Ventilator-Associated Pneumonia and PaO2/FIO2 Diagnostic Accuracy: Changing the Paradigm?

BACKGROUND: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO2/FIO2 ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO2/FIO2 ≤ 240 to diagnose VAP. METHODS: Prospective observational study in 255 consecutive patients with suspected VAP, clustered according to PaO2/FIO2 ≤ 240 vs. > 240 at pneumonia onset. The primary analysis was the association between PaO2/FIO2 ≤ 240 and quantitative microbiologic confirmation of pneumonia, the most reliable diagnostic gold-standard. RESULTS: Mean PaO2/FIO2 at VAP onset was 195 ± 82; 171 (67%) cases had PaO2/FIO2 ≤ 240. Patients with PaO2/FIO2 ≤ 240 had a lower APACHE-II score at ICU admission; however, at pneumonia onset they had higher CPIS, SOFA score, acute respiratory distress syndrome criteria and incidence of shock, and less microbiological confirmation of pneumonia (117, 69% vs. 71, 85%, p = 0.008), compared to patients with PaO2/FIO2 > 240. In multivariate logistic regression, PaO2/FIO2 ≤ 240 was independently associated with less microbiological confirmation (adjusted odds-ratio 0.37, 95% confidence interval 0.15-0.89, p = 0.027). The association between PaO2/FIO2 and microbiological confirmation of VAP was poor, with an area under the ROC curve 0.645. Initial non-response to treatment and length of stay were similar between both groups, while hospital mortality was higher in patients with PaO2/FIO2 ≤ 240. CONCLUSION: Adding PaO2/FIO2 ratio ≤ 240 to the clinical and radiographic criteria does not help in the diagnosis of VAP. PaO2/FIO2 ratio > 240 does not exclude this infection. Using this threshold may underestimate the incidence of VAP.info:eu-repo/semantics/publishedVersio

Information Systems and Quality Management in Healthcare Organization: An Empirical Study

The paper explores current status of information systems, identifies gaps in the current information systems and assessment in healthcare organization. This paper is based on Critical Analysis of literature and a questionnaire is administered on administrative level employees of South Indian healthcare organizations. It has been identified that healthcare organization should have specific strategy and must implement measures derived from strategy. Data and information systems should be seen as business resources. The knowledge base of medical field is large and it is growing rapidly. Hence information system must be integrated across the enterprise. The results of the study determined the relationship between measurement, analysis and knowledge Management on performance. The Information system is the newest dimension among the MBNQA (Malcolm Baldrige National Quality Award) criteria. The Information system performance was assessed in terms of management relevant data and information. The outcomes suggest that there is a growing recognition of the administrators about the importance and use of information systems as a critical resource in healthcare organizations. From the study it is inferred that information system analysis continues to be a challenge. The higher utilization of technology, computerization and the Internet has resulted in dramatic change in the quality performance of the Healthcare Organizations. The paper provides an empirical evidence that information system has an impact on performance in the context of healthcare organizations. The information system is a key performance area of Quality management and it has received limited attention in improving quality performance including MBNQA. Finally, the study concludes that there is an immense scope for altering current information systems and it should be aligned with the quality management environment

Development and evaluation of lessons for class and group situations in grade one

Thesis (Ed.M.)--Boston Universit

Variscan deformation of the Hesperian massif in the Lousã mountain range (central Portugal)

[Abstract] The occidental region of the Central-Iberian Zone of the Variscan Iberian massif, in the central part of Portugal (Lousã mountain range), has a Variscan tectonostructural organization as the one recognized in the occidental border of the massif, in the Porto-Coimbra-Tomar shear zone. In the Iberian massif we can observe neo-proterozoic metasediments of the “Complexo Xisto-Grauváquico”, and important metasedimentary outcrops of Late Palaeozoic (Ordovician, Silurian and lower Devonian) rocks. Both are affected by the first regional variscan deformation phase (FH1), and later refolded by the second variscan deformation phase (FH2). This second regional variscan phase has a penetrative effect in the massif and develops a dextral, north-south, strike-slip faulting, associated with transpressive kinematic deformation (like a Riedel model) similar to the Porto-Coimbra-Tomar shear zone. Some geological examples observed and studied in the Lousã region are showed and discussed

Closing the gender profit gap?

We examine the impact of providing access to mobile savings accounts and improving financial management skills on the performance of microenterprises in Mozambique. The effects are highly heterogeneous: Combining both types of support is associated with a large increase in both short- and long-term firm profits and in financial security for female microentrepreneurs. This allowed female-headed microenterprises, particularly those with a higher level of profits at baseline, to close the gender profit gap in performance and skills relative to their male counterparts. The main drivers of improved business performance are improved financial management practices (bookkeeping), an increase in accessible savings, and reduced transfers to friends and relatives. Providing access to mobile money as a tool to save and manage finances also increases long-term profits of female microentrepreneurs, particularly for those with higher profits at baseline. However, neither treatment has any impact on male-led enterprises. Uncovering this heterogeneity in impact across different types of microenterprises can help improve the targeting of these interventions in the future

