SCADA system implementation in southeast Saskatchewan

Energy Technology Data Exchange (ETDEWEB)

Knudsen, R; Foord, T; Bartle, A

1996-12-31

Supervisory control and data acquisition (SCADA) systems covering Wascana Energy`s whole southeast Saskatchewan operating area were implemented in 1994-95. The benefits of this automation were described. Operations practices were reviewed and a brief description of the system was provided. Main features of the system described included data storage/retrieval, data display, alarm group organization, alarm call out monitoring, dynagraph display, and the Microsoft SQL server computer. Automation was found to significantly change the operator`s traditional role and altered operation practices in general. SCADA systems were found to improve operating efficiencies and production performance significantly, when properly implemented and utilized. 6 refs., 3 figs.

A Study on Promotion and Implementation of Cleaner Production Practices in Malaysian Industry - Development of a National Program and Action Plan for Promotion of Cleaner Production. Progress Report 1

DEFF Research Database (Denmark)

Wangel, Arne

This Progress Report presents the initial findings of the research project 'A Study on Promotion and Implementation of Cleaner Production Practices in Malaysian Industry - Development of a National Program and Action Plan for Promotion of Cleaner Production. Progress Report' funded...

Experimental study of the protective effect of autoantibodies against the β3-adrenorceptor on heart function of rat model with heart failure

Directory of Open Access Journals (Sweden)

Yin-Wen Xia

2016-02-01

Full Text Available Objective: To explore the correlation of gastroesophageal reflux with ventilator-associated pneumonia (VAP. Methods: A total of 84 patients who were performed with mechanical assisted ventilation in our hospital were included in the study. The pharyngeal and tracheal secretions 2 d (T1, 4 d (T2, and 6 d (T3 after mechanical ventilation were collected, respectively. ELISA was used to detect the pepsin concentration. The clinical pulmonary infection score (CPIS was performed to the patients in order to analyze the correlation of pepsin concentration with CPIS. Results: The positive rate of pharyngeal pepsin at T1 was 16.7%, at T2 was 54.8%, and at T3 was 78.6%. The positive rate of pepsin was increased with the extending of mechanical ventilation time. The comparison of pepsin concentration in the pharyngeal secretions at T1 between the VAP patients and non-VAP patients was not statistically significant, but the pepsin concentration in the tracheal secretions was significantly higher than that in the non-VAP patients. The pepsin concentration in the pharyngeal and tracheal secretions at T2 and T3 in the VAP patients was significantly higher than that in the non-VAP patients. The pepsin concentration in the tracheal secretions in the VAP patients was associated with CPIS. Conclusions: The positive rate of pepsin concentration in the pharyngeal and tracheal secretions in the VAP patients is increased with the extending of mechanical ventilation time. The positive rate of pepsin concentration in the tracheal secretions at each timing point in the VAP patients is significantly higher than that in the non-VAP patients. The pepsin concentration in the pharyngeal and tracheal secretions in the VAP patients is positively correlated with CPIS.

Ventilator-associated pneumonia in ARDS patients: the impact of prone positioning. A secondary analysis of the PROSEVA trial.

Science.gov (United States)

Ayzac, L; Girard, R; Baboi, L; Beuret, P; Rabilloud, M; Richard, J C; Guérin, C

2016-05-01

The goal of this study was to assess the impact of prone positioning on the incidence of ventilator-associated pneumonia (VAP) and the role of VAP in mortality in a recent multicenter trial performed on patients with severe ARDS. An ancillary study of a prospective multicenter randomized controlled trial on early prone positioning in patients with severe ARDS. In suspected cases of VAP the diagnosis was based on positive quantitative cultures of bronchoalveolar lavage fluid or tracheal aspirate at the 10(4) and 10(7) CFU/ml thresholds, respectively. The VAP cases were then subject to central, independent adjudication. The cumulative probabilities of VAP were estimated in each position group using the Aalen-Johansen estimator and compared using Gray's test. A univariate and a multivariate Cox model was performed to assess the impact of VAP, used as a time-dependent covariate for mortality hazard during the ICU stay. In the supine and prone position groups, the incidence rate for VAP was 1.18 (0.86-1.60) and 1.54 (1.15-2.02) per 100 days of invasive mechanical ventilation (p = 0.10), respectively. The cumulative probability of VAP at 90 days was estimated at 46.5 % (27-66) in the prone group and at 33.5 % (23-44) in the supine group. The difference between the two cumulative probability curves was not statistically significant (p = 0.11). In the univariate Cox model, VAP was associated with an increase in the mortality rate during the ICU stay [HR 1.65 (1.05-2.61), p = 0.03]. HR increased to 2.2 (1.39-3.52) (p position group, age, SOFA score, McCabe score, and immunodeficiency. In severe ARDS patients prone positioning did not reduce the incidence of VAP and VAP was associated with higher mortality.

Novel Method to Improve Radiologist Agreement in Interpretation of Serial Chest Radiographs in the ICU

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Denise A Castro

2015-01-01

Full Text Available Objectives: To determine whether a novel method and device, called a variable attenuation plate (VAP, which equalizes chest radiographic appearance and allows for synchronization of manual image windowing with comparison studies, would improve consistency in interpretation. Materials and Methods: Research ethics board approved the prospective cohort pilot study, which included 50 patients in the intensive care unit (ICU undergoing two serial chest radiographs with a VAP placed on each one of them. The VAP allowed for equalization of density and contrast between the patients′ serial chest radiographs. Three radiologists interpreted all the studies with and without the use of VAP. Kappa and percent agreement was used to calculate agreement between radiologists′ interpretations with and without the plate. Results: Radiologist agreement was substantially higher with the VAP method, as compared to that with the non-VAP method. Kappa values between Radiologists A and B, A and C, and B and C were 46%, 55%, and 51%, respectively, which improved to 73%, 81%, and 66%, respectively, with the use of VAP. Discrepant report impressions (i.e., one radiologist′s impression of unchanged versus one or both of the other radiologists stating improved or worsened in their impression ranged from 24 to 28.6% without the use of VAP and from 10 to 16% with the use of VAP (χ2 = 7.454, P < 0.01. Opposing views (i.e., one radiologist′s impression of improved and one of the others stating disease progression or vice versa were reported in 7 (12% cases in the non-VAP group and 4 (7% cases in the VAP group (χ2 = 0.85, P = 0.54. Conclusion: Numerous factors play a role in image acquisition and image quality, which can contribute to poor consistency and reliability of portable chest radiographic interpretations. Radiologists′ agreement of image interpretation can be improved by use of a novel method consisting of a VAP and associated software and has the potential

Annex 15 of the IEA Hydrogen Implementing Agreement : Photobiological hydrogen production

Energy Technology Data Exchange (ETDEWEB)

Lindblad, P. [Uppsala Univ., Uppsala (Sweden)]|[International Energy Agency, Paris (France)

2004-07-01

Task 15 of the Hydrogen Implementation Agreement of the International Energy Agency is to advance the science of biophotosynthesis of hydrogen, which is the biological production of hydrogen from water and sunlight using microalgal photosynthesis. A practical process for biophotolysis would result in an innovative biological source of sustainable and environmentally benign renewable energy source. Japan, Norway, Sweden and the United States initially committed to the project. Since then Canada, the Netherlands and the United Kingdom have joined. The current task is to produce hydrogen from both green algae and cyanobacteria with focus on early-stage applied research on biophotolysis processes with intermediate carbon dioxide fixation. Significant advances have also occurred in the scientific field of cyanobacterial biohydrogen. Cyanobacteria has enzymes that metabolise hydrogen. Photosynthetic cyanobacteria have simple nutritional requirements and can grow in air, water, or mineral salts with light as the only source of energy. This research will help provide the advances needed to achieve practical efficiencies and cost objectives of biological hydrogen production. tabs., figs.

[Implementation of the HACCP system in the production line of the traditional sandwich in Phnom Penh City, Cambodia].

Science.gov (United States)

Lay, Kruy Sun; Song, Ping; Merch, Keuth; Sakona, Phoeurng; Buisson, Y

2004-02-01

From July 2000 to July 2001, the hazard analysis and critical control points (HACCP) system was implemented to the benefit of the traditional sandwich production in Phnom Penh City Sandwiches were initially analyzed for bacterial indicators among 6 large-scale producers during a 2 months period. In the second stage of the study, two selected producers were involved in the HACCP process. Microbiological analyses revealed a poor sanitary quality of samples from all the production lines tested. Implementation of HACCP method resulted in a reduction of microbial contamination, but this decrease was not significant compared with others steps of HACCP process (chi2 test for trend, p > 0.05). HACCP system was well accepted by producers but routine practices and wrong perception by production-line workers did limit the success of the process. A regulation on the mass catering sector should be part of a large strategy of food safety and environmental health in the city.

Assessment of a training programme for the prevention of ventilator-associated pneumonia

OpenAIRE

Jam Gatell, M Rosa; Santé Roig, Montserrat; Hernández Vian, Óscar; Carrillo Santín, Esther; Turégano Duaso, Concepción; Fernández Moreno, Inmaculada; Vallés Daunis, Jordi

2012-01-01

Background Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs). Most published studies have analysed nurses' theoretical knowledge about a specific procedure; however, the transfer of this knowledge to the practice has received little attention. Aim To assess the impact of training session on nurses' knowledge regarding VAP, compliance with VAP preventive measures, VAP incidence and determining whether nursing workload affects complia...

Total Productive Maintenance And Role Of Interpretive Structural Modeling And Structural Equation Modeling In Analyzing Barriers In Its Implementation A Literature Review

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Prasanth S. Poduval

2015-08-01

Full Text Available Abstract - The aim of the authors is to present a review of literature of Total Productive Maintenance and the barriers in implementation of Total Productive Maintenance TPM. The paper begins with a brief description of TPM and the barriers in implementation of TPM. Interpretive Structural Modeling ISM and its role in analyzing the barriers in TPM implementation is explained in brief. Applications of ISM in analyzing issues in various fields are highlighted with special emphasis on TPM. The paper moves on to introduction to Structural Equation Modeling SEM and its role in validating ISM in analyzing barriers in implementation of TPM. The paper concludes with a gap analysis from the current literature research that can be carried out and expected outcomes from the proposed research.

A framework for effective implementation of lean production in Small and Medium-sized Enterprises

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Amine Belhadi

2016-09-01

Full Text Available Purpose: The present paper aims at developing an effective framework including all the components necessary for implementing lean production properly in Small and Medium-sized Enterprises. Design/methodology/approach: The paper begins with the review of the main existing framework of lean implementation in order to highlight shortcomings in the literature through a lack of suitable framework for small companies. To overcome this literature gap, data of successful initiatives of lean implementation were collected based on a multiple case study approach. These initiatives has been juxtaposed in order to develop a new, practical and effective framework that includes all the components (process, tools, success factors that are necessary to implement lean in Small and Medium-sized Enterprises. Findings: The proposed framework presents many significant contributions: First, it provides an overcoming for the limitations of the existing frameworks by proposing for consultants, researchers and organizations an effective framework for lean implementation in SMEs that allows SMEs to benefit from competitive advantages  gained by lean. Second, it brings together a set of the more essential and critical elements of lean implementation commonly used by SMEs and derived from the practical experiences of them in lean implementation. Finally, it highlights the successful experiences of small companies in implementing lean programs and then proves that lean can give a relevant results even for SMEs. Research limitations/implications: The proposed framework presents a number of limitations and still evokes extension for further researches: Although it was derived from practical experiences of SMEs, the proposed framework is not supported by practical implementation. On the other hand and even though the elements in the proposed framework from the practical experiences of four SMEs, the identified elements need to be generalized and enriching by conducting

Implementation of heat production and storage technology and devices in power systems

International Nuclear Information System (INIS)

Romanovsky, G.; Mutale, J.

2012-01-01

Implementation of heat storage devices and technologies at power generation plants is a promising way to provide more efficient use of natural energy resources. Heat storage devices can partly replace conventional heating technologies (such as direct use of fossil fuels) during peak energy demand or in the situations where heat and electricity supply and demand do not coincide and to obtain low cost heat energy which can be further transmitted to industrial, commercial and domestic consumers. This paper presents the innovative Heat Production and Storage Device and its application at conventional, nuclear and renewable power generation plants for optimization and balancing of electricity grids. The Heat Production and Storage Device is a vessel type induction-immersion heat production and storage device which produces pre-heated water under pressure for heat energy conservation. Operation of this device is based on simultaneous and/or sequential action of an inductor and an immersion heater and can be easily connected to the electricity network as a single or a three phase unit. Heat energy accumulated by the Heat Production and Storage Device can be utilized in different industrial technological processes during periods of high energy prices. - Highlights: ► Heat Production and Storage Device for energy conservation within low load hours. ► Simultaneous and/or sequential operation of the inductor and immersion heater. ► Transform the energy of low frequency electrical current (50 Hz) into heat energy. ► Connection to the electricity network either in single or three phase unit. ► Heat Production and Storage Device will enhance the economic value of the system.

Predictive value of α-amylase in tracheal aspirates for ventilator-associated pneumonia in elderly patients.

Science.gov (United States)

Qu, Ge-Ping; Fang, Xiang-Qun; Xu, Ya-Ping; Shi, Min; Wang, Yang; Gong, Mei-Liang; Fang, Hao-Ming

2018-04-01

This study aims to investigate the correlation between α-amylase in tracheal aspirates and risk factors of aspiration, as well as ventilator-associated pneumonia (VAP), in elderly patients undergoing mechanical ventilation and explore the clinical value of α-amylase for predicting VAP. Tracheal aspirates were collected from elderly patients within 2 weeks after tracheal intubation in mechanical ventilation, and α-amylase was detected. Patients were grouped according to the presence of VAP. The correlation between α-amylase and risk factors of aspiration before intubation, as well as VAP, were analyzed. The sample of this study comprised 147 patients. The average age of these patients was 86.9 years. The incidence of VAP was 21% during the study period. Tracheal aspirate α-amylase level increased with the increase in the number of risk factors for aspiration before intubation, α-amylase level was significantly higher in the VAP group than in the non-VAP group, the area under the receiver operating characteristic curve (ROC) of the diagnostic value of α-amylase for VAP was 0.813 (95% CI: 0.721-0.896), threshold value was 4,681.5 U/L, sensitivity was 0.801 and specificity was 0.793. Logistic multivariate analysis revealed the following risk factors for VAP: a number of risk factors before intubation of ≥3, a Glasgow score of aspiration of subglottic secretion and a tracheal aspirate α-amylase level of >4681.5 U/L. Tracheal aspirate α-amylase can serve as a biomarker for predicting VAP in elderly patients undergoing mechanical ventilation. © 2017 John Wiley & Sons Ltd.

Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia?

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Hadi Darvishi Khezri

2016-01-01

Full Text Available Background: Ventilator-associated pneumonia (VAP is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV in the intensive care unit (ICU. Patients with type 2 diabetes mellitus (T2DM are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients. Materials and Methods: This study is a secondary analysis of a prospective observational study of the history of T2DM in the ICU over a period of 1 year at Imam Khomeini Hospital in Iran. A total of 186 critically ill trauma patients who required at least 48 h of MV were monitored for the occurrence of VAP by their clinical pulmonary infection score (CPIS until ICU discharge, VAP diagnosis, or death. Results: Forty-one of the 186 patients developed VAP. The median time from hospitalization to VAP was 29.09 days (95% CI: 26.27-31.9. The overall incidence of VAP was 18.82 cases per 1,000 days of intubation (95% CI: 13.86-25.57. Risk of VAP in diabetic patients was greater than nondiabetic patients after adjustments for other potential factors [hazard ratio (HR: 10.12 [95% confidence interval (CI: 5.1-20.2; P < 0.0001]. Conclusion: The findings show that T2DM is associated with a significant increase in the occurrence of VAP in mechanically ventilated adult trauma patients.

Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support: Epidemiology and risk factors of treatment failure.

Science.gov (United States)

Bouglé, Adrien; Bombled, Camille; Margetis, Dimitri; Lebreton, Guillaume; Vidal, Charles; Coroir, Marine; Hajage, David; Amour, Julien

2018-01-01

Ventilator-associated pneumonia (VAP) is frequent in Intensive Care Unit (ICU) patients. In the specific case of patients treated with Veno-Arterial Extracorporeal Membrane Oxygenation Support (VA-ECMO), VAP treatment failures (VAP-TF) have been incompletely investigated. To investigate the risk factors of treatment failure (VAP-TF) in a large cohort of ICU patients treated with VA-ECMO, we conducted a retrospective study in a Surgical ICU about patients assisted with VA-ECMO between January 1, 2013, and December 31, 2014. Diagnosis of VAP was confirmed by a positive quantitative culture of a respiratory sample. VAP-TF was defined as composite of death attributable to pneumonia and relapse within 28 days of the first episode. In total, 152 patients underwent ECMO support for > 48h. During the VA-ECMO support, 85 (55.9%) patients developed a VAP, for a rate of 60.6 per 1000 ECMO days. The main pathogens identified were Pseudomonas aeruginosa and Enterobacteriaceae. VAP-TF occurred in 37.2% of patients and was associated with an increased 28-day mortality (Hazard Ratio 3.05 [1.66; 5.63], P<0.001), and VA-ECMO assistance duration (HR 1.47 [1.05-2.05], P = 0.025). Risk factors for VAP-TF were renal replacement therapy (HR 13.05 [1.73; 98.56], P = 0.013) and documentation of Pseudomonas aeruginosa (HR 2.36 [1.04; 5.35], P = 0.04). VAP in patients treated with VA-ECMO is associated with an increased morbidity and mortality. RRT and infection by Pseudomonas aeruginosa appear as strong risks factors of treatment failure. Further studies seem necessary to precise the best antibiotic management in these patients.

Candida spp. airway colonization: A potential risk factor for Acinetobacter baumannii ventilator-associated pneumonia.

Science.gov (United States)

Tan, Xiaojiang; Zhu, Song; Yan, Dongxing; Chen, Weiping; Chen, Ruilan; Zou, Jian; Yan, Jingdong; Zhang, Xiangdong; Farmakiotis, Dimitrios; Mylonakis, Eleftherios

2016-08-01

This retrospective study was conducted to identify potential risk factors for Acinetobacter baumannii (A. baumannii) ventilator-associated pneumonia (VAP) and evaluate the association between Candida spp. airway colonization and A. baumannii VAP. Intensive care unit (ICU) patients who were on mechanical ventilation (MV) for ≥48 hours were divided into the following groups: patients with and without Candida spp. airway colonization; colonized patients receiving antifungal treatment or not; patients with A. baumannii VAP and those without VAP. Logistic regression analysis and propensity score matching were used to identify factors independently associated with A. baumannii VAP. Among 618 eligible patients, 264 (43%) had Candida spp. airway colonization and 114 (18%) developed A. baumannii VAP. Along with MV for ≥7 days (adjusted odds ratio [aOR] 8.9, 95% confidence intervals [95% CI] 4.9-15.8) and presence of a central venous catheter (aOR 3.2, 95% CI 1.1-9), Candida spp. airway colonization (aOR 2.6, 95% CI 1.6-4.3) was identified as an independent risk factor for A. baumannii VAP. Patients with Candida spp. airway colonization were more likely to develop A. baumannii VAP than non-colonized patients (23% vs 15%, P=.01 and 34% vs. 15%, PCandida spp. airway colonization (43%) and A. baumannii VAP (18%) were common in ICU patients who were on mechanical ventilation for at least 48 hours. Candida spp. airway colonization was an independent risk factor for subsequent A. baumannii VAP. © The Author 2016. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Dysregulated hepatic expression of glucose transporters in chronic disease: contribution of semicarbazide-sensitive amine oxidase to hepatic glucose uptake.

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Karim, Sumera; Liaskou, Evaggelia; Fear, Janine; Garg, Abhilok; Reynolds, Gary; Claridge, Lee; Adams, David H; Newsome, Philip N; Lalor, Patricia F

2014-12-15

Insulin resistance is common in patients with chronic liver disease (CLD). Serum levels of soluble vascular adhesion protein-1 (VAP-1) are also increased in these patients. The amine oxidase activity of VAP-1 stimulates glucose uptake via translocation of transporters to the cell membrane in adipocytes and smooth muscle cells. We aimed to document human hepatocellular expression of glucose transporters (GLUTs) and to determine if VAP-1 activity influences receptor expression and hepatic glucose uptake. Quantitative PCR and immunocytochemistry were used to study human liver tissue and cultured cells. We also used tissue slices from humans and VAP-1-deficient mice to assay glucose uptake and measure hepatocellular responses to stimulation. We report upregulation of GLUT1, -3, -5, -6, -7, -8, -9, -10, -11, -12, and -13 in CLD. VAP-1 expression and enzyme activity increased in disease, and provision of substrate to hepatic VAP-1 drives hepatic glucose uptake. This effect was sensitive to inhibition of VAP-1 and could be recapitulated by H2O2. VAP-1 activity also altered expression and subcellular localization of GLUT2, -4, -9, -10, and -13. Therefore, we show, for the first time, alterations in hepatocellular expression of glucose and fructose transporters in CLD and provide evidence that the semicarbazide-sensitive amine oxidase activity of VAP-1 modifies hepatic glucose homeostasis and may contribute to patterns of GLUT expression in chronic disease. Copyright © 2014 the American Physiological Society.

[Multicenter survey on ventilator-associated pneumonia prevention in intensive care].

Science.gov (United States)

Fischer, M-O; Garreau, N; Jarno, P; Villers, D; Dufour Trivini, M; Gérard, J-L; Fellahi, J-L; Hanouz, J-L; Parienti, J-J

2013-12-01

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care unit (ICU). The aim of the study was to evaluate the follow-up of the guidelines for VAP prevention. Retrospective, observational and multicenter study. During one year, all patients with mechanical ventilation over 48 hours were included in the CCLIN-Ouest Network. The demographic characteristics of the patients, the use of specific protocol for VAP prevention and the density of incidence of VAP were recorded. The use of a protocol for preventing VAP (absence, incomplete, complete and care bundle (i.e. complete prevention of VAP with weaning mechanical protocol and sedation protocol)) was collected. 26 ICU with 5742 patients were included. Ten ICU (38%; 2595 patients) had no protocol for VAP prevention, eight ICU (31%; 1821 patients) had an incomplete protocol, five ICU (19%; 561 patients) had a complete protocol and three ICU (12%; 765 patients) had a care bundle. The density of incidence of VAP was 14.8‰ (Interquartile range [IQR]: 10.2-0.1) for no protocol group, 15.6‰ [IQR: 12.6-6.2] for incomplete protocol group, 11.0‰ [IQR: 9.1-14.0] for complete protocol group and 12.9‰ [5-7,7-9,9-12] for care bundle group (P=0.742). The compliance to prevention of VAP was poor. Proposals for improving practice are discussed. Copyright © 2013. Published by Elsevier SAS.

[Prospective study on the gastro-pulmonary infection route of ventilator-associated pneumonia].

Science.gov (United States)

Zhang, Qing-ling; Liu, Ming-hua; Liu, Yu-fu; Wang, Xian-yuan; Fu, Wei-ling

2004-02-01

To explore the role of gastro-pulmonary infection route in the development of ventilator-associated pneumonia (VAP), so as to improve the management of VAP. Forty-three patients who received mechanical ventilation (MV) were enrolled in the study. Intra-gastric contents were labeled with (99)mTc-DTPA. Randomized two-period crossover trial was employed to determine the radioactive level in the oropharyngeal and bronchial secretion when patients were in supine or semi-reclining position. Gastric juice, oropharyngeal secretion and tracheal lavage fluid were collected for bacterial culture every other day. Bronchoalveolar lavage fluid (BALF) was harvested from those suspected of VAP for quantitative bacterial culture. Infrequent-restriction site amplification (IRS-PCR) was employed in the identification of the identity of the bacteria from intra-gastric colonization with those causing VAP. The sIgA content in the BALF was determined. The gastroesophageal regurgitation rate was higher (89.7%) with lower aspiration rate (28.5%) in patients receiving MV. Moreover, the aspiration rate and the radioactivity of deep tracheal aspirates in patients in supine position were significantly higher than those in semi-reclining position (P VAP (55.8%). The sIgA content in BALF in VAP patients was evidently lower than that in non-VAP patients (P patients receiving MV. Intra-gastric colonized bacteria might be one of the important origins causing VAP. The lowering of sIgA in BALF in patients with MV could be a risk factor for VAP.

Could soluble urokinase plasminogen receptor (suPAR) be used as a diagnostic biomarker for ventilator-associated pneumonia?

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Sunnetcioglu, Aysel; Sunnetcioglu, Mahmut; Adıyaman, Fırat; Binici, Irfan; Soyoral, Lokman

2017-11-01

Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker that is increasingly used for evaluation of systemic inflammation. This study was performed to investigate whether suPAR may possess a diagnostic value in patients with ventilator-associated pneumonia (VAP). This clinical study was performed in the anesthesia intensive care units (ICUs) of our university. In addition to descriptive data, WBC, serum levels of C-reactive protein (CRP) and suPAR prior to and after development of VAP were noted and compared in 31 patients (22 men, 9 women) diagnosed with VAP (Study Group) and 19 patients without VAP (Control Group) in ICU (14 men, 5 women). The suPAR (P = 0.023), CRP (P = 0.037), WBCs (P = 0.024) in patients with VAP were significantly higher than patients without VAP. There was no remarkable difference in terms of WBCs (P = 0.052) and suPAR levels (P = 0.616) between groups on the first day of connection to mechanical ventilator. The suPAR and CRP levels in patients with VAP were significantly higher than prior to development of VAP (P = 0.001 for both). Area under curve value after diagnosis of pneumonia was found 0.248 (P = 0.002). To conclude, our results suggest that suPAR can be a useful diagnostic biomarker in patients with VAP. However, clinical trials on larger series are warranted to explore the clinical significance more accurately. © 2016 John Wiley & Sons Ltd.

Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients.

Science.gov (United States)

Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis

2007-07-01

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.

pH-Dependent Binding of Chloride to a Marine Alkaline Phosphatase Affects the Catalysis, Active Site Stability, and Dimer Equilibrium.

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Hjörleifsson, Jens G; Ásgeirsson, Bjarni

2017-09-26

The effect of ionic strength on enzyme activity and stability varies considerably between enzymes. Ionic strength is known to affect the catalytic activity of some alkaline phosphatases (APs), such as Escherichia coli AP, but how ions affect APs is debated. Here, we studied the effect of various ions on a cold-adapted AP from Vibrio splendidus (VAP). Previously, we have found that the active form of VAP is extremely unstable at low ionic strengths. Here we show that NaCl increased the activity and stability of VAP and that the effect was pH-dependent in the range of pH 7-10. The activity profile as a function of pH formed two maxima, indicating a possible conformational change. Bringing the pH from the neutral to the alkaline range was accompanied by a large increase in both the K i for inorganic phosphate (product inhibition) and the K M for p-nitrophenyl phosphate. The activity transitions observed as the pH was varied correlated with structural changes as monitored by tryptophan fluorescence. Thermal and urea-induced inactivation was shown to be accompanied by neither dissociation of the active site metal ions nor dimer dissociation. This would suggest that the inactivation involved subtle changes in active site conformation. Furthermore, the VAP dimer equilibrium was studied for the first time and shown to highly favor dimerization, which was dependent on pH and NaCl concentration. Taken together, the data support a model in which anions bind to some specific acceptor in the active site of VAP, resulting in great stabilization and catalytic rate enhancement, presumably through a different mechanism.

Co-existing concepts of management control : The containment of tensions due to the implementation of lean production

NARCIS (Netherlands)

Tillema, Sandra; van der Steen, Martijn

2015-01-01

There is substantial evidence that the implementation of lean production and similar inno-vations is not always successful. One of the explanations provided is that elements of tradi-tional control systems may frustrate the transformation process. Although various studies have investigated the

Explicit modelling of SOA formation from α-pinene photooxidation: sensitivity to vapour pressure estimation

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R. Valorso

2011-07-01

Full Text Available The sensitivity of the formation of secondary organic aerosol (SOA to the estimated vapour pressures of the condensable oxidation products is explored. A highly detailed reaction scheme was generated for α-pinene photooxidation using the Generator for Explicit Chemistry and Kinetics of Organics in the Atmosphere (GECKO-A. Vapour pressures (P^vap were estimated with three commonly used structure activity relationships. The values of P^vap were compared for the set of secondary species generated by GECKO-A to describe α-pinene oxidation. Discrepancies in the predicted vapour pressures were found to increase with the number of functional groups borne by the species. For semi-volatile organic compounds (i.e. organic species of interest for SOA formation, differences in the predicted P^vap range between a factor of 5 to 200 on average. The simulated SOA concentrations were compared to SOA observations in the Caltech chamber during three experiments performed under a range of NO_x conditions. While the model captures the qualitative features of SOA formation for the chamber experiments, SOA concentrations are systematically overestimated. For the conditions simulated, the modelled SOA speciation appears to be rather insensitive to the P^vap estimation method.

The Quest for Converting Biorenewable Bifunctional α-Methylene-γ-butyrolactone into Degradable and Recyclable Polyester: Controlling Vinyl-Addition/Ring-Opening/Cross-Linking Pathways

KAUST Repository

Tang, Xiaoyan

2016-10-04

α-Methylene-γ-butyrolactone (MBL), a naturally occurring and biomass-sourced bifunctional monomer, contains both a highly reactive exocyclic C═C bond and a highly stable five-membered γ-butyrolactone ring. Thus, all previous work led to exclusive vinyl-addition polymerization (VAP) product P(MBL)VAP. Now, this work reverses this conventional chemoselectivity to enable the first ring-opening polymerization (ROP) of MBL, thereby producing exclusively unsaturated polyester P(MBL)ROP with Mn up to 21.0 kg/mol. This elusive goal was achieved through uncovering the thermodynamic, catalytic, and processing conditions. A third reaction pathway has also been discovered, which is a crossover propagation between VAP and ROP processes, thus affording cross-linked polymer P(MBL)CLP. The formation of the three types of polymers, P(MBL)VAP, P(MBL)CLP, and P(MBL)ROP, can be readily controlled by adjusting the catalyst (La)/initiator (ROH) ratio, which is determined by the unique chemoselectivity of the La–X (X = OR, NR2, R) group. The resulting P(MBL)ROP is degradable and can be readily postfunctionalized into cross-linked or thiolated materials but, more remarkably, can also be fully recycled back to its monomer thermochemically. Computational studies provided the theoretical basis for, and a mechanistic understanding of, the three different polymerization processes and the origin of the chemoselectivity.

The Quest for Converting Biorenewable Bifunctional α-Methylene-γ-butyrolactone into Degradable and Recyclable Polyester: Controlling Vinyl-Addition/Ring-Opening/Cross-Linking Pathways

KAUST Repository

Tang, Xiaoyan; Hong, Miao; Falivene, Laura; Caporaso, Lucia; Cavallo, Luigi; Chen, Eugene Y X

2016-01-01

α-Methylene-γ-butyrolactone (MBL), a naturally occurring and biomass-sourced bifunctional monomer, contains both a highly reactive exocyclic C═C bond and a highly stable five-membered γ-butyrolactone ring. Thus, all previous work led to exclusive vinyl-addition polymerization (VAP) product P(MBL)VAP. Now, this work reverses this conventional chemoselectivity to enable the first ring-opening polymerization (ROP) of MBL, thereby producing exclusively unsaturated polyester P(MBL)ROP with Mn up to 21.0 kg/mol. This elusive goal was achieved through uncovering the thermodynamic, catalytic, and processing conditions. A third reaction pathway has also been discovered, which is a crossover propagation between VAP and ROP processes, thus affording cross-linked polymer P(MBL)CLP. The formation of the three types of polymers, P(MBL)VAP, P(MBL)CLP, and P(MBL)ROP, can be readily controlled by adjusting the catalyst (La)/initiator (ROH) ratio, which is determined by the unique chemoselectivity of the La–X (X = OR, NR2, R) group. The resulting P(MBL)ROP is degradable and can be readily postfunctionalized into cross-linked or thiolated materials but, more remarkably, can also be fully recycled back to its monomer thermochemically. Computational studies provided the theoretical basis for, and a mechanistic understanding of, the three different polymerization processes and the origin of the chemoselectivity.

PROBLEM SOLVING TECHNIQUES AS A PART OF IMPLEMENTATION OF SIX SIGMA METHODOLOGY IN TIRE PRODUCTION. CASE STUDY

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Maciej WOJTASZAK

2015-07-01

Full Text Available Problem solving methods – are an indispensable part of the management and improvement of production. At the turn of decades, with the development of industry, specific techniques have been implemented and refined by the leaders in this field, such as Toyota, GE and Motorola. The foundation of problem solving is to find real root cause of the problem as soon as possible, its understanding and implementation of appropriate solutions that will ensure that the problem does not occur again. This paper provides an overview of methods and techniques to solve problems in the manufactur-ing plant Trelleborg Wheel Systems Sri Lanka, producing pneumatic tires for light agricultural machinery. These tech-niques are implemented as part of the Lean Six Sigma program.

Ventilator-associated pneumonia: current status and future recommendations.

Science.gov (United States)

Efrati, Shai; Deutsch, Israel; Antonelli, Massimo; Hockey, Peter M; Rozenblum, Ronen; Gurman, Gabriel M

2010-04-01

Ventilator-associated pneumonia (VAP) is a common hazardous complication in ICU patients. The aim of the current review is to give an update on the current status and future recommendations for VAP prevention. This article gives an updated review of the current literature on VAP. The first part briefly reviews pathogenesis and epidemiology while the second includes an in-depth review of evidence-based practice guidelines (EBPG) and new technologies developed for prevention of VAP. VAP remains a frequent and costly complication of critical illness with a pooled relative risk of 9-27% and mortality of 25-50%. Strikingly, VAP adds an estimated cost of more than $40,000 to a typical hospital admission. An important aetiological mechanism of VAP is gross or micro-aspiration of oropharyngeal organisms around the cuff of the endotracheal tube (ETT) into the distal bronchi. Prevention of VAP is preferable. Preventative measures can be divided into two main groups: the implemen- tation of EBPGs and use of device-based technologies. EBPGs have been authored jointly by the American Thoracic Society and the Infectious Diseases Society of America. The Canadian Critical Care Trials group also published VAP Guidelines in 2008. Their recommendations are detailed in this review. The current device-based technologies include drainage of subglottic secretions, silver coated ETTs aiming to influence the internal bio-layer of the ETT, better sealing of the lower airways with ultrathin cuffs and loops for optimal cuff pressure control. EBPG consensus includes: elevation of the head of the bed, use of daily "sedation vacations" and decontamination of the oropharynx. Technological solutions should aim to use the most comprehensive combination of subglottic suction of secretions, optimization of ETT cuff pressure and ultrathin cuffs. VAP is a type of hospital-acquired pneumonia that develops more than 48 h after endotracheal intubation. Its incidence is estimated to be 9-27%, with a

Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction.

