Boussignac continuous positive airway pressure for the management of acute cardiogenic pulmonary edema: prospective study with a retrospective control group

<p>Abstract</p> <p>Background</p> <p>Continuous positive airway pressure (CPAP) treatment for acute cardiogenic pulmonary edema can have important benefits in acute cardiac care. However, coronary care units are usually not equipped and their personnel not adequately trained for applying CPAP with mechanical ventilators. Therefore we investigated in the coronary care unit setting the feasibility and outcome of the simple Boussignac mask-CPAP (BCPAP) system that does not need a mechanical ventilator.</p> <p>Methods</p> <p>BCPAP was introduced in a coronary care unit where staff had no CPAP experience. All consecutive patients transported to our hospital with acute cardiogenic pulmonary edema, a respiratory rate > 25 breaths/min and a peripheral arterial oxygen saturation of < 95% while receiving oxygen, were included in a prospective BCPAP group that was compared with a historical control group that received conventional treatment with oxygen alone.</p> <p>Results</p> <p>During the 2-year prospective BCPAP study period 108 patients were admitted with acute cardiogenic pulmonary edema. Eighty-four of these patients (78%) were treated at the coronary care unit of which 66 (61%) were treated with BCPAP. During the control period 66 patients were admitted over a 1-year period of whom 31 (47%) needed respiratory support in the intensive care unit. BCPAP treatment was associated with a reduced hospital length of stay and fewer transfers to the intensive care unit for intubation and mechanical ventilation. Overall estimated savings of approximately € 3,800 per patient were achieved with the BCPAP strategy compared to conventional treatment.</p> <p>Conclusion</p> <p>At the coronary care unit, BCPAP was feasible, medically effective, and cost-effective in the treatment of acute cardiogenic pulmonary edema. Endpoints included mortality, coronary care unit and hospital length of stay, need of ventilatory support, and cost (savings).</p

Mechanical failure analysis of thin film transistor devices on steel and polyimide substrates for flexible display applications

The crack onset strain (COS) of 4-level thin film transistor (TFT) devices on both steel foils and thin polyimide (PI) films was investigated using tensile experiments carried out in situ in an optical microscope. Cracks initiated first within the SiO2 insulator layer for both types of substrates. The COS was found to be equal to 1.15% and 0.24% for steel and PI, respectively. The influence of loading direction on failure of the TFT stack with anisotropic geometry was moreover found to be considerable, leading to recommendations for backplane design. The large difference in critical strain of the SiO2 layer on the two substrates was analyzed using an energy release rate approach, and found to result from differences in layer/substrate mechanical contrast and in internal stress state. Based on this analysis a correlation between layer/substrate elastic contrast and tensile failure behavior was devised. (C) 2010 Elsevier Ltd. All rights reserved

On the nitrogen-induced lattice expansion of a non-stainless austenitic steel, Invar 36®, under triode plasma nitriding

Chromium, as a strong nitride-forming element, is widely regarded to be an “essential” ingredient for the formation of a nitrogen-expanded lattice in thermochemical nitrogen diffusion treatments of austenitic (stainless) steels. In this article, a proprietary “chrome-free” austenitic iron-nickel alloy, Invar® 36 (Fe-36Ni, in wt pct), is characterized after triode plasma nitriding (TPN) treatments at 400 °C to 450 °C and compared with a “stainless” austenitic counterpart RA 330® (Fe-19Cr-35Ni, in wt pct) treated under equivalent nitriding conditions. Cr does indeed appear to play a pivotal role in colossal nitrogen supersaturation (and hence anisotropic lattice expansion and superior surface hardening) of austenitic steel under low-temperature (≤ 450 °C) nitrogen diffusion. Nevertheless, this work reveals that nitrogen-induced lattice expansion occurs below the nitride-containing surface layer in Invar 36 alloy after TPN treatment, implying that Cr is not a necessity for the nitrogen-interstitial induced lattice expansion phenomenon to occur, also suggesting another type of γN