238 research outputs found
Struttura e organizzazione del trasporto di merci pericolose ai fini della prevenzione del rischio
No full textProlonged mechanical ventilation after critical illness
No full textA significant number of patients that have been critically ill require mechanical ventilation for extended periods of time as they progress towards recovery. Many of these patients can be cared for outside of the Intensive Care Unit in facilities focused on stabilizing the underlying medical problems, managing ventilatory support, and planning for rehabilitation and home care. Although these units have varied administrative structures, they have reported similar encouraging rates of weaning and survival. In a recent study about such a ward at a large academic hospital, it was observed that, although the majority of patients were liberated from the ventilator and returned home with a satisfactory activity level, a significant number of patients did not; these patients eventually died after a protracted hospital stay, mostly after a consensual withdrawal of life support. In the present article, a relevant literature review is presented concerning the outcome of patients undergoing prolonged mechanical ventilation. The main focus of the research was to address how to alleviate the burden of prolonged critical illness on mechanically ventilated patients who may eventually die after a great deal of suffering, and to identify the tangible emotional and financial costs to these patients, their families, and society
Vaccine
No full textInfluenza vaccination remains the most effective tool for reducing seasonal influenza disease burden. Few Low and Middle-Income Countries (LMICs) have robust, sustainable annual influenza national vaccination programs. The Partnership for Influenza Vaccine Introduction (PIVI) was developed as a public-private partnership to support LMICs to develop and sustain national vaccination programs through time-limited vaccine donations and technical support. We review the first 5\u202fyears of experience with PIVI, including the concept, country progress toward sustainability, and lesson learned. Between 2013 and 2018, PIVI worked with Ministries of Health in 17 countries. Eight countries have received donated vaccines and technical support; of these, two have transitioned to sustained national support of influenza vaccination and six are increasing national support of the vaccine programs towards full transition to local vaccine program support by 2023. Nine additional countries have received technical support for building the evidence base for national policy development and/or program evaluation. PIVI has resulted in increased use of vaccines in partner countries, and early countries have demonstrated progress towards sustainability, suggesting that a model of vaccine and technical support can work in LMICs. PIVI expects to add new country partners as current countries transition to self-reliance.2019-08-14T00:00:00Z31288998PMC6685526805
A Potential Method for Precision Position Self-Sensing in Voice-Coil Actuators
No full textAn approach for self-sensing is proposed for voice-coil actuators that have an invertible, position-dependent inductance. Actuators with these properties are denoted as position-invertible, variable-inductance (PIVI) actuators. The self-sensing methodology is based on tracking the inductance of a PIVI actuator from the oscillation frequency of a modified Pierce oscillator. By extension, the oscillation frequency provides a measurement of the actuator position without an external position sensor.
An electrical model for PIVI voice-coil actuators is first derived to aid in analysis. Oscillator theory is then introduced and applied to the analysis of a typical Pierce oscillator. The modified Pierce oscillator is then introduced and analyzed under the assumption of low-frequency actuator motion and driving current relative to the oscillation frequency. The effects of parasitic capacitance from the actuator current source are then discussed along with a mitigation method. A test circuit, including the modified Pierce oscillator and a transconductance amplifier, is then presented. Due to time constraints, the modified Pierce oscillator was constructed with a variable inductor rather than an actual PIVI actuator. This was considered acceptable since the variable inductor mimics a PIVI actuator operating under the low-frequency assumption. Modifications to the transconductance amplifier were presented that allowed parasitic impedance to be increased by a minimum factor of three.
The modified Pierce oscillator circuit was tested under conditions that simulated a powered PIVI actuator. Results showed the oscillation frequency was an invertible function of the core-insertion distance of the variable inductor. It was also observed that the oscillation frequency varied less than 3% in the presence of various disturbance currents through the variable inductor. The tested conditions simulated a powered PIVI actuator, so it was considered likely that these two behaviors would also be observed if the modified Pierce oscillator was used with an actual PIVI actuator. While these results are not definitive, they suggest that the modified Pierce oscillator could be used as a self-sensing methodology for PIVI type voice-coil actuators. However, more work will be needed to verify this behavior with an actual PIVI type voice-coil actuator
Could Lateral Horizontal Position Decrease Aspiration of Gastric Contents in Intubated Patients in a Surgical Intensive Care Unit?