Science.gov (United States)

McCormick, Benjamin J; Deal, Allison; Borawski, Kristy M; Raynor, Mathew C; Viprakasit, Davis; Wallen, Eric M; Woods, Michael E; Pruthi, Raj S

2018-04-10

Pressure on physicians to increase productivity is rising in parallel with administrative tasks, regulations, and the use of electronic health records (EHRs). Physician extenders and clinical pathways are already in use to increase productivity and reduce costs and burnout, but other strategies are required. We evaluated whether implementation of medical scribes in an academic urology clinic would affect productivity, revenue, and patient/provider satisfaction. Six academic urologists were assigned scribes for 1 clinic day per week for 3 months. Likert-type patient and provider surveys were developed to evaluate satisfaction with and without scribes. Matched clinic days in the year prior were used to evaluate changes in productivity and physician/hospital charges and revenue. After using scribes for 3 months, providers reported increased efficiency (p value = 0.03) and work satisfaction (p value = 0.03), while seeing a mean 2.15 more patients per session (+ 0.96 return visits, + 0.99 new patients, and + 0.22 procedures), contributing to an additional 2.6 wRVUs, $542 in physician charges, and $861 in hospital charges per clinic session. At a gross collection rate of 36%, actual combined revenue was + $506/session, representing a 26% increase in overall revenue. At a cost of $77/session, the net financial impact was + $429 per clinic session, resulting in a return-to-investment ratio greater than 6:1, while having no effect on patient satisfaction scores. Additionally, with scribes, clinic encounters were closed a mean 8.9 days earlier. Implementing medical scribes in academic urology practices may be useful in increasing productivity, revenue, and provider satisfaction, while maintaining high patient satisfaction.

Trauma patients meeting both Centers for Disease Control and Prevention's definitions for ventilator-associated pneumonia had worse outcomes than those meeting only one.

Science.gov (United States)

Younan, Duraid; Griffin, Russell; Swain, Thomas; Pittet, Jean-Francois; Camins, Bernard

2017-08-01

The Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) replaced its old definition for ventilator-associated pneumonia (VAP) with the ventilator-associated events algorithm in 2013. We sought to compare the outcome of trauma patients meeting the definitions for VAP in the two modules. Trauma patients with blunt or penetrating injuries and with at least 2 d of ventilator support were identified from the trauma registry from 2013 to 2014. VAP was determined using two methods: (1) VAP as defined by the "old," clinically based NHSN definition and (2) possible VAP as defined by the updated "new" NHSN definition. Cohen's kappa statistic was determined to compare the two definitions for VAP. To compare demographic and clinical outcomes, the chi-square and Student's t-tests were used for categorical and continuous variables, respectively. From 2013 to 2014, there were 1165 trauma patients admitted who had at least 2 d of ventilator support. Seventy-eight patients (6.6%) met the "new" NHSN definition for possible VAP, 361 patients (30.9%) met the "old" definition of VAP, and 68 patients (5.8%) met both definitions. The kappa statistic between VAP as defined by the "new" and "old" definitions was 0.22 (95% confidence interval, 0.17-0.27). There were no differences in age, gender, race, or injury severity score when comparing patients who met the different definitions. Those satisfying both definitions had longer ventilator support days (P = 0.0009), intensive care unit length of stay (LOS; P = 0.0003), and hospital LOS (P = 0.0344) when compared with those meeting only one definition. There was no difference in mortality for those meeting both and those meeting the old definition for VAP; patients meeting both definitions had higher respiratory rate at arrival (P = 0.0178). There was no difference in mortality between patients meeting the "old" and "new" NHSN definitions for VAP; those who met "both" definitions had longer

Ventilator-Associated Pneumonia and Causative Microorganisms in Intensive Care Unit: A Two Year Retrospective Analysis

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Onur Palabıyık

2016-12-01

Full Text Available Objective: Ventilator-associated pneumonia (VAP is the most common nosocomial infection in the intensive care units (ICUs. It causes prolonged hospital stay and increases mortality. In this study, we aimed to investigate the rate of VAP, causative microorganisms, and their antibiotic susceptibilities in anaesthesiology and reanimation ICU (ARICU. Material and Method: This retrospective study included patients who were admitted to 12-bed ARICU between January 2013 and December 2014. The detection of VAP was done according to Centers for Disease Control and Prevention criteria. The rate of VAP, VAP ratio, and ventilator utilization ratio (VUR were calculated according to guidelines of Turkish National Infection Surveillance Control Group. Endotracheal aspiration samples were collected and cultivated. The identification of the isolates was performed by using VITEK-2 automated system. Antibiotic susceptibilities were determined by the disc diffusion method according to the Clinical and Laboratory Standards Institute criteria. Results: VAP was determined in 16 of 359 patients who required invasive mechanic ventilation for longer than 48 hours and hospitalized in ARICU. VUR was 65%, VAP ratio was 4.5% and the rate of VAP was 3.3 per 1000 ventilator days. Seventeen microorganisms were isolated from endotracheal aspiration samples, including Acinetobacter baumannii (n=6, Pseudomonas aeruginosa (n=4, methicillin-resistant Staphylococcus aureus (n=4, Klebsiella pneumoniae, Enterobacter cloacae and Serratia marcescens. The most sensitive antibiotics for microorganisms are listed as follows; Acinetobacter baumannii: colistin, Pseudomonas aeruginosa: amikacin, carbapenems; Methicillin-resistant Staphylococcus aureus: linezolid, teicoplanin, vancomycin, trimethoprim sulfamethoxazole; Klebsiella and Enterobacteriaceae species: carbapenems, trimethoprim sulfamethoxazole, gentamicin. Conclusion: Intermittent analyses and antibiotic susceptibilities of VAP

Towards the implementation of quality by design to the production of therapeutic monoclonal antibodies with desired glycosylation patterns.

Science.gov (United States)

del Val, Ioscani Jimenez; Kontoravdi, Cleo; Nagy, Judit M

2010-01-01

Quality by design (QbD) is a scheme for the development, manufacture, and approval of pharmaceutical products. The end goal of QbD is to ensure product quality by building it into the manufacturing process. The main regulatory bodies are encouraging its implementation to the manufacture of all new pharmaceuticals including biological products. Monoclonal antibodies (mAbs) are currently the leading products of the biopharmaceutical industry. It has been widely reported that glycosylation directly influences the therapeutic mechanisms by which mAbs function in vivo. In addition, glycosylation has been identified as one of the main sources of monoclonal antibody heterogeneity, and thus, a critical parameter to follow during mAb manufacture. This article reviews the research on glycosylation of mAbs over the past 2 decades under the QbD scope. The categories presented under this scope are: (a) definition of the desired clinical effects of mAbs, (b) definition of the glycosylation-associated critical quality attributes (glycCQAs) of mAbs, (c) assessment of process parameters that pose a risk for mAb glycCQAs, and (d) methods for accurately quantifying glycCQAs of mAbs. The information available in all four areas leads us to conclude that implementation of QbD to the manufacture of mAbs with specific glycosylation patterns will be a reality in the near future. We also foresee that the implementation of QbD will lead to the development of more robust and efficient manufacturing processes and to a new generation of mAbs with increased clinical efficacy. Copyright © 2010 American Institute of Chemical Engineers (AIChE).

The impact of hospital-wide use of a tapered-cuff endotracheal tube on the incidence of ventilator-associated pneumonia.

Science.gov (United States)

Bowton, David L; Hite, R Duncan; Martin, R Shayn; Sherertz, Robert

2013-10-01

Aspiration of colonized oropharyngeal secretions is a major factor in the pathogenesis of ventilator-associated pneumonia (VAP). A tapered-cuff endotracheal tube (ETT) has been demonstrated to reduce aspiration around the cuff. Whether these properties are efficacious in reducing VAP is not known. This 2-period, investigator-initiated observational study was designed to assess the efficacy of a tapered-cuff ETT to reduce the VAP rate. All intubated, mechanically ventilated patients over the age of 18 were included. During the baseline period a standard, barrel-shaped-cuff ETT (Mallinckrodt Hi-Lo) was used. All ETTs throughout the hospital were then replaced with a tapered-cuff ETT (TaperGuard). The primary outcome variable was the incidence of VAP per 1,000 ventilator days. We included 2,849 subjects, encompassing 15,250 ventilator days. The mean ± SD monthly VAP rate was 3.29 ± 1.79/1,000 ventilator days in the standard-cuff group and 2.77 ± 2.00/1,000 ventilator days in the tapered-cuff group (P = .65). While adherence to the VAP prevention bundle was high throughout the study, bundle adherence was significantly higher during the standard-cuff period (96.5 ± 2.7%) than in the tapered-cuff period (90.3 ± 3.5%, P = .01). In the setting of a VAP rate very near the average of ICUs in the United States, and where there was high adherence to a VAP prevention bundle, the use of a tapered-cuff ETT was not associated with a reduction in the VAP rate.

Implementing cleaner production in an automotive company: an application of material input per unit of service tool to measure environmental and economic advantages

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Geraldo Cardoso de Oliveira Neto

2017-09-01

Full Text Available Environmental impact reduction has been a growing concern of the automotive industry. One of the main challenges is to implement Cleaner Production as a tool to reduce environmental impacts and provide financial profits. The purpose of this article was to evaluate the environmental impact and economic gains by implementing Cleaner Production, using an unexplored approach, in a company of the automotive sector. The research approach used was a case study, carried out by observation and semi-structured surveys. The production process chosen was updated, so technologies were changed to reduce biotic and abiotic disposal. For the analysis of environmental impacts, the ‘Material Input Per Unit of Service’ tool (MIPS was used, in which data was used to calculate: annual net profit; return on investment (% and return on investment for a period. The results showed that Cleaner Production implementation focusing on changing technology in the production process caused a 75% reduction in environmental impact, and a 62.7% decrease in production costs. Although of this study considers only one case to test the procedure applicability, it can be easily repeated in other more complex systems, by merely making the necessary adjustments due to the complexity of the processes involved.

Improved outcome of ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus in a trauma population.

Science.gov (United States)

Gonzalez, Richard P; Rostas, Jack; Simmons, Jon D; Allen, John; Frotan, Mohammad A; Brevard, Sidney B

2013-03-01

The treatment of ventilator-associated pneumonia (VAP) secondary to methicillin-resistant Staphylococcus aureus (MRSA) remains controversial. We performed a review of all blunt trauma patients diagnosed with MRSA VAP from June 2005 to June 2011. VAP for the first 3 years was diagnosed by sputum aspiration and treated with vancomycin. For the last 3 years of the study period, VAP was diagnosed with bronchoalveolar lavage and treated with linezolid. MRSA VAP patients treated with vancomycin had an average hospital length of stay (LOS) of 49 days (range 9-99 days), an average intensive care unit (ICU) LOS of 43 days (range 6-98 days), and average ventilator days of 34.4 (range 3-76 days). Seventeen MRSA VAP patients treated with linezolid had an average hospital LOS of 27 days (range 11-61), an average ICU LOS of 22 days (range 10-42) days, and average ventilator days of 16.6 (range 2-42). Trauma patients who develop MRSA VAP appear to have fewer ventilator days and shorter ICU and hospital LOS when treated with linezolid. Copyright © 2013 Elsevier Inc. All rights reserved.

Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

Directory of Open Access Journals (Sweden)

Chirichella Thomas J

2011-03-01

Full Text Available Abstract Background Post-traumatic ventilator-associated pneumonia (VAP is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC and other potential risk factors for the development of VAP. Methods We performed a retrospective study of consecutive trauma patients requiring emergency tracheal intubation and evaluated TC, age, gender, ethanol status, smoker status, injury mechanism, chest injury, brain injury, Injury Severity Score (ISS, shock, day-one hypoxemia, and RBC transfusion as potential risks for VAP. Results The 152 patients had ISS 28.1, brain injury 68.4%, VAP 50.0%, ventilator days 14.3, and death 9.9%. Ventilator days were increased with late VAP (p Conclusions Severe traumatic injury produced substantial hypocholesterolemia that is greater with chest injury, shock, and RBC transfusion, but less with brain injury. Total blood cholesterol tended to decrease with increasing injury severity. However, attenuated hypocholesterolemia (ISS ≥ 20-&-TC ≥ 90 mg/dL represents a unique response that can occur with critical injury. Attenuated hypocholesterolemia signals early risk for late VAP, ventilator dependency, and death.

AIP1OGREN: Aerosol Observing Station Intensive Properties Value-Added Product

Energy Technology Data Exchange (ETDEWEB)

Koontz, Annette [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Flynn, Connor [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2017-09-15

The aip1ogren value-added product (VAP) computes several aerosol intensive properties. It requires as input calibrated, corrected, aerosol extensive properties (scattering and absorption coefficients, primarily) from the Aerosol Observing Station (AOS). Aerosol extensive properties depend on both the nature of the aerosol and the amount of the aerosol. We compute several properties as relationships between the various extensive properties. These intensive properties are independent of aerosol amount and instead relate to intrinsic properties of the aerosol itself. Along with the original extensive properties we report aerosol single-scattering albedo, hemispheric backscatter fraction, asymmetry parameter, and Ångström exponent for scattering and absorption with one-minute averaging. An hourly averaged file is produced from the 1-minute files that includes all extensive and intensive properties as well as submicron scattering and submicron absorption fractions. Finally, in both the minutely and hourly files the aerosol radiative forcing efficiency is provided.

Effect of Intensive Education and Training of Nurses on Ventilator-associated Pneumonia and Central Line-associated Bloodstream Infection Incidence in Intensive Care Unit at a Tertiary Care Center in North India.

Science.gov (United States)

Sahni, Neeru; Biswal, Manisha; Gandhi, Komal; Kaur, Kulbeer; Saini, Vikas; Yaddanapudi, Lakshminarayana N

2017-11-01

The aim was to analyze the impact of education and training of nurses on the incidence of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI). A prospective observational study at a tertiary care hospital included adult patients with Intensive Care Unit stay >48 h. The study was done in three phases: in Phase 1, baseline VAP and CLABSI incidence was calculated; in Phase 2, education and training of nurses; and in Phase 3, data were recollected for the incidence of VAP and CLABSI. The baseline incidence of VAP in Phase 1 was 28.86/1000 ventilator days and that of CLABSI was 7.89/1000 central-line days. In Phase 3, the incidence of VAP increased to 35.06 and that of CLABSI decreased significantly, 1.73. Intensive education and training sessions with feedback from nurses over a period of 6 months led to significant reduction in the incidence of CLABSI; however, the incidence of VAP increased.

Function-blocking antibodies to human vascular adhesion protein-1: a potential anti-inflammatory therapy.

Science.gov (United States)

Kirton, Christopher M; Laukkanen, Marja-Leena; Nieminen, Antti; Merinen, Marika; Stolen, Craig M; Armour, Kathryn; Smith, David J; Salmi, Marko; Jalkanen, Sirpa; Clark, Michael R

2005-11-01

Human vascular adhesion protein-1 (VAP-1) is a homodimeric 170-kDa sialoglycoprotein that is expressed on the surface of endothelial cells and functions as a semicarbazide-sensitive amine oxidase and as an adhesion molecule. Blockade of VAP-1 has been shown to reduce leukocyte adhesion and transmigration in in vivo and in vitro models, suggesting that VAP-1 is a potential target for anti-inflammatory therapy. In this study we have constructed mouse-human chimeric antibodies by genetic engineering in order to circumvent the potential problems involved in using murine antibodies in man. Our chimeric anti-VAP-1 antibodies, which were designed to lack Fc-dependent effector functions, bound specifically to cell surface-expressed recombinant human VAP-1 and recognized VAP-1 in different cell types in tonsil. Furthermore, the chimeric antibodies prevented leukocyte adhesion and transmigration in vitro and in vivo. Hence, these chimeric antibodies have the potential to be used as a new anti-inflammatory therapy.

The methodological quality of guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia: A systematic review.

Science.gov (United States)

Ambaras Khan, R; Aziz, Z

2018-05-02

Clinical practice guidelines serve as a framework for physicians to make decisions and to support best practice for optimizing patient care. However, if the guidelines do not address all the important components of optimal care sufficiently, the quality and validity of the guidelines can be reduced. The objectives of this study were to systematically review current guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), evaluate their methodological quality and highlight the similarities and differences in their recommendations for empirical antibiotic and antibiotic de-escalation strategies. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Electronic databases including MEDLINE, CINAHL, PubMed and EMBASE were searched up to September 2017 for relevant guidelines. Other databases such as NICE, Scottish Intercollegiate Guidelines Network (SIGN) and the websites of professional societies were also searched for relevant guidelines. The quality and reporting of included guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) instrument. Six guidelines were eligible for inclusion in our review. Among 6 domains of AGREE-II, "clarity of presentation" scored the highest (80.6%), whereas "applicability" scored the lowest (11.8%). All the guidelines supported the antibiotic de-escalation strategy, whereas the majority of the guidelines (5 of 6) recommended that empirical antibiotic therapy should be implemented in accordance with local microbiological data. All the guidelines suggested that for early-onset HAP/VAP, therapy should start with a narrow spectrum empirical antibiotic such as penicillin or cephalosporins, whereas for late-onset HAP/VAP, the guidelines recommended the use of a broader spectrum empirical antibiotic such as the penicillin extended spectrum carbapenems and glycopeptides. Expert guidelines

Production optimisation in the petrochemical industry by hierarchical multivariate modelling. Phase 2: On-line implementation

Energy Technology Data Exchange (ETDEWEB)

Nilsson, Aasa; Persson, Fredrik; Andersson, Magnus

2009-07-15

IVL, together with Emerson Process Management, has developed a decision support system (DSS) based on multivariate statistical process models. The system was implemented at Nynas AB's refinery in order to provide real-time TBP curves and to enable the operator to optimise the process with regards to product quality and energy consumption. The project resulted in the following proven benefits at the industrial reference site, Nynas Refinery in Gothenburg: - Increased yield with up to 14 % (relative terms) for the most valuable product - Decreased energy consumption of 8 %. Validation of model predictions compared to the laboratory analysis showed that the prediction error lay within 1 deg C throughout the whole test period

Numerical simulation in steam injection process by a mechanistic approach

Energy Technology Data Exchange (ETDEWEB)

De Souza, J.C.Jr.; Campos, W.; Lopes, D.; Moura, L.S.S. [Petrobras, Rio de Janeiro (Brazil)

2008-10-15

Steam injection is a common thermal recovery method used in very viscous oil reservoirs. The method involves the injection of heat to reduce viscosity and mobilize oil. A steam generation and injection system consists primarily of a steam source, distribution lines, injection wells and a discarding tank. In order to optimize injection and improve the oil recovery factor, one must determine the parameters of steam flow such as pressure, temperature and steam quality. This study focused on developing a unified mathematical model by means of a mechanistic approach for two-phase steam flow in pipelines and wells. The hydrodynamic and heat transfer mechanistic model was implemented in a computer simulator to model the parameters of steam injection while trying to avoid the use of empirical correlations. A marching algorithm was used to determine the distribution of pressure and temperature along the pipelines and wellbores. The mathematical model for steam flow in injection systems, developed by a mechanistic approach (VapMec) performed well when the simulated values of pressures and temperatures were compared with the values measured during field tests. The newly developed VapMec model was incorporated in the LinVap-3 simulator that constitutes an engineering supporting tool for steam injection wells operated by Petrobras. 23 refs., 7 tabs., 6 figs.

Airway microbiome research: a modern perspective on surveillance cultures?

NARCIS (Netherlands)

Roux, Damien; van Oort, Pouline M.; Ricard, Jean-Damien; Bos, Lieuwe D. J.

2017-01-01

The incidence of ventilator-associated pneumonia (VAP) is estimated to be around 10% in a high-risk population. Over the last decade, major improvements have been made in the prevention of VAP, with great cost-effectiveness. However, we still do not understand the exact pathogenesis of VAP. A better

SYSTEM CONTROL OF SMOKING PROCESS AND MEASURING BENZO[A]PYRENE IN TRADITIONAL PRODUCTION OF BOSNIAN DRY CURED HAM (BOSANSKI PRŠUT BY IMPLEMENTING HACCP SYSTEM

Directory of Open Access Journals (Sweden)

Almir Toroman

2013-08-01

Full Text Available As it is well known, traditional production of smoked meat products requires technological processes, which carry some food safety hazards (e.g. content of Benzo[a]pyrene. (B[a]P. “OMEGA COMERC Ltd.”, a member of the meat industry in Visoko region, has implemented food safety management system according to the recommendations from Codex Alimentarius CAC-RCP (9, recommended International Code of Practice - General Principles of Food Hygiene. By implementing HACCP system, the Company established adequate control measures in producing Bosnian dry cured ham (bosanski pršut on traditional way including the smoking process in the chambers. By doing this, they have created conditions to measure B[a]P content in the Bosnian dry cured ham and implement HACCP system without impairing traditional production and food safety of the final product.The aim of this study is to present the effect of the specific production process onto the meat smoking in order to preserve hygienic, nutritional and sensory values, and also to control B[a]P content in the final product.Key words: Bosnian dry cured ham, traditional production, smoking process, Benzo[a]pyrene, HACCP

Ventilator associated pneumonia and infection control

Directory of Open Access Journals (Sweden)

Alp Emine

2006-04-01

Full Text Available Abstract Ventilator associated pneumonia (VAP is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20–75% according to the study population. Aspiration of colonized pathogenic microorganisms on the oropharynx and gastrointestinal tract is the main route for the development of VAP. On the other hand, the major risk factor for VAP is intubation and the duration of mechanical ventilation. Diagnosis remains difficult, and studies showed the importance of early initiation of appropriate antibiotic for prognosis. VAP causes extra length of stay in hospital and intensive care units and increases hospital cost. Consequently, infection control policies are more rational and will save money.

Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya

Directory of Open Access Journals (Sweden)

Stefanie Setiawan

2018-03-01

Full Text Available Antibiotic Stewardship Program (ASP is mandatory to all Indonesian hospitals, in accordance to the 2015 Minister of Health Decree No. 8. Dr. Ramelan Naval Hospital Surabaya is one among the many hospitals in Indonesia that has implemented the ASP. The study objective was to describe quantitative-qualitatively the use of antibiotics, along with clinical and microbiological outcomes observed in an Intensive Care Unit (ICU after ASP implementation in dr. Ramelan Naval Hospital Surabaya. The design was a 3-month (February–May 2016 cross-sectional observational study. Quantitative description was reported using Days of Therapy (DOT/100 patient-days, the qualitative description was reviewed using Gyssens’ flowchart. Clinical outcomes observed include nosocomial infection, infection-related mortality, and average length of stay (LOS. Microbiological outcome was observed through the occurences of multi-drug resistant organism. The results showed overall antibiotic use was 151.63 DOT/100 patient-days. Quality of antibiotic use were 52.73% definitely appropriate; 8.18% inappropriate regarding dose, intervals, durations, and timing; 7.27% no indication; and no mutual agreement in 31.82% (κ=0.59; p<0.05. Hospital Acquired Pneumonias (HAPs/Ventilator Associated Pneumonias (VAPs were the most observed nosocomial infection, infection-related mortality rate was 44.68%; and average LOS were 7.17±1.9 days (p<0.05. No incidents of Methicillin-resistant Staphylococcus aureus (MRSA or Extended Spectrum Beta-Lactamase (ESBL have been found, but there were two cases of Multi Drug Resistant (MDR Acinetobacter baumannii.

Routine aspiration of subglottic secretions after major heart surgery: impact on the incidence of ventilator-associated pneumonia.

Science.gov (United States)

Pérez Granda, M J; Barrio, J M; Hortal, J; Muñoz, P; Rincón, C; Bouza, E

2013-12-01

Aspiration of subglottic secretions (ASS) is recommended in patients requiring mechanical ventilation for ≥48h. We assessed the impact of the introduction of ASS routinely in all patients after major heart surgery in an ecological study comparing ventilator-acquired pneumonia (VAP) incidence, days of mechanical ventilation, and cost of antimicrobial agents before and after the implementation of ASS. Before and after the intervention the results (per 1000 days) were: VAP incidence, 23.92 vs 16.46 (P = 0.04); cost of antimicrobials, €71,384 vs €63,446 (P = 0.002); and days of mechanical ventilation, 507.5 vs 377.5 (P = 0.009). From the moment of induction of anaesthesia all patients undergoing major heart surgery should routinely receive ASS. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Dedication increases productivity: an analysis of the implementation of a dedicated medical team in the emergency department.

Science.gov (United States)

Ramos, Pedro; Paiva, José Artur

2017-12-01

In several European countries, emergency departments (EDs) now employ a dedicated team of full-time emergency medicine (EM) physicians, with a distinct leadership and bed-side emergency training, in all similar to other hospital departments. In Portugal, however, there are still two very different models for staffing EDs: a classic model, where EDs are mostly staffed with young inexperienced physicians from different medical departments who take turns in the ED in 12-h shifts and a dedicated model, recently implemented in some hospitals, where the ED is staffed by a team of doctors with specific medical competencies in emergency medicine that work full-time in the ED. Our study assesses the effect of an intervention in a large academic hospital ED in Portugal in 2002, and it is the first to test the hypothesis that implementing a dedicated team of doctors with EM expertise increases the productivity and reduces costs in the ED, maintaining the quality of care provided to patients. A pre-post design was used for comparing the change on the organisational model of delivering care in our medical ED. All emergency medical admissions were tracked in 2002 (classic model with 12-h shift in the ED) and 2005/2006 (dedicated team with full-time EM physicians), and productivity, costs with medical human resources and quality of care measures were compared. We found that medical productivity (number of patients treated per hour of medical work) increased dramatically after the creation of the dedicated team (X 2 KW = 31.135; N = 36; p work reduced both in regular hours and overtime. Moreover, hospitalisation rates decreased and the length of stay in the ED increased significantly after the creation of the dedicated team. Implementing a dedicated team of doctors increased the medical productivity and reduced costs in our ED. Our findings have straightforward implication for Portuguese policymakers aiming at reducing hospital costs while coping with increased ED demand.

Implementation of Balanced Scorecard and the Successful of Implementation Strategy: a Review

OpenAIRE

Ellitan, Lena; Anatan, Lina

2008-01-01

The balanced scorecard is a formal management technique for development, implementation and management of business strategy. It is difficult to ascertain the success of the technique as most of the literature on its implementation is put out by those with a vested interest in its success as a commercial product. Much has been written about barriers to strategy implementation but not specifically to the implementation of balanced scorecard. This paper presents a review of the factors that cont...

KPIs for measuring the sustainability performance of ecodesign implementation into product development and related processes: a systematic literature review

DEFF Research Database (Denmark)

Rodrigues, Vinicius Picanco; Pigosso, Daniela Cristina Antelmi; McAloone, Tim C.

, many difficulties still surround the implementation and management of ecodesign. The main challenges in embedding ecodesign into PDRP are: (i) the lack of support to select key performance indicators (KPI) to measure how well a company is being successful in ecodesign integration from a product......’s impact on the overall corporate behaviour.This research aims at presenting a comprehensive set of sustainability KPI to measure the ecodesign implementation into the PDRP by systematically reviewing the relevant literature regarding sustainability KPIs (social, economic and environmental dimensions......). The underlying research question is “which arethe KPIs for measuring sustainability of ecodesign integration into the product development and related processes?” This research excludes the indicators dealing directly and exclusively with product’s attributes and properties, such as energy and material...

Risk factors associated with development of ventilator associated pneumonia.

Science.gov (United States)

Noor, Ahmed; Hussain, Syed Fayyaz

2005-02-01

To assess the risk factors associated with development of ventilator associated pneumonia (VAP). A case control study. Intensive Care Unit (ICU) at the Aga Khan University Hospital, Karachi, between January 1999 and June 2000. All patients with assisted mechanical ventilation were assessed for the development of VAP. Risk factors associated with development of VAP were determined. Adult patients who developed pneumonia, 48 hours after ventilation, were called cases while those who did not develop pneumonia were called controls. Seventy (28%) out of 250 mechanically ventilated patients developed VAP (rate of VAP was 26 cases per 1000 ventilator days). Shock during first 48 hours of ventilation (odds ratio (OR), 5.95; 95% confidence interval (CI), 2.83-12.52), transport out of ICU during mechanical ventilation (OR, 6.0; 95% CI, 2.92-12.37), re-intubation (OR, 4.23; 95% CI, 2.53-9.85), prior episode of aspiration of gastric content (OR, 3.07; 95% CI, 1.35-7.01), and use of antibiotics prior to intubation (OR,2.55; 95% CI, 1.20-5.41) were found to be independently associated with a higher risk of developing VAP. Gram negative organisms and Staphylococcus aureus were responsible for over 90% of cases. Patients with VAP had higher crude mortality rate (57.1%) compared with controls (32.2%). Ventilator associated pneumonia is associated with a high mortality. This study has identified risk factors associated with VAP.

Diagnostic Performance of Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Ventilator-Associated Pneumonia of Patients with Ischemic Stroke

Directory of Open Access Journals (Sweden)

Yuetian Yu

2017-01-01

Full Text Available Objective. To investigate the effect of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1 in serum, bronchoalveolar lavage fluid (BALF, endotracheal aspiration (ETA, and exhaled breath condensate (EBC samples as early biomarkers for the diagnosis of ventilator-associated pneumonia (VAP in patients with ischemic stroke. Methods. One hundred and thirty-two patients with clinically suspected VAP were enrolled in this study. Bronchoscopy was performed on the day of clinically suspected VAP. sTREM-1 levels in serum, BALF, ETA, and EBC were measured. VAP was diagnosed by quantitative cultures of BALF (≥104 cfu/mL. Results. VAP was confirmed in 76 (57.58% cases. Patients with VAP showed significantly higher sTREM-1 in BALF [32.35 (IQR, 30.08–41.72 versus 18.92 (11.89–31.72] pg/mL and in EBC [1.57 (IQR, 1.02–2.61 versus 0.41 (0.19–1.61] pg/mL than patients without VAP. The area under the curve was 0.813 (p<0.001. The optimum cut-off value for sTREM-1 in BALF was 23.61 pg/mL, yielding sensitivity and specificity of 85.5% and 73.1%. sTREM-1 in BALF had excellent correlation with that in EBC (R2 = 0.78, p<0.05. Conclusions. sTREM-1 in EBC and BALF had good diagnostic performance in differentiating patients with and without VAP.

Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms.

Science.gov (United States)

Kanafani, Zeina A; Kara, Layla; Hayek, Shady; Kanj, Souha S

2003-11-01

Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country. Prospective observational cohort study. The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries. All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed. Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate. Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.

Scaling-up vaccine production: implementation aspects of a biomass growth observer and controller.

Science.gov (United States)

Soons, Zita I T A; van den IJssel, Jan; van der Pol, Leo A; van Straten, Gerrit; van Boxtel, Anton J B

2009-04-01

This study considers two aspects of the implementation of a biomass growth observer and specific growth rate controller in scale-up from small- to pilot-scale bioreactors towards a feasible bulk production process for whole-cell vaccine against whooping cough. The first is the calculation of the oxygen uptake rate, the starting point for online monitoring and control of biomass growth, taking into account the dynamics in the gas-phase. Mixing effects and delays are caused by amongst others the headspace and tubing to the analyzer. These gas phase dynamics are modelled using knowledge of the system in order to reconstruct oxygen consumption. The second aspect is to evaluate performance of the monitoring and control system with the required modifications of the oxygen consumption calculation on pilot-scale. In pilot-scale fed-batch cultivation good monitoring and control performance is obtained enabling a doubled concentration of bulk vaccine compared to standard batch production.

Operational, design and microbial aspects related to power production with microbial fuel cells implemented in constructed wetlands.

Science.gov (United States)

Corbella, Clara; Guivernau, Miriam; Viñas, Marc; Puigagut, Jaume

2015-11-01

This work aimed at determining the amount of energy that can be harvested by implementing microbial fuel cells (MFC) in horizontal subsurface constructed wetlands (HSSF CWs) during the treatment of real domestic wastewater. To this aim, MFC were implemented in a pilot plant based on two HSSF CW, one fed with primary settled wastewater (Settler line) and the other fed with the effluent of a hydrolytic up-flow sludge blanket reactor (HUSB line). The eubacterial and archaeal community was profiled on wetland gravel, MFC electrodes and primary treated wastewater by means of 16S rRNA gene-based 454-pyrosequencing and qPCR of 16S rRNA and mcrA genes. Maximum current (219 mA/m(2)) and power (36 mW/m(2)) densities were obtained for the HUSB line. Power production pattern correlated well with water level fluctuations within the wetlands, whereas the type of primary treatment implemented had a significant impact on the diversity and relative abundance of eubacteria communities colonizing MFC. It is worth noticing the high predominance (13-16% of relative abundance) of one OTU belonging to Geobacter on active MFC of the HUSB line that was absent for the settler line MFC. Hence, MFC show promise for power production in constructed wetlands receiving the effluent of a HUSB reactor. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pre-hospital intubation factors and pneumonia in trauma patients.

Science.gov (United States)

Evans, Heather L; Warner, Keir; Bulger, Eileen M; Sharar, Sam R; Maier, Ronald V; Cuschieri, Joseph

2011-10-01

We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. The subgroup was derived from an existing data set of consecutive adult trauma patients intubated prior to Level I trauma center admission July 2007-July 2008. Intubation details recorded included bag-valve mask ventilation (BVM) and the presence of material in the airway. The diagnosis of VAP was made preferentially by quantitative bronchoalveolar lavage (BAL) cultures (≥ 10⁴ colony-forming units indicating infection). Baseline data, injury characteristics, and circumstances of intubation of patients with and without VAP were compared by univariable analysis. Detailed data were available for 197 patients; 32 (16.2%) developed VAP, on average 6.0±0.7 days after admission. Baseline characteristics were similar in the groups, but diabetes mellitus was more common in the VAP group (4 [12.5%] vs. 5 [3.0%]; p=0.02). There was a higher rate of blunt injury in the VAP patients (28 [87.5%] vs. 106 [64.2%]; p=0.01) and higher injury severity scores (33.1±2.8 vs. 23.0±1.0; p=0.0002) and chest Abbreviated Injury Scores (2.6±0.3 vs. 1.5±0.1; p=0.002). Lower Glasgow Coma Scale scores (7.9±0.9 vs. 9.9±0.4; p=0.04) and greater use of BVM (18 [56.3%] vs. 56 [34.0%]; p=0.02) were observed in patients who developed VAP. Among aspirations, 10 (31.3%) of patients with emesis developed VAP compared with only 4 (12.5%) with blood in the airway (p=0.003). Aspiration, along with depressed consciousness and greater injury severity, may predispose trauma patients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.

Blockade of Vascular Adhesion Protein-1 Inhibits Lymphocyte Infiltration in Rat Liver Allograft Rejection

OpenAIRE

Martelius, Timi; Salaspuro, Ville; Salmi, Marko; Krogerus, Leena; Höckerstedt, Krister; Jalkanen, Sirpa; Lautenschlager, Irmeli

2004-01-01

Vascular adhesion protein-1 (VAP-1) has been shown to mediate lymphocyte adhesion to endothelia at sites of inflammation, but its functional role in vivo has not been tested in any rodent model. Here we report the effects of VAP-1 blockade on rat liver allograft rejection. BN recipients of PVG liver allografts (known to develop acute rejection by day 7) were treated with 2 mg/kg anti-VAP-1 (a new anti-rat VAP-1 mAb 174–5) or isotype-matched irrelevant antibody (NS1) every other day (n = 6/gro...

