25 research outputs found

    Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

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    BACKGROUND: Among methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT’s) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT’s versus the broader evidence base. METHODS: Bacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence. RESULTS: Within SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 – 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT’s versus benchmark groups with data available. CONCLUSIONS: The topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0714-x) contains supplementary material, which is available to authorized users

    Caractérisation des transformations physico-chimiques des déchets en compostage. Substrat : déchets verts

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    [Departement_IRSTEA]EEE [TR1_IRSTEA]21 - TECHNEAU / BIODECL'étude s'inscrit dans l'objectif d'une meilleure compréhension du procédé de compostage et a consisté en la caractérisation des transformations physico-chimiques de déchets verts traités sur une plate-forme industrielle. Afin de caractériser l'affinage progressif du compost et de s'affranchir de l'hétérogénéité du produit à analyser, l'échantillon prélevé a été fractionné sur tamis plan selon deux mailles carrées 6.3 et 25 mm. Le produit global et les fractions granulométriques d'une part et l'extrait aqueux issu du produit global d'autre part ont ensuite été caractérisés. Sur le produit global et sur les fractions granulométriques ont été mesurés la matiÚre sÚche, la matiÚre organique, l'azote Kjeldahl et l'azote ammoniacal, sur les extraits aqueux le pH, la demande chimique en oxygÚne, l'azote Kjeldahl et ammoniacal. Les faibles et trÚs lentes variations des concentrations en matiÚre organique, carbone et azote Kjeldahl du produit global traduisent la faible cinétique de biodégradation des déchets verts et expliquent la complexité à identifier sur le global des indicateurs de stabilisation du produit. Le suivi des extraits aqueux permet en revanche l'identification des différentes étapes du procédé

    a prospective study

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    A multi-objective optimization model for the installed capacity of a hybrid renewable energy system for seaport operations considering power disruptions

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    Seaports prove to be one of the most integral parts of global trade and of any nation’s economy, handling 80 to 90% of global trade volume and contributing as much as 1.9% to a nation’s economy. However, it has been found to also be one of the most harmful industries in the world today, contributing up to 15% of global air pollution emissions. To combat this, seaports worldwide have begun their journey towards a more sustainable way of operations through the implementation of environmental initiatives, present in the form of strategic management of high energy consuming seaport activities to further reduce environmental impact. The study utilizes a MINLP multi-objective optimization model paired with a two-stage framework such that the first stage identifies the optimal installation capacities of HRES energy sub-systems, while the second stage focuses on the optimal management of such energy sub-systems in order to cater to day-to-day seaport operations such as berth allocation and container handling activities. The optimal installed capacities obtained from the first stage were then used as input parameters in the second stage to determine which energy sub-systems will be used or stored, depending on the amount of energy needed per time period. Previous related studies have only considered integrating the dual combination of operation strategies such as berth allocation and onshore power supply (OPS) allocation, or berth allocation with energy management. However, there have not been studies that have explored integrating these operation strategies altogether. Furthermore, with the apparent need for environmental strategies in the seaport, previous studies have only either considered the use of renewable energy or the use of onshore power supply, but never both at the same time. With this, the novel contribution of this study stems from the integration of all these seaport operations, together with the environmental initiatives of renewable energy and OPS connection while also considering the possibility of power disruptions as an additional novelty. For the first stage of the model, it was discovered that cost and emissions are reduced when installed capacities of energy sub-systems are adjusted based on port energy demand from port operations, wherein both OPS and RE are integrated. With regard to the second stage of the model, findings show that costs and emissions are reduced when waiting time is minimized and OPS ships are allocated to OPS berths in berth allocation with HRES components present and used, especially during disruptions so that the diesel generator use is minimal. Moreover, system interplays are heavily influenced by OPS related factors given that the allocation of more OPS installations led to a berth allocation behavior that reduced lateness cost and emissions but with higher energy consumption costs due to OPS demand. Given the dependence of irradiance levels on geographical factors, it was also found that areas with lower irradiance have lower recommended RE installation capacities due to high costs and low returns in terms of how much energy can be generated and obtained. Meanwhile, with the presence of power disruptions in the model, it was found that the ESS is used first when the disruptions are short in duration, while the diesel generator is used first in times of longer disruptions. Overall, findings reinforce the importance of the HRES in terms of maximizing the installation of renewable energy and allocating an optimal capacity for the ESS in order to increase resiliency of port operations amidst power disruptions

    Facteurs prédictifs de la douleur dans les gestes techniques dermatologiques. [Predictive factors for pain in technical dermatological procedures].

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    International audienceBACKGROUND: Technical procedures in dermatology are painful. AIM: The aim of the study was to determine predictive factors for pain in such procedures. PATIENTS AND METHODS: This observational study evaluated pain by means of a numerical pain rating scale and a questionnaire about the circumstances of the pain and the use of analgesic methods. Data were analysed using Excel and SAS software. RESULTS: Five hundred and forty-six questionnaires were analysed. Among the patients, 45.4% had mild pain, 34.5% moderate pain and 20.1% severe pain. The least painful procedures were cryotherapy, surgical excision and biopsy, debridement and curettage. Procedures causing moderate to severe pain were treatments involving laser and lights as well as injections (hyaluronic acid, intralesional corticosteroids, botulinum toxin). Pain scores were higher for procedures involving fingers, toes and armpits, while the least painful areas were the trunk and limbs. Among the patients, 62.5% had no preventive analgesia before the procedure, 37.5% had preventive analgesia and 34.2% underwent local or topical anaesthesia (3.7% by cold, 2.0% by oral premedication, 0.5% by hypnosis and 0.4% by nitrous oxide). CONCLUSION: Awareness of predictive factors for pain could allow better use of analgesic methods to offer the patient relief and improve the quality of the procedure

    Prototyping of an Ultrasonic Test Machine for Washing Fabrics

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    This thesis, entitled Prototyping of an Ultrasonic Test Machine for Washing Fabrics, is a study of ultrasonic concept, and characterization of ultrasonic fabric cleaning using a test machine. Through characterization, a preliminary standard of ultrasonic cleaning for fabric was made. This would enable further research on the field of ultrasonic used for cleaning fabrics, focused on innovation and sustainability, which may be integrated to a washing machine and would be allow less or non-usage of detergents to clean fabrics
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