Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock. a systematic review and meta-analysis

Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock

GeoBIM for built environment condition assessment supporting asset management decision making

The digital transformation in management of the built environment is more and more evident. While the benefits of location data, from Building Information Modelling or Geographical Information Systems, have been explored separately, their combination - GeoBIM - in asset management has never been explored. Data collection for condition assessment is challenging due to quantity, types, frequency and quality of data. We first describe the opportunities and challenges of GeoBIM for condition assessment. The theoretical approach is then validated developing an integrated GeoBIM model of the digital built environment, for a neighbourhood in Milan, Italy. Data are collected, linked, processed and analysed, through multiple software platforms, providing relevant information for asset management decision making. Good results are achieved in rapid massive data collection, improved visualisation, and analysis. While further testing and development is required, the case study outcomes demonstrated the innovation and the mid-term service-oriented potential of the proposed approach

Cost-effectiveness of a quality improvement bundle for emergency laparotomy.

Background: The recent Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study showed that the use of a specific care bundle reduced mortality in patients undergoing emergency laparotomy. However, the costs of implementation of the ELPQuiC bundle remain unknown. The aim of this study was to assess the in-hospital and societal costs of implementing the ELPQuiC bundle. Methods: The ELPQuiC study employed a before-after approach using quality improvement methodology. To assess the costs and cost-effectiveness of the bundle, two models were constructed: a short-term model to assess in-hospital costs and a long-term model (societal decision tree) to evaluate the patient's lifetime costs (in euros). Results: Using health economic modelling and data collected from the ELPQuiC study, estimated costs for initial implementation of the ELPQuiC bundle were €30 026·11 (range 1794·64-40 784·06) per hospital. In-hospital costs per patient were estimated at €14 817·24 for standard (non-care bundle) treatment versus €15 971·24 for the ELPQuiC bundle treatment. Taking a societal perspective, lifetime costs of the patient in the standard group were €23 058·87, compared with €19 102·37 for patients receiving the ELPQuiC bundle. The increased life expectancy of 4 months for patients treated with the ELPQuiC bundle was associated with cost savings of €11 410·38 per quality-adjusted life-year saved. Conclusion: Implementation of the ELPQuiC bundle is associated with lower mortality and higher in-hospital costs but reduced societal costs

Planetary Science Virtual Observatory architecture

In the framework of the Europlanet-RI program, a prototype of Virtual Observatory dedicated to Planetary Science was defined. Most of the activity was dedicated to the elaboration of standards to retrieve and visualize data in this field, and to provide light procedures to teams who wish to contribute with on-line data services. The architecture of this VO system and selected solutions are presented here, together with existing demonstrators

Pharmacodynamic Analysis of a Fluid Challenge.

OBJECTIVE: This study aims to describe the pharmacodynamics of a fluid challenge over a 10-minute period in postoperative patients. DESIGN: Prospective observational study. SETTING: General and cardiothoracic ICU, tertiary hospital. PATIENTS: Twenty-six postoperative patients. INTERVENTION: Two hundred and fifty-milliliter fluid challenge performed over 5 minutes. Data were recorded over 10 minutes after the end of fluid infusion MEASUREMENTS AND MAIN RESULTS:: Cardiac output was measured with a calibrated LiDCOplus (LiDCO, Cambridge, United Kingdom) and Navigator (Applied Physiology, Sydney, Australia) to obtain the Pmsf analogue (Pmsa). Pharmacodynamics outcomes were modeled using a Bayesian inferential approach and Markov chain Monte Carlo estimation methods. Parameter estimates were summarized as the means of their posterior distributions, and their uncertainty was assessed by the 95% credible intervals. Bayesian probabilities for groups' effect were also derived. The predicted maximal effect on cardiac output was observed at 1.2 minutes (95% credible interval, -0.6 to 2.8 min) in responders. The probability that the estimated area under the curve of central venous pressure was smaller in nonresponders was 0.12. (estimated difference, -4.91 mm Hg·min [95% credible interval, -13.45 to 3.3 mm Hg min]). After 10 minutes, there is no evidence of a difference between groups for any hemodynamic variable. CONCLUSIONS: The maximal change in cardiac output should be assessed 1 minute after the end of the fluid infusion. The global effect of the fluid challenge on central venous pressure is greater in nonresponders, but not the change observed 10 minutes after the fluid infusion. The effect of a fluid challenge on hemodynamics is dissipated in 10 minutes similarly in both groups