Ecodesign Implementation and LCA

DEFF Research Database (Denmark)

McAloone, Tim C.; Pigosso, Daniela Cristina Antelmi

2018-01-01

implementation into manufacturing companies. Existing methods and tools for ecodesign implementation will be described, focusing on a multifaceted approach to environmental improvement through product development. Additionally, the use of LCA in an ecodesign implementation context will be further described...... in terms of the challenges and opportunities, together with the discussion of a selection of simplified LCA tools. Finally, a seven-step approach for ecodesign implementation which has been applied by several companies will be described....

Ventilator-associated pneumonia: Its incidence, the risk factor and drug resistance pattern in a tertiary care hospital

Directory of Open Access Journals (Sweden)

Sourabh Mitra

2015-01-01

Full Text Available Background: Ventilator-associated pneumonia (VAP is an infection of the lung that develops 48 h or longer after mechanical ventilation. Objectives: The present study was aimed to find out the bacteriological profile of VAP along with the resistance pattern of bacteriological isolates. Materials and Methods: A prospective observational study was conducted from January 2013 to May 2014 among 791 patients admitted in critical care units of our tertiary care hospital. After selection by applying inclusion and exclusion criteria endotracheal aspirates were collected from ventilated patients. Samples were subjected to further processing by Gram-staining, culture, biochemical testing and antibiogram. Results : Out of 791 patients admitted in intensive care unit in this tertiary care hospital with VAP 540 (68.2% patients were culture positive. Pseudomonas aeruginosa was most commonly isolated pathogen of both early onset and late onset VAP. In early VAP Acinetobacter baumannii showed 62.5% metallo-beta-lactamase (MBL positivity. P. aeruginosa showed 27.5% MBL positivity, whereas in late onset VAP, 71.4% A. baumannii isolates and 75.8% P. aeruginosa isolates showed MBL positivity, respectively. Conclusion : Simple prevention of aspiration, sterilization of equipments, hand washing of personnel can reduce VAP in hospital care setting.

Timing of intubation and ventilator-associated pneumonia following injury.

Science.gov (United States)

Evans, Heather L; Zonies, David H; Warner, Keir J; Bulger, Eileen M; Sharar, Sam R; Maier, Ronald V; Cuschieri, Joseph

2010-11-01

In an emergency medical system with established rapid-sequence intubation protocols, prehospital (PH) intubation of patients with trauma is not associated with a higher rate of ventilator-associated pneumonia (VAP) than emergency department (ED) intubation. Retrospective observational cohort. Level I trauma center. Adult patients with trauma intubated in a PH or an ED setting from July 1, 2007, through July 31, 2008. Diagnosis of VAP by means of bronchoscopic alveolar lavage or clinical assessment when bronchoscopic alveolar lavage was impossible. Secondary outcomes included time to VAP, length of hospitalization, and in-hospital mortality. Of 572 patients, 412 (72.0%) underwent PH intubation. The ED group was older than the PH group (mean ages, 46.4 vs 39.1 years; P VAP (30 [18.8%] vs 71 [17.2%]; P = .66) or mean time to diagnosis (8.1 [1.2] vs 7.8 [1.0] days; P = .89). Logistic regression analysis identified history of drug abuse, lowest recorded ED systolic blood pressure, and injury severity score as 3 independent factors predictive of VAP. Prehospital intubation of patients with trauma is not associated with higher risk of VAP. Further investigation of intubation factors and the incidence and timing of aspiration is required to identify potentially modifiable factors to prevent VAP.

High-dose Sulbactam Treatment for Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant

Directory of Open Access Journals (Sweden)

In Beom Jeong

2016-11-01

Full Text Available Background Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. Methods Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. Results Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023 and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046 were associated with 30-day mortality. Conclusions High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.

The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention.

Science.gov (United States)

Safdar, Nasia; Crnich, Christopher J; Maki, Dennis G

2005-06-01

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with major morbidity and attributable mortality. Strategies to prevent VAP are likely to be successful only if based upon a sound understanding of pathogenesis and epidemiology. The major route for acquiring endemic VAP is oropharyngeal colonization by the endogenous flora or by pathogens acquired exogenously from the intensive care unit environment, especially the hands or apparel of health-care workers, contaminated respiratory equipment, hospital water, or air. The stomach represents a potential site of secondary colonization and reservoir of nosocomial Gram-negative bacilli. Endotracheal-tube biofilm formation may play a contributory role in sustaining tracheal colonization and also have an important role in late-onset VAP caused by resistant organisms. Aspiration of microbe-laden oropharyngeal, gastric, or tracheal secretions around the cuffed endotracheal tube into the normally sterile lower respiratory tract results in most cases of endemic VAP. In contrast, epidemic VAP is most often caused by contamination of respiratory therapy equipment, bronchoscopes, medical aerosols, water (eg, Legionella) or air (eg, Aspergillus or the severe acute respiratory syndrome virus). Strategies to eradicate oropharyngeal and/or intestinal microbial colonization, such as with chlorhexidine oral care, prophylactic aerosolization of antimicrobials, selective aerodigestive mucosal antimicrobial decontamination, or the use of sucralfate rather than H(2) antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semirecumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of VAP. Measures to prevent epidemic VAP include rigorous disinfection of respiratory equipment and bronchoscopes, and infection-control measures to prevent contamination of medical aerosols. Hospital water should be

Ventilator-associated pneumonia rates at major trauma centers compared with a national benchmark: a multi-institutional study of the AAST.

Science.gov (United States)

Michetti, Christopher P; Fakhry, Samir M; Ferguson, Pamela L; Cook, Alan; Moore, Forrest O; Gross, Ronald

2012-05-01

Ventilator-associated pneumonia (VAP) rates reported by the National Healthcare Safety Network (NHSN) are used as a benchmark and quality measure, yet different rates are reported from many trauma centers. This multi-institutional study was undertaken to elucidate VAP rates at major trauma centers. VAP rate/1,000 ventilator days, diagnostic methods, institutional, and aggregate patient data were collected retrospectively from a convenience sample of trauma centers for 2008 and 2009 and analyzed with descriptive statistics. At 47 participating Level I and II centers, the pooled mean VAP rate was 17.2 versus 8.1 for NHSN (2006-2008). Hospitals' rates were highly variable (range, 1.8-57.6), with 72.3% being above NHSN's mean. Rates differed based on who determined the rate (trauma service, 27.5; infection control or quality or epidemiology, 11.9; or collaborative effort, 19.9) and the frequency with which VAP was excluded based on aspiration or diagnosis before hospital day 5. In 2008 and 2009, blunt trauma patients had higher VAP rates (17.3 and 17.6, respectively) than penetrating patients (11.0 and 10.9, respectively). More centers used a clinical diagnostic strategy (57%) than a bacteriologic strategy (43%). Patients with VAP had a mean Injury Severity Score of 28.7, mean Intensive Care Unit length of stay of 20.8 days, and a 12.2% mortality rate. 50.5% of VAP patients had a traumatic brain injury. VAP rates at major trauma centers are markedly higher than those reported by NHSN and vary significantly among centers. Available data are insufficient to set benchmarks, because it is questionable whether any one data set is truly representative of most trauma centers. Application of a single benchmark to all centers may be inappropriate, and reliable diagnostic and reporting standards are needed. Prospective analysis of a larger data set is warranted, with attention to injury severity, risk factors specific to trauma patients, diagnostic method used, VAP definitions

Discussion after implementation of possible ergonomics contributions in production lines automation project

Directory of Open Access Journals (Sweden)

José Adriano Canton

2016-11-01

Full Text Available This paper addresses the issue of work spaces designed based on Activity-Centered Ergonomics. The aim was to reflect on the role of Ergonomics in the design of productive situations in order to anticipate and mitigate the emergence of new constraints. This study was developed using a case study from the packaging industry, where an automated line was implemented to mitigate the injuries suffered as result of the manual system. This article was based on the results of an Ergonomic Work Analysis of the solution implemented, and the subsequent analysis of this design process. It was found that the adopted solution does not have enough leeway for dealing with variations inherent to the process, requiring constant interventions in the operation, by the operators in order to free the line to continue work. It was evident that the adopted solution did not involve the participation of important agents such as the operators and the maintenance crew, giving the project a technical vision that was concerned with eliminating the human factor. The conclusion of this study was that the Ergonomics integrated into the project development favors the collective construction of analysis of the research, and consequently, the development of more effective solutions.

A survey on microorganisms and their sensitivity by E-test in ventilator-associated pneumonia at Toxicological-Intensive Care Unit of Loghman-Hakim Hospital.

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Talaie, Haleh; Sabeti, Shahram; Mahdavinejad, Arezou; Barari, Behjat; Kamalbeik, Sepideh

2010-12-01

Ventilator associated pneumonia (VAP) is the most common nosocomial infection at ICUs, with high mortality and morbidity. The diagnostic method for VAP is based on the combination of clinical, radiological, and microbiological criteria. Lower respiratory tract culture results are useful to confirm the etiology of VAP and adjusted antibiotics. Endotracheal aspiration (EA) is the simplest noninvasive technique for performing lower respiratory tract culture, with high sensitivity and moderately high specificity. The aim of this survey was to evaluate the quantitative cultures of endotracheal aspirates in VAP patients and the sensitivity patterns of microorganisms through E-test. Among 582 ICU admitted patients who were under mechanical ventilation for more than 48 hours, 72 suspected patients of VAP were prospectively evaluated during a 10 month period. Evaluation of our ICU standards by APACHE III scoring, and GCS were carried out on the first day of admission in all patients. Quantitative cultures of EA were performed on all 72 patients. Antibiotic resistance pattern of isolated pathogens was defined by E-test. VAP was confirmed in 46 out of 72 cases (50, 69.4% males and 22, 30.6% females - mean age was 33 +/- 12 years) through quantitative cultures of EA samples. The probable incidence of VAP was 7.9% (per ventilated patients > or = 48 hours). The mean APACHE III score was 31.28 +/- 16. GCS in most of the patients was between 8 and 12. Staphylococcus aureus was the most frequently isolated organism (58.7%), with high sensitivity to Amikacin, Ciprofloxacin, and Teicoplanin (>92%); Pseudomonas aeruginosa was the second most frequent organism (17.4 percent); Acinetobacter isolates were potentially drug resistant, and only Amikacin was effective. Tracheal aspirates in combination with clinical findings show important roles in the management of VAP and decrease inappropriate antimicrobial therapy. S. aureus is the main agent leading to VAP in the TICU of the Loghman

Impact of pathogen-directed antimicrobial therapy for ventilator-associated pneumonia in trauma patients on charges and recurrence.

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Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Swanson, Joseph M; Wood, G Christopher; Fabian, Timothy C; Croce, Martin A

2015-04-01

Ventilator-associated pneumonia (VAP) represents one of the driving forces behind antibiotic use in the ICU. In a previous study, we established a defined algorithm for treatment of hospital-acquired VAP dictated by the causative pathogen. The purpose of the current study was to evaluate the impact of this algorithm for hospital-acquired VAP on recurrence and charges in trauma patients. Patients with VAP secondary to MRSA, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or Enterobacteriaceae during 5 years subsequent to the previous study were evaluated. All VAP were diagnosed using quantitative cultures of the bronchoalveolar lavage effluent. Duration of antimicrobial therapy was dictated by the causative pathogen. If microbiologic resolution, defined as 10(5) colony-forming units/mL on subsequent bronchoalveolar lavage performed within 2 weeks after completion of appropriate therapy. Five hundred and twenty-nine VAP episodes were identified in 381 patients. Overall recurrence was unchanged compared with the previous study (1.5% vs 2%; p = 0.3). There was a decrease in the number of bronchoalveolar lavages performed per patient compared with the previous study (1.6 vs 2.3; p = 0.24) and a reduction of 4.8 antibiotic days per VAP episode compared with the previous study. Both changes resulted in a cumulative reduction of $3,535.04 per patient, for a savings of $1.35 million during the study period. Hospital-acquired VAP can be managed effectively by a defined course of therapy dictated by the causative pathogen. Adherence to an established algorithm simplified the management of VAP and contributed to a cumulative reduction in patient charges without impacting recurrence. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Validation of the standalone implementation of the dynamic wake meandering model for power production

DEFF Research Database (Denmark)

Keck, Rolf-Erik Henrik Jussi

2015-01-01

This paper presents validation for using the standalone implementation of the dynamic wake meandering (DWM) model to conduct numerical simulations of power production of rows of wind turbines. The standalone DWM model is an alternative formulation of the conventional DWM model that does not require...... information exchange with an aeroelastic code. As a consequence, the standalone DWM model has significantly shorter computational times and lower demands on the user environment. The drawback of the standalone DWM model is that it does not have the capability to predict turbine loads. Instead, it should...

Orchestrating Lean Implementation

DEFF Research Database (Denmark)

Riis, Jens Ove; Mikkelsen, Hans; Andersen, Jesper Rank

2008-01-01

The notion of Lean Manufacturing is not merely confined to a set of well defined techniques, but represents a broad approach to managing a company. Working with lean entails many aspects, such as production planning and control, production engineering, product development, supply chain......, and organizational issues. To become effective, many functional areas and departments must be involved. At the same time companies are embedded in a dynamic environment. The aim of the paper is to propose a comprehensive approach to better implementation of lean initiatives, based on two empirical studies. The paper...... will discuss how a concerted effort can be staged taking into account the interdependencies among individual improvement initiatives. The notion of orchestration will be introduced, and several means for orchestration will be presented. Critical behavioral issues for lean implementation will be discussed....

Impact of a monitored program of care on incidence of ventilator-associated pneumonia: results of a longterm performance-improvement project.

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Weireter, Leonard J; Collins, J N; Britt, Rebecca C; Reed, Scott F; Novosel, T J; Britt, L D

2009-05-01

Ventilator-associated pneumonia (VAP) remains a major source of morbidity, mortality, and expense in the ICU despite therapies directed against it. A retrospective review of a prospectively developed performance-improvement project monitoring the incidence of VAP in two adjacent ICUs was conducted. In response to an excessive VAP rate, weekly multidisciplinary team meetings were instituted to review data, develop care protocols, and modify care routines. Protocol compliance was monitored daily and feedback provided weekly to the care teams. VAP rates were determined by the institutional Infection Control Committee and reviewed monthly with the ICU multidisciplinary team. Duration of the investigational period was 10 years. A standardized ventilator-weaning protocol was instituted with confirmed 95% use. Additional modifications of care, such as patient positioning, use of specific endotracheal tubes to minimize aspiration of supraglottic secretions, an oral-care regimen, and aggressive antibiotic stewardship were standardized, with a compliance rate >90%. VAP rates dropped from 12.8 per 1,000 patient-days in 1998 to 1.1 in 2007 in the burn trauma ICU and from 21.2 to VAP rate in the ICU.

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

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Caserta Raquel A

2012-09-01

Full Text Available Abstract Background Ventilator-associated pneumonia (VAP is a common infection in the intensive care unit (ICU and associated with a high mortality. Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS, were adopted for patients undergoing mechanical ventilation. Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27. We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. Conclusion These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting.

Science.gov (United States)

Caserta, Raquel A; Marra, Alexandre R; Durão, Marcelino S; Silva, Cláudia Vallone; Pavao dos Santos, Oscar Fernando; Neves, Henrique Sutton de Sousa; Edmond, Michael B; Timenetsky, Karina Tavares

2012-09-29

Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement's (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

Science.gov (United States)

2012-01-01

Background Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. Conclusion These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored. PMID:23020101

Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study

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Serin Simay

2004-04-01

Full Text Available Abstract Background Ventilator-associated pneumonia (VAP which is an important part of all nosocomial infections in intensive care unit (ICU is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. Methods This is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients. Results Median length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5 and 2.5 (IQR: 2.0 days respectively (P Conclusion Respiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately five-fold higher than non-infected patients.

Ventilator-associated pneumonia: role of positioning.

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Li Bassi, Gianluigi; Torres, Antoni

2011-02-01

Ventilator-associated pneumonia (VAP) is a lung infection commonly acquired following tracheal intubation. This review assesses the role of the supine semirecumbent and the prone position as VAP preventive strategies and calls attention for further investigation on novel body positions that could potentially reduce risks of VAP. The most recent studies on the semirecumbent position failed to achieve an orientation of the head of the bed higher than 30° and did not corroborate any benefit of the semirecumbent position on VAP, as reported in earlier studies. To date, there is clear evidence that the supine horizontal body position increases risks of pulmonary aspiration and VAP, particularly when patients are enterally fed. Laboratory reports are emphasizing the importance of an endotracheal tube-oropharynx-trachea axis below horizontal to avoid VAP. The prone position potentially increases drainage of oropharyngeal and airways secretions and recent evidence is supporting its beneficial effects. However, several associated adverse effects preclude its regular use as a VAP preventive strategy for patients other than those with acute respiratory distress syndrome. Body position greatly affects several pathogenetic mechanisms of VAP. The current evidence recommends avoidance of supine horizontal position in order to prevent aspiration of colonized gastric contents. The semirecumbent position has proven benefits and should be routinely used but there is still limited evidence to recommend the lowest orientation of the bed at which the patient can be safely maintained. Results from pioneering laboratory investigation call attention to new possible positions, that is lateral Trendelenburg position, aimed to avoid pulmonary aspiration and to enhance mucus clearance in intubated patients.

Fusion Implementation

International Nuclear Information System (INIS)

Schmidt, J.A.

2002-01-01

If a fusion DEMO reactor can be brought into operation during the first half of this century, fusion power production can have a significant impact on carbon dioxide production during the latter half of the century. An assessment of fusion implementation scenarios shows that the resource demands and waste production associated with these scenarios are manageable factors. If fusion is implemented during the latter half of this century it will be one element of a portfolio of (hopefully) carbon dioxide limiting sources of electrical power. It is time to assess the regional implications of fusion power implementation. An important attribute of fusion power is the wide range of possible regions of the country, or countries in the world, where power plants can be located. Unlike most renewable energy options, fusion energy will function within a local distribution system and not require costly, and difficult, long distance transmission systems. For example, the East Coast of the United States is a prime candidate for fusion power deployment by virtue of its distance from renewable energy sources. As fossil fuels become less and less available as an energy option, the transmission of energy across bodies of water will become very expensive. On a global scale, fusion power will be particularly attractive for regions separated from sources of renewable energy by oceans

Preliminary Analysis of the (Process and Product) Quality of Physical Education in Flemish Secondary Schools: Implementation of IKLO

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Huts, K.; Van Hoecke, J.; De Knop, P.; Theeboom, M.

2009-01-01

The purpose of the present study was twofold, namely implementing a multifunctional (self-) evaluation instrument for physical education in a sample of Flemish secondary schools (N=100), while simultaneously obtaining a preliminary picture of the subjects' product and process quality. Descriptive statistics revealed that P. E. teachers' engagement…

[Ventilator bundle guided by context of JCI settings can effectively reduce the morbidity of ventilator-associated pneumonia].

Science.gov (United States)

Zhao, Lili; Liu, Lili; Chen, Jing; Yang, Caili; Nie, Jianjian; Zhang, Minwei

2017-07-01

To observe the impact of improving the compliance of ventilator bundle on morbidity of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients undergoing mechanical ventilation (MV) guided by context of Joint Commission International (JCI) settings, and to study the oral care efficacy of suction tube sponge brush. A prospective study was conducted. The patients who needed MV admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2013 to December 2016 were enrolled. In the context of JCI settings, necessary measurements were taken to enhance the compliance of ventilator bundle each year. In 2013, the preventive measures were set up and the education was strengthened. In 2014, the compliance of hand hygiene and bedside elevation was strengthened. In 2015, a control study was conducted to evaluate the effect between the traditional cotton dipped in chlorhexidine and the suction tube sponge brush rinsed with chlorhexidine on oral health impact parameters. The suction tube sponge brush rinsed with chlorhexidine oral care was introduced to improve compliance. In 2016, electronic bundle checklist for daily self-audits was conducted. The annually morbidity of VAP through the software of hospital and ICU was collected and calculated. The annual incidence of VAP was indicated by the VAP cases per 1 000 MV days. Based on the VAP incidence rate in 2013 as 1, the VAP incidence-rate ratio (IRR) of each year was calculated. During the study period, a total of 2 733 patients admitted to the ICU, including 1 403 patients undergoing MV. Ninety-four of the 1 403 patients with community-acquired pneumonia (CAP), aspiration pneumonia, back elevation ban, incomplete information, and withdrew from the study were excluded. 1 399 patients undergoing MV were enrolled in the final analysis, with total MV days of 11 012 days, and 94 patients occurred VAP. The annual incidence of VAP was progressively declined

Ventilator-associated pneumonia.

Science.gov (United States)

Shaw, Michael Jan

2005-05-01

This review summarises some of the notable papers on ventilator-associated pneumonia (VAP) from January 2003 to October 2004. Ventilator-associated pneumonia remains an important drain on hospital resources. All population groups are affected, but patients with VAP are more likely to be older, sicker, and male, with invasive medical devices in situ. Early VAP diagnosis is desirable to reduce VAP mortality and to retard emergence of multidrug-resistant microbes. This may be possible using preliminary culture results or intracellular organism in polymorphonuclear cells. In most intensive care units, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii are the commonest organisms isolated in VAP. However, causative organisms vary between and within hospitals. Consequently, individual intensive care units should develop empirical antibiotic policies to target the pathogenic bacteria prevalent in their patient populations. Preventative strategies aimed at reducing aerodigestive tract colonisation by pathogenic organisms, and also their subsequent aspiration, are becoming increasingly important. Educating medical staff about these simple measures is therefore pertinent. To reduce the occurrence of multidrug-resistant organisms, limiting the duration of antibiotic treatment to 8 days and antimicrobial rotation should be contemplated. Empirical therapy with antipseudomonal penicillins plus beta-lactamase inhibitors should be considered. If methicillin-resistant Staphylococcus aureus VAP is a possibility, linezolid may be better than vancomycin. Prevention remains the key to reducing VAP prevalence.

Estimating enthalpy of vaporization from vapor pressure using Trouton's rule.

Science.gov (United States)

MacLeod, Matthew; Scheringer, Martin; Hungerbühler, Konrad

2007-04-15

The enthalpy of vaporization of liquids and subcooled liquids at 298 K (delta H(VAP)) is an important parameter in environmental fate assessments that consider spatial and temporal variability in environmental conditions. It has been shown that delta H(VAP)P for non-hydrogen-bonding substances can be estimated from vapor pressure at 298 K (P(L)) using an empirically derived linear relationship. Here, we demonstrate that the relationship between delta H(VAP)and PL is consistent with Trouton's rule and the ClausiusClapeyron equation under the assumption that delta H(VAP) is linearly dependent on temperature between 298 K and the boiling point temperature. Our interpretation based on Trouton's rule substantiates the empirical relationship between delta H(VAP) degree and P(L) degrees for non-hydrogen-bonding chemicals with subcooled liquid vapor pressures ranging over 15 orders of magnitude. We apply the relationship between delta H(VAP) degrees and P(L) degrees to evaluate data reported in literature reviews for several important classes of semivolatile environmental contaminants, including polycyclic aromatic hydrocarbons, chlorobenzenes, polychlorinated biphenyls and polychlorinated dibenzo-dioxins and -furans and illustrate the temperature dependence of results from a multimedia model presented as a partitioning map. The uncertainty associated with estimating delta H(VAP)degrees from P(L) degrees using this relationship is acceptable for most environmental fate modeling of non-hydrogen-bonding semivolatile organic chemicals.

Ventilators in ICU: A boon or burden

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Man Mohan Mehndiratta

2016-01-01

Full Text Available Background and Aims: Ventilator-associated pneumonia (VAP is a major challenge in intensive care units (ICUs. This challenge is even more discernible in a neurological setting owing to the predispositions of patients. Data on VAP in the neurology and neurosurgery ICUs (NNICUs are scanty in developing countries. This study was conducted to find out the occurrence of VAP, its risk factors, microbiological profile, and antibiotic resistance in patients admitted to the NNICU of a tertiary care institute in India. Materials and Methods: Endotracheal aspirate and blood samples were collected from 100 patients admitted to the NNICU. Complete blood count, microscopic examination, culture and sensitivity testing of aspirate were done. Chest x-ray was also performed to aid in the diagnosis of VAP. Results: Incidence rate of VAP was found to be 24%. Acinetobacter baumannii was the most common pathogen (24.3% isolated from patients with VAP, and all of these isolates were sensitive to meropenem. Duration of mechanical ventilation (P < 0.0001 and associated comorbid illness (P = 0.005 were found to be significantly associated with VAP, and the duration of mechanical ventilation was found to be the only independent risk factor (P < 0.0001. Conclusions: This study highlights the risks and microbiological perspective of ventilator use among neurology patients so that adequate preventive strategies can be adopted on time.

Impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia: study protocol for a randomized controlled study.

Science.gov (United States)

Bouglé, Adrien; Foucrier, Arnaud; Dupont, Hervé; Montravers, Philippe; Ouattara, Alexandre; Kalfon, Pierre; Squara, Pierre; Simon, Tabassome; Amour, Julien

2017-01-23

Ventilator-associated pneumonia (VAP) accounts for 25% of infections in intensive care units. Compared to a long duration (LD) of antibiotic therapy, a short duration (SD) has a comparable clinical efficacy with less antibiotic use and less multidrug-resistant (MDR) pathogen emergence, with the exception of documented VAP of non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA). These results have led the American Thoracic Society to recommend SD therapy for VAP, except for PA-VAP. Thus the beneficial effect of SD therapy in PA-VAP is still a matter of debate. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) versus prolonged antibiotic therapy (15 days) in PA-VAP. The impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia (iDIAPASON) trial is a randomized, open-labeled non-inferiority controlled trial, conducted in 34 French intensive care units (ICUs), comparing two groups of patients with PA-VAP according to the duration (8 days or 15 days) of effective antibiotic therapy against PA. The primary outcome is a composite endpoint combining day 90 mortality and PA-VAP recurrence rate during hospitalization in the ICU. Furthermore, durations of mechanical ventilation and hospitalization, as well as number and types of extrapulmonary infections or acquisition of MDR pathogens during the hospitalization in the ICU will be recorded. Recurrence with predefined criteria (clinical suspicion of VAP associated with a positive quantitative culture of a respiratory sample) will be evaluated by two independent experts. Demonstrating that an SD (8 days) versus LD (15 days) therapy strategy in PA-VAP treatment is safe and not associated with an increased mortality or recurrence rate could lead to a change in practices and guidelines in the management of antibiotic therapy of this frequent ICU complication. This strategy could lead to

Multicenter Evaluation of a Novel Surveillance Paradigm for Complications of Mechanical Ventilation

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Klompas, Michael; Khan, Yosef; Kleinman, Kenneth; Evans, R. Scott; Lloyd, James F.; Stevenson, Kurt; Samore, Matthew; Platt, Richard

2011-01-01

Background Ventilator-associated pneumonia (VAP) surveillance is time consuming, subjective, inaccurate, and inconsistently predicts outcomes. Shifting surveillance from pneumonia in particular to complications in general might circumvent the VAP definition's subjectivity and inaccuracy, facilitate electronic assessment, make interfacility comparisons more meaningful, and encourage broader prevention strategies. We therefore evaluated a novel surveillance paradigm for ventilator-associated complications (VAC) defined by sustained increases in patients' ventilator settings after a period of stable or decreasing support. Methods We assessed 600 mechanically ventilated medical and surgical patients from three hospitals. Each hospital contributed 100 randomly selected patients ventilated 2–7 days and 100 patients ventilated >7 days. All patients were independently assessed for VAP and for VAC. We compared incidence-density, duration of mechanical ventilation, intensive care and hospital lengths of stay, hospital mortality, and time required for surveillance for VAP and for VAC. A subset of patients with VAP and VAC were independently reviewed by a physician to determine possible etiology. Results Of 597 evaluable patients, 9.3% had VAP (8.8 per 1,000 ventilator days) and 23% had VAC (21.2 per 1,000 ventilator days). Compared to matched controls, both VAP and VAC prolonged days to extubation (5.8, 95% CI 4.2–8.0 and 6.0, 95% CI 5.1–7.1 respectively), days to intensive care discharge (5.7, 95% CI 4.2–7.7 and 5.0, 95% CI 4.1–5.9), and days to hospital discharge (4.7, 95% CI 2.6–7.5 and 3.0, 95% CI 2.1–4.0). VAC was associated with increased mortality (OR 2.0, 95% CI 1.3–3.2) but VAP was not (OR 1.1, 95% CI 0.5–2.4). VAC assessment was faster (mean 1.8 versus 39 minutes per patient). Both VAP and VAC events were predominantly attributable to pneumonia, pulmonary edema, ARDS, and atelectasis. Conclusions Screening ventilator settings for VAC captures a

Effects of velvet antler polypeptide on sexual behavior and testosterone synthesis in aging male mice.

Science.gov (United States)

Zang, Zhi-Jun; Tang, Hong-Feng; Tuo, Ying; Xing, Wei-Jie; Ji, Su-Yun; Gao, Yong; Deng, Chun-Hua

2016-01-01

Twenty-four-month-old male C57BL/6 mice with low serum testosterone levels were used as a late-onset hypogonadism (LOH) animal model for examining the effects of velvet antler polypeptide (VAP) on sexual function and testosterone synthesis. These mice received VAP for 5 consecutive weeks by daily gavage at doses of 100, 200, or 300 mg kg-1 body weight per day (n = 10 mice per dose). Control animals (n = 10) received the same weight-based volume of vehicle. Sexual behavior and testosterone levels in serum and interstitial tissue of testis were measured after the last administration of VAP. Furthermore, to investigate the mechanisms of how VAP affects sexual behavior and testosterone synthesis in vivo, the expression of steroidogenic acute regulatory protein (StAR), cytochrome P450 cholesterol side-chain cleavage enzyme (P450scc), and 3β-hydroxysteroid dehydrogenase (3β-HSD) in Leydig cells was also measured by immunofluorescence staining and quantitative real-time PCR. As a result, VAP produced a significant improvement in the sexual function of these aging male mice. Serum testosterone level and intratesticular testosterone (ITT) concentration also increased in the VAP-treated groups. The expression of StAR, P450scc, and 3β-HSD was also found to be enhanced in the VAP-treated groups compared with the control group. Our results suggested that VAP was effective in improving sexual function in aging male mice. The effect of velvet antler on sexual function was due to the increased expression of several rate-limiting enzymes of testosterone synthesis (StAR, P450scc, and 3β-HSD) and the following promotion of testosterone synthesis in vivo.

Assessment of a training programme for the prevention of ventilator-associated pneumonia.

Science.gov (United States)

Jam Gatell, M Rosa; Santé Roig, Montserrat; Hernández Vian, Óscar; Carrillo Santín, Esther; Turégano Duaso, Concepción; Fernández Moreno, Inmaculada; Vallés Daunis, Jordi

2012-01-01

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs). Most published studies have analysed nurses' theoretical knowledge about a specific procedure; however, the transfer of this knowledge to the practice has received little attention. To assess the impact of training session on nurses' knowledge regarding VAP, compliance with VAP preventive measures, VAP incidence and determining whether nursing workload affects compliance. A prospective, quasiexperimental, pre- and post-study of the nursing team in a 16-bed medical/surgical ICU. Pre-intervention phase: a questionnaire to assess nurses' knowledge of VAP prevention measures, direct observation and review of clinical records to assess compliance. Intervention phase: eight training sessions for nurses. The post-intervention phase mirrored the pre-intervention phase. Nurses answered more questions correctly on the post-intervention questionnaire than on the pre-intervention (17·87 ± 2·69 versus 15·91 ± 2·68, p = 0·002). Compliance with the following measures was better during the post-intervention period (p = 0·001): use of the smallest possible nasogastric tube, controlled aspiration of subglottic secretions and endotracheal tube cuff pressure, use of oral chlorhexidine and recording the endotracheal tube fixation number. VAP incidence remained unchanged throughout the study. However, a trend towards lower incidence of late (>4 days after intubation) VAP was observed (4·6 versus 3·1 episodes/1000 ventilation days, p = 0·37). The programme improved both knowledge of and compliance with VAP preventive measures, although improved knowledge did not always result in improved compliance. © 2012 The Authors. Nursing in Critical Care © 2012 British Association of Critical Care Nurses.

Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- A preliminary study of 100 patients

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M N Vijai

2016-01-01

Full Text Available Background and Aims: Oropharyngeal colonisation followed by aspiration of contaminated secretions is the major cause for ventilator-associated pneumonia (VAP. Pooled secretions present in the sub-glottic area above inflated endotracheal tube cuff may be aspirated into the lower airways. It was hypothesised that intermittent suctioning of sub-glottic secretions would prevent VAP. Methods: Group I (n = 50 patients were intubated with HiLo Evac™ endotracheal (ET tube with facility for sub-glottic suctioning, and Group II (n = 50 patients were intubated with HiLo Contour™ ET tube without such facility. In the Group I, sub-glottic suctioning was performed every 2 h. Incidence of VAP, mean ventilator days, Intensive Care Unit (ICU stay and mortality were compared. Qualitative variables were reported as percentages and were compared by Chi-square test or unpaired two-tailed, Fisher′s exact test, as appropriate, to analyse the significance of difference between the two groups. Results: The two groups were similar with respect to demographic characteristics. VAP was seen in 6% of patients in Group I and 22% of patients in Group II (P = 0.021. Both early- and late-onset VAPs were significantly reduced in Group I. Both ventilator days (8.0 vs. 6.45; P = 0.001 and ICU stay (8.33 vs. 6.33; P = 0.001 on the day of onset of VAP were significantly more in the Group I. Total ventilator days were significantly less (6.52 vs. 8.32; P = 0.006 with lower incidence of mortality (36% vs. 48%; P = 0.224 in the Group I. Conclusion: Intermittent sub-glottic suctioning reduces the incidence of VAP including late-onset VAP.

Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- A preliminary study of 100 patients.

Science.gov (United States)

Vijai, M N; Ravi, Parli R; Setlur, Rangaraj; Vardhan, Harsh

2016-05-01

Oropharyngeal colonisation followed by aspiration of contaminated secretions is the major cause for ventilator-associated pneumonia (VAP). Pooled secretions present in the sub-glottic area above inflated endotracheal tube cuff may be aspirated into the lower airways. It was hypothesised that intermittent suctioning of sub-glottic secretions would prevent VAP. Group I (n = 50) patients were intubated with HiLo Evac™ endotracheal (ET) tube with facility for sub-glottic suctioning, and Group II (n = 50) patients were intubated with HiLo Contour™ ET tube without such facility. In the Group I, sub-glottic suctioning was performed every 2 h. Incidence of VAP, mean ventilator days, Intensive Care Unit (ICU) stay and mortality were compared. Qualitative variables were reported as percentages and were compared by Chi-square test or unpaired two-tailed, Fisher's exact test, as appropriate, to analyse the significance of difference between the two groups. The two groups were similar with respect to demographic characteristics. VAP was seen in 6% of patients in Group I and 22% of patients in Group II (P = 0.021). Both early- and late-onset VAPs were significantly reduced in Group I. Both ventilator days (8.0 vs. 6.45; P = 0.001) and ICU stay (8.33 vs. 6.33; P = 0.001) on the day of onset of VAP were significantly more in the Group I. Total ventilator days were significantly less (6.52 vs. 8.32; P = 0.006) with lower incidence of mortality (36% vs. 48%; P = 0.224) in the Group I. Intermittent sub-glottic suctioning reduces the incidence of VAP including late-onset VAP.

MICROBIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERNS OF PATHOGENS CAUSING VENTILATOR- ASSOCIATED PNEUMONIA AT INTENSIVE CARE UNIT, SESTRE MILOSRDNICE UNIVERSITY HOSPITAL CENTER, ZAGREB, CROATIA.

Science.gov (United States)

Turković, Tihana Magdić; Grginić, Ana Gverić; Cucujić, Branka Đuras; Gašpar, Božena; Širanović, Mladen; Perić, Mladen

2015-06-01

Ventilator-associated pneumonia (VAP) is very common in many intensive care Units, but there are still many uncertainties about VAP, especially about the choice of initial empiric antibiotics. The incidence of specific pathogens with different susceptibility patterns causing VAP varies from hospital to hospital. This is the reason why empiric initial antibiotic treatment for VAP should be based not only on general guidelines (that recommend therapy according to the presence of risk factors for multidrug-resistant bacteria), but also on up-to-date information on local epidemiology. The aim of this study was to determine the microbial profile of pathogens causing VAP and their antibiotic susceptibility patterns. The study was conducted in the 15-bed surgical and neurosurgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia. Retrospective data were collected from September 2009 to March 2013. All patients that developed VAP during the study period were eligible for the study. According to study results, the incidence of VAP was 29.4%. The most commonly isolated bacterium was Staphylococcus aureus (21.1%), followed by Pseudomonas aeruginosa (19.0%) and Acinetobacter species (13.6%). All Staphylococcus aureus isolates were susceptible to vancomycin and linezolid. Pseudomonas aeruginosa showed 100% susceptibility to cefepime and very high susceptibility to pip'eracillin-tazobactam (96%), ceftazidime (93%) and ciprofloxacin (89%). Ampicillin-sulbactam was highly effective for Acinetobacter species, showing resistance in only 8% of isolates. In conclusion, according to study data, appropriate empiric antibiotic therapy for patients with VAP without risk factors for multidrug-resistant bacteria is ceftriaxone and for patients with risk factors for multidrug-resistant bacteria ampicillin-sulbactam plus cefepime plus vancomycin or linezolid.

Microbiological pattern of ventilator associated pneumonia

International Nuclear Information System (INIS)

Ali, S.; Wahid, K.; Iqbal, Z.

2015-01-01

Ventilator associated pneumonia (VAP) is an important and common complication of mechanically ventilated patients. It is the leading cause of morbidity and mortality in Intensive Care Units (ICU) worldwide. The aim of study was to determine the pattern of bacteria involved in VAP in intensive care unit of Jinnah hospital Lahore. Methods: It was descriptive case series study, conducted over a period of one year on mechanically ventilated 50 patients. American Thoracic Society (ATS) guidelines recommend quantitative/semi-quantitative culture of endotracheal aspirates (ETA) or bronchoscopic aspirates/washing from the infected lung segments for the diagnosis of VAP. Hence this study was conducted to identify the types of bacteria involved in VAP in our ICU. Patients enrolled were clinically and radiologically suspected VAP, admitted in the ICU of Jinnah Hospital/Allama Iqbal Medical College (AIMC) Lahore. Bronchial washings were taken with the help of Fiber optic bronchoscope. Wherever bronchoscopy was not possible, subglottic secretions were collected with the help of sterilized catheter and sucker. Collected samples were sent to the Pathology laboratory of AIMC for aerobic culture and sensitivity. Results: Major pathogenic bacteria isolated were Gram negative (74%). Among this group E. coli, Pseudomonas, Klebsiella and Acinetobacter were the commonest organisms. Gram positive bacteria were 20%, Staphylococcus aureus (MRSA) and haemolyticus streptococci were the major isolate. In 4% cases mixed growth and in 2% cases no growth was reported. Conclusion: Major pathogenic organisms of VAP in our ICU are Gram negative bacteria. The Bacteriological culture of endobroncheal aspirates is helpful in the diagnosis and management of VAP. Emperic antibiotic therapy for VAP should cover Gram negative organisms. (author)

Assessment of a training programme for the prevention of ventilator-associated pneumonia

Science.gov (United States)

Jam Gatell, M Rosa; Santé Roig, Montserrat; Hernández Vian, Óscar; Carrillo Santín, Esther; Turégano Duaso, Concepción; Fernández Moreno, Inmaculada; Vallés Daunis, Jordi

2012-01-01

Background Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs). Most published studies have analysed nurses' theoretical knowledge about a specific procedure; however, the transfer of this knowledge to the practice has received little attention. Aim To assess the impact of training session on nurses' knowledge regarding VAP, compliance with VAP preventive measures, VAP incidence and determining whether nursing workload affects compliance. Method A prospective, quasiexperimental, pre- and post-study of the nursing team in a 16-bed medical/surgical ICU. Pre-intervention phase: a questionnaire to assess nurses' knowledge of VAP prevention measures, direct observation and review of clinical records to assess compliance. Intervention phase: eight training sessions for nurses. The post-intervention phase mirrored the pre-intervention phase. Findings Nurses answered more questions correctly on the post-intervention questionnaire than on the pre-intervention (17·87 ± 2·69 versus 15·91 ± 2·68, p = 0·002). Compliance with the following measures was better during the post-intervention period (p = 0·001): use of the smallest possible nasogastric tube, controlled aspiration of subglottic secretions and endotracheal tube cuff pressure, use of oral chlorhexidine and recording the endotracheal tube fixation number. VAP incidence remained unchanged throughout the study. However, a trend towards lower incidence of late (>4 days after intubation) VAP was observed (4·6 versus 3·1 episodes/1000 ventilation days, p = 0·37). Conclusion The programme improved both knowledge of and compliance with VAP preventive measures, although improved knowledge did not always result in improved compliance. PMID:23061618

The role of surveillance cultures in guiding ventilator-associated pneumonia therapy.

Science.gov (United States)

Luna, Carlos M; Bledel, Ignacio; Raimondi, Alejandro

2014-04-01

Ventilator-associated pneumonia (VAP) is the most frequent cause of death among the nosocomial infections acquired in the ICU. Routine surveillance endotracheal aspirate (ETA) cultures in patients on mechanical ventilation have been proposed to predict the cause of VAP. Our aim is to review the available experience regarding the role of surveillance ETA cultures in guiding VAP antimicrobial therapy. Microorganisms arrive in the lower respiratory tract by aspiration from the oropharynx or gastric reflux, extension from a contiguous infection, air contamination or by hematogenous seeding. Bacterial colonization of the airway leads to the development of VAP and may result from the aspiration of oropharyngeal or gastric secretions. Recent studies have suggested that surveillance cultures could provide a rationale for prescribing appropriate antibiotics, while waiting for culture results, in up to 95% of patients in whom VAP is ultimately diagnosed by bronchoalveolar lavage fluid culture. However, some authors observed that guiding therapy with those routine surveillance cultures leads to unacceptably low coverage of the pathogens producing VAP. This article describes the evidence supporting the use of routine ETA cultures to prescribe appropriate initial empirical therapy compared with the current practice dictated by guidelines.

Web-Based Implementation of E-Marketing to Support Product Marketing of Chemical Manufacturing Company

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Riswan Efendi Tarigan

2015-10-01

Full Text Available Currently, many company’s marketing strategies are limited only to face-to-face communication, telephone, facsimile, company portfolio, and product brochures. However, those marketing strategies are well- known to have limited impacts. Therefore, the presence of e-marketing as one of the marketing strategies would be appropriate to cover the weaknesses and to solve a number of the marketing problems. The purpose of this study is to discuss matters related to marketing, such    as, proposing a marketing plan using website, expanding marketing segment, and introducing existing  products for a chemical manufacturing company. The adopted research method is a descriptive method where the study is directly performed on the research object to acquire necessary data. The collected data are further analyzed using the Porter’s Five Force and SWOT analysis. Fi- nally, the work provides a number of recommendations for implementing e-marketing strategies to support the company business.

Increased cefepime MIC for enterobacteriacae clinical isolates.

Science.gov (United States)

Najafi, Narges; Alikhani, Ahmad; Babamahmoudi, Farhang; Davoudi, Alireza; Ghasemiyan, Roya; Aliyan, Shahriar; Shoujaiifar, Arman

2013-01-01

Background : Cefepime was used as empirical treatment in ventilator-associated pneumonia (VAP) induced by gram-negative and gram-positive bacteria. This study aimed to determine the antimicrobial susceptibility pattern of cefepime against microorganism causing VAP in Mazandaran, North of Iran. This study was performed on VAP patients diagnosed with clinical pulmonary infection score (CPIS) scores in ICU of two hospitals. For each patient suspected of having VAP, quantitative culture of endotracheal aspiration (QEA) was performed and MIC was determined by micro dilution test. Data were collected and analyzed. Thirty- five cases of enterobacteriaceae were isolated orderly including E coli 13, P. aeruginosa 11, Enterobacter 7 and K. pneumonia 4 cases. All the isolated E. coli, Enterobacter and Klebsiella, 54.5% of P. aeruginosa isolated were fully resistant to cefepime. The results of this study show that cefepime is not a reasonable choice for empirical treatment of nosocomial pneumonia and VAP.

Implementation of methodology for analyzing the added value in a metallurgical industry of custom products

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Paulo Cesar Mayer

2015-03-01

Full Text Available This paper addresses the implementation of a methodology for the analysis of added value in a job where steel sheets operations are processed by oxyfuel in a CNC (computer numerical control machine. The method used was based on a case study, followed by descriptive research by observing and recording the movements of the work. For this purpose, all the movements and tasks of the operators and the machine were defined, and classified according to the concepts adopted by Ohno (2002. Their chrono-analyses occurred in the period from March to June 2010 and later improvements were made throughout the workplace, allowing the elimination and reduction of losses, significant increase in the added value and increased occupation of the machine. Through this case study, it was found that the understandings of Ohno (2002 about the added value developed for an automotive industry manufacturing a standard product are perfectly applicable to a company that works with a production system under design and does not manufacture standard products

Empiric antibiotics pending bronchoalveolar lavage data in patients without pneumonia significantly alters the flora, but not the resistance profile, if a subsequent pneumonia develops.

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Thakkar, Rajan K; Monaghan, Sean F; Adams, Charles A; Stephen, Andrew; Connolly, Michael D; Gregg, Shea; Cioffi, William G; Heffernan, Daithi S

2013-05-01

Ventilator-associated pneumonia (VAP) occurs in up to 25% of mechanically ventilated patients, with an associated mortality up to 50%. Early diagnosis and appropriate empiric antibiotic coverage of VAP are crucial. Given the multitude of noninfectious clinical and radiographic anomalies within trauma patients, microbiology from bronchioalveolar lavage (BAL) is often needed. Empiric antibiotics are administered while awaiting BAL culture data. Little is known about the effects of these empiric antibiotics on patients with negative BAL microbiology if a subsequent VAP occurs during the same hospital course. This is a retrospective chart review of intubated trauma patients undergoing BAL for suspected pneumonia over a 3-y period at a Level 1 trauma center. All patients with suspected VAP undergoing a BAL receive empiric antibiotics. If microbiology data are negative at 72 h, all antibiotics are stopped; however, if the BAL returns with ≥10(5) colony-forming units per milliliter, the diagnosis of VAP is confirmed. We divided patients into three groups. Group 1 consisted of patients in whom the initial BAL was positive for VAP. Group 2 consisted of patients with an initial negative BAL, who subsequently developed VAP at a later point in the hospital course. Group 3 consisted of patients with negative BAL who did not develop a subsequent VAP. We obtained 499 BAL specimens in 185 patients over the 3-y period. A total of 14 patients with 23 BAL specimens initially negative for VAP subsequently developed VAP later during the same hospital stay. These patients did not have an increase in the hospital length of stay, intensive care unit days, ventilator days, or mortality compared with those who had a positive culture on the first suspicion of VAP. There was a significant increase in the percentage of Enterobacter (21% versus 8%) and Morganella (8% versus 0%) as the causative organism in these 14 patients when the VAP occurred. Furthermore, the profile of the top two

Production Cells in Construction: Considering Time, Space and Information Linkages to Seek Broader Implementations

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Renato Nunes Mariz

2013-01-01

Full Text Available The use of production cells in manufacturing has achieved many benefits, motivating researchers to apply them in the construction environment. The aim of this research is to identify time, space, and information linkages in construction’s production cells applications, seeking opportunities for broader implementations. We adopted a literature review approach focusing on cases in the Brazilian construction sector that addressed cell applications. Subsequently, comparative tables of these publications were prepared, analyzing the consideration of time, space, and information linkages, as well as identified results. The article pointed out that there is a gap in publications that address the application of a production cell in almost all construction flows, except the job site flow, reflecting the tendency of most companies of applying lean concepts firstly in physical flows. By analyzing these aspects (group of features that enhance the use of the cell, it was found that “material flow and pull systems” and “operators interaction” were the aspects most often considered, but mostly partially. Few cases reported the use of “flexibility” and “equipment maintenance”. No case reported comprehensive considerations of the three important linkages of time, space, and information. Space was the linkage better considered compared to time and information linkages. Lead time reduction, cost savings and increased productivity were among the greatest benefits reported from the applications of production cells. There is also a positive correlation between the linkages coverage and the number of benefits obtained. Further research is suggested in order to investigate the results of a more comprehensive application considering all linkages.

Outcome measures and scar aesthetics in minimally invasive video-assisted parathyroidectomy.

LENUS (Irish Health Repository)

Casserly, Paula

2012-02-01

OBJECTIVES: To compare the scar outcome of video-assisted parathyroidectomy (VAP) with traditional bilateral cervical exploration (BCE) using previously validated scar assessment scales, and to examine the feasibility of introducing VAP into a general otolaryngology-head and neck practice. DESIGN: A retrospective review of medical records from a prospectively obtained database of patients and long-term follow-up of scar analysis. PATIENTS: The records of 60 patients undergoing parathyroidectomy were reviewed: 29 patients underwent VAP and 31 patients underwent an open procedure with BCE. The groups were matched for age and sex. A total of 46 patients were followed up to assess scar outcome. MAIN OUTCOME MEASURES: The primary outcome was a comparison of patient and observer scar satisfaction between VAP and traditional BCE using validated scar assessment tools: the Patient Scar Assessment Scale and the Manchester Scar Scale. The secondary outcomes were to retrospectively evaluate our results with VAP and to assess the suitability of introducing this technique into a general otolaryngology-head and neck practice. RESULTS: The average scar length in the VAP group was 1.7 cm, and the average scar length in the BCE group was 4.3 cm. The patients in the BCE group scored higher than the patients in the VAP group on the Manchester Scar Scale (P < .01) and on the Patient and Observer Scar Scales (P = .02), indicating a worse scar outcome. The mean operative time in the VAP group was 41 minutes compared with 115 minutes in the open procedure BCE group. There was no difference between the 2 groups in terms of postoperative complications. CONCLUSIONS: Video-assisted parathyroidectomy is a safe and feasible procedure in the setting of a general otolaryngology-head and neck practice, with outcomes and complication rates that are comparable to those of traditional bilateral neck exploration. Both patient and observer analysis demonstrated that VAP was associated with a more

Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

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Wen-Ping Zeng

2015-01-01

Full Text Available Background: Ventilator-associated pneumonia (VAP occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs. Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients′ medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days was significantly lower than that in the control group (0.495 cases per 1000 ventilator days. We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an

Ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae carrying multiple metallo-beta-lactamase genes

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Dwivedi Mayank

2009-07-01

Full Text Available Context: Ventilator-associated pneumonia (VAP is a leading nosocomial infection in the intensive care unit (ICU. Members of Enterobacteriaceae are the most common causative agents and carbapenems are the most commonly used antibiotics. Metallo-beta-lactamase (MBL production leading to treatment failure may go unnoticed by routine disc diffusion susceptibility testing. Moreover, there is not much information on association of MBL-producing Enterobacteriaceae with ICU-acquired VAP. Therefore, a study was undertaken to find out the association of MBL-producing Enterobacteriaceae with VAP. Settings: This study was conducted in a large tertiary care hospital of North India with an eight-bed critical care unit. Materials and Methods: The respiratory samples (bronchoalveolar lavage, protected brush catheter specimens and endotracheal or transtracheal aspirates obtained from VAP patients (during January 2005-December 2006 were processed, isolated bacteria identified and their antibiotic susceptibilities tested as per standard protocols. The isolates of Enterobacteriaceae resistant to carbapenem were subjected to phenotypic and genotypic tests for the detection of MBLs. Results: Twelve of 64 isolates of Enterobacteriaceae were detected as MBL producers, bla IMP being the most prevalent gene. Additionally, in three strains, simultaneous coexistence of multiple MBL genes was detected. Conclusion: The coexistence of multiple MBL genes in Enterobacteriaceae is an alarming situation. As MBL genes are associated with integrons that can be embedded in transposons, which in turn can be accommodated on plasmids thereby resulting in a highly mobile genetic apparatus, the further spread of these genes in different pathogens is likely to occur.

The gastrointestinal tract and ventilator-associated pneumonia.

Science.gov (United States)

Kallet, Richard H; Quinn, Thomas E

2005-07-01

The gastrointestinal tract is believed to play an important role in ventilator-associated pneumonia (VAP), because during critical illness the stomach often is colonized with enteric Gram-negative bacteria. These are the same bacteria that frequently are isolated from the sputum of patients with VAP. Interventions such as selective decontamination of the digestive tract (SDD), use of sucralfate for stress ulcer prophylaxis, and enteral feeding strategies that preserve gastric pH, or lessen the likelihood of pulmonary aspiration, are used to decrease the incidence of VAP. A review of both meta-analyses and large randomized controlled trials providing Level I evidence on these topics has led to the following conclusions. First, SDD substantially decreases the incidence of VAP and may have a modest positive effect on mortality. However, there is strong contravening evidence that SDD promotes infections by Gram-positive bacteria. In the context of an emerging public health crisis from the steady rise in drug-resistant Gram-positive bacteria, we cannot endorse the general use of SDD to prevent VAP. Rather, therapy should be focused on strategies other than antibiotic prophylaxis. Second, in patients who are at risk for clinically important gastrointestinal bleeding, a histamine-2 receptor antagonist should be used for stress ulcer prophylaxis, rather than sucralfate, because histamine-2 receptor antagonist provides substantially better protection without substantially increasing the risk of VAP. Third, post-pyloric enteral feeding may reduce the incidence of VAP.

eTOXlab, an open source modeling framework for implementing predictive models in production environments.

Science.gov (United States)

Carrió, Pau; López, Oriol; Sanz, Ferran; Pastor, Manuel

2015-01-01

Computational models based in Quantitative-Structure Activity Relationship (QSAR) methodologies are widely used tools for predicting the biological properties of new compounds. In many instances, such models are used as a routine in the industry (e.g. food, cosmetic or pharmaceutical industry) for the early assessment of the biological properties of new compounds. However, most of the tools currently available for developing QSAR models are not well suited for supporting the whole QSAR model life cycle in production environments. We have developed eTOXlab; an open source modeling framework designed to be used at the core of a self-contained virtual machine that can be easily deployed in production environments, providing predictions as web services. eTOXlab consists on a collection of object-oriented Python modules with methods mapping common tasks of standard modeling workflows. This framework allows building and validating QSAR models as well as predicting the properties of new compounds using either a command line interface or a graphic user interface (GUI). Simple models can be easily generated by setting a few parameters, while more complex models can be implemented by overriding pieces of the original source code. eTOXlab benefits from the object-oriented capabilities of Python for providing high flexibility: any model implemented using eTOXlab inherits the features implemented in the parent model, like common tools and services or the automatic exposure of the models as prediction web services. The particular eTOXlab architecture as a self-contained, portable prediction engine allows building models with confidential information within corporate facilities, which can be safely exported and used for prediction without disclosing the structures of the training series. The software presented here provides full support to the specific needs of users that want to develop, use and maintain predictive models in corporate environments. The technologies used by e

The Framework for KM Implementation in Product and Service Oriented SMEs: Evidence from Field Studies in Taiwan

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Yao Chin Lin

2015-03-01

Full Text Available Knowledge management (KM is a core competency that determines the success of small and medium-sized enterprises (SMEs in this knowledge-based economy. Instead of competing on the basis of physical and financial capital, the success of SMEs is influenced by the knowledge, experience and skills of the owners and its employees. Unfortunately, many SMEs are still struggling with KM implementation due to lacking a comprehensive KM framework. This study aims to identify enablers for KM success and build up a framework for KM implementation in service and product oriented SMEs. By using multiple research methods, this study collects data from SMEs in Taiwan to prove our suggested enablers and reference KM framework. The suggested framework can provide useful assistance and guidance for holistic KM solutions. The K-object concept, which adopted the XML standard, may become a significant managerial and technical element in the KM practice. The enhanced KM framework mandates every employee’s participation in knowledge activities, not just some elite knowledge workers. The findings provide useful implications for researchers and practitioners by providing useful templates for implementing KM initiatives in different industries and more comprehensive framework for KM implementation in different types of SMEs.

Implementing the clinical nurse leader role using the Virginia Mason Production System.

Science.gov (United States)

Tachibana, Charleen; Nelson-Peterson, Dana L

2007-11-01

More than 90 members of the American Association of Colleges of Nursing and 190 practice sites have partnered to develop the clinical nurse leader (CNL) role. The partnership has created synergy between education and practice and nurtured innovation and diffusion of learning on a national basis. In this ongoing department, the editor, Jolene Tornabeni, MA, RN, FAAN, FACHE, showcases a variety of nurse leaders who discuss their new patient care delivery models in preparation for the CNL role and CNLs who highlight partnerships with their clinical colleagues to improve patient care. In this article, the authors discuss the needs for changes in the nursing care delivery model, the implementation of the role of the CNL using the tools of the Virginia Mason Production System, as well as early outcomes and future opportunities for the expansion of the CNL role.

Impact of product configuration systems on product profitability and costing accuracy

DEFF Research Database (Denmark)

Myrodia, Anna; Kristjansdottir, Katrin; Hvam, Lars

2017-01-01

in control of their product assortment, making the right decisions in the sales phase and increasing sales of optimal products. These benefits should have an impact on the company's ability to make more accurate cost estimations in the sales phase, which can positively affect the products’ profitability......This article aims at analyzing the impact of implementing a product configuration system (PCS) on the increased accuracy of the cost calculations and the increased profitability of the products. Companies that have implemented PCSs have achieved substantial benefits in terms of being more...... and after a PCS was implemented. The comparison in the case study revealed that increased accuracy of the cost calculations in the sales phase and consequently increased profitability can be achieved by implementing a PCS....

Impact of a bundle on prevention and control of healthcare associated infections in intensive care unit.

Science.gov (United States)

Gao, Fang; Wu, Yan-yan; Zou, Jun-ning; Zhu, Ming; Zhang, Jie; Huang, Hai-yan; Xiong, Li-juan

2015-04-01

Inpatients in the intensive care unit (ICU) are at high risk for healthcare-associated infections (HAIs). In the current study, a bundle of interventions and measures for preventing and controlling HAIs were developed and implemented in the ICU by trained personnel, and the impact of the bundle was evaluated. The incidence of HAIs, the adjusted daily incidence of HAIs and the incidence of three types of catheter-related infections before and after the bundle implementation were compared. The execution rate of the bundle for preventing and controlling ventilator-associated pneumonia (VAP) was increased from 82.06% in 2012 to 96.88% in 2013. The execution rate was increased from 83.03% in 2012 to 91.33% in 2013 for central line-associated bloodstream infection (CLABSI), from 87.00% to 94.40% for catheter-associated urinary tract infection (CAUTI), and from 82.05% to 98.55% for multidrug-resistant organisms (MDROs), respectively. In total, 136 cases (10.37%) in 2012 and 113 cases (7.72%) in 2013 involved HAIs, respectively. Patients suffered from infection of the lower respiratory tract, the most common site of HAIs, in 134 cases (79.29%) in 2012 and 107 cases (74.30%) in 2013 respectively. The incidence of VAP was 32.72‰ and 24.60‰, the number of strains of pathogens isolated was 198 and 173, and the number of MDROs detected in the ICU was 91 and 74 in 2012 and 2013, respectively. The percentage of MDROs among the pathogens causing HAIs was decreased in each quarter of 2013 as compared with the corresponding percentage in 2012. In 2013, the execution rate of the bundle for preventing and controlling HAIs was increased, whereas the incidence of HAIs and VAP decreased as compared with that in 2012.

FLEXIBILITY OF INDUSTRIAL “PRODUCT-SERVICE” SYSTEM: IMPLEMENTATION AND MEANS OF MEASUREMENT

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S. Panteleev

2016-01-01

Full Text Available Article is devoted to the analysis of the flexibility of industrial “product-service” systems (hereafter IPSS, meaning provision of adaptability to the changing needs of users along the life-cycle of IPSS. Flexibility of the system gives company-producer of the industrial equipment competitive advantages on the b-to-b market. Due to this reason development and improvement of the means of valuation of flexibility is an important field of study. Aim of the article is IPSS flexibility analysis and development of efficient means of flexibility valuation.Article tasks. Research the advantages of the IPSS flexibility; analyze problems that arise as the result of flexibility implementation; propose ways to solve these problems.Methodology. Methodological base of the article are the following scientific methods: deduction, comparative and individual analysis, methods of systematization and generalization of theoretical materials.Results. Conclusions / importance. Article proposes to use IPSS concept model that takes into consideration IPSS resources, actions and functions. With the help of this model switching options, that reflect the flexibility of IPSS, can be defi ned. Economic and technological aspects of changes should be taken into consideration with the help of integrated, iterative approach, that compares supplier costs on flexibility implementation and the clients desire to pay for it. At the same time supplier can calculate the potential profi t from provision of fl exibility. Thus, the basis for efficient decision making when the IPSS is structures is made.

Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

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S Qureshi

2015-01-01

Full Text Available The rise in super bugs causing Ventilator-Associated Pneumonia (VAP is a major cause of mortality and morbidity despite recent advances in management owing to the looming ′antibiotic apocalypse′. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV for ≥48 hrs. Endotracheal aspirates (ETA from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP, while Nonfermenting Gram negative bacilli (NFGNB were significantly associated with late onset VAP (LOVAP. Most of the isolates were multi drug resistant (MDR super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

Using JPSS Retrievals to Implement a Multisensor, Synoptic, Layered Water Vapor Product for Forecasters

Science.gov (United States)

Forsythe, J. M.; Jones, A. S.; Kidder, S. Q.; Fuell, K.; LeRoy, A.; Bikos, D.; Szoke, E.

2015-12-01

Forecasters have been using the NOAA operational blended total precipitable water (TPW) product, developed by the Cooperative Institute for Research in the Atmosphere (CIRA), since 2009. Blended TPW has a wide variety of uses related to heavy precipitation and flooding, such as measuring the amount of moisture in an atmospheric river originating in the tropics. But blended TPW conveys no information on the vertical distribution of moisture, which is relevant to a variety of forecast concerns. Vertical profile information is particularly lacking over the oceans for landfalling storms. A blended six-satellite, four-layer, layered water vapor product demonstrated by CIRA and the NASA Short-term Prediction Research and Transition Center (SPoRT) in allows forecasters to see the vertical distribution of water vapor in near real-time. National Weather Service (NWS) forecaster feedback indicated that this new, vertically-resolved view of water vapor has a substantial impact on forecasts. This product uses NOAA investments in polar orbiting satellite sounding retrievals from passive microwave radiances, in particular, the Microwave Integrated Retrieval System (MIRS). The product currently utilizes data from the NOAA-18 and -19 spacecraft, Metop-A and -B, and the Defense Meteorological Program (DMSP) F18 spacecraft. The sounding instruments onboard the Suomi-NPP and JPSS spacecraft will be cornerstone instruments in the future evolution of this product. Applications of the product to heavy rain cases will be presented and compared to commonly used data such as radiosondes and Geostationary Operational Environmental Satellite (GOES) water vapor channel imagery. Research is currently beginning to implement advective blending, where model winds are used to move the water vapor profiles to a common time. Interactions with the NOAA Satellite Analysis Branch (SAB), National Center for Environmental Prediction (NCEP) centers including the Ocean Prediction Center (OPC) and Weather

Prevention of ventilator-associated pneumonia through aspiration of subglottic secretions: a systematic review and meta-analysis.

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Leasure, A Renee; Stirlen, Joan; Lu, Shu Hua

2012-01-01

Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonias and is a serious, sometimes fatal, complication in patients who need mechanical ventilation. In addition, pay-for-performance initiative has placed increased emphasis on preventing nosocomial infections including VAP. Facilities may not be reimbursed for costs associated with prevalence infections. This article presents a review and meta-analysis of the prevention of VAP through the aspiration of subglottic secretion.

Th17 cells are associated with protection from ventilator associated pneumonia.

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Marika Orlov

Full Text Available CD4+ T-helper 17 (Th17 cells and Interleukin (IL-17A play an important role in clearing pathogens in mouse models of pneumonia. We hypothesized that numbers of Th17 cells and levels of IL-17A are associated with risk for nosocomial pneumonia in humans.We collected bronchoalveolar lavage (BAL fluid from mechanically ventilated (n = 25 patients undergoing quantitative bacterial culture to evaluate for ventilator associated pneumonia (VAP. We identified Th17 cells by positive selection of CD4+ cells, stimulation with ionomycin and PMA, then staining for CD4, CD45, CCR6, IL-17A, and IFN-γ followed by flow cytometric analysis (n = 21. We measured inflammatory cytokine levels, including IL-17A, in BAL fluid by immunoassay.VAP was detected in 13 of the 25 subjects. We identified a decreased percentage of IL-17A producing Th17 cells in BAL fluid from patients with VAP compared to those without (p = 0.02. However, we found no significant difference in levels of IL-17A in patients with VAP compared to those without (p = 0.07. Interestingly, IL-17A levels did not correlate with Th17 cell numbers. IL-17A levels did show strong positive correlations with alveolar neutrophil numbers and total protein levels.Th17 cells are found at lower percentages in BAL fluid from mechanically ventilated patients with VAP and IL-17A levels correlated with Th17 cell percentages in non-VAP subjects, but not those with VAP. These findings suggest that Th17 cells may be protective against development of nosocomial pneumonia in patients receiving mechanical ventilation and that alveolar IL-17A in VAP may be derived from sources other than alveolar Th17 cells.

[The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia].

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Gürgün, Alev; Korkmaz Ekren, Pervin; Bacakoğlu, Feza; Başoğlu, Ozen Kaçmaz; Dirican, Nigar; Aydemir, Şöhret; Nart, Deniz; Sayıner, Abdullah

2013-01-01

Ventilator associated pneumonia (VAP) is one of the most important causes of mortality in patients treated with invasive mechanical ventilation (IMV) in intensive care unit (ICU). Microbiological examinations are required as clinical and radiological findings are usually insufficient in the diagnosis. Twenty four patients who were receiving IMV because of respiratory failure, had a Clinical Pulmonary Infection Score (CPIS) of ≥ 6 in the follow-up and died with the suspicion of VAP were enrolled in our study. Six patients were excluded as post-mortem biopsy could not be performed. The patients who had pre-mortem CPIS ≥ 6, in whom a causative organism was identified from the culture of post-mortem lung biopsy and/or histopathological examination of lung biopsy was compatible with pneumonia were diagnosed as VAP. In the 18 patients in whom a post-mortem lung biopsy was performed, quantitative culture results of endotracheal aspirate performed 48 hours prior to death were compared with microbiological and histopathological results of post-mortem lung biopsy specimens, and the role of endotracheal aspirate in the diagnosis of VAP was evaluated retrospectively. Out of 18 patients (12 men, mean age 67.0 ± 13.0 years) included in the study, 11 (61.1%) were diagnosed as VAP. The quantitative culture of endotracheal aspirate was positive in 9 (81.8%) out of 11 patients diagnosed as VAP. The sensitivity, specificity, positive and negative predictive values of endotracheal aspirate culture for identifying VAP were found to be 81.8%, 14.3%, 60.0% and 33.3%, respectively. Our study shown that quantitative culture of endotracheal aspirate is a practical and reliable method that can be used for the diagnosis of VAP in patients receiving IMV in ICU and having CPIS ≥ 6.

Health economic aspects of vertebral augmentation procedures.

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Borgström, F; Beall, D P; Berven, S; Boonen, S; Christie, S; Kallmes, D F; Kanis, J A; Olafsson, G; Singer, A J; Åkesson, K

2015-04-01

We reviewed all peer-reviewed papers analysing the cost-effectiveness of vertebroplasty and balloon kyphoplasty for osteoporotic vertebral compression fractures. In general, the procedures appear to be cost effective but are very dependent upon model input details. Better data, rather than new models, are needed to answer outstanding questions. Vertebral augmentation procedures (VAPs), including vertebroplasty (VP) and balloon kyphoplasty (BKP), seek to stabilise fractured vertebral bodies and reduce pain. The aim of this paper is to review current literature on the cost-effectiveness of VAPs as well as to discuss the challenges for economic evaluation in this research area. A systematic literature search was conducted to identify existing published studies on the cost-effectiveness of VAPs in patients with osteoporosis. Only peer-reviewed published articles that fulfilled the criteria of being regarded as full economic evaluations including both morbidity and mortality in the outcome measure in the form of quality-adjusted life years (QALYs) were included. The search identified 949 studies, of which four (0.4 %) were identified as relevant with one study added later. The reviewed studies differed widely in terms of study design, modelling framework and data used, yielding different results and conclusions regarding the cost-effectiveness of VAPs. Three out of five studies indicated in the base case results that VAPs were cost effective compared to non-surgical management (NSM). The five main factors that drove the variations in the cost-effectiveness between the studies were time horizon, quality of life effect of treatment, offset time of the treatment effect, reduced number of bed days associated with VAPs and mortality benefit with treatment. The cost-effectiveness of VAPs is uncertain. In answering the remaining questions, new cost-effectiveness analysis will yield limited benefit. Rather, studies that can reduce the uncertainty in the underlying data

Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia.

