1,720,973 research outputs found
Extracorporeal membrane oxygenation
No full textPurpose of review Extracorporeal membrane oxygenation (ECMO) has become a more or less accepted standard in the algorithm of advanced acute respiratory distress syndrome therapy in adult patients when all other treatment options have failed. This article reviews the current status of ECMO therapy with particular focus on new technical developments and their potential implications for performance and indications for ECMO therapy. Recent findings A recently published review on a single-center experience in 255 adult ECMO patients identified using multivariate logistic regression analysis age, sex, initial pH 7.10 or lower and PaO2/FiO(2) ratio, and days of mechanical ventilation before ECMO as a significant predictors of survival. Additionally, a careful cost-effectiveness study for neonatal ECMO relating a 4-year base to the UK neonatal ECMO trial has clearly demonstrated cost-effectiveness. Summary Over the years, the technique for ECMO therapy underwent substantial changes in indications and the materials used. Impressive technical progress has been made in pumps, oxygenators, and coating of artificial surfaces, leading to a higher biocompatibility and to a lower rate of procedure-related complications. The potential of new inline pumps in combination with a decreasing rate of procedure-related complications might lead to a re-evaluation of the role of extracorporeal lung support in acute respiratory distress syndrome therapy. A very recent development is the use of spontaneous arteriovenous devices for carbon dioxide removal, allowing significant reduction of ventilator settings at decreased carbon dioxide partial pressures and at increased pH values. Ongoing studies are looking at the potential of this approach to reduce side effects of mechanical ventilation further
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Differences among forced-air warming systems with upper body blankets are small. A randomized trial for heat transfer in volunteers
No full textBackground: Forced-air warming is known as an effective procedure in prevention and treatment of perioperative hypothermia. Significant differences have been described between forced-air warming systems in combination with full body blankets. We investigated four forced-air warming systems in combination with upper body blankets for existing differences in heat transfer. Methods: After approval of the local Ethics Committee and written informed consent, four forced-air warming systems combined with upper body blankets were investigated in a randomized cross-over trial on six healthy volunteers: ( 1) BairHugger(TM) 505 and Upper Body Blanket 520, Augustine Medical; ( 2) ThermaCare(TM) TC 3003, Gaymar(TM) and Optisan(TM) Upper Body Blanket, Brinkhaus; ( 3) WarmAir(TM) 134 and FilteredFlow(TM) Upper Body Blanket, CSZ; and ( 4) WarmTouch(TM) 5800 and CareDrape(TM) Upper Body Blanket, Mallinckrodt. Heat transfer from the blanket to the body surface was measured with 11 calibrated heat flux transducers (HFTs) with integrated thermistors on the upper body. Additionally, the blanket temperature was measured 1 cm above the HFT. After a preparation time of 60 min measurements were started for 20 min. Mean values were calculated over 20 min. The t-test for matched pairs with Bonferroni-Holm-correcture for multiple testing was used for statistical evaluation at a P-level of 0.05. The values are presented as mean +/- SD. Results: The WarmTouch(TM) blower with the CareDrape(TM) blanket obtained the best heat flux ( 17.0 +/- 3.5W). The BairHugger(TM) system gave the lowest heat transfer (8.1 +/- 1.1W). The heat transfer of the ThermaCare(TM) system andWarmAir(TM) systems were intermediate with 14.3 +/- 2.1Wand 11.3 +/- 1.0W. Conclusions: Based on an estimated heat loss from the covered area of 38W the heat balance is changed by 46.1W to 55W by forced-air warming systems with upper body blankets. Although the differences in heat transfer are significant, the clinical relevance of this difference is small
Heat transfer by conductive warming with circulating-water mattresses
No full textAim of the study: To determine the heat transfer by circulating-water mattresses placed under the back and over both legs of human volunteers. Methods: With approval by the local ethics committee and informed consent eight minimally clothed volunteers were included in the study. Six calibrated heat flux transducers were placed on the back and additionally eight sensors were placed on both legs of each volunteer. The volunteers reclined on a circulating-water mattress (ComfortPad Plus(R), Cincinnati Sub-Zero Products Inc., Cincinnati, OH, USA) coated with gel (Granulab International, Armersfoort, Niederlande). Another circulating-water mattress (Plastipad(TM), Cincinnati Sub-Zero Products Inc.) was placed over both legs. Both devices were heated to 41 degreesC by a hypo-hyperthermia system (Hico-Variotherm 530, Hirtz & Co. Hospitalwerk, Cologne, Germany). Heat flux data were sampled during steady-state conditions. After determination of the contact area between the mattresses and the skin, heat transfer was calculated by multiplication of the heat flux per area by the contact area. Results: Heat flux per area to the back was 45.6 +/- 4.5 W m(-2), the contact area was 0.39 +/- 0.03 m(2). This resulted in a heat transfer of 18.0 +/- 2.4 W. Heat flux per area to the legs was 24.7 +/- 4.3 W m(-2), the contact area was 0.12 +/- 0.01 m(2). This resulted in a heat transfer of 2.9 +/- 0.6 W. Conclusion: The heat transfer of the circulating-water mattress to the back was much higher than the heat transfer to the legs. Nevertheless, model calculations show that conductive warming of the legs is more important for the prevention of perioperative hypothermia than conductive warming of the back, because it has a higher impact on the heat balance
Implementation of a new emergency room protocol at a University Medical Center in Germany. Basis for improved flow of information, adequate quality management and scientific assessment
No full textBackground. After analyzing the existing documentation protocol for the emergency room (ER), the department of anesthesiology of the Medical University of Gottingen (UMG) developed a new department-specific ER protocol. Aim. The objective was to improve the flow of patient information from the preclinical situation through the emergency room to the early inpatient period. With this in mind a new emergency protocol was developed that encompasses the very heterogeneic patient collective in the ER as well as forming a basis for quality management and scientific investigation, taking user friendliness and efficiency into consideration. Material and methods. A strategical development of a new emergency room protocol is represented, which was realized using a self-developed 8-step approach. Technical support and realization was carried out using the Scribus 1.4.2 open source desktop and GIMP 2.8.4 GNU image manipulation graphic programs. Results. The new emergency room protocol was developed based on scientific knowledge and defined targets. The following 13 sections represent the contents of the new protocol: general characteristics, emergency event, initial findings and interventions, vital parameters, injury pattern, vascular access, hemodynamics, hemogram/blood gas analysis (BGA), coagulopathy, diagnostics, emergency interventions, termination of ER treatment and final evaluation. Conclusion. The structured and elaborated documentation was limited to the target of two sides and succeeds in incorporating trauma patients as well as non-trauma patients in the ER
Implementation of a new Emergency Room Protocol at a University Hospital in Germany (vol 64, pg 208, 2015)
No full textVariations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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