Heat Stroke:A Medical Emergency Appearing in New Regions

Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat waves will occur in previously cooler regions. Therefore it is important to raise awareness of heat stroke since outcome depends on early recognition and rapid cooling

Optimal damping of multi-story buildings under wind excitation

Wind excited vibrations of high-rise buildings can be reduced by installing additional damping devices like tuned mass dampers. The design of tuned mass dampers on different levels of the building is performed via a computer-aided modeling and design approach. A multi body system model is used for describing the dynamic behavior of the structure and the problem of optimizing the parameters of the damping devices is formulated as a nonlinear programming problem. An application to a building of the University of Stuttgart shows that optimal designs with minimal accelerations of the building can easily be obtained

Co-administration of iloprost and eptifibatide in septic shock (CO-ILEPSS):A randomised, controlled, double-blind investigator-initiated trial investigating safety and efficacyA randomised, controlled, double-blind investigator-initiated trial investigating safety and efficacy

Publisher's version (útgefin grein). The CO-ILEPSS trial was approved by the ethics committee in The Capital Region of Denmark with protocol number: H-3-2014-087.Background: Part of the pathophysiology in septic shock is a progressive activation of the endothelium and platelets leading to widespread microvascular injury with capillary leakage, microthrombi and consumption coagulopathy. Modulating the inflammatory response of endothelium and thrombocytes might attenuate this vicious cycle and improve outcome. Method: The CO-ILEPSS trial was a randomised, placebo-controlled, double-blind, pilot trial. Patients admitted to the intensive care unit with septic shock were randomised and allocated in a 2:1 ratio to active treatment with dual therapy of iloprost 1 ng/kg/min and eptifibatide 0.5 μg/kg/min for 48 h or placebo. The primary outcomes were changes in biomarkers reflecting endothelial activation and disruption, platelet consumption and fibrinolysis. We compared groups with mixed models, post hoc Wilcoxon signed-rank test and Mann-Whitney U test. Results: We included 24 patients of which 18 (12 active, 6 placebo) completed the full 7-day trial period and were included in the per-protocol analyses of the primary outcomes. Direct comparison between groups showed no differences in the primary outcomes. Analyses of within-group delta values revealed that biomarkers of endothelial activation and disruption changed differently between groups with increasing levels of thrombomodulin (p = 0.03) and nucleosomes (p = 0.02) in the placebo group and decreasing levels of sE-Selectin (p = 0.007) and sVEGFR1 (p = 0.005) in the active treatment group. Platelet count decreased the first 48 h in the placebo group (p = 0.049) and increased from baseline to day 7 in the active treatment group (p = 0.023). Levels of fibrin monomers declined in the active treatment group within the first 48 h (p = 0.048) and onwards (p = 0.03). Furthermore, there was a significant reduction in SOFA score from 48 h (p = 0.024) and onwards in the active treatment group. Intention-to-treat analyses of all included patients showed no differences in serious adverse events including bleeding, use of blood products or mortality. Conclusion: Our results could indicate benefit from the experimental treatment with reduced endothelial injury, reduced platelet consumption and ensuing reduction in fibrinolytic biomarkers along with improved SOFA score. The results of the CO-ILEPSS trial are exploratory and hypothesis generating and warrant further investigation in a large-scale trial. Trial registration: Clinicaltrials.com, NCT02204852 (July 30, 2014); EudraCT no. 2014-002440-41Funding was provided by Professor Per I. Johansson, Senior Physician, DMSC, MPA, The Capital Region Blood Bank, and Rigshospitalet. We would like to acknowledge all the nurses and doctors at the intensive care unit and the nurses at the post-operative care unit at NOH for the work associated with the trial treatment including randomisation, preparation of trial medication and blood sampling.Peer Reviewe

Analyzing and optimizing multibody systems

Optimization of holonomic as well as non-holonomic multibody systems is presented as a nonlinear programming problem that can be solved with general-purpose optimization codes. The adjoint variable approach is used for calculating design derivatives of a rather general integral type performance measure with respect to design parameters. The resulting equations are solved by numerical integration backward in time. A multi-step integration algorithm with order and step-size control is adapted for this application by including an interpolation scheme. Numerical experiments and a comparison to the common approach of approximating the gradient of the performance measure by finite differences show that high efficiency, accuracy, and reliability are achievable

