41 research outputs found

    Pulmonary Hypertension in the Critically Ill

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    Innovative productivity improvements in forest operations: a comparative study of the Assortment Grapple using a machine simulator

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    Because of generally small log piles, loading forwarders during thinning is time consuming. The Assortment Grapple, an innovative grapple with an extra pair of claws which facilitates the handling of two assortments during one loading crane cycle, has been designed to decrease forwarders’ loading time consumption. A standardized experiment was performed in a virtual thinning stand using a machine simulator with the objectives to form guidelines for working with the Assortment Grapple and to analyse its development potential. Four experienced operators participated in the study. According to the results, the Assortment Grapple’s accumulating function is beneficial only when there are no remaining trees between piles loaded during the same crane cycle. In such cases, none of participating operators lost time, and 3 of 4 operators saved time notably. The problem with the remaining trees is the extra time required to steer the crane tip around them. Therefore, a harvester should place those log piles that are later to be forwarded together in the same space with no remaining trees between the piles. Furthermore, we recommend that the Assortment Grapple’s usability will be improved by adding an own rocker switch on the forwarder’s controls to command the extra claws

    Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

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    Introduction: Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE). Methods: Fifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI). Results: EBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively). Conclusions: EBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction

    Extravascular lung water index improves the diagnostic accuracy of lung injury in patients with shock

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    Introduction: The diagnosis of acute lung injury (ALI) may be more robust if more accurate physiological markers can be identified. Extravascular lung water (EVLW) is one possible marker, and it has been shown to correlate with respiratory function and mortality in patients with sepsis. Whether EVLW confers diagnostic value in a general population with shock, as well as which index performs best, is unclear. We investigated the diagnostic accuracy of various EVLW indices in patients with shock. Methods: We studied a prospective, observational cohort of 51 patients with shock admitted to a tertiary ICU. EVLW was measured within 6 hours of ICU admission and indexed to actual body weight (EVLW/ABW), predicted body weight (EVLW/PBW) and pulmonary blood volume (EVLW/PBV). The relationship of these indices to the diagnosis and severity of lung injury and ICU mortality were studied. Positive and negative likelihood ratios, pre- and posttest odds for diagnosis of lung injury and mortality were calculated. Results: All EVLW indices were higher among patients with lung injury and significantly correlated with respiratory parameters. Furthermore, all EVLW indices were significantly higher in nonsurvivors. The use of EVLW improves the posttest OR for the diagnosis of ALI, acute respiratory distress syndrome (ARDS) and severe lung injury (sLI) by up to eightfold. Combining increased EVLW and a diagnosis of ALI, ARDS or sLI increases the posttest odds of ICU mortality. EVLW/ABW and EVLW/PBV demonstrated the best diagnostic performance in this population. Conclusions: EVLW was associated with degree of lung injury and mortality, regardless of the index used, confirming that it may be used as a bedside indicator of disease severity. The use of EVLW as a bedside test conferred added diagnostic value for the identification of patients with lung injury

    Ungdomars attityd till hälsosam kostvana  : En kvalitativ studie om ungdomars inställning till att förändra sina kostvanor för att uppnå hälsa

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    Det allmänna hälsotillståndet är ett resultat av de levnadsvanor som individen har och lever under. En förändring av vanor är starkt relaterat till individens attityd och inställning! Syftet med den här studien, är att undersöka ungdomars attityd till hälsosam kost och inställning till att förändra kostvana, samt söka klarhet i vilka eventuella hinder och incitament som föreligger vid en förändring av kostvana.The overall health status is a result of the lifestyle that the individual has. A change of habits is strongly related to individual attitudes! The purpose of this study is explore adolescents attitudes to healthy eating and willingness to change a diet habit, and seek clarification of the possible barriers and incentives exist for a change in dietary habit

    Infammatory response to hyperbaric trauma. An experimental and clinical study

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    Reductions in ambient pressure liberates gas in various tissues and can result in decompression illness. In this thesis the patophysiological implications of a blood gas interface resulting from decompression was investigated with reference to the influence on biochemical mediators of inflammation. In a series of experiments, animals and human subjects have been exposed to hyperbaric trauma of different severity and duration. The hyperbaric exposures were performed using a dry decompression chamber and in open water dives. Post dive bubbledetection in the venous circulation was performed using echocardiography and levels of inflammatory mediators were analysed. The main results and conclusions were : • Dives in accordance with normal diving tables produces intravascular bubbles in the venous circulation, not necessarily correlated to clinical symptoms of DCS. Bubbles can be detected for as long as 16 h post dive. • A verified blood - gas interface after decompression seems capable of activating inflammatory cells and pro-inflammatory mediators as well as to stimulate an anti-inflammatory counter- response in a dose dependent fashion. • The magnitude of the systemic pro inflammatory response seem to correlate to the severity of the hyperbaric trauma in that way that only a trauma severe enough to cause profound clinical DCS resulted in systemic significant levels of proinflammatory mediators. • The response of an acute hyperbaric trauma were found to be different from a repetitive one in respect of the anti-inflammatory response, suggesting an adaptation mechanism of the anti-inflammatory system. • The findings presented in this thesis are consistent with different levels of activation of the inflammatory system. It is plausible that the bubble formation during decompression is the trigger of this inflammatory response. It is therefore suggested that the interplay between pro- and anti-inflammatory substances is a fine-tuned balance-act and it is only when this balance collapses that morbidity ensues. • The inflammatory interplay demonstrated in this thesis suggests an inflammatory mechanism as part of the pathogenesis in DCS

    Materials for High-Temperature Catalytic Combustion

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    Catalytic combustion is an environmentally friendlytechnique to combust fuels in e.g. gas turbines. Introducing acatalyst into the combustion chamber of a gas turbine allowscombustion outside the normal flammability limits. Hence, theadiabatic flame temperature may be lowered below the thresholdtemperature for thermal NOXformation while maintaining a stable combustion.However, several challenges are connected to the application ofcatalytic combustion in gas turbines. The first part of thisthesis reviews the use of catalytic combustion in gas turbines.The influence of the fuel has been studied and compared overdifferent catalyst materials. The material section is divided into two parts. The firstconcerns bimetallic palladium catalysts. These catalysts showeda more stable activity compared to their pure palladiumcounterparts for methane combustion. This was verified both byusing an annular reactor at ambient pressure and a pilot-scalereactor at elevated pressures and flows closely resembling theones found in a gas turbine combustor. The second part concerns high-temperature materials, whichmay be used either as active or washcoat materials. A novelgroup of materials for catalysis, i.e. garnets, has beensynthesised and tested in combustion of methane, a low-heatingvalue gas and diesel fuel. The garnets showed some interestingabilities especially for combustion of low-heating value, LHV,gas. Two other materials were also studied, i.e. spinels andhexaaluminates, both showed very promising thermal stabilityand the substituted hexaaluminates also showed a good catalyticactivity. Finally, deactivation of the catalyst materials was studied.In this part the sulphur poisoning of palladium, platinum andthe above-mentioned complex metal oxides has been studied forcombustion of a LHV gas. Platinum and surprisingly the garnetwere least deactivated. Palladium was severely affected formethane combustion while the other washcoat materials were mostaffected for carbon monoxide and hydrogen. Keywords:catalytic combustion, catalyst materials,palladium, platinum, bimetallic, garnet, spinel, hexaaluminate,deactivation, sulphur, poisoning, diesel, methane,hydrocarbonsNR 2014080
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