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Li Bassi, Gianluigi; Panigada, Mauro; Ranzani, Otavio T; Zanella, Alberto; Berra, Lorenzo; Cressoni, Massimo; Parrini, Vieri; Kandil, Hassan; Salati, Giovanni; Selvaggi, Paola; Amatu, Alessandro; Sanz-Moncosi, Miquel; Biagioni, Emanuela; Tagliaferri, Fernanda; Furia, Mirella; Mercurio, Giovanna; Costa, Antonietta; Manca, Tullio; Lindau, Simone; Babel, Jaksa; Cavana, Marco; Chiurazzi, Chiara; Marti, Joan-Daniel; Consonni, Dario; Gattinoni, Luciano; Pesenti, Antonio; Wiener-Kronish, Janine; Bruschi, Cecilia; Ballotta, Andrea; Salsi, Pierpaolo; Livigni, Sergio; Iotti, Giorgio; Fernandez, Javier; Girardis, Massimo; Barbagallo, Maria; Moise, Gabriella; Antonelli, Massimo; Caspani, Maria Luisa; Vezzani, Antonella; Meybohm, Patrick; Gasparovic, Vladimir; Geat, Edoardo; Amato, Marcelo; Niederman, Michael; Kolobow, Theodor; Torres, Antoni

2017-11-01

The lateral Trendelenburg position (LTP) may hinder the primary pathophysiologic mechanism of ventilator-associated pneumonia (VAP). We investigated whether placing patients in the LTP would reduce the incidence of VAP in comparison with the semirecumbent position (SRP). This was a randomized, multicenter, controlled study in invasively ventilated critically ill patients. Two preplanned interim analyses were performed. Patients were randomized to be placed in the LTP or the SRP. The primary outcome, assessed by intention-to-treat analysis, was incidence of microbiologically confirmed VAP. Major secondary outcomes included mortality, duration of mechanical ventilation, and intensive care unit length of stay. At the second interim analysis, the trial was stopped because of low incidence of VAP, lack of benefit in secondary outcomes, and occurrence of adverse events. A total of 194 patients in the LTP group and 201 in the SRP group were included in the final intention-to-treat analysis. The incidence of microbiologically confirmed VAP was 0.5% (1/194) and 4.0% (8/201) in LTP and SRP patients, respectively (relative risk 0.13, 95% CI 0.02-1.03, p = 0.04). The 28-day mortality was 30.9% (60/194) and 26.4% (53/201) in LTP and SRP patients, respectively (relative risk 1.17, 95% CI 0.86-1.60, p = 0.32). Likewise, no differences were found in other secondary outcomes. Six serious adverse events were described in LTP patients (p = 0.01 vs. SRP). The LTP slightly decreased the incidence of microbiologically confirmed VAP. Nevertheless, given the early termination of the trial, the low incidence of VAP, and the adverse events associated with the LTP, the study failed to prove any significant benefit. Further clinical investigation is strongly warranted; however, at this time, the LTP cannot be recommended as a VAP preventive measure. CLINICALTRIALS. NCT01138540.

Impact of patient position on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials.

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Alexiou, Vangelis G; Ierodiakonou, Vrettos; Dimopoulos, George; Falagas, Matthew E

2009-12-01

The aim of this study is to summarize the effect of position (prone and semirecumbent 45 degrees ) of mechanically ventilated patients on the incidence of ventilator-associated pneumonia (VAP) and other outcomes. A systematic search for randomized control trials (RCTs) was done. We estimated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using fixed effects model or random effects model, where appropriate. For continuous variables, we calculated the estimation of weighted mean differences. We analyzed data extracted from 3 RCTs studying the semirecumbent 45 degrees and 4 RCTs studying the prone position with a total of 337 and 1018 patients, respectively. The odds of developing clinically diagnosed VAP were significantly lower among patients in the semirecumbent 45 degrees position compared to patients in the supine position (OR = 0.47; 95% CI, 0.27-0.82; 337 patients). The comparison of prone vs supine position group showed a moderate trend toward better outcomes regarding the incidence of clinically diagnosed VAP among patients in the prone position (OR = 0.80; 95% CI, 0.60-1.08; 1018 patients). The subanalysis regarding the incidence of microbiologically documented VAP, the length of intensive care unit stay, and the duration of mechanical ventilation showed that patients in the semirecumbent 45 degrees position have a moderate trend toward better clinical outcomes. This meta-analysis provides additional evidence that the usual practice of back-rest elevation of 15 degrees to 30 degrees is not sufficient to prevent VAP in mechanically ventilated patients. Patients positioned semirecumbently 45 degrees have significantly lower incidence of clinically diagnosed VAP compared to patients positioned supinely. On the other hand, the incidence of clinically diagnosed VAP among patients positioned pronely does not differ significantly from the incidence of clinically diagnosed VAP among patients positioned supinely.

Implementation of Lean System on Erbium Doped Fibre Amplifier Manufacturing Process to Reduce Production Time

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Maneechote, T.; Luangpaiboon, P.

2010-10-01

A manufacturing process of erbium doped fibre amplifiers is complicated. It needs to meet the customers' requirements under a present economic status that products need to be shipped to customers as soon as possible after purchasing orders. This research aims to study and improve processes and production lines of erbium doped fibre amplifiers using lean manufacturing systems via an application of computer simulation. Three scenarios of lean tooled box systems are selected via the expert system. Firstly, the production schedule based on shipment date is combined with a first in first out control system. The second scenario focuses on a designed flow process plant layout. Finally, the previous flow process plant layout combines with production schedule based on shipment date including the first in first out control systems. The computer simulation with the limited data via an expected value is used to observe the performance of all scenarios. The most preferable resulted lean tooled box systems from a computer simulation are selected to implement in the real process of a production of erbium doped fibre amplifiers. A comparison is carried out to determine the actual performance measures via an analysis of variance of the response or the production time per unit achieved in each scenario. The goodness of an adequacy of the linear statistical model via experimental errors or residuals is also performed to check the normality, constant variance and independence of the residuals. The results show that a hybrid scenario of lean manufacturing system with the first in first out control and flow process plant lay out statistically leads to better performance in terms of the mean and variance of production times.

Implementation of Capacity Planning Agent of Demand Responsive Planning Framework : Master’s Thesis in Production Engineering of The Royal Institute of Technology

OpenAIRE

Juhong, Nirut

2013-01-01

This master’s thesis is conducted as a conclusion of Master degree of Science in Production Engineering and Management at The Royal Institute of Technology. The focus of this thesis work is to implement a Capacity planning agent. Nowadays, companies need to adapt themselves to be as responsive to customers’ demand as possible. However, the responsiveness is usually limited by the fixed capacity of the production. Evolvable Production System (EPS), motivated by the limitation mentioned above, ...

Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: conflicting recommendations.

Science.gov (United States)

Burk, Ruth Srednicki; Grap, Mary Jo

2012-01-01

Pressure ulcers and ventilator-associated pneumonia (VAP) are both common in acute and critical care settings and are considerable sources of morbidity, mortality, and health care costs. To prevent pressure ulcers, guidelines limit bed backrest elevation to less than 30 degrees, whereas recommendations to reduce VAP include use of backrest elevations of 30 degrees or more. Although a variety of risk factors beyond patient position have been identified for both pressure ulcers and VAP, this article will focus on summarizing the major evidence for each of these apparently conflicting positioning strategies and discuss implications for practice in managing mechanically ventilated patients with risk factors for both pressure ulcers and VAP. Copyright © 2012 Elsevier Inc. All rights reserved.

Proposal for evaluation of the level of implementation of typical practices of lean production in company a sector of the metal-mechanic

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Maria da Graça Saraiva Nogueira

2008-07-01

Full Text Available Aiming at the advantages obtained when performing lean production, different sectors of the production of goods and services have adopted its principles and practices. Due to its degree of abstraction, it is difficult to establish a level of incorporation of such concepts. On the other hand, because of the operational features of its practices, such assessment becomes possible through the quantification of the elements involved (time, cost, raw material. The use of lean production practices does not guarantee its implementation and sustainability. However, the assessment of such practices might, in an indirect way, provide hints on how widespread its principles are and to what extent they are being adopted. The present assessment took place at an metal-mechanic company which has been implementing lean production as a philosophy of production at corporate levels since 2002. The operational manager and managers responsible for quality, production, sales, purchase, maintenance, and PCP also took part in this research. Each manager answered to an interview and filled a checklist and a ranking in order to evaluate performance and importance, respectively. Just-in-time, leveling production (heijunka, and integration practices with the supply chain yielded the most unfavorable results, whereas group technology, continuous improvement, and visual management yielded the best results. With regard to the importance criterion, the practices of standardized operations, just-in-time, and quick changeover were considered the most important, whereas workforce flexibility, group technology, and development of lean product were the least important. Key-words: Lean Production; Measurement of Performance and Importance, Sector of the metal-mechanic

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

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Hyun Oh Park

2017-10-01

Full Text Available Background: Ventilator-associated pneumonia (VAP is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU. This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5% had at least 1 episode of VAP, 10 (21.7% of whom died in the ICU. Of the 55 (54.5% patients who did not have pneumonia, 9 (16.4% died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029. Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6–12 is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

Can routine surveillance samples from tracheal aspirate predict bacterial flora in cases of ventilator-associated pneumonia?

Science.gov (United States)

Lampati, L; Maggioni, E; Langer, M; Malacarne, P; Mozzo, R; Pesenti, A; Fumagalli, R

2009-10-01

The aim of this study was to investigate the hypothesis that periodical sampling of the tracheo-bronchial tree in the absence of clinical suspicion of pneumonia is useful to identify bacteria responsible for subsequent late ventilator associated pneumonia (VAP). This was a retrospective observational human study carried out in two medical-surgical intensive care units of two different hospitals. From January 1999 to December 2000, 559 patients, who received invasive respiratory support for more than 48 hours, were screened. Tracheal aspiration (TA) was performed once or twice weekly in all mechanically ventilated patients. The microbiological findings from TA surveillance cultures done in the eight days before suspicion of VAP were compared to those isolated from the positive diagnostic samples done for late onset VAP (after more than four days of mechanical ventilation). The sensitivity, specificity, and positive/negative predictive values of the ability of the surveillance sample to anticipate the VAP pathogen were calculated. Among the microorganisms isolated from TA, 68% were retrieved from diagnostic samples. All VAP pathogens previously isolated were from 43% of the TA samples. If TA was collected 2-4 days before the clinical diagnosis of VAP, pathogens were detected in 58% of samples. In contrast, only 27% were collected more than four days earlier (PVAP is suspected.

Orotracheal tube as a risk factor for lower respiratory tract infection: preliminary data from a randomised trial.

Science.gov (United States)

Muzlovic, Igor; Perme, Janja; Stubljar, David

2018-05-01

The aim of the study was to investigate whether polyurethane (PU) endotracheal tubes, continuous measurements of cuff pressure and aspiration of the subglottic space as a bundle of parameters could reduce patients' risk for developing ventilator associated pneumonia (VAP). Two groups of patients that differed only in terms of endotracheal tubes and intubation intervention were compared. Group A was ventilated using PU tubes a with conical cuff; they also had continuous cuff pressure measurement and continuous subglottic aspiration. Group B was ventilated using PVC tubes with a cylindrical cuff; the patients underwent intermittent cuff pressure measurement and intermittent subglottic aspiration. Seven patients in group A (13.2%) and 18 in group B (36.0%) out of 103 were diagnosed with VAP. VAP patients were in general older, stayed longer in the ICU and were ventilated significantly longer compared with the patients with no VAP. Eight more patients in group B died compared with group A. Moreover, subjects in group A survived longer. Patient age, hours on mechanical ventilation, and days on an ICU were all positively associated with the occurrence of VAP. Prevention parameters in ventilation (PU cuff, conical cuff, continuous subglottic drainage and continuous cuff pressure measurement) could prevent the incidence of VAP in ICU patients.

Assessing implementation mechanisms for an international agreement on research and development for health products.

Science.gov (United States)

Hoffman, Steven J; Røttingen, John-Arne

2012-11-01

The Member States of the World Health Organization (WHO) are currently debating the substance and form of an international agreement to improve the financing and coordination of research and development (R&D) for health products that meet the needs of developing countries. In addition to considering the content of any possible legal or political agreement, Member States may find it helpful to reflect on the full range of implementation mechanisms available to bring any agreement into effect. These include mechanisms for states to make commitments, administer activities, manage financial contributions, make subsequent decisions, monitor each other's performance and promote compliance. States can make binding or non-binding commitments through conventions, contracts, declarations or institutional reforms. States can administer activities to implement their agreements through international organizations, sub-agencies, joint ventures or self-organizing processes. Finances can be managed through specialized multilateral funds, financial institutions, membership organizations or coordinated self-management. Decisions can be made through unanimity, consensus, equal voting, modified voting or delegation. Oversight can be provided by peer review, expert review, self-reports or civil society. Together, states should select their preferred options across categories of implementation mechanisms, each of which has advantages and disadvantages. The challenge lies in choosing the most effective combinations of mechanisms for supporting an international agreement (or set of agreements) that achieves collective aspirations in a way and at a cost that are both sustainable and acceptable to those involved. In making these decisions, WHO's Member States can benefit from years of experience with these different mechanisms in health and its related sectors.

Virulence of Rhodococcus equi Isolated from Cats and Dogs

OpenAIRE

Takai, Shinji; Martens, Ronald J.; Julian, Alan; Garcia Ribeiro, Márcio; Rodrigues de Farias, Marconi; Sasaki, Yukako; Inuzuka, Kazuho; Kakuda, Tsutomu; Tsubaki, Shiro; Prescott, John F.

2003-01-01

Nine cat isolates and nine dog isolates of Rhodococcus equi from clinical material were investigated for the presence of the virulence-associated antigens (VapA and VapB) and virulence plasmids. Five of the cat isolates and one dog isolate were VapA positive and contained an 85-kb type I or an 87-kb type I plasmid. The remaining 12 isolates were avirulent R. equi strains and contained no virulence plasmids.

Impact of Gram stain results on initial treatment selection in patients with ventilator-associated pneumonia: a retrospective analysis of two treatment algorithms

OpenAIRE

Yoshimura, Jumpei; Kinoshita, Takahiro; Yamakawa, Kazuma; Matsushima, Asako; Nakamoto, Naoki; Hamasaki, Toshimitsu; Fujimi, Satoshi

2017-01-01

Background Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care units (ICUs). Several studies have suggested that the Gram stain of endotracheal aspirates is a useful method for accurately diagnosing VAP. However, the usefulness of the Gram stain in predicting which microorganisms cause VAP has not been established. The purpose of this study was to evaluate whether a Gram stain of endotracheal aspirates could be used to determine appropriate initial antimicr...

Effects of tracheal orientation on development of ventilator-associated pneumonia: an experimental study.

Science.gov (United States)

Zanella, Alberto; Cressoni, Massimo; Epp, Myra; Hoffmann, Viktoria; Stylianou, Mario; Kolobow, Theodor

2012-04-01

Orientation of the trachea and tracheal tube below horizontal may prevent aspiration of oropharyngeal secretions into the lungs, which is a pivotal pathway in the pathogenesis of ventilator-associated pneumonia (VAP). The incidence of VAP was evaluated in swine with orientation of trachea and tracheal tube above horizontal (model of semirecumbent position, currently recommended in patients) and below horizontal. Twenty-six mini-pigs were randomized into four groups: (A) eight mechanically ventilated with orientation of trachea 45° above horizontal for 72 h. In the remaining groups (B, C, D) the trachea was oriented 10° below horizontal, with (B) six mechanically ventilated for 72 h, (C) six mechanically ventilated for 72 h with enteral feeding, and (D) six mechanically ventilated for 168 h with enteral feeding. At the end of the study period, all pigs were sacrificed and the clinical diagnosis of VAP was microbiologically evaluated. No antibiotics were administered. All eight pigs kept orientated with the trachea 45° above horizontal developed VAP and respiratory failure (PaO(2)/F(i)O(2) = 132 ± 139 mmHg) with a median of 5.5 pulmonary lobes out of 6 colonized with average colonization of 9.3 × 10(7) CFU/g. None of the 18 pigs kept oriented with the trachea below horizontal developed VAP; 16 had sterile lungs, while 2, ventilated for 7 days, developed a low level of colonization. Orientation of the trachea above horizontal was uniformly associated with VAP and respiratory failure; positioning the trachea below horizontal consistently prevented development of VAP.

A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions.

Science.gov (United States)

Boyer, Anthony F; Schoenberg, Noah; Babcock, Hilary; McMullen, Kathleen M; Micek, Scott T; Kollef, Marin H

2015-01-01

The Centers for Disease Control and Prevention has shifted policy away from using ventilator-associated pneumonia (VAP) and toward using ventilator-associated conditions (VACs) as a marker of ICU quality. To date, limited prospective data regarding the incidence of VAC among medical and surgical ICU patients, the ability of VAC criteria to capture patients with VAP, and the potential clinical preventability of VACs are available. This study was a prospective 12-month cohort study (January 2013 to December 2013). We prospectively surveyed 1,209 patients ventilated for ≥ 2 calendar days. Sixty-seven VACs were identified (5.5%), of which 34 (50.7%) were classified as an infection-related VAC (IVAC) with corresponding rates of 7.0 and 3.6 per 1,000 ventilator days, respectively. The mortality rate of patients having a VAC was significantly greater than that of patients without a VAC (65.7% vs 14.4%, P VACs included IVACs (50.7%), ARDS (16.4%), pulmonary edema (14.9%), and atelectasis (9.0%). Among IVACs, 44.1% were probable VAP and 17.6% were possible VAP. Twenty-five VACs (37.3%) were adjudicated to represent potentially preventable events. Eighty-six episodes of VAP occurred in 84 patients (10.0 of 1,000 ventilator days) during the study period. The sensitivity of the VAC criteria for the detection of VAP was 25.9% (95% CI, 16.7%-34.5%). Although relatively uncommon, VACs are associated with greater mortality and morbidity when they occur. Most VACs represent nonpreventable events, and the VAC criteria capture a minority of VAP episodes.

Implementation of total productive maintenance (TPM to increase overall equipment efficiency of an hotel industry

Directory of Open Access Journals (Sweden)

Manjunatha B.

2018-01-01

Full Text Available Hotel industries are one of the fastest growing areas in India, which is attracting more number of jobs & tourists. This also results in direct impact on Indian economy. All Hotels comprises a higher element of total working cost and they are a good source of income. Hospitality is one of the most important components of hotel industry. To give a good hospitality in hotels to customers, we need to use different machines in different departments. For example if we take section of housekeeping it consists of different sub departments like Rooms & corridors, Toilets, Linen, Furniture and furnishings, Gardens, Public areas etc. In this connection a small implementation of TPM tool called focused improvement & planned maintenance, implemented in alternative usage of electrical systems (energy conservation. Result showed a very significant improvement in energy saving. By adopting Small changes show a significant improvement in the overall system. It also indicates the dire need of proper industrial tools in hotels. Total Productive Maintenance (TPM is one of the pioneering approaches which can be achieved in above said things [1][2].

ON THE QUESTION OF CORPORATE FUNDING IMPLEMENTATION OF EXPLORATION AND PRODUCTION INVESTMENT PROJECTS

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Voronin D. M.

2016-03-01

Full Text Available As part of the research, the content of the required theoretical and methodological tools in the field of corporate finance investment projects of exploration and production of hydrocarbons described. Indicated cash flow characteristics of such projects in accordance with the phases of the project, identified the risks associated with cash flows. In practical terms, the proposed approach to the financing of projects includes sequential algorithm deciding on the implementation of funding is considered on case studies and can be used in the process of financial planning oil and gas companies, in building policy project financing, corporate procedures and regulations. In solving problems of theoretical and applied scientific methods used in the study, including methods of logical, comparative and systematic analysis, as well as methods of economic-mathematical modeling.

Strategy of formation and training for the basic units of cooperative production. Actions for their implementation

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Iriadna Marín de León

2014-06-01

The implementation of the strategy of Formation and Training had great importance since applying the same one, they could get rich our cooperatives, of elements that contribute to the obtaining of a bigger level of efficiency and effectiveness of the human resources, given by the knowledge that they can acquire the same ones.   The article approaches the topics of Administration of human resources, formation and training theoretically, the elements of the functional strategy, and lastly a journey for the Cooperative Sector leaving of its emergence until specifying the characteristics of the Basic Units of Cooperative Production as part of the same one.   He is also carried out a valuation of the current situation as for Formation and Training of the human resources in the UBPC of the County of Pinar del Ro. This is made going to different diagnosis techniques. Later on they intend the actions that allow the implementation of this strategy.

The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study.

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Marik, P E; Careau, P

1999-01-01

Aspiration of oropharyngeal material, with its high concentration of anaerobic bacteria, has been implicated in the pathogenesis of both ventilator-associated pneumonia (VAP) and aspiration pneumonitis (AP). Consequently, patients with these disorders are usually treated with antimicrobial agents with anaerobic activity. To determine the incidence of anaerobic bacteria in patients with VAP and AP. Prospective, nonrandomized, interventional study. University-affiliated community teaching hospital. We performed sequential blind protected specimen brush (PSB) sampling and mini-BAL in 143 patients with 185 episodes of suspected VAP and 25 patients with AP who required mechanical ventilation. Quantitative aerobic and anaerobic cultures were performed on all specimens. Pneumonia was considered to be present when either > 500 cfu/mL cultured from blind PSB sampling or > 5,000 cfu/mL cultured from mini-BAL were present. Using the predefined criteria, bacterial pneumonia was diagnosed in 63 of 185 suspected VAP episodes (34%) and 12 of 25 patients with AP (48%). At least one dose of an antibiotic was given in the 24 h prior to bacteriologic sampling in 106 suspected VAP episodes (57%) and in 12 patients with AP (48%). More than one pathogen was isolated from 11 VAP and four AP patients. Pseudomonas aeruginosa, Staphylococcus aureus, and enteric Gram-negative organisms were isolated most frequently from patients with VAP. In the patients with AP, enteric Gram-negative organisms were isolated in patients with GI disorders and Streptococcus pneumoniae and Haemophilus influenzae predominated in patients with "community-acquired" aspiration. Only one anaerobic organism was isolated from the entire group of patients; Veillonella paravula was isolated from a blind PSB specimen in a patient with suspected aspiration pneumonia. Despite painstaking effort, we were able to isolate only one anaerobic organism (nonpathogenic) from this group of patients. The spectrum of aerobes in

Serum Vascular Adhesion Protein-1 Predicts End-Stage Renal Disease in Patients with Type 2 Diabetes.

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Hung-Yuan Li

Full Text Available Diabetes is the leading cause of end-stage renal disease (ESRD worldwide. Vascular adhesion protein-1 (VAP-1 participates in inflammation and catalyzes the deamination of primary amines into aldehydes, hydrogen peroxide, and ammonia, both of which are involved in the pathogenesis of diabetic complications. We have shown that serum VAP-1 is higher in patients with diabetes and in patients with chronic kidney disease (CKD, and can predict cardiovascular mortality in subjects with diabetes. In this study, we investigated if serum VAP-1 can predict ESRD in diabetic subjects.In this prospective cohort study, a total of 604 type 2 diabetic subjects were enrolled between 1996 to 2003 at National Taiwan University Hospital, Taiwan, and were followed for a median of 12.36 years. The development of ESRD was ascertained by linking our database with the nationally comprehensive Taiwan Society Nephrology registry. Serum VAP-1 concentrations at enrollment were measured by time-resolved immunofluorometric assay.Subjects with serum VAP-1 in the highest tertile had the highest incidence of ESRD (p<0.001. Every 1-SD increase in serum VAP-1 was associated with a hazard ratio of 1.55 (95%CI 1.12-2.14, p<0.01 for the risk of ESRD, adjusted for smoking, history of cardiovascular disease, body mass index, hypertension, HbA1c, duration of diabetes, total cholesterol, use of statins, ankle-brachial index, estimated GFR, and proteinuria. We developed a risk score comprising serum VAP-1, HbA1c, estimated GFR, and proteinuria, which could predict ESRD with good performance (area under the ROC curve = 0.9406, 95%CI 0.8871-0.9941, sensitivity = 77.3%, and specificity = 92.8%. We also developed an algorithm based on the stage of CKD and a risk score including serum VAP-1, which can stratify these subjects into 3 categories with an ESRD risk of 0.101%/year, 0.131%/year, and 2.427%/year, respectively.In conclusion, serum VAP-1 can predict ESRD and is a useful biomarker to

Implementation and de-implementation: two sides of the same coin?

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van Bodegom-Vos, Leti; Davidoff, Frank; Marang-van de Mheen, Perla J

2017-06-01

Avoiding low value care received increasing attention in many countries, as with the Choosing Wisely campaign and other initiatives to abandon care that wastes resources or delivers no benefit to patients. While an extensive literature characterises approaches to implementing evidence-based care, we have limited understanding of the process of de-implementation, such as abandoning existing low value practices. To learn more about the differences between implementation and de-implementation, we explored the literature and analysed data from two published studies (one implementation and one de-implementation) by the same orthopaedic surgeons. We defined 'leaders' as those orthopaedic surgeons who implemented, or de-implemented, the target processes of care and laggards as those who did not. Our findings suggest that leaders in implementation share some characteristics with leaders in de-implementation when comparing them with laggards, such as more open to new evidence, younger and less time in clinical practice. However, leaders in de-implementation and implementation differed in some other characteristics and were not the same persons. Thus, leading in implementation or de-implementation may depend to some degree on the type of intervention rather than entirely reflecting personal characteristics. De-implementation seemed to be hampered by motivational factors such as department priorities, and economic and political factors such as cost-benefit considerations in care delivery, whereas organisational factors were associated only with implementation. The only barrier or facilitator common to both implementation and de-implementation consisted of outcome expectancy (ie, the perceived net benefit to patients). Future studies need to test the hypotheses generated from this study and improve our understanding of differences between the processes of implementation and de-implementation in the people who are most likely to lead (or resist) these efforts. Published by the

Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: Conflicting recommendations

OpenAIRE

Burk, Ruth Srednicki; Jo Grap, Mary

2012-01-01

Pressure ulcers and ventilator-associated pneumonia (VAP) are both common in acute and critical care settings and are considerable sources of morbidity, mortality, and health care costs. To prevent pressure ulcers, guidelines limit bed backrest elevation to less than 30 degrees, whereas recommendations to reduce VAP include use of backrest elevations of 30 degrees or more. Although a variety of risk factors beyond patient position have been identified for both pressure ulcers and VAP, this ar...

Creating an effective system of quality management in health care organizations through the implementation of technology lean production

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M. A. Gurina

2017-01-01

Full Text Available In the conditions of changing management paradigm in the public sphere, strengthening political, economic, social and technological risks on the part of stakeholders of medical organizations, there is a need to create an effective quality management system based on the technology of lean production. This system is aimed at increasing the satisfaction of consumers of medical services, reducing the labor losses of medical personnel, improving the quality and productivity of labor in medical organizations. The use of lin-production in the framework of pilot projects implemented in Russia for the last three years shows significant advantages in the work of medical organizations in comparison with traditional approaches in the organization of the provision of services by polyclinics. In the article, step-by-step organization of the work on creating a thrifty polyclinic is considered.

Implementing Life Cycle Assessment in Product development

DEFF Research Database (Denmark)

Bhander, Gurbakhash Singh

2003-01-01

The overall aim of the paper is to provide an understanding of the environmental issues involved in the early stages of product development and the capacity of life cycle assessment techniques to address these issues. The paper aims to outline the problems for the designer in evaluating the envir......The overall aim of the paper is to provide an understanding of the environmental issues involved in the early stages of product development and the capacity of life cycle assessment techniques to address these issues. The paper aims to outline the problems for the designer in evaluating......, and of the opportunities for introducing environmental criteria in the design process through meeting the information requirements of the designer on the different life cycle stages, producing an in-depth understanding of the attitudes of practitioners among product developers to the subject area, and an understanding...... of possible future directions for product development. An Environmentally Conscious Design method is introduced and trade-offs are presented between design degrees of freedom and environmental solutions. Life cycle design frameworks and strategies are addressed. The paper collects experiences and ideas around...

Training for successful lean manufacturing implementation

OpenAIRE

Ichimura, Maki; Jahankhani, Hamid; Arunachalam, Subramaniam

2006-01-01

Implementing lean manufacturing is a complex and everlasting task. The workers involving in production processes are the pivot of the lean manufacturing implementation. Training is known as a vehicle to assist the implementation process. Despite awareness of the training importance, so far, a little is available to assist to organise an efficient training. This paper summarises the overview of lean manufacturing and discuss the importance of human resource within lean implementation process. ...

Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine.

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Tuon, Felipe Francisco; Gavrilko, Oleg; Almeida, Saulo de; Sumi, Eigi Ricardo; Alberto, Thiago; Rocha, Jaime Luis; Rosa, Edvaldo Antonio

2017-03-01

Chlorhexidine (CHX) is the most commonly used oral hygiene product for the prevention of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation (MV). The change in dental plaque (DP) microbiota following CHX use in patients under MV has not been described previously. The aim of this study was to evaluate the incidence of pathogenic bacteria associated with VAP and the coverage of DP within the oral cavity in patients administered CHX. This was a prospective, randomised, controlled, double-blind study in patients (n=16) under MV who were mouth-rinsed with either CHX or placebo. Microbiology samples were collected from the oral mucosa (OM) and DP after admission to the ICU and on Days 3, 5, 7 and 10. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of CHX were determined. Upon admission, the occurrence of multidrug-resistant (MDR) bacteria, including carbapenem-resistant Klebsiella pneumoniae, was reported. The CHX group had a lower incidence of methicillin-resistant Staphylococcus aureus (MRSA) compared with the placebo group for the OM (RR=0.51, 95% CI 0.27-0.98; P=0.011). There was high agreement between the culture results of OM and DP (κ=0.825). VAP developed in six patients. The species identified following tracheal aspiration of VAP patients were similar to those found in the OM for four cases. The strains showed low MICs and MBCs for CHX (<0.039mg/mL). Although DP is rapidly colonised by MDR bacteria, use of 2% CHX reduced the incidence of S. aureus colonisation. Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

Spin-Projected Matrix Product States: Versatile Tool for Strongly Correlated Systems.

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Li, Zhendong; Chan, Garnet Kin-Lic

2017-06-13

We present a new wave function ansatz that combines the strengths of spin projection with the language of matrix product states (MPS) and matrix product operators (MPO) as used in the density matrix renormalization group (DMRG). Specifically, spin-projected matrix product states (SP-MPS) are constructed as [Formula: see text], where [Formula: see text] is the spin projector for total spin S and |Ψ MPS (N,M) ⟩ is an MPS wave function with a given particle number N and spin projection M. This new ansatz possesses several attractive features: (1) It provides a much simpler route to achieve spin adaptation (i.e., to create eigenfunctions of Ŝ 2 ) compared to explicitly incorporating the non-Abelian SU(2) symmetry into the MPS. In particular, since the underlying state |Ψ MPS (N,M) ⟩ in the SP-MPS uses only Abelian symmetries, one does not need the singlet embedding scheme for nonsinglet states, as normally employed in spin-adapted DMRG, to achieve a single consistent variationally optimized state. (2) Due to the use of |Ψ MPS (N,M) ⟩ as its underlying state, the SP-MPS can be closely connected to broken-symmetry mean-field states. This allows one to straightforwardly generate the large number of broken-symmetry guesses needed to explore complex electronic landscapes in magnetic systems. Further, this connection can be exploited in the future development of quantum embedding theories for open-shell systems. (3) The sum of MPOs representation for the Hamiltonian and spin projector [Formula: see text] naturally leads to an embarrassingly parallel algorithm for computing expectation values and optimizing SP-MPS. (4) Optimizing SP-MPS belongs to the variation-after-projection (VAP) class of spin-projected theories. Unlike usual spin-projected theories based on determinants, the SP-MPS ansatz can be made essentially exact simply by increasing the bond dimensions in |Ψ MPS (N,M) ⟩. Computing excited states is also simple by imposing orthogonality constraints

Preemptive antibiotic treatment based on gram staining reduced the incidence of ARDS in mechanically ventilated patients.

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Matsushima, Asako; Tasaki, Osamu; Shimizu, Kentaro; Tomono, Kazunori; Ogura, Hiroshi; Shimazu, Takeshi; Sugimoto, Hisashi

2008-08-01

Ventilator-associated pneumonia (VAP) is one of the major complications in the intensive care unit. VAP sometimes results in acute respiratory distress syndrome (ARDS), and the associated mortality is high. We hypothesized that preemptive antibiotic therapy based on results of bedside gram staining would reduce the incidence of VAP. Patients who were endotracheally intubated in our intensive care unit for more than 72 hours were included. Patients younger than 16 years of age or patients died because of brain death were excluded. The study was divided into two periods. During the first period, we used antibiotics according to the American Thoracic Society guidelines. During the second period, antibiotics were given according to the results of bedside gram staining even before radiographic infiltrate appeared. One hundred twenty-eight patients and 133 patients were included in the first and second periods, respectively. The incidence of VAP was significantly decreased in the second period (first period, 22%; second period, 9%, p gram staining significantly reduced the incidences of VAP and ARDS without an increase in the use of antibiotics.

ThermoData Engine (TDE): software implementation of the dynamic data evaluation concept. 5. Experiment planning and product design.

Science.gov (United States)

Diky, Vladimir; Chirico, Robert D; Kazakov, Andrei F; Muzny, Chris D; Magee, Joseph W; Abdulagatov, Ilmutdin; Kang, Jeong Won; Kroenlein, Kenneth; Frenkel, Michael

2011-01-24

ThermoData Engine (TDE) is the first full-scale software implementation of the dynamic data evaluation concept, as reported recently in this journal. In the present paper, we describe development of an algorithmic approach to assist experiment planning through assessment of the existing body of knowledge, including availability of experimental thermophysical property data, variable ranges studied, associated uncertainties, state of prediction methods, and parameters for deployment of prediction methods and how these parameters can be obtained using targeted measurements, etc., and, indeed, how the intended measurement may address the underlying scientific or engineering problem under consideration. A second new feature described here is the application of the software capabilities for aid in the design of chemical products through identification of chemical systems possessing desired values of thermophysical properties within defined ranges of tolerance. The algorithms and their software implementation to achieve this are described. Finally, implementation of a new data validation and weighting system is described for vapor-liquid equilibrium (VLE) data, and directions for future enhancements are outlined.

Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients.

Science.gov (United States)

Martínez-Reséndez, Michel Fernando; Garza-González, Elvira; Mendoza-Olazaran, Soraya; Herrera-Guerra, Alexis; Rodríguez-López, Juan Manuel; Pérez-Rodriguez, Edelmiro; Mercado-Longoria, Roberto; Camacho-Ortiz, Adrián

2014-07-01

Up to 25% of all nosocomial infections (NIs) develop in critically ill patients. Our objective was to evaluate chlorhexidine (CHX) bathing and hand hygiene (HH) compliance in the reduction of NIs in the intensive care unit. The study comprised three 6-month periods: preintervention (PIP; soap/water bathing), intervention (IP; bathing with CHX-impregnated wipes), and postintervention (PoIP; soap/water bathing). An HH program was implemented during the IP and PoIP. Primary outcomes were global and specific NI rates. A total of 1007 patients were included. Infection rates per 100 discharges were higher in the PIP compared with the IP and also higher in the PoIP compared with the IP (P = .0004 and .0109, respectively). Global infection rates per 1000 hospital-days were higher in the PIP than in the IP (P = .0268). The rates of ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI) were higher in the PIP than in the IP (P = .036 and .0001, respectively). Isolation of Acinetobacter baumannii from VAP specimens (P = .0204) and isolation of Candida spp from CAUTI specimens (P = .0005) decreased as well. The combined intervention reduced global and specific infection rates, including rates of VAP associated with A baumannii and CAUTI associated with Candida spp. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Implementation of Cyber-Physical Production Systems for Quality Prediction and Operation Control in Metal Casting.