No full textCharacterization of Hysteretic Behavior of a FeCo Magnet for the Design of a Novel Ion Gantry
No full textIn the framework of the euroSIG project and within an international collaboration between CNAO, CERN, INFN, and MedAustron, the design of a novel gantry for hadron therapy based on superconducting magnets and a downstream scanning system has been undertaken. The choice of placing the scanning system downstream of the last superconducting dipole plays a crucial role in the overall layout of the gantry, having a direct impact on its radius, weight, and cost. The proposed design for the scanning system considers two separate normal-conducting scanning magnets with a central field in the order of 1 T, three times higher than the current state-of-the-art scanning magnets for hadron therapy. Such a magnetic field value for a fast-pulsed magnet poses interesting questions regarding non-linearities due to the yoke saturation, hysteretic effects, and eddy currents. In this context, it is important to develop reliable models to study the behavior of the magnet at various levels of current and magnetic field. For this reason, we implemented two and three-dimensional simulations of a short dipole with FeCo yoke and we validated them against experimental measurements. In this paper, we focus on the modelization of the hysteretic behavior of this magnet, providing insight into the feasibility of proposed scanning magnets
Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial
No full textBackground. A prospective, randomized controlled clinical trial was conducted in 33 Italian surgical departments with the aim of evaluating the efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections. Methods. Between July 1990 and May 1992, 278 patients were enrolled in the study. Fifty-four dropped out because of unresectable disease and six were excluded because of protocol violation; the remaining 218 were randomly assigned to the octreotide group (n=111) or to the placebo group (n=107). There were 131 men and 87 women with a mean age of 58.2±11.7 yrs. Pancreaticoduodenectomy was the most common operation performed (n=143), sixty-four percent of patients had a pancreatic or periampullary cancer; chronic pancreatitis accounted for 8.2% of cases. Results. Mortality rate was 6.9%. A pancreatic fistula occurred in 31 patients (14.2%), 9% in the octreotide group and 19.6% in the placebo group (p<0.05). Morbidity rate was significantly lower in the octreotide (21.6%) than in the placebo group (36.4%) (p<0.05). When specific pancreatic complications were grouped together and evaluated, they occurred less frequently in the treated (15.3%) than in the placebo group (29.9%) (p<0.05). Conclusions. Octreotide was able to reduce significantly the incidence of pancreatic fistula after elective pancreatic resections
Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients : a feasibility study
No full textBACKGROUND: Recent data suggest that during mechanical ventilation the lateral-horizontal patient position (in which the endotracheal tube is horizontal) decreases the risk of ventilator-associated pneumonia, compared to the recommended semi-recumbent position (in which the endotracheal tube slopes downward into the trachea). We tested the feasibility of the lateral-horizontal patient position, measured the incidence of aspiration of gastric contents, and watched for any adverse effects related to the lateral-horizontal position. METHODS: Ten adult intensive care unit patients were ventilated for 64 hours in the standard semi-recumbent position, and ten for 12 24 hours in the lateral-horizontal position. Tracheal secretions were collected every 8 hours and every 4 hours, respectively, and tested for pepsin, which is a marker of gastric contents. We also recorded clinical, physiologic, and outcome variables. RESULTS: The patients remained stable during ventilation in the lateral-horizontal position, and no adverse events occurred. Pepsin was detected in the trachea of 7 semi-recumbent patients and in five of the lateral-horizontal patients (P = .32). The number of ventilator-free days was 8 days (range 0-21 days) in the semi-recumbent patients, versus 24 days (range 12-25 days) in the lateral-horizontal patients (P = .04). CONCLUSIONS: Implementing the lateral-horizontal position for 12-24 hours in adult intubated intensive care unit patients is feasible, and our patients had no adverse events. The incidence of aspiration of gastric contents in the lateral-horizontal position seems to be similar to that in the semi-recumbent position
Artificial intelligence-assisted optical diagnosis for the resect-and-discard strategy in clinical practice: the Artificial intelligence BLI Characterization (ABC) study