Mehrkriterienoptimierung von Mehrkörpersystemen

Mit Strategien wie der Zieloptimierung kann man Konflikte zwischen verschiedenen Gütekriterien erkennen und es läßt sich durch geeignete Wahl der Optimierungsziele für jedes Kriterium ein für den Anwender "optimales" Ergebnis ermitteln. Alle Verfahren sind jedoch nur als wertvolle Hilfsmittel anzusehen, die es ermöglichen, das Wissen über den mehrdimensionalen Kriterienraum zu erweitern. Die Entscheidung für einen bestimmten Entwurf ist und bleibt eine echte Ingenieuraufgabe

Self-Rated Health as a Predictor of Death after Two Years:The Importance of Physical and Mental Wellbeing Postintensive Care

Introduction. The objective of this study is, among half-year intensive care survivors, to determine whether self-assessment of health can predict two-year mortality. Methods. The study is a prospective cohort study based on the Procalcitonin and Survival Study trial. Half-year survivors from this 1200-patient multicenter intensive care trial were sent the SF-36 questionnaire. We used both a simple one-item question and multiple questions summarized as a Physical Component Summary (PCS) and a Mental Component Summary (MCS) score. The responders were followed for vital status 730 days after inclusion. Answers were dichotomized into a low-risk and a high-risk group and hazard ratios (HR) with 95% confidence interval (CI) were calculated by Cox proportional hazard analyses. Conclusion. We found that self-rated health measured by a single question was a strong independent predictor of two-year all-cause mortality (HR: 1.8; 95% CI: 1.1–3.0). The multi-item component scores of the SF-36 also predicted two-year mortality (PCS: HR: 2.9; 95% CI 1.7–5.0) (MCS: HR: 1.9; 95% CI 1.1–3.4). These results suggest that self-rated health questions could help in identifying patients at excess risk. Randomized controlled trials are needed to test whether our findings represent causality

An orthogonal complement matrix formulation for constrained multibody systems

A method is proposed for the automatic generation of an orthogonal complement matrix to the constraint matrix for the dynamic analysis of constrained multibody systems. The clue for this method lies in the determination of local constraint matrices and their orthogonal complements relative to the local reference frames of particular constrained points. These matrices are then transformed into the system's configuration space in order to form the final constraint matrix and its orthogonal complement. The avoidance of singularities in the formulation is discussed. The method is specially suited for the dynamic analysis of multibody systems with many constraints and/or closed-loops

Duration of acute kidney injury in critically ill patients

BACKGROUND:Duration of acute kidney injury (AKI) has been recognized a risk factor for adverse outcomes following AKI. We sought to examine the relationship of AKI duration and recurrent AKI with short-term outcomes in critically ill patients who were mechanically ventilated and met criteria for the acute respiratory distress syndrome. METHODS:Participants in the NHLBI ARDS Network SAILS multicenter trial who developed AKI were included in this analysis and divided into groups based on AKI duration. Differences in outcomes were evaluated using t test and Chi-square test. Competing risks regression and Cox regression were used to evaluate factors associated with resolving AKI and recurrent AKI. RESULTS:In total, 238 patients were included in the study. Seventy-seven patients had short duration AKI (1-2 days), 47 medium duration AKI (3-7 days), 87 persistent AKI (> 7 days) and 38 died during their AKI episode. Persistent AKI was associated with worse outcomes including increased ICU length of stay, time on the ventilator and days with cardiovascular failure. We found no clinical differences between patients with short and medium duration AKI, even when accounting for AKI severity and recurrent AKI. Patients with resolving AKI were less likely to have oliguria or moderate/severe ARDS on the day AKI criteria were met. Recurrent AKI was associated with poorer clinical outcomes. No baseline clinical factors were found to predict development of recurrent AKI. CONCLUSIONS:In critically ill patients with sepsis-associated ARDS and AKI, the impact of short and medium duration AKI on clinical outcomes was modest. Persistent and recurrent AKI were both associated with worse clinical outcomes, emphasizing the importance of identifying these patients, who may benefit from novel interventions