Science.gov (United States)

Lee, JuneHyuck; Noh, Sang Do; Kim, Hyun-Jung; Kang, Yong-Shin

2018-05-04

The prediction of internal defects of metal casting immediately after the casting process saves unnecessary time and money by reducing the amount of inputs into the next stage, such as the machining process, and enables flexible scheduling. Cyber-physical production systems (CPPS) perfectly fulfill the aforementioned requirements. This study deals with the implementation of CPPS in a real factory to predict the quality of metal casting and operation control. First, a CPPS architecture framework for quality prediction and operation control in metal-casting production was designed. The framework describes collaboration among internet of things (IoT), artificial intelligence, simulations, manufacturing execution systems, and advanced planning and scheduling systems. Subsequently, the implementation of the CPPS in actual plants is described. Temperature is a major factor that affects casting quality, and thus, temperature sensors and IoT communication devices were attached to casting machines. The well-known NoSQL database, HBase and the high-speed processing/analysis tool, Spark, are used for IoT repository and data pre-processing, respectively. Many machine learning algorithms such as decision tree, random forest, artificial neural network, and support vector machine were used for quality prediction and compared with R software. Finally, the operation of the entire system is demonstrated through a CPPS dashboard. In an era in which most CPPS-related studies are conducted on high-level abstract models, this study describes more specific architectural frameworks, use cases, usable software, and analytical methodologies. In addition, this study verifies the usefulness of CPPS by estimating quantitative effects. This is expected to contribute to the proliferation of CPPS in the industry.

Implementation of Cyber-Physical Production Systems for Quality Prediction and Operation Control in Metal Casting

Directory of Open Access Journals (Sweden)

JuneHyuck Lee

2018-05-01

Full Text Available The prediction of internal defects of metal casting immediately after the casting process saves unnecessary time and money by reducing the amount of inputs into the next stage, such as the machining process, and enables flexible scheduling. Cyber-physical production systems (CPPS perfectly fulfill the aforementioned requirements. This study deals with the implementation of CPPS in a real factory to predict the quality of metal casting and operation control. First, a CPPS architecture framework for quality prediction and operation control in metal-casting production was designed. The framework describes collaboration among internet of things (IoT, artificial intelligence, simulations, manufacturing execution systems, and advanced planning and scheduling systems. Subsequently, the implementation of the CPPS in actual plants is described. Temperature is a major factor that affects casting quality, and thus, temperature sensors and IoT communication devices were attached to casting machines. The well-known NoSQL database, HBase and the high-speed processing/analysis tool, Spark, are used for IoT repository and data pre-processing, respectively. Many machine learning algorithms such as decision tree, random forest, artificial neural network, and support vector machine were used for quality prediction and compared with R software. Finally, the operation of the entire system is demonstrated through a CPPS dashboard. In an era in which most CPPS-related studies are conducted on high-level abstract models, this study describes more specific architectural frameworks, use cases, usable software, and analytical methodologies. In addition, this study verifies the usefulness of CPPS by estimating quantitative effects. This is expected to contribute to the proliferation of CPPS in the industry.

Implementation of Cyber-Physical Production Systems for Quality Prediction and Operation Control in Metal Casting

Science.gov (United States)

Lee, JuneHyuck; Noh, Sang Do; Kim, Hyun-Jung; Kang, Yong-Shin

2018-01-01

The prediction of internal defects of metal casting immediately after the casting process saves unnecessary time and money by reducing the amount of inputs into the next stage, such as the machining process, and enables flexible scheduling. Cyber-physical production systems (CPPS) perfectly fulfill the aforementioned requirements. This study deals with the implementation of CPPS in a real factory to predict the quality of metal casting and operation control. First, a CPPS architecture framework for quality prediction and operation control in metal-casting production was designed. The framework describes collaboration among internet of things (IoT), artificial intelligence, simulations, manufacturing execution systems, and advanced planning and scheduling systems. Subsequently, the implementation of the CPPS in actual plants is described. Temperature is a major factor that affects casting quality, and thus, temperature sensors and IoT communication devices were attached to casting machines. The well-known NoSQL database, HBase and the high-speed processing/analysis tool, Spark, are used for IoT repository and data pre-processing, respectively. Many machine learning algorithms such as decision tree, random forest, artificial neural network, and support vector machine were used for quality prediction and compared with R software. Finally, the operation of the entire system is demonstrated through a CPPS dashboard. In an era in which most CPPS-related studies are conducted on high-level abstract models, this study describes more specific architectural frameworks, use cases, usable software, and analytical methodologies. In addition, this study verifies the usefulness of CPPS by estimating quantitative effects. This is expected to contribute to the proliferation of CPPS in the industry. PMID:29734699

Synthesis and structure activity relationships of carbamimidoylcarbamate derivatives as novel vascular adhesion protein-1 inhibitors.

Science.gov (United States)

Yamaki, Susumu; Yamada, Hiroyoshi; Nagashima, Akira; Kondo, Mitsuhiro; Shimada, Yoshiaki; Kadono, Keitaro; Yoshihara, Kosei

2017-11-01

Vascular adhesion protein-1 (VAP-1) is a promising therapeutic target for the treatment of diabetic nephropathy. Here, we conducted structural optimization of the glycine amide derivative 1, which we previously reported as a novel VAP-1 inhibitor, to improve stability in dog and monkey plasma, and aqueous solubility. By chemical modification of the right part in the glycine amide derivative, we identified the carbamimidoylcarbamate derivative 20c, which showed stability in dog and monkey plasma while maintaining VAP-1 inhibitory activity. We also found that conversion of the pyrimidine ring in 20c into saturated rings was effective for improving aqueous solubility. This led to the identification of 28a and 35 as moderate VAP-1 inhibitors with excellent aqueous solubility. Further optimization led to the identification of 2-fluoro-3-{3-[(6-methylpyridin-3-yl)oxy]azetidin-1-yl}benzyl carbamimidoylcarbamate (40b), which showed similar human VAP-1 inhibitory activity to 1 with improved aqueous solubility. 40b showed more potent ex vivo efficacy than 1, with rat plasma VAP-1 inhibitory activity of 92% at 1h after oral administration at 0.3mg/kg. In our pharmacokinetic study, 40b showed good oral bioavailability in rats, dogs, and monkeys, which may be due to its improved stability in dog and monkey plasma. Copyright © 2017 Elsevier Ltd. All rights reserved.

Aligning clinical compensation with clinical productivity: design and implementation of the financial value unit (FVU) system in an academic department of internal medicine.

Science.gov (United States)

Stites, Steven; Steffen, Patrick; Turner, Scott; Pingleton, Susan

2013-07-01

A new metric was developed and implemented at the University of Kansas School of Medicine Department of Internal Medicine, the financial value unit (FVU). This metric analyzes faculty clinical compensation compared with clinical work productivity as a transparent means to decrease the physician compensation variability and compensate faculty equitably for clinical work.The FVU is the ratio of individual faculty clinical compensation compared with their total work relative value units (wRVUs) generated divided by Medical Group Management Association (MGMA) salary to wRVUs of a similar MGMA physician.The closer the FVU ratio is to 1.0, the closer clinical compensation is to that of an MGMA physician with similar clinical productivity. Using FVU metrics to calculate a faculty salary gap compared with MGMA median salary and wRVU productivity, a divisional production payment was established annually.From FY 2006 to FY 2011, both total faculty numbers and overall clinical activity increased. With the implementation of the FVU, both clinical productivity and compensation increased while, at the same time, physician retention rates remained high. Variability in physician compensation decreased. Dramatic clinical growth was associated with the alignment of clinical work and clinical compensation in a transparent and equable process.

Knowledge of Critical Care Provider on Prevention of Ventilator Associated Pneumonia

Directory of Open Access Journals (Sweden)

Passang Chiki Sherpa

2014-01-01

Full Text Available Background: Ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in ventilated patient. Prevention of VAP in critically ill patient is significant concern for health care team in intensive care units (ICUs. Knowledge on prevention of VAP would have a significant impact on patient outcome. Aims and Objectives: To assess knowledge on prevention of VAP in critical care providers and to find the association between knowledge on prevention of VAP and educational qualification and years of experience in ICUs. Settings and Design: The study was conducted in 5 different ICUs of Kasturba Hospital, Manipal, and using descriptive study design. Material and Methods: The study involved a purposive sample of 138 critical care providers. Critical care providers who were willing to participate in the study were included. Tools on demographic proforma and self-administered structured knowledge questionnaire on prevention of VAP were developed and content validity was established. The reliability of the tools was established.The data was categorized and analyzed by using descriptive and inferential statistics. The SPSS 16.0 version was used for the analysis of the study. Result: Majority 89.1% of the participant were 20-29 years, 63% unmarried 51.4% had completed diploma course and majority 81.2% were from nursing discipline. The study revealed that only 55.80% of subjects were having adequate knowledge on prevention of VAP based on median score. There was no significant association between knowledge score and educational qualification (÷²=0, p=0.833, years of experience in ICU (÷²= 2.221, p=0.329.

A novel porcine model of ventilator-associated pneumonia caused by oropharyngeal challenge with Pseudomonas aeruginosa.

Science.gov (United States)

Li Bassi, Gianluigi; Rigol, Montserrat; Marti, Joan-Daniel; Saucedo, Lina; Ranzani, Otavio T; Roca, Ignasi; Cabanas, Maria; Muñoz, Laura; Giunta, Valeria; Luque, Nestor; Rinaudo, Mariano; Esperatti, Mariano; Fernandez-Barat, Laia; Ferrer, Miquel; Vila, Jordi; Ramirez, Jose; Torres, Antoni

2014-05-01

Animal models of ventilator-associated pneumonia (VAP) in primates, sheep, and pigs differ in the underlying pulmonary injury, etiology, bacterial inoculation methods, and time to onset. The most common ovine and porcine models do not reproduce the primary pathogenic mechanism of the disease, through the aspiration of oropharyngeal pathogens, or the most prevalent human etiology. Herein the authors characterize a novel porcine model of VAP due to aspiration of oropharyngeal secretions colonized by Pseudomonas aeruginosa. Ten healthy pigs were intubated, positioned in anti-Trendelenburg, and mechanically ventilated for 72 h. Three animals did not receive bacterial challenge, whereas in seven animals, a P. aeruginosa suspension was instilled into the oropharynx. Tracheal aspirates were cultured and respiratory mechanics were recorded. On autopsy, lobar samples were obtained to corroborate VAP through microbiological and histological studies. In animals not challenged, diverse bacterial colonization of the airways was found and monolobar VAP rarely developed. In animals with P. aeruginosa challenge, colonization of tracheal secretion increased up to 6.39 ± 0.34 log colony-forming unit (cfu)/ml (P VAP was confirmed in six of seven pigs, in 78% of the cases developed in the dependent lung segments (right medium and lower lobes, P = 0.032). The static respiratory system elastance worsened to 41.5 ± 5.8 cm H2O/l (P = 0.001). The authors devised a VAP model caused by aspiration of oropharyngeal P. aeruginosa, a frequent causative pathogen of human VAP. The model also overcomes the practical and legislative limitations associated with the use of primates. The authors' model could be employed to study pathophysiologic mechanisms, as well as novel diagnostic/preventive strategies.

Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers.

Science.gov (United States)

Grindlinger, Gene A; Cairo, Sarah B; Duperre, Carole B

2016-12-01

Ventilator-associated pneumonia (VAP) is a common cause of infectious morbidity and mortality in the intensive care unit (ICU). The type of stress-ulcer prophylaxis (SUP) given to ventilated patients may, in part, be responsible. We observed an increase in VAP as ventilator bundle compliance increased and a decrease in VAP when bundle compliance decreased. We reasoned that SUP which raises gastric pH such as proton-pump inhibitors (PPIs) and histamine II (H2) receptor antagonists as opposed to SUP which does not raise pH such as sucralfate (S) may be responsible and also may alter the causative bacteria. This is a single-center retrospective cohort analysis of all intubated, adult surgical patients admitted to the surgical ICU between January and June during the 3-y period 2012-2014. Demographics, APACHE II, Injury Severity Score, VAP occurrence, culprit bacteria, ventilator days, and ICU days were recorded based on the type of SUP given. There were 45 instances of VAP in the 504 study patients, 33 in the PPI/H2 group, and 12 in the S group (P < 0.01). VAP per 1000 ventilator days were 10.2 for PPI/H2 and 3.7 for S (P < 0.01). Culprit bacteria were mostly Pseudomonas, gram-negative bacilli, and methicillin-resistant Staphylococcus aureus in PPI/H2 patients (n = 29) compared with oropharyngeal flora in S patients (n = 6; P < 0.001). There was a substantial difference in VAP occurrence and in the culprit bacteria between S and PPI/H2 treated patients due perhaps to gastric alkalization. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementation of graphic health warning labels on tobacco products in India: the interplay between the cigarette and the bidi industries.

Science.gov (United States)

Sankaran, Sujatha; Hiilamo, Heikki; Glantz, Stanton A

2015-11-01

To understand the competition between and among tobacco companies and health groups that led to graphical health warning labels (GHWL) on all tobacco products in India. Analysis of internal tobacco industry documents in the Legacy Tobacco Document Library, documents obtained through India's Right to Information Act, and news reports. Implementation of GHWLs in India reflects a complex interplay between the government and the cigarette and bidi industries, who have shared as well as conflicting interests. Joint lobbying by national-level tobacco companies (that are foreign subsidiaries of multinationals) and local producers of other forms of tobacco blocked GHWLs for decades and delayed the implementation of effective GHWLs after they were mandated in 2007. Tobacco control activists used public interest lawsuits and the Right to Information Act to win government implementation of GHWLs on cigarette, bidi and smokeless tobacco packs in May 2009 and rotating GHWLs in December 2011. GHWLs in India illustrate how the presence of bidis and cigarettes in the same market creates a complex regulatory environment. The government imposing tobacco control on multinational cigarette companies led to the enforcement of regulation on local forms of tobacco. As other developing countries with high rates of alternate forms of tobacco use establish and enforce GHWL laws, the tobacco control advocacy community can use pressure on the multinational cigarette industry as an indirect tool to force implementation of regulations on other forms of tobacco. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Perbandingan Efek Dekontaminasi Oral Listerine® Dengan Klorheksidin 0,2% Terhadap Kejadian Ventilator Associated Pneumonia Di Unit Perawatan Intensif Rumah Sakit Haji Adam Malik Medan

OpenAIRE

Simamora, Boynardo

2016-01-01

Ventilator associated pneumonia (VAP) is an important nosocomial infection which form of hospital acquired pneumonia (HAP) in intensive care unit (ICU). VAP is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation. The risk of VAP is a highest early in the course of hospital stay, and is estimated to be three percent per day during the first five days of ventilation, two percent per day during days 5 to 10 ventilation, and one...

The Role of Political and Economic Factors in Thailand’s Last Two Coups D’ Etat

Science.gov (United States)

2007-09-01

Reg Invalid Total Population VAP Vote/ VAP PR CL Status 1975 8,695,000 18,500,000 47.0% N/A 41,896,000 18,902,400 46.0% 2 3 PF 1976 9,084,104...and registered voters are approximate. Terms are as follow: VAP =voting age population; PR=political rights; CL=civil liberties; Invalid=the number of...existed. However, by 1996, two parties were emerging as being dominant over the smaller parties—the Democrats and New Aspiration . This was about

Duration of antibiotic therapy for ventilator-associated pneumonia in burn patients.

Science.gov (United States)

Wahl, Wendy L; Taddonio, Michael A; Arbabi, Saman; Hemmila, Mark R

2009-01-01

Shorter compared with longer courses of antibiotic therapy for ventilator-associated pneumonia (VAP) in mixed medical-surgical intensive care units (ICUs) have been reported to produce equivalent outcomes. There have been few studies on the duration of antibiotic therapy for VAP in the burn population. We hypothesized that a shorter duration of antibiotic therapy for VAP would produce similar outcomes in our burn ICU. All burn patients from July 2001 to December 2006 admitted to the burn ICU requiring mechanical ventilation were studied. VAP was diagnosed prospectively by our Infection Control Liaison using bronchoalveolar lavage for cultures. Patients were cohorted into two groups: before July 1, 2004, antibiotic therapy duration was directed by the discretion of the attending physician (preprotocol), and after, the goal was 8 days of appropriate therapy or longer based on physician discretion (postprotocol). There were 98 patients treated for VAP with similar rates of inhalation injury, %TBSA burn size, age, and need for mechanical ventilation between the groups. The incidence of recurrent VAP was the same: 17% for the preprotocol and 15% for the postprotocol periods. The overall duration of antibiotic therapy did not change from 11 +/- 4 to 12 +/- 6 days. For patients treated longer than the target of 8 days, 66% had positive respiratory cultures at 4 days after initiation of antibiotic therapy. For the majority of patients with aspiration-type organisms or nonvirulent strains, there were fewer antibiotic days overall at 10 +/- 5 days (P VAP with the same bacteria. Despite a focused effort to decrease antibiotic usage for VAP in burn patients, the overall duration of therapy did not change. The majority of patients with virulent organisms such as methicillin-resistant Staphylococcus aureus or nonfermenting Gram-negative rods still had clinical signs of pneumonia and positive cultures, leading clinicians to continue antibiotics. In patients without virulent

Ventilator associated pneumonia: evolving definitions and preventive strategies.

Science.gov (United States)

Mietto, Cristina; Pinciroli, Riccardo; Patel, Niti; Berra, Lorenzo

2013-06-01

Ventilator-associated pneumonia (VAP) is one of the most frequent hospital-acquired infections occurring in intubated patients. Because VAP is associated with higher mortality, morbidity, and costs, there is a need to solicit further research for effective preventive measures. VAP has been proposed as an indicator of quality of care. Clinical diagnosis has been criticized to have poor accuracy and reliability. Thus, the Centers for Disease Control and Prevention has introduced a new definition based upon objective and recordable data. Institutions are nowadays reporting a VAP zero rate in surveillance programs, which is in discrepancy with clinical data. This reduction has been highlighted in epidemiological studies, but it can only be attributed to a difference in patient selection, since no additional intervention has been taken to modify pathogenic mechanisms in these studies. The principal determinant of VAP development is the presence of the endotracheal tube (ETT). Contaminated oropharyngeal secretions pool over the ETT cuff and subsequently leak down to the lungs through a hydrostatic gradient. Impairment of mucociliary motility and cough reflex cannot counterbalance with a proper clearance of secretions. Lastly, biofilm develops on the inner ETT surface and acts as a reservoir for microorganism inoculum to the lungs. New preventive strategies are focused on the improvement of secretions drainage and prevention of bacterial colonization. The influence of gravity on mucus flow and body positioning can facilitate the clearance of distal airways, with decreased colonization of the respiratory tract. A different approach proposes ETT modifications to limit the leakage of oropharyngeal secretions: subglottic secretion drainage and cuffs innovations have been addressed to reduce VAP incidence. Moreover, coated-ETTs have been shown to prevent biofilm formation, although there is evidence that ETT clearance devices (Mucus Shaver) are required to preserve the

Ventilator-Associated Pneumonia in Trauma Patients: Different Criteria, Different Rates.

Science.gov (United States)

Leonard, Kenji L; Borst, Gregory M; Davies, Stephen W; Coogan, Michael; Waibel, Brett H; Poulin, Nathaniel R; Bard, Michael R; Goettler, Claudia E; Rinehart, Shane M; Toschlog, Eric A

2016-06-01

No consensus exists regarding the definition of ventilator-associated pneumonia (VAP). Even within a single institution, inconsistent diagnostic criteria result in conflicting rates of VAP. As a Level 1 trauma center participating in the Trauma Quality Improvement Project (TQIP) and the National Healthcare Safety Network (NHSN), our institution showed inconsistencies in VAP rates depending on which criteria was applied. The purpose of this study was to compare VAP definitions, defined by culture-based criteria, National Trauma Data Bank (NTDB) and NHSN, using incidence in trauma patients. A retrospective chart review of consecutive trauma patients who were diagnosed with VAP and met pre-determined inclusion and exclusion criteria admitted to our rural, 861-bed, Level 1 trauma and tertiary care center between January 2008 and December 2011 was performed. These patients were identified from the National Trauma Registry of the American College of Surgeons (NTRACS) database and an in-house infection control database. Ventilator-associated pneumonia diagnosis criteria defined by the U.S. Center for Disease Control and Prevention (used by the NHSN), the NTDB, and our institutional, culture-based criteria gold standard were compared among patients. Two hundred seventy-nine patients were diagnosed with VAP (25.4% met NHSN criteria, 88.2% met NTDB, and 76.3% met culture-based criteria). Only 58 (20.1%) patients met all three criteria. When NHSN criteria were compared with culture-based criteria, NHSN showed a high specificity (92.5%) and low sensitivity (28.2%). The positive predictive value (PPV) was 84.5%, but the negative predictive value (NPV) was 47.1%. The agreement between the NHSN and the culture-based criteria was poor (κ = 0.18). Conversely, the NTDB showed a lower specificity (57.8%), but greater sensitivity (86.4%) compared with culture-based criteria. The PPV and NPV were both 74% and the two criteria showed fair agreement (κ = 0.41). The lack of

What Is a Ventilator?

Science.gov (United States)

... who are on ventilators for shorter periods. The advantage of this tube is that it can be ... other disease or condition. VAP is treated with antibiotics. You may need special antibiotics if the VAP ...

Oracle SOA Governance 11g implementation

CERN Document Server

Weir, Luis Augusto

2013-01-01

This book is a practical tutorial, with lots of step-by-step instructions for achieving SOA Governance by implementing the component Oracle products.This book is written for SOA architects and project managers who want to learn how to implement Oracle SOA Governance.

Hurdles in clinical implementation of academic advanced therapy medicinal products: A national evaluation.

Science.gov (United States)

de Wilde, Sofieke; Veltrop-Duits, Louise; Hoozemans-Strik, Merel; Ras, Thirza; Blom-Veenman, Janine; Guchelaar, Henk-Jan; Zandvliet, Maarten; Meij, Pauline

2016-06-01

Since the implementation of the European Union (EU) regulation for advanced therapy medicinal products (ATMPs) in 2009, only six ATMPs achieved marketing authorization approval in the EU. Recognizing the major developments in the ATMP field, starting mostly in academic institutions, we investigated which hurdles were experienced in the whole pathway of ATMP development towards clinical care. Quality interviews were executed with different stakeholders in The Netherlands involved in the ATMP development field, e.g. academic research groups, national authorities and patient organizations. Based on the hurdles mentioned in the interviews, questionnaires were subsequently sent to the academic principal investigators (PIs) and ATMP good manufacturing practice (GMP) facility managers to quantify these hurdles. Besides the familiar regulatory routes of marketing authorization (MA) and hospital exemption (HE), a part of the academic PIs perceived that ATMPs should become available by the Tissues and Cells Directive or did not anticipate on the next development steps towards implementation of their ATMP towards regular clinical care. The main hurdles identified were: inadequate financial support, rapidly evolving field, study-related problems, lacking regulatory knowledge, lack of collaborations and responsibility issues. Creating an academic environment stimulating and planning ATMP development and licensing as well as investing in expanding the relevant regulatory knowledge in academic institutions seems a prerequisite to develop ATMPs from bench to patient. Copyright © 2016 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Value of CT in the diagnosis of ventilator-associated pneumonia

International Nuclear Information System (INIS)

Hahn, U.; Pereira, P.; Laniado, M.; Claussen, C.D.; Heininger, A.

1999-01-01

Purpose: To analyse the diagnostic accuracy of computed tomography (CT) in ventilator-associated pneumonia (VAP). Materials and methods: 23 patients on mechanical ventilation with a new pulmonary abnormality on chest X-ray were examined with both spiral-CT and high-resolution CT. The diagnosis VAP was made according to prospectively defined criteria. Bronchoscopic specimen asservation with protected specimen brushing (PSB) served as gold standard. Results: With PSB, 11 of 23 patients were found to have VAP. CT showed a sensitivity and specificity of 53% and 63%, respectively. Ground glass infiltrates appeared to have a 100% specificity but were found in only 5/11 patients. Conclusions: CT is not the method of choice for diagnosing VAP. Groundglass infiltrates seeming to be highly specific are only inconstantly found. (orig.) [de

Risk prediction models for mortality in patients with ventilator-associated pneumonia

DEFF Research Database (Denmark)

Larsson, Johan E; Itenov, Theis Skovsgaard; Bestle, Morten Heiberg

2017-01-01

the receiver operator characteristic curve (AUC). RESULTS: We identified 19 articles studying 7 different models' ability to predict mortality in VAP patients. The models were Acute Physiology and Chronic Health Evaluation (APACHE) II (9 studies, n = 1398); Clinical Pulmonary Infection Score (4 studies, n...... = 303); "Immunodeficiency, Blood pressure, Multilobular infiltrates on chest radiograph, Platelets and hospitalization 10 days before onset of VAP" (3 studies, n = 406); "VAP Predisposition, Insult Response and Organ dysfunction" (2 studies, n = 589); Sequential Organ Failure Assessment (7 studies, n......: The PubMed and EMBASE were searched in February 2016. We included studies in English that evaluated models' ability to predict the risk of mortality in patients with VAP. The reported mortality with the longest follow-up was used in the meta-analysis. Prognostic accuracy was measured with the area under...

I-PFO: the new technology for simple and flexible implementation of high productive on-the-fly remote processes

Science.gov (United States)

Müllegger, Andreas; Ryba, Tracey

2017-02-01

Standardized production systems which can be implemented, programmed, maintained and sourced in a simple and efficient way are key for a successful global production of automobiles or related parts at component suppliers. This is also valid for systems, which are built by laser based processes. One of the key applications is remote laser welding (RLW) of "Body in White" (BIW) parts (such as hang-on parts, B-Pillars, side frames, etc.), but also builtin components (such as car seats, batteries, etc.). The majority of RLW applications are based on the implementation of a 3-D scanner optic (e.g. the PFO 3D from TRUMPF) which positions the laser beam on the various component surfaces to be welded. Over the past 10 years it has been proven that the most efficient way to build up the RLW process is to have a system where an industrial robot and a scanner optic are combined in one production cell. They usually cooperate within an "On-The-Fly" (OTF) process as this ensures minimum cycle times. Until now there are several technologies on the market which can coordinate both the robot and scanner in the OTF mode. But none of them meet all requirements of global standardized production solutions. With the introduction of the I-PFO (Intelligent Programmable Focusing Optics) technology the situation has changed. It is now possible to program or adopt complex remote processes in a fast and easy way by the "Teach-in" function via the robot teach pendant. Additionally a 3D offline designer software is an option for this system. It automatically creates the ideal remote process based on the part, fixture, production cell and required process parameters. The I-PFO technology doesn't need additional hardware due to the fact that it runs on the controller within the PFO 3D. Furthermore it works together with different types of industrial robots (e.g. ABB, Fanuc and KUKA) which allow highest flexibility for the production planning phase. Finally a single TRUMPF laser source can supply

Microbiological performance of dairy processing plants is influenced by scale of production and the implemented food safety management system: a case study.

Science.gov (United States)

Opiyo, Beatrice Atieno; Wangoh, John; Njage, Patrick Murigu Kamau

2013-06-01

The effects of existing food safety management systems and size of the production facility on microbiological quality in the dairy industry in Kenya were studied. A microbial assessment scheme was used to evaluate 14 dairies in Nairobi and its environs, and their performance was compared based on their size and on whether they were implementing hazard analysis critical control point (HACCP) systems and International Organization for Standardization (ISO) 22000 recommendations. Environmental samples from critical sampling locations, i.e., workers' hands and food contact surfaces, and from end products were analyzed for microbial quality, including hygiene indicators and pathogens. Microbial safety level profiles (MSLPs) were constructed from the microbiological data to obtain an overview of contamination. The maximum MSLP score for environmental samples was 18 (six microbiological parameters, each with a maximum MSLP score of 3) and that for end products was 15 (five microbiological parameters). Three dairies (two large scale and one medium scale; 21% of total) achieved the maximum MSLP scores of 18 for environmental samples and 15 for the end product. Escherichia coli was detected on food contact surfaces in three dairies, all of which were small scale dairies, and the microorganism was also present in end product samples from two of these dairies, an indication of cross-contamination. Microbial quality was poorest in small scale dairies. Most operations in these dairies were manual, with minimal system documentation. Noncompliance with hygienic practices such as hand washing and cleaning and disinfection procedures, which is common in small dairies, directly affects the microbial quality of the end products. Dairies implementing HACCP systems or ISO 22000 recommendations achieved maximum MSLP scores and hence produced safer products.

Electrospray Encapsulation of Toll-Like Receptor Agonist Resiquimod in Polymer Microparticles for the Treatment of Visceral Leishmaniasis

Science.gov (United States)

2013-01-15

solvent droplet.29,30 = = + ρ ρ − − ∞⎜ ⎟ ⎛ ⎝ ⎞ ⎠D D Pe solvent evaporation polymer diffusion ln 1 m m msolvent,air 1 polymer,solvent gas solvent vap ,0... vap , vap ,0 (2) In eq 2, Dsolvent,air and Dpolymer,solvent are the diffusion coefficients for solvent vapor in air (gas phase) and for polymer in...for a given series of experimental conditions and controls. The medium was then aspirated off; the formazan was resuspended in 200 μL of isopropyl

Defense Attache Saigon: RVNAF Quarterly Assessment, 3rd Quarter FY74.

Science.gov (United States)

1974-05-01

Part A - Saigon 1,037,000 Hospital Equipment 500,000 Clothing Factory - Go Vap 312,000 Arsenal Foundry - Go Vap 195,000 54th Construction Bn - Hoc Mon...185,000 $5,896,000 (2) Funded Projects Under Design/ Advertisement: Arsenal Phase II - Go Vap $985,000 450 Bed Hospital - Part B - Saigon 850,000...1973 Age-Limit s Combat Specialist Private, PFC, Corporal, Sergeant 41 43 NCO 46 48 Aspirant , 2LT, iLT 47 49 Captain 48 51 rda~or 49 53 Lieutenant

Implementation of a change management solution based on a product lifecycle management system for a large international project

International Nuclear Information System (INIS)

Luehr, Anneke

2011-08-01

This Thesis describes the implementation of a Change Management solution based on a Product Lifecycle Management System (PLM System) for a large international project. The objective of Change Management is to ensure a systematic line of action for approving and implementing changes in the project. The Deutsches Elektronen-Synchrotron DESY is one of the world's leading accelerator centres with locations in Hamburg and Zeuthen. Currently, DESY participates in the realization of the international research facility European X-Ray Free-Electron Laser (XFEL) at the Hamburg site. DESY was responsible for the planning of the XFEL. When the project entered the construction phase it was internationalized and now comprises project groups in 12 countries. Thus the requirements on Change Management have changed, as participants from several labs at many different locations are now involved. First the project scope is described and then a target process for the Change Management solution is developed by a requirement analysis. Afterwards the technical implementation of this process in DESY's PLM System is described and the Change Management solution is tested. The process is visualized using the Unified Modeling Language (UML). Finally a description is given of how to transfer the solution to the project

Ventilator-associated pneumonia: a review.

Science.gov (United States)

Ashraf, Madiha; Ostrosky-Zeichner, Luis

2012-02-01

Ventilator-associated pneumonia (VAP) is the most common infection seen in intensive care units (ICUs); it accounts for one-fourth of the infections occurring in critically ill patients and is the reason for half of antibiotic prescriptions in mechanically ventilated patients. In addition to being a financial burden on ICUs, it continues to contribute significantly to the morbidity and mortality of ICU patients, with an estimated attributable mortality rate of 8% to 15%. While the pathophysiology of VAP remains relatively unchanged, diagnostic techniques and preventive measures are constantly evolving. The focus of this article is on recent trends in VAP epidemiology, modifiable risk factors, diagnostic techniques, challenges in management, and current data on the prevention of VAP. Important messages that the reader should take away include: 1) There is no gold standard for the diagnosis of VAP; whenever VAP is suspected, if feasible, a quantitative culture should be obtained by invasive or noninvasive methods (whichever is more readily available before initiation of antibiotics); 2) Suspicion based on clinical features should prompt the initiation of a broad spectrum of antibiotics depending on suspected pathogens; 3) Close attention should be paid to de-escalation of antibiotics once microbiological results become available or as the patient starts responding clinically; the ideal duration of treatment should be 8 days instead of the conventional 10 to 14 days, except in situations where Pseudomonas may be suspected or the patient's comorbidities dictate otherwise; and 4) Prevention remains the key to reducing the burden of VAP. We promote the proven preventive measures of using noninvasive ventilation when possible, semirecumbent patient positioning, continuous aspiration of subglottic secretions, and oral chlorhexidine washes along with stress ulcer prophylaxis only after careful assessment of the risks versus benefits.

Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia.

Science.gov (United States)

Caruso, Pedro; Denari, Silvia; Ruiz, Soraia A L; Demarzo, Sergio E; Deheinzelin, Daniel

2009-01-01

To compare the incidence of ventilator-associated pneumonia (VAP) with or without isotonic saline instillation before tracheal suctioning. As a secondary objective, we compared the incidence of endotracheal tube occlusion and atelectasis. Randomized clinical trial. The study was conducted in a medical surgical intensive care unit of an oncologic hospital. We selected consecutive patients needing mechanical ventilation for >72 hrs. Patients were allocated into two groups: a saline group that received instillation of 8 mL of saline before tracheal suctioning and a control group which did not. VAP was diagnosed based on clinical suspicion and confirmed by bronchoalveolar lavage quantitative culture. The incidence of atelectasis on daily chest radiography and endotracheal tube occlusions were recorded. The sample size was calculated to a power of 80% and a type I error probability of 5%. One hundred thirty patients were assigned to the saline group and 132 to the control group. The baseline demographic variables were similar between groups. The rate of clinically suspected VAP was similar in both groups. The incidence of microbiological proven VAP was significantly lower in the saline group (23.5% x 10.8%; p = 0.008) (incidence density/1.000 days of ventilation 21.22 x 9.62; p < 0.01). Using the Kaplan-Meier curve analysis, the proportion of patients remaining without VAP was higher in the saline group (p = 0.02, log-rank test). The relative risk reduction of VAP in the saline instillation group was 54% (95% confidence interval, 18%-74%) and the number needed to treat was eight (95% confidence interval, 5-27). The incidence of atelectases and endotracheal tube occlusion were similar between groups. Instillation of isotonic saline before tracheal suctioning decreases the incidence of microbiological proven VAP.

Imipenem, meropenem, or doripenem to treat patients with Pseudomonas aeruginosa ventilator-associated pneumonia.

Science.gov (United States)

Luyt, Charles-Edouard; Aubry, Alexandra; Lu, Qin; Micaelo, Maïté; Bréchot, Nicolas; Brossier, Florence; Brisson, Hélène; Rouby, Jean-Jacques; Trouillet, Jean-Louis; Combes, Alain; Jarlier, Vincent; Chastre, Jean

2014-01-01

Only limited data exist on Pseudomonas aeruginosa ventilator-associated pneumonia (VAP) treated with imipenem, meropenem, or doripenem. Therefore, we conducted a prospective observational study in 169 patients who developed Pseudomonas aeruginosa VAP. Imipenem, meropenem, and doripenem MICs for Pseudomonas aeruginosa isolates were determined using Etests and compared according to the carbapenem received. Among the 169 isolates responsible for the first VAP episode, doripenem MICs were lower (Pimipenem and meropenem (MIC50s, 0.25, 2, and 0.38, respectively); 61%, 64%, and 70% were susceptible to imipenem, meropenem, and doripenem, respectively (P was not statistically significant). Factors independently associated with carbapenem resistance were previous carbapenem use (within 15 days) and mechanical ventilation duration before VAP onset. Fifty-six (33%) patients had at least one VAP recurrence, and 56 (33%) died. Factors independently associated with an unfavorable outcome (recurrence or death) were a high day 7 sequential organ failure assessment score and mechanical ventilation dependency on day 7. Physicians freely prescribed a carbapenem to 88 patients: imipenem for 32, meropenem for 24, and doripenem for 32. The remaining 81 patients were treated with various antibiotics. Imipenem-, meropenem-, and doripenem-treated patients had similar VAP recurrence rates (41%, 25%, and 22%, respectively; P=0.15) and mortality rates (47%, 25%, and 22%, respectively; P=0.07). Carbapenem resistance emerged similarly among patients treated with any carbapenem. No carbapenem was superior to another for preventing carbapenem resistance emergence.