Differences in salivary α-amylase levels among women with different taste sensitivities

Saliva is the main component of taste receptor cells external environment, and consequently it may have a decisive role in taste perception. Taste sensitivity varies among different individuals. Sensitivity to the compound n-6-propylthiouracil (PROP) has been considerably studied and besides the known influence of genetic background, the contribution of perireceptor environment is not completely clear yet. Salivary α-amylase (one of the main proteins of saliva) is involved in carbohydrate digestion and its enzymatic activity may change the levels of sugars present in the mouth, influencing food perception. To evaluate differences in salivary total protein content and α-amylase activity and expression among individuals with different PROP taste sensitivities. Sixty seven female women (18-30 years old) were classified in one of the three groups of taste sensitivity (non-taster, medium-taster or super-taster), according to the perceived intensity for PROP, using Labeled Magnitude Scales. Saliva was collected without stimulation. Flow rate was calculated by dividing total volume for the 5 minutes collection. Bradford method was used for total protein assessment. Dinitrosalicylic acid assay was used for measuring the starch-hydrolyzing activity of salivary α-amylase, while the expression of this enzyme was evaluated by Wester blot. 20,9% of the subjects were classified as non-taters. The three groups presented similar saliva flow rates and total protein content was not significantly different although a tendency for lower protein concentration in medium-tasters individuals was observed. Salivary α-amylase activity (U/min) was higher in supertasters (P<0,05). Salivary α-amylase activity (U/min) was higher in super-tasters (P<0,05) without any significant differences in expression. In women individual differences in saliva composition can contribute to the different taste sensitivity. One of the differences appears to be α-amylase enzymatic activity. The reason for this deserves to be elucidated, as well as the potential involvement of others salivary proteins

Electrochemical characterization of poly(ethylene oxide)- zinc chloride system and its application in rechargeable batteries

The system PEOnZnCl2 with n=4-16 was studied in view of its potential application in a solid state rechargeable zinc battery. A.c. conductivity and cationic transference number measurements, in the temperature range 20-150ºC, were performed and the electrochemical stability window was established for the polymer electrolyte with n=4 composition. The ionic conductivity, σ, of this film, follows a VTF behaviour, with an activation energy of 3.3 ± 0.2 kJ mol-1 and σ values were found between 2.50x10-7 S cm-1 at 24ºC and 4.81x10-4 S cm-1 at 145ºC. Acceptable zinc ion transference numbers of 0.36 (medium value) and decomposition voltage values between 3.19V (20ºC) and 1.44V (150ºC) were estimated. Cyclic voltammetric studies using Zn/PEO4ZnCl2/Zn cell indicated reversibility of the Zn/Zn2+ couple at the electrode/electrolyte interface. Several cells Zn(-)/PEO4ZnCl2/Nb2O5(+) were assembled and studied at 55ºC, with several discharge current densities. Results of cell’s discharge profiles, capacity values, charge-discharge cycles behaviour and stability are reported

Martins Sarmento.

Volume especial, 1900, p. 64

Historical fire records at the two ends of Iberian Central Mountain system: Estrela massif and Ayllon massif

The Iberian Peninsula has a long history of fire, as the Central Mountain System, from the Estrela massif in Portugal to the Ayllón massif in Spain, is a major fire-prone area. Despite being part of the same natural region, there are different environmental, political and socio-economic contexts at either end, which might have led to distinct human causes of wildfires and associated fire regimes. The hypothesis for this research lies in the historical long-term relationship between wildfire risks and fire use practices within a context of landscape dynamics. In addition to conducting an analysis of the statistical period, a spatial and temporal multiscale approach was taken by reconstructing the historical record of prestatistical fires and land management history at both ends of the Central Mountain System. The main result is the different structural causes of wildland fires at either end of the Central Mountain System, with human factors being more important than environmental factors in determining the fire regimes in both contexts. The study shows that the development of the fire regime was non-linear in the nineteenth and twentieth centuries, due to broader local human context factors which led to a shift in fire-use practicesLa Península Ibérica cuenta con una larga historia de incendios forestales. Es el caso del Sistema Central, desde la Sierra de Estrela en Portugal a la Sierra de Ayllón en España, aunque las causas humanas y el régimen de incendios difieren en función del contexto ambiental, político y socioeconómico en uno y otro extremo de la cordillera. La validación de la hipótesis de trabajo, sobre la relación histórica entre el riesgo de incendios y el uso del fuego en las actividades humanas, se ha llevado a partir de la reconstrucción del registro histórico de incendios forestales y de la gestión del territorio, y mediante el análisis multiescalar espacio- temporal de los incendios históricos y estadísticos. Como principal resultado se han identificado las causas estructurales de incendios en las sierras de Estrela y Ayllón. Además, se ha demostrado la influencia mayor de los aspectos humanos que de los físicos en la evolución del régimen de fuego. En conclusión, este trabajo evidencia la evolución discontinua de los incendios forestales a lo largo de los siglos XIX y XX debido a los factores contextuales humanos que influyen en el manejo tradicional del fuego a escala localinfo:eu-repo/semantics/publishedVersio