Intensive Care Units (ICUs), and Ordinary Means: Turning Virtue Into Vice

There is a social process by which what have been virtues in one social context can become vices in another. Alasdair MacIntyre 1 </jats:p

An hierarchical approach to hull form design

As ship design tools become more integrated and more advanced analysis tools are introduced, the ability to rapidly develop and modify hull forms becomes essential. Modern hull design applications give an experienced user the ability to create almost any shape of hull. However, the direct manipulation of hull surface representations is laborious and may limit the exploration of design concept to the fullest extent. Transformation of parent forms and parametric hull generation tools can provide a quick solution, but neither method is conducive for innovative design. A hull design tool is required that can integrate the separate techniques creating a fair hull form surface that can be modified easily throughout the design process. This paper explores the concept of separating the hull surface into global and local features by establishing a hierarchical definition structure and introduces some of the benefits of this approach

Secondary business districts in Ljubljana: Analysis of conditions and assessment of planned development

This paper presents secondary business districts in Ljubljana according to the conditions in the 2008 proposal of the City of Ljubljana spatial plan. The introduction first clarifies the term “secondary business district” and continues by presenting the basic typology of secondary business districts, which is based on a historical approach and represents an inventory of these districts in Ljubljana. Selected features of these districts are presented, especially from the business viewpoint. The structure of companies, the time of their establishment, capital ownership and size are presented in greater detail. The second part analyses the draft spatial plan in order to determine the future changes in secondary business districts, their creation and disappearance. Simple criteria are used to critically assess the City of Ljubljana draft spatial plan and identify the six most critical secondary business districts that deviate significantly from these criteria

Sensitivity of the Exporting Economy on the External Shocks: Evidence from Slovene Firms

In this paper we investigate the export participation of Slovene firms. We first show that sunk costs are an important factor for explaining the export behavior of Slovene firms. Next we show that when the absorption power of the exporting market declines, firms still trade with their established buyers (hysteresis) despite the fact that due to lower prices their exporting revenues decline. We show that this can be explained with high exit costs, which consist of switching costs (costs of replacing stable buyers with new ones) and cost of reducing the production (compensation money for excess workers) and high re-entry costs.International trade, export, distressed export, entry costs, exit costs, credit raiting

Sensitivity of the Exporting Economy on the External Shocks: Evidence from Slovene Firms

In this paper we investigate the export participation of Slovene firms. We first show that sunk costs are an important factor for explaining the export behavior of Slovene firms. Next we show that when the absorption power of the exporting market declines, firms still trade with their established buyers (hysteresis) despite the fact that due to lower prices their exporting revenues decline. We show that this can be explained with high exit costs, which consist of switching costs (costs of replacing stable buyers with new ones) and cost of reducing the production (compensation money for excess workers) and high re-entry costs.http://deepblue.lib.umich.edu/bitstream/2027.42/40020/3/wp634.pd

Clinical outcomes of remote ischemic preconditioning prior to cardiac surgery: A meta‐analysis of randomized controlled trials