Decreasing incidence and mortality among hospitalized patients suffering a ventilator-associated pneumonia: Analysis of the Spanish national hospital discharge database from 2010 to 2014.

Science.gov (United States)

de Miguel-Díez, Javier; López-de-Andrés, Ana; Hernández-Barrera, Valentín; Jiménez-Trujillo, Isabel; Méndez-Bailón, Manuel; Miguel-Yanes, José M de; Del Rio-Lopez, Benito; Jiménez-García, Rodrigo

2017-07-01

The aim of this study was to describe trends in the incidence and outcomes of ventilator-associated pneumonia (VAP) among hospitalized patients in Spain (2010-2014).This is a retrospective study using the Spanish national hospital discharge database from year 2010 to 2014. We selected all hospital admissions that had an ICD-9-CM code: 997.31 for VAP in any diagnosis position. We analyzed incidence, sociodemographic and clinical characteristics, procedures, pathogen isolations, and hospital outcomes.We identified 9336 admissions with patients suffering a VAP. Incidence rates of VAP decreased significantly over time (from 41.7 cases/100,000 inhabitants in 2010 to 40.55 in 2014). The mean Charlson comorbidity index (CCI) was 1.08 ± 0.98 and it did not change significantly during the study period. The most frequent causative agent was Pseudomonas and there were not significant differences in the isolation of this microorganism over time. Time trend analyses showed a significant decrease in in-hospital mortality (IHM), from 35.74% in 2010 to 32.81% in 2014. Factor associated with higher IHM included male sex, older age, higher CCI, vein or artery occlusion, pulmonary disease, cancer, undergone surgery, emergency room admission, and readmission.This study shows that the incidence of VAP among hospitalized patients has decreased in Spain from 2010 to 2014. The IHM has also decreased over the study period. Further investigations are needed to improve the prevention and control of VAP.

An Implementation Model for Production Quality Management in ...

African Journals Online (AJOL)

PROF. O. E. OSUAGWU

2013-06-01

Jun 1, 2013 ... of Iran must become more flexible in order to meet customer needs ... into consideration desires and demands of consumers will win the .... and capacities of current process;. 7. ... Attention to production of a. Quality product for.

A semiempirical correlation between enthalpy of vaporization and saturation concentration for organic aerosol.

Science.gov (United States)

Epstein, Scott A; Riipinen, Ilona; Donahue, Neil M

2010-01-15

To model the temperature-induced partitioning of semivolatile organics in laboratory experiments or atmospheric models, one must know the appropriate heats of vaporization. Current treatments typically assume a constant value of the heat of vaporization or else use specific values from a small set of surrogate compounds. With published experimental vapor-pressure data from over 800 organic compounds, we have developed a semiempirical correlation between the saturation concentration (C*, microg m(-3)) and the heat of vaporization (deltaH(VAP), kJ mol(-1)) for organics in the volatility basis set. Near room temperature, deltaH(VAP) = -11 log(10)C(300)(*) + 129. Knowledge of the relationship between C* and deltaH(VAP) constrains a free parameter in thermodenuder data analysis. A thermodenuder model using our deltaH(VAP) values agrees well with thermal behavior observed in laboratory experiments.

La validation des acquis professionnels une pratique de professionnalisation ?

OpenAIRE

Savarieau, Béatrice Verquin

2014-01-01

La validation des acquis professionnels (VAP) est un mode de reconnaissance de la fonction formatrice du travail, dans ce sens où elle octroie la dispense du titre requis pour pouvoir accéder à un diplôme. La VAP peut-elle alors s’apparenter à la dimension socioéconomique de la professionnalisation ? Cette dimension qui se situe à un niveau individuel est le renforcement de la professionnalité du praticien dans un processus de socialisation du travail. Nos hypothèses seront alors que la VAP e...

PREPREČEVANJE VENTILATORSKE PLJUČNICE

OpenAIRE

Mori, Jernej

2016-01-01

Ventilatorska pljučnica (VAP) je med najpogostejšimi zapleti pri pacientih, ki ležijo v intenzivni enoti in so priklopljeni na mehanično ventilacijo. VAP podaljša ležalno dobo na intenzivni enoti, pogosto povzroči smrt pacienta in predstavlja velik dodaten strošek za zdravstveni sistem. Namen diplomskega dela je bil opisati in predstaviti ukrepe za preprečevanje VAP. V diplomskem delu smo uporabili deskriptivno (opisno) metodo dela, pri kateri nam je bila v pomoč domača, predvsem pa tuja lite...

Procedure guide for the implementation of quality management program in products and services link with the utilization of tracers technology (TT) and Nucleonic Control System

International Nuclear Information System (INIS)

Resnizky, S.; Banados Perez, H.; Longo, G.; Rodriguez Cardona, R.L.; Sebastian Calvo, C.; Kohnenkamp O, I.; Duran P, O.

2000-01-01

This Manual was elaborated in the mark of the project RLA/8/024 ARCAL XLII 'Industrial Applications of the Tracer Technology and Nucleonic Control Systems'. The objective of the present Quality Manual is to spread the Quality Policy and to describe the form of implementing the Quality Management System, according to the requirements of the Standard ISO 9001:2000. It is applied to the design, development, implementation and maintenance of the products of the Organization of Tracers Technology (TT) and Nucleonic Control Systems (SCN). It have 9 Section: I. Introduction, II. Normative references, III. Definitions, IV. Quality Management System; V. Direction Responsibility; VI. Resources Management; VII. Products Accomplishment; VIII. Measurement, Analysis and Improvement and 7 Annex

The efficiency of routine endotracheal aspirate cultures compared to ...

African Journals Online (AJOL)

Objective: Ventilator-associated pneumonia (VAP) is the most common ... diagnosis, acute physiology and chronic health evaluation II score, and sequential organ ... cultures, pre-VAP EA identified the same microorganism with the same ..... hospital‑acquired, ventilatorassociated and healthcare‑associated pneumonia.

Minnesota agripower project. Quarterly report, April--June 1997

Energy Technology Data Exchange (ETDEWEB)

Baloun, J.

1997-07-01

The Minnesota Valley Alfalfa Producers (MnVAP) propose to build an alfalfa processing plant integrated with an advanced power plant system at the Granite Falls, Minnesota Industrial Park to provide 75 MW of base load electric power and a competitively priced source of value added alfalfa based products. This project will utilize air blown fluidized bed gasification technology to process alfalfa stems and another biomass to produce a hot, clean, low heating value gas that will be used in a gas turbine. Exhaust heat from the gas turbine will be used to generate steam to power a steam turbine and provide steam for the processing of the alfalfa leaf into a wide range of products including alfalfa leaf meal, a protein source for livestock. The plant will demonstrate high efficiency and environmentally compatible electric power production, as well as increased economic yield from farm operations in the region. The initial phase of the Minnesota Agripower Project (MAP) will be to perform alfalfa feedstock testing, prepare preliminary designs, and develop detailed plans with estimated costs for project implementation. The second phase of MAP will include detailed engineering, construction, and startup. Full commercial operation will start in 2001.

Exploring the use of mothers' own milk as oral care for mechanically ventilated very low-birth-weight preterm infants.

Science.gov (United States)

Thibeau, Shelley; Boudreaux, Cynthia

2013-06-01

The purpose of this study was to explore the use of mothers' own milk (colostrums, transitional milk, and mature milk) as oral care in the ventilator-associated pneumonia (VAP)-prevention bundle of mechanically ventilated preterm infants weighing 1500 g or less. Mechanically ventilated preterm infants weighing 1500 g or less admitted to a regional level III NICU in the Gulf South between January 1, 2006, and December 31, 2009. Retrospective descriptive. Oral care with mothers' own milk was implemented as part of the VAP-prevention bundle in the neonatal intensive care unit in the fourth quarter of 2007. Using retrospective deidentified data retrieved from the electronic medical record, the primary and secondary outcome variables were collected among eligible infants (≤1500 g) admitted January 1, 2006, to December 31, 2007 (before implementation) and January 1, 2008, to December 31, 2009 (after implementation). Sample characteristics, including infant gestational age, birth weight, and gender, as well as maternal age, type of delivery, and incidence of maternal chorioamnionitis, were also collected. Data analysis included frequencies and distributions to summarize sample characteristics and variables of interest. Appropriate tests for differences were conducted on outcome variables between the before and after groups of the human milk oral care intervention. The feasibility outcome variable included nursing compliance with the oral care procedure. The safety outcome variable included record of any adverse events associated with the oral care procedure. The efficacy health outcomes included the rate of positive tracheal aspirates, positive blood cultures, the number of ventilator days, and length of stay. Infant age (26.1-26.6 weeks) and weight (840-863 g) were similar in the before (n = 70) and after (n = 68) sample subjects. There were no statistically significant differences in ventilator days, χ² (46, n = 115) = 46.22, P = .46, and length of stay, χ (75, n

Framework for implementing product portfolio management in software business

NARCIS (Netherlands)

Jagroep, Erik; Van De Weerd, Inge; Brinkkemper, Sjaak; Dobbe, Ton

2014-01-01

Whether a software product company takes up a project depends on the strategic decisions that are made with regard to an organization's products. A software project needs to fit strategic goals and enable an organization to realize a vision through its software products. Making decisions on a

Opportunities for implementation of concepts and tools lean production aiming to improve competitiveness of enterprises of shoe APL Jaú / SP

Directory of Open Access Journals (Sweden)

Célio Favoni

2013-08-01

Full Text Available Lean production has been applied by organizations around the world as part of strategy to reduce waste in their value stream intending to improve performance. Despite the use of lean production concepts and tools have continually been introduced in different companies, the literature shows the most of application is identified in large companies than in Small-and  Medium-sized Enterprises (SMEs. The reason can be the lack of financial and human resources available to the lean initiatives in these enterprises. However, a wide range of concepts and techniques of lean production can be applied without considerable financial investments. This paper aims to study the opportunities and difficulties of lean production applicability in SMEs. Case research was developed in three SMEs of industrial cluster of Jaú/SP and the results suggest that these companies face similar difficulties. Nevertheless, the study confirms that there are several opportunities to implement lean production concepts and techniques which can lead to improve performance in these companies.

PV Status Report 2009. Research, Solar Cell Production and Market Implementation of Photovoltaics

International Nuclear Information System (INIS)

Jaeger-Waldau, A.

2009-08-01

Photovoltaics is a key technology option to realise the shift to a decarbonised energy supply. The solar resources in Europe and world wide are abundant and cannot be monopolised by one country. Regardless for what reasons and how fast the oil price and energy prices increase in the future, Photovoltaics and other renewable energies are the only ones to offer a reduction of prices rather than an increase in the future. As a response to the economic crisis, most of the G20 countries have designed economic recovery packages which include 'green stimulus' measures. However, compared to the new Chinese Energy Revitalisation Plan under discussion, the pledged investments in green energy are marginal. If no changes are made, China which now strongly supports its renewable energy industry, will emerge even stronger after the current financial crisis. In 2008, the Photovoltaic industry production almost doubled and reached a world-wide production volume of 7.3 GWp of Photovoltaic modules. Yearly growth rates over the last decade were in average more than 40%, which makes Photovoltaics one of the fastest growing industries at present. Business analysts predict the market volume to increase to 40 billion euros in 2010 and expect lower prices for consumers. The trend that thin-film Photovoltaics grew faster than the overall PV market continued in 2008. The Eighth Edition of the 'PV Status Report' tries to give an overview about the current activities regarding Research, Manufacturing and Market Implementation.

Implementing new production management modes

DEFF Research Database (Denmark)

Riis, Jens Ove; Knopp, Jeanette

1998-01-01

This paper represents an attempt to shed light on an important issue for development of production management, namely the orchestration of several individual development projects and initiatives of different type and nature necessary for achieving an overall significant improved performance....... The paper will first introduce three types of development initiatives: (1) Crossfunctional development; (2) Functional development; and (3) Local development. Then incremental and innovative changes will be discussed and a more differentiated classification will be proposed. This provides a framework...... for modeling different development processes which will be illustrated by means of two case examples. In addition, the results of a Danish survey on Continuous Improvements will be related to the three types of initiatives. Tentative theoretical and practical implications will be outlined....

Study of activity based costing implementation for palm oil production using value-added and non-value-added activity consideration in PT XYZ palm oil mill

Science.gov (United States)

Sembiring, M. T.; Wahyuni, D.; Sinaga, T. S.; Silaban, A.

2018-02-01

Cost allocation at manufacturing industry particularly in Palm Oil Mill still widely practiced based on estimation. It leads to cost distortion. Besides, processing time determined by company is not in accordance with actual processing time in work station. Hence, the purpose of this study is to eliminates non-value-added activities therefore processing time could be shortened and production cost could be reduced. Activity Based Costing Method is used in this research to calculate production cost with Value Added and Non-Value-Added Activities consideration. The result of this study is processing time decreasing for 35.75% at Weighting Bridge Station, 29.77% at Sorting Station, 5.05% at Loading Ramp Station, and 0.79% at Sterilizer Station. Cost of Manufactured for Crude Palm Oil are IDR 5.236,81/kg calculated by Traditional Method, IDR 4.583,37/kg calculated by Activity Based Costing Method before implementation of Activity Improvement and IDR 4.581,71/kg after implementation of Activity Improvement Meanwhile Cost of Manufactured for Palm Kernel are IDR 2.159,50/kg calculated by Traditional Method, IDR 4.584,63/kg calculated by Activity Based Costing Method before implementation of Activity Improvement and IDR 4.582,97/kg after implementation of Activity Improvement.

Program Implementation Plan

International Nuclear Information System (INIS)

1987-06-01

The Program Implementation Plan (PIP) describes the US Department of Energy's (DOE's) current approaches for managing the permanent disposal of defense high-level waste (HLW), transuranic (TRU) waste, and low-level waste (LLW) from atomic energy defense activities. It documents the implementation of the HLW and TRU waste policies as stated in the Defense Waste Management Plan (DWMP) (DOE/DP-0015), dated June 1983, and also addresses the management of LLW. The narrative reflects both accomplishments and changes in the scope of activities. All cost tables and milestone schedules are current as of January 1987. The goals of the program, to provide safe processing and utilization, storage, and disposal of DOE radioactive waste and byproducts to support defense nuclear materials production activities, and to implement cost-effective improvements in all of its ongoing and planned activities, have not changed

PV status report 2004. Research, Solar cell production and market implementation of photovoltaic s

International Nuclear Information System (INIS)

Jager-Waldau, A.

2004-01-01

The increasing demand for photovoltaic devices leads to the search for new developments with respect to material use and consumption, device design and production technologies, as well as new concepts to increase the overall efficiency. At present solar cell manufacturing is based on single junction device silicon wafer technology with close to 90% market share. Consistent with the time needed for any major change in the energy infrastructure, another 20 to 30 years of sustained and aggressive growth will be required for photovoltaic to substitute a significant share of the conventional energy sources. This growth will be possible if a continuous introduction of new technologies takes place, made possible by sound fundamental research. In October 2004 the Russian Duma ratified the Kyoto Protocol and it can be expected that the Protocol will now be set into force by the beginning of 2005. This recent development will definitively have an impact on the further implementation of renewable energies and photovoltaic is a prime source to deliver it. The Third Edition of the PV Status Report will widen its view to the enlarged European Union as well as the new player China and tries to give an overview about the current activities regarding Research, Manufacturing and Market Implementation. The opinion given in this report is based on the current information available to the author, and does not reflect the opinion of the European Commission. (author)

Management of ventilator associated pneumonia with a new antibiotic adjuvant entity (ceftriaxone+sulbactam+disodium edetate) - A novel approach to spare carbapenems.

Science.gov (United States)

Sathe, Prachee; Maddani, Sagar; Kulkarni, Shilpa; Munshi, Nita

2017-10-01

Ventilator associated pneumonia (VAP) is one of the most serious nosocomial infections in Intensive Care Unit (ICU). The aim of this study was to evaluate a new approach to spare the carbapenems for the management of patients diagnosed with VAP due to Acinetobacter baumannii (A. baumannii). This retrospective study was conducted on VAP patients presenting for treatment at tertiary care centre between May 2014 and March 2016. The case sheets of patients who have been treated for VAP with meropenem, antibiotic adjuvant entity (AAE) and colistin were analysed. Out of 113 patients analysed, 24 (21.3%) patients were having VAP due to MDR A. baumannii. Microbial sensitivity has shown that 87.5% of patients were sensitive to AAE and colistin whereas all of them were resistant to meropenem, imipenem and gentamycin. The mean treatment durations were 12.4±2.1, 13.2±2.4 and 14.3±2.1days for AAE, meropenem+colistin and AAE+colistin treatment groups. In AAE susceptible patients, the mean treatment duration and cost could be reduced by 23-24% and 43-53% if AAE is used empirically. In AAE-resistant patients, the mean treatment duration and cost could be reduced by 21% and 26% if AAE+colistin regime is used empirically instead of meropenem followed by AAE+colistin. Clinical assessment with microbial eradication and pharmaco-economic evaluation clearly shows benefits in using AAE empirically in the management of A. baumannii infected VAP cases. Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of overall level of evidence behind the Institute of Healthcare Improvement ventilator-associated pneumonia guidelines

Directory of Open Access Journals (Sweden)

Iqbal M

2011-08-01

Full Text Available Background Clinical practice guidelines are developed to assist in patient care but the evidence basis for many guidelines has recently been called into question. Methods We conducted a literature review using PubMed and analyzed the overall quality of evidence and made strength of recommendation behind 6 Institute of Health Care (IHI guidelines for prevention of ventilator associated pneumonia (VAP. Quality of evidence was assessed by the American Thoracic Society levels of evidence (levels I through III with addition of level IV when evidence existed that the guideline increased VAP. We also examined our own intensive care units (ICUs for evidence of a correlation between guideline compliance and the development of VAP. Results None of the guidelines could be given more than a moderate recommendation. Only one of the guidelines (head of bed elevation was graded at level II and could be given a moderate recommendation. One was graded at level IV (stress ulcer disease prophylaxis. The remainder were graded level III and given weak recommendations. In our ICUs compliance with the guidelines did not correlate with a reduction in VAP (p<0.05. Conclusions Most of the IHI guidelines are based on level III evidence. Data from our ICUs did not support guideline compliance as a method of reducing VAP. Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current IHI VAP guidelines to direct patient care decisions or as an assessment of the quality of care.

[Prospective evaluation on ventilator-associated events: a cohort study from eight intensive care units].

Science.gov (United States)

Chen, W S; Liu, J; Liu, H; Song, Y Y; Chen, H Y; Wang, R; Zhang, Y P; Jiang, W; Li, H F; Li, S Q; Zhang, S M; Liu, B; Zhang, X; Zhang, W H

2016-08-10

The aim of this study was to prospectively investigate the incidence of ventilator associated events (VAEs) in intensive care units (ICUs) among adult patients, and to evaluate the correlation between VAEs and ventilator associated pneumonia (VAP). A prospective 3-month cohort study (January 2015 to March 2015) was carried out. VAEs were divided into three groups: with ventilator-associated condition (VAC), with infection related ventilator-associated complication (IVAC) and with possible VAP (PVAP). Sensitivity and specificity of VAEs were evaluated and compared to the traditional VAP. Kappa test was applied to judge the consistency of VAC and VAP. During Jan. 2015 and Mar. 2015, 1 014 patients were admitted to 8 ICUs, with 7 977 patients per day. In total, 197 patients used the mechanical ventilation installation, with, a total number of 3 152 ventilator-days. Finally, 1 214 ventilation days in the VAC group and 1 938 ventilation days in the non-VAC group) that were available for final analysis. 46 VAC cases were identified including 22 classified as IVAC (14.59 and 6.98 per 1 000 ventilation days, respectively). Length of ICU stay and duration on mechanical ventilation for VAC patients were both significantly longer than those for non-VAC patients (PVAC criteria for the detection of VAP were 36.92% and 83.33%, respectively. The VAEs surveillance paradigms could be applied to monitor patients on the use of mechanical ventilation installation. However, sensitivity and specificity of VAC were under pool for the diagnosis of VAP. However, automatically surveillance programs was relied on the improvement of auto-information systems.

The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation

Directory of Open Access Journals (Sweden)

Mehdi Shahabi

2016-01-01

Full Text Available Background: Ventilator-associated pneumonia (VAP is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA, Chi-square, and independent t-test. Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05. Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

Production of Gouda cheese and Camembert with probiotic cultures: the suitability of some commercial probiotic cultures to be implemented in cheese.

Science.gov (United States)

Van de Casteele, S; Ruyssen, T; Vanheuverzwijn, T; Van Assche, P

2003-01-01

The behaviour of 10 probiotic cultures (L. acidophilus, Bifidobacterium sp., L. rhamnosus and L. paracasei) was examined during the production and ripening of Gouda cheese and Camembert. The overall objective of this research project was to obtain a product (cheese) containing at least 10(7) probiotic cfu/g. In general 10(6) cfu of a probiotic culture must be implemented per ml cheese milk, together with the cheesestarter, to reach this objective. L. paracasei sp. have the ability to grow more than 2 log units during cheese ripening. A lower inoculation value can be considered for these cultures.

Implementing NetScaler VPX

CERN Document Server

Sandbu, Marius

2014-01-01

An easy-to-follow guide with detailed step-by step-instructions on how to implement the different key components in NetScaler, with real-world examples and sample scenarios.If you are a Citrix or network administrator who needs to implement NetScaler in your virtual environment to gain an insight on its functionality, this book is ideal for you. A basic understanding of networking and familiarity with some of the different Citrix products such as XenApp or XenDesktop is a prerequisite.

Determination and ranking cleaner production criteria by using analytic hierarchy process (Case study: Latif paper products company

Directory of Open Access Journals (Sweden)

Yaghob Asadizadeh

2018-02-01

Full Text Available Cleaner production process is an environmentally friendly approach that attempts to reduce waste and energy consumption then reduce environmental pollutions of industrial processes to provide the possibility of sustainable production in industrial units. To achieve this goal and alignment with cleaner production strategies, paper industries should consider reducing wastes of production processes and irregular consumption of energy as a priority in their programs. In this research Analytic Hierarchy Process has been applied and a three level hierarchy model was structured to facilitate the cleaner production process in Latif paper products firm. Using a literature review and field study, the proposed model provided a framework for cleaner production implementation in the firm. Results showed priorities of the main criteria of cleaner production are process change, product modification, implementation of preventive maintenance system, resititution and man force capitals respectively. Process change criterion allocated 40 percent of the total weighing value and has the highest priority in implementation of cleaner production strategy. Existence of industrial automation and its technology level which is a sub criterion of process change has the highest priority among 31 sub criteria. Also some of higher priority sub criteria such as use of higher quality inclusion and implementation of calibration system are related to process change. Therefore, to achieve cleaner production goals and implementation of its strategic objectives it is necessary to pay more attention to this criterion. Inconsistency ratio of the research is 0.06 which indicates the results are compatible. The results of this research can be used to accelerate the implementation of cleaner production process in Iran’s pulp and paper industry.

SAFARI: An Environment for Creating Tutoring Systems in Industrial Training.

Science.gov (United States)

Gecsei, J.; Frasson, C.

Safari is a cooperative project involving four Quebec universities, two industrial partners (Virtual Prototypes, Inc., providing the VAPS software package, and Novasys, Inc., a consulting firm specializing in artificial intelligence and training), and government. VAPS (Virtual Applications Prototyping System) is a commercial interface-building and…

The efficiency of routine endotracheal aspirate cultures compared to ...

African Journals Online (AJOL)

Acinetobacter baumannii was the most frequently isolated microorganism from BAL cultures (n = 21, 51%). The diagnostic value of pre.VAP EA results in predicting A. baumannii VAP documented with the following values (sensitivity: 62%; specificity: 95%, positive predictive value: 87%, negative predictive value: 82%).

Humidification policies for mechanically ventilated intensive care patients and prevention of ventilator-associated pneumonia: a systematic review of randomized controlled trials.

Science.gov (United States)

Niël-Weise, B S; Wille, J C; van den Broek, P J

2007-04-01

The Dutch Working Party on Infection Prevention (WIP) aimed to determine whether certain humidification policies are better than others in terms of prevention of ventilator-associated pneumonia (VAP) in mechanically ventilated intensive care unit (ICU) patients. Publications were retrieved by a systematic search of Medline and the Cochrane Library up to February 2006. All (quasi-) randomized trials and systematic reviews/meta-analyses comparing humidification methods in ventilated ICU patients were selected. Two reviewers independently assessed trial quality and extracted data. If the data was incomplete, clarification was sought from original authors and used to calculate the relative risk of VAP. Data for VAP were combined in the analysis, where appropriate, using a random-effects model. Ten trials were included in the review. In general, the quality of the trials and the way they were reported were unsatisfactory. The results did not show any benefit from specific humidification techniques in terms of reducing VAP. WIP do not recommend either passive or active humidifiers to prevent VAP, nor the type of passive humidifiers to be used. Regarding active humidification, WIP recommends using heated wire circuits. This is due to the theoretical consideration that less condensate reduces colonization and subsequent risk of spread throughout an ICU when condensate is removed.

The Effect of a Designed Respiratory Care Program on the Incidence of Ventilator-Associated Pneumonia: A Clinical Trial

Directory of Open Access Journals (Sweden)

Mohammad Abbasinia

2016-01-01

Full Text Available Introduction: Ventilator-associated pneumonia is a common complication of mechanical ventilation. This study aimed to evaluate the effect of designed respiratory care program on incidence of ventilator-associated pneumonia (VAP in the mechanically ventilated patient. Methods: In this clinical trial, 64 patients were selected among those who had undergone mechanical ventilation in the ICU of Al‑Zahra Hospital, Isfahan, Iran, using convenience sampling method. The subjects were randomly allocated to intervention and control groups. In the intervention group an upper respiratory care program and in the control group, routine cares were done. Modified Clinical Pulmonary Infection Questionnaire was completed before and on the third, fourth and fifth day of study. Data were analyzed by Chi-square and independent t-test through SPSS Ver.13. Results: The results of this study showed that until the third day of study, the incidence of VAP was similar in the both groups. However, on the fifth day of study, the incidence of VAP in the intervention group was significantly lower than control group. Conclusion: The results of this study showed that an upper respiratory care program reduced the incidence of VAP. Therefore, nurses are recommended to perform this program for prevention of VAP.

Patient positioning and ventilator-associated pneumonia.

Science.gov (United States)

Hess, Dean R

2005-07-01

Rotational beds, prone position, and semi-recumbent position have been proposed as procedures to prevent ventilator-associated pneumonia (VAP). Rotational therapy uses a special bed designed to turn continuously, or nearly continuously, the patient from side to side; specific designs include kinetic therapy and continuous lateral rotation therapy. A meta-analysis of studies evaluating the effect of rotational bed therapy shows a decrease in the risk of pneumonia but no effect on mortality. Two studies reported a lower risk of VAP in patients placed in a prone position, with no effect on mortality. Studies using radiolabeled enteral feeding solutions in mechanically ventilated patients have reported that aspiration of gastric contents occurs to a greater degree when patients are in the supine position, compared with the semirecumbent position. One study reported a lower rate of VAP in patients randomized to semi-recumbent compared to supine position. Although each of the techniques discussed in this paper has been shown to reduce the risk of VAP, none has been shown to affect mortality. The available evidence suggests that semi-recumbent position should be used routinely, rotational therapy should be considered in selected patients, and prone position should not be used as a technique to reduce the risk of VAP.

[The use of 16S rDNA sequencing in species diversity analysis for sputum of patients with ventilator-associated pneumonia].

Science.gov (United States)

Yang, Xiaojun; Wang, Xiaohong; Liang, Zhijuan; Zhang, Xiaoya; Wang, Yanbo; Wang, Zhenhai

2014-05-01

To study the species and amount of bacteria in sputum of patients with ventilator-associated pneumonia (VAP) by using 16S rDNA sequencing analysis, and to explore the new method for etiologic diagnosis of VAP. Bronchoalveolar lavage sputum samples were collected from 31 patients with VAP. Bacterial DNA of the samples were extracted and identified by polymerase chain reaction (PCR). At the same time, sputum specimens were processed for routine bacterial culture. The high flux sequencing experiment was conducted on PCR positive samples with 16S rDNA macro genome sequencing technology, and sequencing results were analyzed using bioinformatics, then the results between the sequencing and bacteria culture were compared. (1) 550 bp of specific DNA sequences were amplified in sputum specimens from 27 cases of the 31 patients with VAP, and they were used for sequencing analysis. 103 856 sequences were obtained from those sputum specimens using 16S rDNA sequencing, yielding approximately 39 Mb of raw data. Tag sequencing was able to inform genus level in all 27 samples. (2) Alpha-diversity analysis showed that sputum samples of patients with VAP had significantly higher variability and richness in bacterial species (Shannon index values 1.20, Simpson index values 0.48). Rarefaction curve analysis showed that there were more species that were not detected by sequencing from some VAP sputum samples. (3) Analysis of 27 sputum samples with VAP by using 16S rDNA sequences yielded four phyla: namely Acitinobacteria, Bacteroidetes, Firmicutes, Proteobacteria. With genus as a classification, it was found that the dominant species included Streptococcus 88.9% (24/27), Limnohabitans 77.8% (21/27), Acinetobacter 70.4% (19/27), Sphingomonas 63.0% (17/27), Prevotella 63.0% (17/27), Klebsiella 55.6% (15/27), Pseudomonas 55.6% (15/27), Aquabacterium 55.6% (15/27), and Corynebacterium 55.6% (15/27). (4) Pyrophosphate sequencing discovered that Prevotella, Limnohabitans, Aquabacterium

Product integration rules at Clenshaw-Curtis and related points: A robust implementation

International Nuclear Information System (INIS)

Adam, G.; Nobile, A.

1989-12-01

Product integration rules generalizing the Fejer, Clenshaw-Curtis and Filippi quadrature rules respectively are derived for integrals with trigonometric and hyperbolic weight factors. The study puts in evidence the existence of well-conditioned fully analytic solutions, in terms of hypergeometric functions 0 F 1 . An a priori error estimator is discussed which is shown both to avoid wasteful invocation of the integration rule and to increase significantly the robustness of the automatic quadrature procedure. Then, specializing to extended Clenshaw-Curtis (ECC) rules, three types of a posteriori error estimates are considered and the existence of a great risk of their failure is put into evidence by large scale validation tests. An empirical error estimator, superseding them at slowly varying integrands, is found to result in a spectacular increase in the output reliability. Finally, enhancements in the control of the interval subdivision strategy aiming at increasing code robustness is discussed. Comparison with the code DQAWO of QUADPACK, extending over a statistics of about hundred thousand solved integrals, is illustrative for the increased robustness and error estimate reliability of our computer code implementation of the ECC rules. (author). 19 refs, 8 tabs

THE EVALUATION OF EIGHT PILLARS TOTAL PRODUCTIVE MAINTENANCE (TPM IMPLEMENTATION AND THEIR IMPACT ON OVERALL EQUIPMENT EFFECTIVENESS (OEE AND WASTE

Directory of Open Access Journals (Sweden)

Herry Agung Prabowo

2018-02-01

Full Text Available In this global era where the level of competition is higher, in addition to the influence of the suitable marketing strategy is also required strategy from the side of production/productivity. PT. XYZ is a company engaged in the manufacturing of snacks especially biscuits. The problem that often occurs in this company is the number of biscuits that are not in accordance with the standard and the production does not reach the target set because the machine suddenly breaks down frequently. To overcome the problems PT. XYZ then choose to implement the Total Productive Maintenance (TPM strategy. This study aims to evaluate the implementation of 8 TPM Pillars and measure the effects on manufacturing performance in the form of Overall Equipment Effectiveness (OEE and Waste. This study uses questionnaire-based survey method. The number of samples distributed is 40 units. Which returned and filled 33 questionnaires and which is worth to be processed as many as 30 samples. Then tested the validity and reliability of data using SPSS program. Validity critical value R = 0.361 for n = 30 and error rate 5%. For reliability test, R value = 0.60 was selected. From the validity test, there are 7 items of questions that are not valid so it is not included in the next process. For the reliability test of the questionnaire is quite reliable with the value of Cronbach's alpha of 0.811. From the CFA analysis, only 6 of 8 TPM pillars are significant while for manufacturing performance only OEE variable is significant. Correlation between 8 Pillars of TPM and manufacturing performance is Strong enough with a value of R = 0.862, which also means 74.3% (R2 variable manufacturing performance can be explained/influenced by variable 8 Pillar TPM and 26.7% the rest by other variables.

Multiplex polymerase chain reaction: Could change diagnosis of ...

African Journals Online (AJOL)

Mervat Gamal Eldin Mansour

2017-09-28

Sep 28, 2017 ... the cost of hospital care and to the length of hospital stays. Besides ... Aim of study: To identify the causative bacterial pathogens of VAP by both conventional microbiological ... making about acquisition of ventilator-associated pneumonia ... that are considered serious causative pathogens for VAP world-.

Ventilator associated pneumonia and infection control

NARCIS (Netherlands)

Alp, E.; Voss, A.

2006-01-01

Ventilator associated pneumonia (VAP) is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20-75% according to the study population. Aspiration of colonized pathogenic microorganisms on

Adolescent violence against parents. Is it a consequence of gender inequality?

Directory of Open Access Journals (Sweden)

Oscar Diaz

2009-01-01

Full Text Available The aim of the present study was to explore the psychosocial profile of juveniles reported for violent behaviours against their parents, as well as the extent to which the phenomenon of violence against parents (VAP can be explained by the hypothesis of the bi-directionality of intra-family violence. For this purpose we selected a sample of 103 juveniles classified in three groups –(a VAP offences, (b VAP offences and other types of offence, and (c other offences. In total we analyzed 413 files from the office of the Public Prosecutor for Juveniles in Bilbao (Basque Country, northern Spain. We extracted personal, family context and judicial variables for the juveniles. The results suggest the existence of a specific profile of juveniles reported for VAP, and also show that through the hypothesis of the bi-directionality of intra-family violence it is possible to explain one-third of the cases analyzed.

Reducing the risk of ventilator-acquired pneumonia through head of bed elevation.

Science.gov (United States)

Keeley, Libby

2007-01-01

It has been suggested that placing critically ill ventilated patients in a semirecumbent position minimizes the likelihood of nosocomial pneumonia. This pilot study explores whether the incidence of ventilator-acquired pneumonia (VAP) can be reduced by elevating the head of the bed to 45 degrees. The design is quantitative in nature, using a randomized controlled trial. The method involves adult ventilated patients being randomly assigned to one of two positions, i.e. 45 degrees raised head of bed (treatment group) or 25 degrees raised head of bed (control group). Data collection relied upon the diagnosis of clinically suspected and microbiologically confirmed pneumonia defined by the Consensus Conference on VAP. Thirty patients were included in the study--17 in the treatment group and 13 in the control group. Results showed that 29% (five) in the treatment group and 54% (seven) in the control group contracted VAP (P VAP in the patients nursed at 45 degrees. However, because of the sample size this difference did not reach statistical significance.