STEREO database of interplanetary Langmuir electric waveforms

International audienceThis paper describes a database of electric waveforms that is available at the Centre de Données de la Physique des Plasmas (CDPP, http://cdpp.eu/). This database is specifically dedicated to waveforms of Langmuir/Z-mode waves. These waves occur in numerous kinetic processes involving electrons in space plasmas. Statistical analysis from a large data set of such waves is then of interest, e.g., to study the relaxation of high-velocity electron beams generated at interplanetary shock fronts, in current sheets and magnetic reconnection region, the transfer of energy between high and low frequencies, the generation of electromagnetic waves. The Langmuir waveforms were recorded by the Time Domain Sampler (TDS) of the WAVES radio instrument on board the STEREO mission. In this paper, we detail the criteria used to identify the Langmuir/Z-mode waves among the whole set of waveforms of the STEREO spacecraft. A database covering the November 2006 to August 2014 period is provided. It includes electric waveforms expressed in the normalized frame inline image with B and Vsw the local magnetic field and solar wind velocity vectors, and the local magnetic field in the variance frame, in an interval of ±1.5 min around the time of the Langmuir event. Quicklooks are also provided that display the three components of the electric waveforms together with the spectrum of E∥, together with the magnitude and components of the magnetic field in the 3 min interval, in the variance frame. Finally, the distribution of the Langmuir/Z-mode waves peak amplitude is also analyzed

Hemodynamic Effect of Different Doses of Fluids for a Fluid Challenge: A Quasi-Randomized Controlled Study.

OBJECTIVE: The objectives of this study are to determine what is the minimal volume required to perform an effective fluid challenge and to investigate how different doses of IV fluids in an fluid challenge affect the changes in cardiac output and the proportion of responders and nonresponders. DESIGN: Quasi-randomized controlled trial. SETTING: Cardiothoracic ICU, tertiary university hospital. PATIENTS: Eighty postcardiac surgery patients. INTERVENTION: IV infusion of 1, 2, 3, or 4 mL/Kg (body weight) of crystalloid over 5 minutes. MEASUREMENTS AND MAIN RESULTS: Mean systemic filling pressure measured using the transient stop-flow arm arterial-venous equilibrium pressure, arterial and central venous pressure, cardiac output (LiDCOplus; LiDCO, Cambridge, United Kingdom), and heart rate. The groups were well matched with respect to demographic and baseline physiologic variables. The proportion of responders increased from 20% in the group of 1 mL/kg to 65% in the group of 4 mL/kg (p = 0.04). The predicted minimal volume required for an fluid challenge was between 321 and 509 mL. Only 4 mL/Kg increases transient stop-flow arm arterial-venous equilibrium pressure beyond the limits of precision and was significantly associated with a positive response (odds ratio, 7.73; 95% CI, 1.78-31.04). CONCLUSION: The doses of fluids used for an fluid challenge modify the proportions of responders in postoperative patients. A dose of 4 mL/Kg increases transient stop-flow arm arterial-venous equilibrium pressure and reliably detects responders and nonresponders

The prediction of future from the past: an old problem from a modern perspective

The idea of predicting the future from the knowledge of the past is quite natural when dealing with systems whose equations of motion are not known. Such a long-standing issue is revisited in the light of modern ergodic theory of dynamical systems and becomes particularly interesting from a pedagogical perspective due to its close link with Poincar\'e's recurrence. Using such a connection, a very general result of ergodic theory - Kac's lemma - can be used to establish the intrinsic limitations to the possibility of predicting the future from the past. In spite of a naive expectation, predictability results to be hindered rather by the effective number of degrees of freedom of a system than by the presence of chaos. If the effective number of degrees of freedom becomes large enough, regardless the regular or chaotic nature of the system, predictions turn out to be practically impossible. The discussion of these issues is illustrated with the help of the numerical study of simple models.Comment: 9 pages, 4 figure

BIM AND GIS INTEGRATION FOR INFRASTRUCTURE ASSET MANAGEMENT: A BIBLIOMETRIC ANALYSIS

The integration of Building Information Modelling (BIM) and Geographical Information Systems (GIS) is gaining momentum in digital built Asset Management (AM), and has the potential to improve information management operations and provide advantages in process control and delivery of quality AM services, along with underlying data management benefits through entire life cycle of an asset. Work has been carried out relating GeoBIM/AM to buildings as well as infrastructure assets, where the potential financial savings are extensive. While information form BIM maybe be sufficient for building-AM; for infrastructure AM a combination of GIS and BIM is required. Scientific literature relating to this topic has been growing in recent years and has now reached a point where a systematic analysis of current and potential uses of GeoBIM in AM for Infrastructure is possible. Three specific areas form part of the analysis – a review of BIM and Infrastructure AM and GIS and Infrastructure AM leads to a better understanding of current practice. Combining the two, a review of GeoBIM and Infrastructure AM allows the benefits of, and issues relating to, GeoBIM to be clearly identified, both at technical and operational levels. A set of 54 journal articles was selected for in-depth contents analysis according to the AM function addressed and the managed asset class. The analysis enabled the identification of three categories of issues and opportunities: data management, interoperability and integration and AM process and service management. The identified knowledge gaps, in turn, underpin problem definition for the next phases of research into GeoBIM for infrastructure AM