No full textBackground Optical diagnosis of colonic polyps is poorly reproducible outside of high volume referral centers. The present study aimed to assess whether real-time artificial intelligence (AI)-assisted optical diagnosis is accurate enough to implement the leave-in-situ strategy for diminutive (≤ 5 mm) rectosigmoid polyps (DRSPs). Methods Consecutive colonoscopy outpatients with ≥ 1 DRSP were included. DRSPs were categorized as adenomas or nonadenomas by the endoscopists, who had differing expertise in optical diagnosis, with the assistance of a real-time AI system (CAD-EYE). The primary end point was ≥ 90 % negative predictive value (NPV) for adenomatous histology in high confidence AI-assisted optical diagnosis of DRSPs (Preservation and Incorporation of Valuable endoscopic Innovations [PIVI-1] threshold), with histopathology as the reference standard. The agreement between optical- and histology-based post-polypectomy surveillance intervals (≥ 90 %; PIVI-2 threshold) was also calculated according to European Society of Gastrointestinal Endoscopy (ESGE) and United States Multi-Society Task Force (USMSTF) guidelines. Results Overall 596 DRSPs were retrieved for histology in 389 patients; an AI-assisted high confidence optical diagnosis was made in 92.3 %. The NPV of AI-assisted optical diagnosis for DRSPs (PIVI-1) was 91.0 % (95 %CI 87.1 %-93.9 %). The PIVI-2 threshold was met with 97.4 % (95 %CI 95.7 %-98.9 %) and 92.6 % (95 %CI 90.0 %-95.2 %) of patients according to ESGE and USMSTF, respectively. AI-assisted optical diagnosis accuracy was significantly lower for nonexperts (82.3 %, 95 %CI 76.4 %-87.3 %) than for experts (91.9 %, 95 %CI 88.5 %-94.5 %); however, nonexperts quickly approached the performance levels of experts over time. Conclusion AI-assisted optical diagnosis matches the required PIVI thresholds. This does not however offset the need for endoscopistsʼ high level confidence and expertise. The AI system seems to be useful, especially for nonexperts
Guidance for setting easy-to-adopt competence criteria for optical diagnosis of diminutive colorectal polyps: a simulation approach
No full textBackground and Aims: One reason the optical diagnosis strategy for diminutive colorectal polyps has not yet been implemented is that the current competence criteria (Preservation and Incorporation of Valuable Endoscopic Innovation [PIVI] initiative) are difficult to use in daily practice. To provide guidance for setting alternative easy-to-adopt competence criteria, we determined the lowest proportion of diminutive polyps that should have a correct optical diagnosis to meet the PIVI. Methods: For this simulation study, we used datasets from 2 prospectively collected cohorts of patients who underwent colonoscopy in either a primary colonoscopy or fecal immunochemical test (FIT) screening setting. In the simulation approach, virtual endoscopists or computer-aided diagnosis systems performed optical diagnosis of diminutive polyps with a fixed diagnostic performance level (strategy) on all individuals in the cohort who had ≥1 diminutive polyp. Strategies were defined by systematically varying the proportion of correct optical diagnoses for each polyp subtype (ie, adenomas, hyperplastic polyps, sessile serrated lesions). For each strategy, we determined whether PIVI-1 (≥90% agreement with U.S. or European Society for Gastrointestinal Endoscopy [ESGE] surveillance guidelines) and PIVI-2 (≥90% negative predictive value [NPV] for neoplastic lesions in the rectosigmoid) were met using Monte Carlo sampling with 1000 repetitions, with histology as reference. Results: The level of overall diagnostic accuracy to achieve the PIVI differed significantly depending on the clinical setting and guidelines used. In the colonoscopy screening setting, all diagnostic strategies in which 92% of all diminutive polyps (regardless of histology) were diagnosed correctly led to 90% or more agreement with U.S. surveillance intervals (ie, PIVI-1). For all diagnostic strategies in which ≥89% of all diminutive polyps were correctly diagnosed, at least 90% NPV was achieved (ie, PIVI-2). For the FIT screening setting, values were respectively ≥77% and ≥94%. When using ESGE guidelines, PIVI-1 was in both settings already met when 40% of all diminutive polyps were diagnosed correctly. Conclusions: In contrast to the fixed PIVI criteria, our simulation study shows that different thresholds for the proportion of correctly diagnosed diminutive polyps lead to different clinical consequences depending on guidelines and clinical setting. However, this target proportion of diminutive colorectal polyps correctly diagnosed with optical diagnosis represents easier-to-adopt competence criteria
- …
