Prevention of acute kidney injury and protection of renal function in the intensive care unit

Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention

Prediction of second neurological attack in patients with clinically isolated syndrome using support vector machines

The aim of this study is to predict the conversion from clinically isolated syndrome to clinically definite multiple sclerosis using support vector machines. The two groups of converters and non-converters are classified using features that were calculated from baseline data of 73 patients. The data consists of standard magnetic resonance images, binary lesion masks, and clinical and demographic information. 15 features were calculated and all combinations of them were iteratively tested for their predictive capacity using polynomial kernels and radial basis functions with leave-one-out cross-validation. The accuracy of this prediction is up to 86.4% with a sensitivity and specificity in the same range indicating that this is a feasible approach for the prediction of a second clinical attack in patients with clinically isolated syndromes, and that the chosen features are appropriate. The two features gender and location of onset lesions have been used in all feature combinations leading to a high accuracy suggesting that they are highly predictive. However, it is necessary to add supporting features to maximise the accuracy. © 2013 IEEE

An efficient numerical scheme for the thermo-hydraulic simulations of thermal grids

Renewable and smart energy systems require district heating and cooling grids able to operate with variable flow rates, to manage different supply temperatures, and to support distributed energy production involving bidirectional flows. Due to these requirements, accurate and effective thermo-hydraulic models are essential to correctly simulate the flow rates, the head drops and the temperature transients for supporting the design, management and optimisation of thermal distribution networks. In this article, an efficient numerical scheme for the simulation of thermal grids based on a thermo-hydraulic model with a quasi-dynamic approach is proposed. Global gradient algorithm of Todini together with a uniformly distributed representation of demand along the pipes is used for steady-state hydraulic simulations of the networks modelled according to the graph theory. The temperature distribution is computed by solving a first order hyperbolic PDE which accounts for heat advection in the flux term and heat dissipation in an algebraic source term. A very efficient second-order Eulerian-Lagrangian finite volume scheme is employed on a staggered mesh, which evolves in time the temperature distribution starting from the velocity distribution given by the hydraulic solver. The usage of a Eulerian-Lagrangian algorithm for the discretisation of the convective terms, allows the proposed model to be unconditionally stable for every time step size. As such, the main advantages of the proposed model are the flexibility due to the admissibility of any spatial-temporal discretisation, the second order accuracy provided by both the demand schematisation and the thermo-hydraulic solver, and the computational efficiency guaranteed by the decoupled modelling approach. The resulting algorithm is extensively validated on four tests consisting of thermal grids of various complexity that have been carefully designed in order to capture different features and behaviours of the model. The accuracy of the results in terms of velocity, pressure and temperature is tested by separately checking the symmetry, the advection term, the heat loss component and, finally, by simulating a complex grid configuration with multiple heat sources. The article aims to present a proof-of-concept concerning a breakthrough numerical scheme for the efficient thermo-hydraulic simulation of pipeline networks, which proves to be suitably implemented in the modelling of district heating and cooling networks

EDEN ISS Rack-like food production unit: results after mission in Antarctica

Plant cultivation in large-scale closed environments is challenging and several key technologies necessary for space-based plant production are not yet space-qualified or remain in early stages of development. The Horizon2020 EDEN ISS project aims at development and demonstration of higher plant cultivation technologies, suitable for near term deployment on the International Space Station (ISS) and, in a longer term perspective, within Moon and Mars habitats. The EDEN ISS consortium, as part of the performed activities, has designed and built a plant cultivation system having form, fit and function of a European Drawer Rack 2 (EDR II) payload, with a modularity that would allow its incremental installation in the ISS homonymous rack, occupying from one-quarter rack to the full system. The developed system, named RUCOLA (Rack-like Unit for Consistent on-orbit Leafy crops Availability) was completed and tested in a laboratory environment in early 2017. The system was then operated in the highly-isolated German Antarctic Neumayer Station III, in a container-sized test facility to provide realistic mass flow relationships and interaction with a crewed environment. This paper describes the key results of the RUCOLA plant growth facility tests in Antarctica as a space-analogue environment

Physical exercise-mediated effects on left ventricular diastolic function outweigh other modifiable risk factors in coronary artery disease patients

Cette contribution propose une approche inédite de l’expérience minoritaire à travers l’exemple des converti‑e‑s blanc‑he‑s à l’islam en France et aux États-Unis. Elle aborde le processus de « minoration » de façon dynamique en mobilisant un corpus d’entretiens biographiques réalisés de part et d’autre de l’Atlantique. L’article démontre que, lorsqu’elles et ils décident de revêtir les signes visibles d’appartenance à la religion musulmane, les converti‑e‑s se trouvent soudainement exposé‑e‑s à des formes de rejet et de discrimination à caractère explicitement racial – autant d’expériences qui leur étaient jusqu’ici inconnues en vertu de leur appartenance à la population majoritaire. Dans des contextes nationaux marqués par la « racialisation » de l’islam, la minoration liée à la conversion religieuse est ainsi vécue comme une subalternisation. Face à ces assignations identitaires nouvelles et mal maîtrisées, les converti‑e‑s déploient toutefois des stratégies de négociation plurielles qui révèlent la multiplicité de leurs devenirs minoritaires.This article focuses on white converts to Islam in France and the United States as a fruitful case to explore the specificities of the minority experience. Using in-depth interviews with Muslim converts on the two sides of the Atlantic, it offers a dynamic and biographic understanding of minoritizing processes. The data reveals that, when donning the visible attributes of Islam, converts find themselves suddenly exposed to racial exclusion and discrimination – a process of otherization that was previously unknown to them by virtue of their belonging to the majority group. In national contexts where Islam as a religion has been « racialized », the minority experience stemming from religious conversion is therefore akin to a form of subalternization. In light of the often undesirable identities that people assign to them, converts resort to various strategies to maneuver their new minority selves, thereby revealing the diversity of the minority experience