Matrix product operators, matrix product states, and ab initio density matrix renormalization group algorithms

Science.gov (United States)

Chan, Garnet Kin-Lic; Keselman, Anna; Nakatani, Naoki; Li, Zhendong; White, Steven R.

2016-07-01

Current descriptions of the ab initio density matrix renormalization group (DMRG) algorithm use two superficially different languages: an older language of the renormalization group and renormalized operators, and a more recent language of matrix product states and matrix product operators. The same algorithm can appear dramatically different when written in the two different vocabularies. In this work, we carefully describe the translation between the two languages in several contexts. First, we describe how to efficiently implement the ab initio DMRG sweep using a matrix product operator based code, and the equivalence to the original renormalized operator implementation. Next we describe how to implement the general matrix product operator/matrix product state algebra within a pure renormalized operator-based DMRG code. Finally, we discuss two improvements of the ab initio DMRG sweep algorithm motivated by matrix product operator language: Hamiltonian compression, and a sum over operators representation that allows for perfect computational parallelism. The connections and correspondences described here serve to link the future developments with the past and are important in the efficient implementation of continuing advances in ab initio DMRG and related algorithms.

[Comparison of endotracheal aspiration and mini-BAL culture results in the diagnosis of ventilator-associated pneumonia].

Science.gov (United States)

Artuk, Cumhur; Gül, Hanefi Cem; Mert, Gürkan; Karakaş, Ahmet; Bedir, Orhan; Eyigün, Can Polat

2012-07-01

The objective of this study was to compare the results of cultures obtained by mini-bronchoalveolar lavage (BAL) and endotracheal aspiration (ETA) techniques, used for rapid and accurate determination of pathogens causing ventilator-associated pneumonia (VAP) in intensive care units. Of the 92 patients on mechanical ventilation followed at the emergency intensive care unit of our hospital between June 2010 and June 2011, 30 (32.2%) patients were diagnosed as VAP and they were included in this study. VAP diagnosis were based on the clinical and radiological findings. Clinical pulmonary infection score (CPIS) of > 6 was accepted as the clinical criteria of VAP. Initially ETA samples were collected from the patients followed by mini-BAL sampling 15 minutes later, together with urine and two blood cultures. Microbiological evaluation and identification were performed by conventional methods and Phoenix 100 (BD Diagnostic Systems, ABD) automated system. In quantitative culture analysis, > 10.000 cfu/ml for BAL and > 100.000 cfu/ml for ETA were accepted as the positive result. The mean ages of VAP-developed (n= 30; 18 were male) and nondeveloped (n= 62; 39 were male) patients were 68.23 ± 16.19 and 52.16 ± 10.41 years, respectively, and the mean durations of mechanical ventilation were 29.57 ± 15.78 and 12.11 ± 6.01 days, respectively. Multivariate logistic regression analysis showed that older age (pVAP development. There was also a statistically significant difference in CPIS values between patients who developed VAP and not (6.8 ± 1.15 and 2.71 ± 1.06, respectively; pVAP diagnosis was found to be useful in patients on mechanical ventilation. In our study, a total of 16 strains (six A.baumannii, three P.aeruginosa, one K.pneumoniae, six S.aureus) were isolated from ETA cultures, while 34 strains (16 A.baumannii, six P.aeruginosa, four K.pneumoniae, two E.coli, six S.aureus) were isolated from mini-BAL cultures of 30 VAP patients. The contamination rate for ETA

Implementation of lean leadership

Directory of Open Access Journals (Sweden)

Trenkner Małgorzata

2016-12-01

Full Text Available The Toyota case proves that lean leadership is of critical importance for the successful implementation and permanent functioning of Lean Production System. There is no ready formula for developing Toyota style lean leadership. However, one may gain inspiration from its experience.

Extended infusion versus intermittent infusion of imipenem in the treatment of ventilator-associated pneumonia.

Science.gov (United States)

Ibrahim, Mohamed M; Tammam, Tarek Fouad; Ebaed, Mohy El Deen; Sarhan, Hatem A; Gad, Gamal F; Hussein, Amal K

2017-01-01

Mechanical ventilation support can be the main source of ventilator-associated pneumonia (VAP). VAP is a serious infection that may be associated with dangerous gram-negative bacteria mainly, and it leads to an increase in the mortality in the intensive care unit (ICU). Imipenem is one of the strongest antibiotics now available for treating VAP which is associated with gram-negative and gram-positive bacteria, and it belongs to beta-lactam antibiotic group (carbapenem). This study tried to investigate the efficacy of imipenem against VAP when it was infused within 180 min versus the efficacy when it was infused within 30-60 min. This study was conducted in main ICU in general hospital which consists of surgical and medical beds within 2 years. One hundred and eighty-seven patients were enrolled on it. This study is a retrospective cohort which was conducted within 2 years. The efficacy of imipenem which was administered by intermittent infusion (30-60 min) within first year was compared with the efficacy of imipenem which was administered by extended infusion (180 min) within second year in the field of VAP curing and cost reduction. All data were collected retrospectively from patient medical files and were statistically analyzed by SPSS version 20. The study was designed to measure clinical and cost reduction outcomes, mortality and hospital stay. The results indicated that there is a significant decrease in mortality, number of recurrent infection, and ICU stay length, and the number of mechanical ventilator days was associated with extended imipenem infusion during the second year of the study. The use of imipenem with extended infusion over 3 hours enhances its clinical outcomes in the treatment of VAP.

Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients.

Science.gov (United States)

Ghoochani Khorasani, Ahmad; Shadnia, Shahin; Mashayekhian, Mohammad; Rahimi, Mitra; Aghabiklooei, Abbas

2016-01-01

Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10%) and Acinetobacter spp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients.

Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

Directory of Open Access Journals (Sweden)

Ahmad Ghoochani Khorasani

2016-01-01

Full Text Available Background. Ventilator-associated pneumonia (VAP is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1 subglottic secretion drainage (SSD group who were intubated by Evac ETT (n=43 and (2 control group who were intubated by C-ETT (n=48. Results. Of the 91 eligible patients, 56 (61.5% were male. VAP was detected in 24 of 43 (55.8% patients in the case group and 23 of 48 (47.9% patients in the control group (P=0.45. The most frequently isolated microorganisms were S. aureus (54.10% and Acinetobacter spp. (19.68%. The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P=0.68. Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients.

Analysis of ventilator-associated pneumonia infection route by genome macrorestriction-pulsed-field gel electrophoresis and its prevention with combined nursing strategies.

Science.gov (United States)

Wang, Xiaodong; Wang, Junping; Li, Jing; Wang, Jing

2014-12-01

The aim of the present study was to explore the infection route of ventilator-associated pneumonia (VAP) and assess the effectiveness of a combined nursing strategy to prevent VAP in intensive care units. Bacteria from the gastric juice and drainage from the hypolarynx and lower respiratory tracts of patients with VAP were analyzed using genome macrorestriction-pulsed-field gel electrophoresis (GM-PFGE). A total of 124 patients with tracheal intubation were placed in the intervention group and were treated with a combined nursing strategy, comprising mosapride (gastric motility stimulant) administration and semi-reclining positioning. A total of 112 intubated patients were placed in the control group and received routine nursing care. The incidence rate of VAP, days of ventilation and mortality rate of patients were compared between the two groups. The GM-PFGE fingerprinting results of three strains of Pseudomonas aeruginosa from the gastric juice, subglottic secretion drainage and drainage of the lower respiratory tract in patients with VAP were similar across groups. The number of days spent on a ventilator by patients in the intervention group (7.37±5.32 days) was lower compared with that by patients in the control group (12.34±4.98 days) (PVAP was reduced from 40.81 to 21.25% following intervention with the combined nursing strategy (Ppatients in the intervention group was 29.46%, a significant reduction compared with the 41.94% mortality rate observed in the control group (PVAP. The combined nursing strategy of gastric motility stimulant administration and the adoption of a semi-reclining position was effective in preventing VAP by reducing the occurrence of GER.

A modified implementation of tristate inverter based static master-slave flip-flop with improved power-delay-area product.

Science.gov (United States)

Singh, Kunwar; Tiwari, Satish Chandra; Gupta, Maneesha

2014-01-01

The paper introduces novel architectures for implementation of fully static master-slave flip-flops for low power, high performance, and high density. Based on the proposed structure, traditional C(2)MOS latch (tristate inverter/clocked inverter) based flip-flop is implemented with fewer transistors. The modified C(2)MOS based flip-flop designs mC(2)MOSff1 and mC(2)MOSff2 are realized using only sixteen transistors each while the number of clocked transistors is also reduced in case of mC(2)MOSff1. Postlayout simulations indicate that mC(2)MOSff1 flip-flop shows 12.4% improvement in PDAP (power-delay-area product) when compared with transmission gate flip-flop (TGFF) at 16X capacitive load which is considered to be the best design alternative among the conventional master-slave flip-flops. To validate the correct behaviour of the proposed design, an eight bit asynchronous counter is designed to layout level. LVS and parasitic extraction were carried out on Calibre, whereas layouts were implemented using IC station (Mentor Graphics). HSPICE simulations were used to characterize the transient response of the flip-flop designs in a 180 nm/1.8 V CMOS technology. Simulations were also performed at 130 nm, 90 nm, and 65 nm to reveal the scalability of both the designs at modern process nodes.

Environmental and Social Management System Implementation Handbook : Animal Production

OpenAIRE

International Finance Corporation

2014-01-01

Environmental and social responsibility is becoming more and more important in todayapos;s global economy. There are thousands of environmental and social codes and standards in the world today. The codes and standards define the rules and the objectives. But the challenge is in the implementation. An environmental and social management system (ESMS) helps companies to integrate the ru...

Continuous Energy Photon Transport Implementation in MCATK

Energy Technology Data Exchange (ETDEWEB)

Adams, Terry R. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Trahan, Travis John [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Sweezy, Jeremy Ed [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Nolen, Steven Douglas [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Hughes, Henry Grady [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Pritchett-Sheats, Lori A. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Werner, Christopher John [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-10-31

The Monte Carlo Application ToolKit (MCATK) code development team has implemented Monte Carlo photon transport into the MCATK software suite. The current particle transport capabilities in MCATK, which process the tracking and collision physics, have been extended to enable tracking of photons using the same continuous energy approximation. We describe the four photoatomic processes implemented, which are coherent scattering, incoherent scattering, pair-production, and photoelectric absorption. The accompanying background, implementation, and verification of these processes will be presented.

A Sand Cone Model of Lean Implementation

OpenAIRE

Yestemessov, Azamat

2011-01-01

Over the past 20 years Lean Production system has been a focus of researches by different academicians. A numerous works have been written in the field of Lean implementation in manufacturing companies. However, as shown, most of the academic topics relate to the issues of implementing Lean tools and techniques. Critical Success Factors have been also described widely; however, no efforts in systematization have been made. Only several works have a focus on integration of Lean implementation ...

Ventilator associated pneumonia caused by extensive-drug resistant Acinetobacter species: Colistin is the remaining choice

Directory of Open Access Journals (Sweden)

Ahmed Hasanin

2016-07-01

Conclusions: XDR AB-VAP is endemic in our ICU without a definite factor associated with increased risk of infection. Given that almost half of the strains are also resistant to tigecycline, colistin appears to be an appropriate first-line antimicrobial drug in critically ill patients developing VAP based on invitro results.

Application of the suggestion system in the improvement of the production process and product quality control

Science.gov (United States)

Gołaś, H.; Mazur, A.; Gruszka, J.; Szafer, P.

2016-08-01

The elaboration is a case study and the research was carried out in the company Alco-Mot Ltd., which employs 120 people. The company specializes in the production of lead poles for industrial and traction batteries using gravity casting. The elements embedded in the cast are manufactured on a machining centre, which provides the stability of the process and of the dimensions of the product as well as a very short production time. As a result of observation and analysis the authors have developed a concept for the implementation of a dynamic suggestion system in ALCO-MOT, including, among others, a standard for actions in the implementation of the suggestion system, as well as clear guidelines for the processing and presentation of the activities undertaken in the time between the establishment of the concept (suggestions) and the benefits analysis after the proposed solutions have been implemented. The authors also present how suggestions proposed by ALCO-MOT staff contributed to the improvement of the processes of production and quality control. Employees offered more than 30 suggestions, of which more than a half are being implemented now and further actions are being prepared for implementation. The authors will present the results of improvements in, for example, tool replacement time, scrap reduction. The authors will present how kaizen can improve the production and quality control processes. They will present how the production and quality control processes looked before and after the implementation of employee suggestions.

Optimizing the order processing of customized products using product configuration

DEFF Research Database (Denmark)

Hvam, Lars; Bonev, Martin; Denkena, B.

2011-01-01

. Product configuration based on integrated modular product structure and product family architecture has been recognized as an effective means for implementing mass customization. In order to evaluate the effects of product configuration on order processing, a study has been conducted by the Department...... and its benefits for the order processing have been evaluated....

Probiotics for preventing ventilator-associated pneumonia

Science.gov (United States)

Bo, Lulong; Li, Jinbao; Tao, Tianzhu; Bai, Yu; Ye, Xiaofei; Hotchkiss, Richard S; Kollef, Marin H; Crooks, Neil H; Deng, Xiaoming

2014-01-01

Background Ventilator-associated pneumonia (VAP) is common in intensive care units (ICUs). Some evidence indicates that probiotics may reduce the incidence of VAP. Several additional published studies have demonstrated that probiotics are safe and efficacious in preventing VAP in ICUs. We aimed to systematically summarise the results of all available data to generate the best evidence for the prevention of VAP. Objectives To evaluate the effectiveness and safety of probiotics for preventing VAP. Search methods We searched CENTRAL (2014, Issue 8), MEDLINE (1948 to September week 1, 2014) and EMBASE (2010 to September 2014). Selection criteria Randomised controlled trials (RCTs) comparing probiotics with placebo or another control (excluding RCTs that use probiotics in both study groups) to prevent VAP. Data collection and analysis Two review authors independently assessed eligibility and the quality of trials, and extracted data. Main results We included eight RCTs, with 1083 participants. All studies compared a form of probiotic (Lactobacillus casei rhamnosus; Lactobacillus plantarum; Synbiotic 2000FORTE; Ergyphilus; combination Bifidobacterium longum + Lactobacillus bulgaricus + Streptococcus thermophilus) versus a control group (placebo; glutamine; fermentable fibre; peptide; chlorhexidine). The analysis of all RCTs showed that the use of probiotics decreased the incidence of VAP (odds ratio (OR) 0.70, 95% confidence interval (CI) 0.52 to 0.95, low quality evidence). However, the aggregated results were uncertain for ICU mortality (OR 0.84, 95% CI 0.58 to 1.22 very low quality evidence), in-hospital mortality (OR 0.78, 95% CI 0.54 to 1.14, very low quality evidence), incidence of diarrhoea (OR 0.72, 95% CI 0.47 to 1.09, very low quality evidence), length of ICU stay (mean difference (MD) −1.60, 95% CI −6.53 to 3.33, very low quality evidence), duration of mechanical ventilation (MD −6.15, 95% CI −18.77 to 6.47, very low quality evidence) and antibiotic

Gen IV Materials Handbook Implementation Plan

International Nuclear Information System (INIS)

Rittenhouse, P.; Ren, W.

2005-01-01

A Gen IV Materials Handbook is being developed to provide an authoritative single source of highly qualified structural materials information and materials properties data for use in design and analyses of all Generation IV Reactor Systems. The Handbook will be responsive to the needs expressed by all of the principal government, national laboratory, and private company stakeholders of Gen IV Reactor Systems. The Gen IV Materials Handbook Implementation Plan provided here addresses the purpose, rationale, attributes, and benefits of the Handbook and will detail its content, format, quality assurance, applicability, and access. Structural materials, both metallic and ceramic, for all Gen IV reactor types currently supported by the Department of Energy (DOE) will be included in the Gen IV Materials Handbook. However, initial emphasis will be on materials for the Very High Temperature Reactor (VHTR). Descriptive information (e.g., chemical composition and applicable technical specifications and codes) will be provided for each material along with an extensive presentation of mechanical and physical property data including consideration of temperature, irradiation, environment, etc. effects on properties. Access to the Gen IV Materials Handbook will be internet-based with appropriate levels of control. Information and data in the Handbook will be configured to allow search by material classes, specific materials, specific information or property class, specific property, data parameters, and individual data points identified with materials parameters, test conditions, and data source. Details on all of these as well as proposed applicability and consideration of data quality classes are provided in the Implementation Plan. Website development for the Handbook is divided into six phases including (1) detailed product analysis and specification, (2) simulation and design, (3) implementation and testing, (4) product release, (5) project/product evaluation, and (6) product

Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial.

Science.gov (United States)

Fujimoto, Hiroko; Yamaguchi, Osamu; Hayami, Hajime; Shimosaka, Mika; Tsuboi, Sayaka; Sato, Mitsunori; Takebayashi, Shigeo; Morita, Satoshi; Saito, Mari; Goto, Takahisa; Kurahashi, Kiyoyasu

2018-03-23

Aspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP. A single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay. Fifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days). Although continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.

Treatment of Chryseobacterium indologenes ventilator-associated pneumonia in a critically ill trauma patient.

Science.gov (United States)

Monteen, Megan R; Ponnapula, Supriya; Wood, G Christopher; Croce, Martin A; Swanson, Joseph M; Boucher, Bradley A; Fabian, Timothy C

2013-12-01

To report a case of Chryseobacterium indologenes ventilator-associated pneumonia (VAP) in a critically ill trauma patient. This report describes a 66-year-old critically ill trauma patient who developed VAP, which was caused by C indologenes. The patient was injured in a riding lawn mower accident that trapped him underwater in a pond. The patient required surgery for intra-abdominal injuries and was mechanically ventilated in the trauma intensive care unit. On hospital day 5, the patient developed signs and symptoms of VAP. A diagnosis of C indologenes VAP was confirmed based on a quantitative culture from a bronchoscopic bronchoalveolar lavage. The patient's infection was successfully treated with moxifloxacin for 2 days followed by cefepime for 7 days. Formally known as Flavobacterium indologenes, C indologenes is a Gram-negative bacillus normally found in plants, soil, foodstuffs, and fresh and marine water sources. Recently, worldwide reports of C indologenes infections in humans have been increasing, though reports from the United States are still rare. Bacteremia and pneumonia are the most commonly reported infections, and most patients are immunocompromised. The current case differs from most previous reports because this patient was in the United States and did not have any traditional immunocompromised states (eg, transplant, cancer, HIV/AIDS, or corticosteroid use). This case report demonstrates that C indologenes can cause VAP in a trauma ICU patient.

Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients.

Science.gov (United States)

Mounier, R; Adrie, C; Français, A; Garrouste-Orgeas, M; Cheval, C; Allaouchiche, B; Jamali, S; Dinh-Xuan, A T; Goldgran-Toledano, D; Cohen, Y; Azoulay, E; Timsit, J-F; Ricard, J-D

2010-04-01

The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome. 2,409 prospectively included patients were admitted over 9 yrs (2000-2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios patients on the PP propensity score (+/-10%), MV duration longer than that in PP patients before the first turn prone, and centre. VAP incidence was similar in the PP and control groups (24 versus 13 episodes.1,000 patient-days MV(-1) respectively, p = 0.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64 (95% CI 0.70-3.84); p = 0.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39-0.79); p = 0.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for >1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score >50). In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP >1 day might decrease mortality, particularly in the sickest patients.

Implementation of hybrid parallel kanban-CONWIP system: A case study

Directory of Open Access Journals (Sweden)

Joshua Prakash

2014-12-01

Full Text Available The most common form of production control strategy in lean management is the pull system. One emerging form of pull system uses kanban and CONWIP systems to handle products with different demand patterns. Case studies have protractedly depicted the actual implementation of pull systems; however, the use of hybrid systems is rare. This paper examines the procedures involved in implementing a hybrid system in a low variety/low volume shop floor. This paper presents discussions on shop floor constraints in the proposed system and how the simplicity of a pull system is able to reduce work-in-process inventory by 23%. Guidelines for the replication of the system for similar production environments are also provided. The case study proves that pull systems can be successfully implemented in production environments that do not conform to the typical prerequisites of the kanban system.

The current state of Lean implementation in health care: literature review.

Science.gov (United States)

Poksinska, Bozena

2010-01-01

The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care. A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions. Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.

Pneumonia associada à ventilação mecânica: epidemiologia e impacto na evolução clínica de pacientes em uma unidade de terapia intensiva Ventilator-associated pneumonia: epidemiology and impact on the clinical evolution of ICU patients

Directory of Open Access Journals (Sweden)

Pedro Mendes de Azambuja Rodrigues

2009-11-01

Full Text Available OBJETIVO: Apesar de representar uma das principais causas de infecção nosocomial, o papel da pneumonia associada à ventilação mecânica (PAVM no prognóstico ainda permanece indefinido. O objetivo deste estudo foi avaliar o impacto dessa doença na evolução clínica dos pacientes. MÉTODOS: Estabeleceu-se uma coorte prospectiva de 233 pacientes sob ventilação mecânica (grupo PAV, n = 64; grupo controle, n = 169. Os desfechos primários foram tempo de ventilação mecânica (TVM, tempo de permanência na UTI (TUTI, tempo de permanência hospitalar (TH e mortalidade na UTI. Os desfechos secundários foram mortalidade hospitalar, perfil microbiológico, uso prévio de antibióticos e fatores de risco para PAVM. RESULTADOS: Os desfechos dos grupos controle e PAVM foram, respectivamente, os seguintes: mediana do TVM (dias, 9 (intervalo interquartílico [II]: 5-15 e 23 (II: 15-37; p OBJECTIVE: Although ventilator-associated pneumonia (VAP is a major cause of nosocomial infection, its role in the prognosis of patients remains undefined. The objective of this study was to evaluate the impact of VAP on the clinical evolution of patients. METHODS: This was a prospective cohort study involving 233 patients on mechanical ventilation (VAP group, n = 64; control group, n = 169. Primary outcomes were time on mechanical ventilation (TMV, time in ICU (TICU, overall length of hospital stay (LHS and in-ICU mortality. Secondary outcomes were in-hospital mortality, microbiological profile, prior use of antibiotics and risk factors for VAP acquisition. RESULTS: Control and VAP group outcomes were, respectively, as follows: median TMV (days, 9 (interquartile range [IQR]: 5-15 and 23 (IQR: 15-37; p < 0.0001; median TICU (days, 12 (IQR: 8-21 and 27 (IQR: 17-42; p < 0.0001; median LHS (days, 33 (IQR: 18-64 and 46 (IQR: 25-90; p = 0.05; and in-ICU mortality, 38% (95% CI: 31-45 and 55% (95% CI: 42-67; p = 0.02. VAP was a predictor of in-ICU mortality (OR = 3

Strategies to prevent ventilation-associated pneumonia: the effect of cuff pressure monitoring techniques and tracheal tube type on aspiration of subglottic secretions: an in-vitro study.

Science.gov (United States)

Carter, Eleanor L; Duguid, Alasdair; Ercole, Ari; Matta, Basil; Burnstein, Rowan M; Veenith, Tonny

2014-03-01

Ventilation-associated pneumonia (VAP) is the commonest nosocomial infection in intensive care. Implementation of a VAP prevention care bundle is a proven method to reduce its incidence. The UK care bundle recommends maintenance of the tracheal tube cuff pressure at 20 to 30  cmH₂O with 4-hourly pressure checks and use of tracheal tubes with subglottic aspiration ports in patients admitted for more than 72  h. To evaluate the effects of tracheal tube type and cuff pressure monitoring technique on leakage of subglottic secretions past the tracheal tube cuff. Bench-top study. Laboratory. A model adult trachea with simulated subglottic secretions was intubated with a tracheal tube with the cuff inflated to 25  cmH₂O. Experiments were conducted using a Portex Profile Soft Seal tracheal tube with three cuff pressure monitoring strategies and using a Portex SACETT tracheal tube with intermittent cuff pressure checks. Rate of simulated secretion leakage past the tracheal tube cuff. Mean ± SD leakage of fluid past the Profile Soft Seal tracheal tube cuff was 2.25 ± 1.49  ml  min⁻¹ with no monitoring of cuff pressure, 2.98 ± 1.63  ml  min⁻¹ with intermittent cuff pressure monitoring and 3.83 ± 2.17  ml  min⁻¹ with continuous cuff pressure monitoring (P aspiration port and aspirating the simulated secretions prior to intermittent cuff pressure checks reduced the leakage rate to 0.50 ± 0.48  ml  min⁻¹ (P aspiration port. Further evaluation of medical device performance is needed in order to design more effective VAP prevention strategies.

Improving compliance to meal-replacement food regimens. Forming implementation intentions (conscious IF-THEN plans) increases compliance.

Science.gov (United States)

Zandstra, E H; den Hoed, W; van der Meer, N; van der Maas, A

2010-12-01

Creating and changing habits around dieting behaviour can be a way to help consumers to consume more healthy products and to control their weight. Previous studies suggested that implementation intentions - deliberate plans on when, where and how - increase the likelihood that consumers perform the intended behaviour (Armitage, 2004; Gollwitzer & Sheeran, 2006; Jackson et al., 2005). This study investigated the effect of forming implementation intentions on compliance to a regimen based on a range of meal-replacement food products and snacks. Participants (n = 57) were allocated to one of two groups, either: (1) an implementation-intention group, who formed deliberate plans (implementation intentions) to consume the products - these implementation intentions were formed only once at the beginning of the study -, or (2) a control group who formed no implementation intentions. Participants were then instructed to follow a daily regimen, which included the consumption of foods from a range of meal-replacement products and snacks provided gratis for four weeks. Results showed that the implementation-intention group consumed significantly more meal-replacement food products per week (p intentions was apparent for 18 days. These findings indicate that forming implementation intentions may assist individuals in their compliance to a meal-replacement product regimen. Copyright © 2010 Elsevier Ltd. All rights reserved.

Observed benefits from product configuration systems

DEFF Research Database (Denmark)

Hvam, Lars; Haug, Anders; Mortensen, Niels Henrik

2013-01-01

This article presents a study of the benefits obtained from applying product configuration systems based on a case study in four industry companies. The impacts are described according to main objectives in literature for imple-menting product configuration systems: lead time in the specification...... affected by the use of product configu-ration systems e.g. increased sales, decrease in the number of SKU's, improved ability to introduce new products, and cost reductions.......This article presents a study of the benefits obtained from applying product configuration systems based on a case study in four industry companies. The impacts are described according to main objectives in literature for imple-menting product configuration systems: lead time in the specification...... processes, on-time delivery of the specifica-tions, and resource consumption for making specifications, quality of specifications, optimization of products and services, and other observations. The purpose of the study is partly to identify specific impacts observed from implementing product configuration...

Diversification of industrial productions by implementing new technologies in the postindustrial era: analysis of the actions model

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O. A. Yeremchenko

2016-01-01

Full Text Available The article analyses business processes and actions models, based on the utilization of new sciencedriven technologies used for the production of products and services that are implemented by large international industrial conglomerates within the framework of realizing the diversification strategies. As a research sample, we have chosen models of managing technological innovations, which formed the basis of the diversification strategy of Fujifilm Holdings Corporation in 2000–2015. The article notes that the company expedited the widening of new technological areas for development since the beginning of the 2000’s. High technology products manufactured using new technologies are no longer launched by the company every 7–10 years as in 20th century but instead, much more rapidly, every 3–4 years. There is noted a significant change in the company’s approach to reducing the life span of innovations. Today, Fujifilm prefers to enter new markets by purchasing innovations already used by medium sized fast growing high tech companies, and not form new research departments in their holding company. Attention is drawn to the fact that more often Fujifilm uses the strategy of unrelated diversification, by demonstrating whereby the readiness to widen the scope of its activities in any sphere with the good return on investments perspectives. The article emphasizes the significant importance of Russian industrial companies to be able to purchase innovative solutions and partner with providers of science-driven technologies and products, including small and medium-sized enterprises.

Effect of enhanced ultraviolet germicidal irradiation in the heating ventilation and air conditioning system on ventilator-associated pneumonia in a neonatal intensive care unit.

Science.gov (United States)

Ryan, R M; Wilding, G E; Wynn, R J; Welliver, R C; Holm, B A; Leach, C L

2011-09-01

The objective of this study was to test the hypothesis that enhanced ultraviolet germicidal irradiation (eUVGI) installed in our neonatal intensive care unit (NICU) heating ventilation and air conditioning system (HVAC) would decrease HVAC and NICU environment microbes, tracheal colonization and ventilator-associated pneumonia (VAP). The study was designed as a prospective interventional pre- and post-single-center study. University-affiliated Regional Perinatal Center NICU. Intubated patients in the NICU were evaluated for colonization, and a high-risk sub-population of infants <30 weeks gestation ventilated for ≥ 14 days was studied for VAP. eUVGI was installed in the NICU's remote HVACs. The HVACs, NICU environment and intubated patients' tracheas were cultured pre- and post-eUVGI for 12 months. The high-risk patients were studied for VAP (positive bacterial tracheal culture, increased ventilator support, worsening chest radiograph and ≥ 7 days of antibiotics). Pseudomonas, Klebsiella, Serratia, Acinetobacter, Staphylococcus aureus and Coagulase-negative Staphylococcus species were cultured from all sites. eUVGI significantly decreased HVAC organisms (baseline 500,000 CFU cm(-2); P=0.015) and NICU environmental microbes (P<0.0001). Tracheal microbial loads decreased 45% (P=0.004), and fewer patients became colonized. VAP in the high-risk cohort fell from 74% (n=31) to 39% (n=18), P=0.04. VAP episodes per patient decreased (Control: 1.2 to eUVGI: 0.4; P=0.004), and antibiotic usage was 62% less (P=0.013). eUVGI decreased HVAC microbial colonization and was associated with reduced NICU environment and tracheal microbial colonization. Significant reductions in VAP and antibiotic use were also associated with eUVGI in this single-center study. Large randomized multicenter trials are needed.

A genetic screen identifies Tor as an interactor of VAPB in a Drosophila model of amyotrophic lateral sclerosis

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Senthilkumar Deivasigamani

2014-10-01

Full Text Available Amyotrophic Lateral Sclerosis (ALS is a progressive neurodegenerative disorder characterized by selective death of motor neurons. In 5–10% of the familial cases, the disease is inherited because of mutations. One such mutation, P56S, was identified in human VAPB that behaves in a dominant negative manner, sequestering wild type protein into cytoplasmic inclusions. We have conducted a reverse genetic screen to identify interactors of Drosophila VAPB. We screened 2635 genes and identified 103 interactors, of which 45 were enhancers and 58 were suppressors of VAPB function. Interestingly, the screen identified known ALS loci – TBPH, alsin2 and SOD1. Also identified were genes involved in cellular energetics and homeostasis which were used to build a gene regulatory network of VAPB modifiers. One key modifier identified was Tor, whose knockdown reversed the large bouton phenotype associated with VAP(P58S expression in neurons. A similar reversal was seen by over-expressing Tuberous Sclerosis Complex (Tsc1,2 that negatively regulates TOR signaling as also by reduction of S6K activity. In comparison, the small bouton phenotype associated with VAP(wt expression was reversed with Tsc1 knock down as well as S6K-CA expression. Tor therefore interacts with both VAP(wt and VAP(P58S, but in a contrasting manner. Reversal of VAP(P58S bouton phenotypes in larvae fed with the TOR inhibitor Rapamycin suggests upregulation of TOR signaling in response to VAP(P58S expression. The VAPB network and further mechanistic understanding of interactions with key pathways, such as the TOR cassette, will pave the way for a better understanding of the mechanisms of onset and progression of motor neuron disease.

Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial.

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Zeng, Juan; Wang, Chun-Ting; Zhang, Fu-Shen; Qi, Feng; Wang, Shi-Fu; Ma, Shuang; Wu, Tie-Jun; Tian, Hui; Tian, Zhao-Tao; Zhang, Shu-Liu; Qu, Yan; Liu, Lu-Yi; Li, Yuan-Zhong; Cui, Song; Zhao, He-Ling; Du, Quan-Sheng; Ma, Zhuang; Li, Chun-Hua; Li, Yun; Si, Min; Chu, Yu-Feng; Meng, Mei; Ren, Hong-Sheng; Zhang, Ji-Cheng; Jiang, Jin-Jiao; Ding, Min; Wang, Yu-Ping

2016-06-01

To evaluate the potential preventive effect of probiotics on ventilator-associated pneumonia (VAP). This was an open-label, randomized, controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were randomized to receive (1) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis (Medilac-S) 0.5 g three times daily through a nasogastric feeding tube plus standard preventive strategies or (2) standard preventive strategies alone, for a maximum of 14 days. The development of VAP was evaluated daily, and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter. The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients (36.4 vs. 50.4 %, respectively; P = 0.031). The mean time to develop VAP was significantly longer in the probiotics group than in the control group (10.4 vs. 7.5 days, respectively; P = 0.022). The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms (PPMOs) was lower in the probiotics group (24 %) than the control group (44 %) (P = 0.004). However, the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups. The administration of probiotics did not result in any improvement in the incidence of clinically suspected VAP, antimicrobial consumption, duration of mechanical ventilation, mortality and length of hospital stay. Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach.

Respiratory Pattern and Tidal Volumes Differ for Pressure Support and Volume-assured Pressure Support in Amyotrophic Lateral Sclerosis.

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Nicholson, Trevor T; Smith, Sean B; Siddique, Teepu; Sufit, Robert; Ajroud-Driss, Senda; Coleman, John M; Wolfe, Lisa F

2017-07-01

Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease resulting in respiratory failure and death. Use of noninvasive ventilation (NIV) improves survival. However, use of volume-assured pressure support (VAPS) has not been extensively studied in ALS. To explore the clinical usefulness of a detailed evaluation of device-recorded NIV data in the management of chronic respiratory failure in ALS, and to determine whether there are differences in efficacy between patients using VAPS or PS. We performed a retrospective chart review of 271 patients with ALS using either PS or VAPS, along with an evaluation of device-recorded data to explore differences in attainment of goal tidal volumes (Vt) and ratio of respiratory rate to tidal volume (f/Vt), in addition to triggering and cycling ability. Two hundred and fifteen patients were using PS, while 56 were using VAPS. There were no significant differences in demographic data, symptoms, pulmonary function, or patient compliance. Compared with VAPS, achieved Vt was significantly lower for PS while f/Vt was significantly higher. Percent spontaneous triggering was relatively preserved in both cohorts, whereas percent spontaneous cycling was considerably decreased in both. Furthermore, there was no association found between spontaneous triggering or cycling, and pulmonary function, indicating the presence of low spontaneous breath cycling or triggering ability is difficult to predict. Examination of device data for exhaled tidal volumes and f/Vt may be of use in evaluating efficacy of NIV in ALS. VAPS provides more reliable goal Vt than does PS, and is associated with decreased f/Vt. Spontaneous cycling is decreased in ALS despite preservation of triggering ability. Although a set backup rate may address decreased triggering, perhaps more importantly, setting a sufficient fixed inspiratory time would address the issue of decreased cycling.