Background Multiple randomized controlled trials of remote ischemic preconditioning ( RIPC ) prior to cardiac surgery have failed to demonstrate clinical benefit. The aim of this updated meta‐analysis was to evaluate the effect of RIPC on outcomes following cardiac surgery. Methods and Results Searches of PubMed, Cochrane, EMBASE , and Web of Science databases were performed for 1970 to December 13, 2015. Randomized controlled trials comparing RIPC with a sham procedure prior to cardiac surgery performed with cardiopulmonary bypass were assessed. All‐cause mortality, acute kidney injury ( AKI ), and myocardial infarction were the primary outcomes of interest. We identified 21 trials that randomized 5262 patients to RIPC or a sham procedure prior to undergoing cardiac surgery. The majority of patients were men (72.6%) and the mean or median age ranged from 42.3 to 76.3 years. Of the 9 trials that evaluated mortality, 188 deaths occurred out of a total of 4210 randomized patients, with 96 deaths occurring in 2098 patients (4.6%) randomized to RIPC and 92 deaths occurring in 2112 patients (4.4%) randomized to a sham control procedure, demonstrating no significant reduction in all‐cause mortality (risk ratio [RR], 0.987; 95% CI , 0.653–1.492, P =0.95). Twelve studies evaluated AKI in 4209 randomized patients. In these studies, AKI was observed in 516 of 2091 patients (24.7%) undergoing RIPC and in 577 of 2118 patients (27.2%) randomized to a sham procedure. RIPC did not result in a significant reduction in AKI ( RR , 0.839; 95% CI , 0.703–1.001 [ P =0.052]). In 6 studies consisting of 3799 randomized participants, myocardial infarction occurred in 237 of 1891 patients (12.5%) randomized to RIPC and in 282 of 1908 patients (14.8%) randomized to a sham procedure, resulting in no significant reduction in postoperative myocardial infarction ( RR , 0.809; 95% CI , 0.615–1.064 [ P =0.13]). A subgroup analysis was performed a priori based on previous studies suggesting that propofol may mitigate the protective benefits of RIPC . Three studies randomized patients undergoing cardiac surgery to RIPC or sham procedure in the absence of propofol anesthesia. Most of these patients were men (60.3%) and the mean or median age ranged from 57.0 to 70.6 years. In this propofol‐free subgroup of 434 randomized patients, 71 of 217 patients (32.7%) who underwent RIPC developed AKI compared with 103 of 217 patients (47.5%) treated with a sham procedure. In this cohort, RIPC resulted in a significant reduction in AKI ( RR , 0.700; 95% CI , 0.527–0.930 [ P =0.014]). In studies of patients who received propofol anesthesia, 445 of 1874 (23.7%) patients randomized to RIPC developed AKI compared with 474 of 1901 (24.9%) who underwent a sham procedure. The RR for AKI was 0.928 (95% CI , 0.781–1.102; P =0.39) for RIPC versus sham. There was no significant interaction between the two subgroups ( P =0.098). Conclusions RIPC does not reduce morbidity or mortality in patients undergoing cardiac surgery with cardiopulmonary bypass. In the subgroup of studies in which propofol was not used, a reduction in AKI was seen, suggesting that propofol may interact with the protective effects of RIPC . Future studies should evaluate RIPC in the absence of propofol anesthesia. </jats:sec

Rituximab in combination with high-dose methylprednisolone for the treatment of chronic lymphocytic leukemia.

We observed that high-dose methylprednisolone (HDMP) and rituximab was well tolerated and had promising activity when used in combination to treat patients with fludarabine-refractory chronic lymphocytic leukemia (CLL). This prompted us to evaluate the use of these agents in frontline therapy. A total of 28 patients with a median age of 65 years enrolled in this study. Patients received HDMP at 1 g/m(2) each day for 3 days during each of the three 4-week cycles together with rituximab and prophylactic antimicrobial therapy. The treatment was well tolerated with few adverse events of grade III or higher. The overall response rate was 96% (N=27). Nine patients (32%) achieved a complete remission (CR), two of which were without detectable minimal residual disease (MRD). Six patients with MRD received consolidation with alemtuzumab; five of these patients achieved an MRD-negative CR. With over 3 years of follow-up median progression-free survival was 30.3 months with only 39% of patients requiring additional therapy, and an overall survival was 96%. This study demonstrates that HDMP and rituximab is an effective nonmyelosuppressive treatment combination for patients with CLL that warrants consideration particularly for patients with limited myeloid reserve that might not tolerate standard treatment regimens

Online Prediction of Battery Discharge and Estimation of Parasitic Loads for an Electric Aircraft

Predicting whether or not vehicle batteries contain sufficient charge to support operations over the remainder of a given flight plan is critical for electric aircraft. This paper describes an approach for identifying upper and lower uncertainty bounds on predictions that aircraft batteries will continue to meet output power and voltage requirements over the remainder of a flight plan. Battery discharge prediction is considered here in terms of the following components; (i) online battery state of charge estimation; (ii) prediction of future battery power demand as a function of an aircraft flight plan; (iii) online estimation of additional parasitic battery loads; and finally, (iv) estimation of flight plan safety. Substantial uncertainty is considered to be an irremovable part of the battery discharge prediction problem. However, high-confidence estimates of flight plan safety or lack of safety are shown to be generated from even highly uncertain prognostic predictions