Implementing glucose control in intensive care: a multicenter trial using statistical process control

Glucose control (GC) with insulin decreases morbidity and mortality of critically ill patients. In this study we investigated GC performance over time during implementation of GC strategies within three intensive care units (ICUs) and in routine clinical practice. All adult critically ill patients who stayed for >24 h between 1999 and 2007 were included. Effects of implementing local GC guidelines and guideline revisions on effectiveness/efficiency-related indicators, safety-related indicators, and protocol-related indicators were measured. Data of 17,111 patient admissions were evaluated, with 714,141 available blood glucose levels (BGL) measurements. Mean BGL, time to reach target, hyperglycemia index, sampling frequency, percentage of hyperglycemia events, and in-range measurements statistically changed after introducing GC in all ICUs. The introduction of simple rules on GC had the largest effect. Subsequent changes in the protocol had a smaller effect than the introduction of the protocol itself. As soon as the protocol was introduced, in all ICUs the percentage of hypoglycemia events increased. Various revisions were implemented to reduce hypoglycemia events, but levels never returned to those from pre-implementation. More intensive implementation strategies including the use of a decision support system resulted in better control of the process. There are various strategies to achieve GC in routine clinical practice but with variable success. All of them were associated with an increase in hypoglycemia events, but GC was never stopped. Instead, these events have been accepted and managed. Statistical process control is a useful tool for monitoring phenomena over time and captures within-institution change

Towards ‘languages for all’ in England: the state of the debate

Whether the study of languages should be a core element of a balanced and broadly based curriculum for all pupils in England’s 11–16 state-funded secondary schools is also part of a wider debate concerning how to harness England’s rich linguistic and cultural diversity and improve the quality and range of language skills of the country. While learning a second language throughout compulsory schooling is increasingly the norm across the world, fewer than 50% of 14–16 year olds in state-funded schools in England gained a modern language qualification (General Certification of Secondary Education or GCSE) in 2015. From 2015, recent government education policy has required the majority of pupils commencing secondary school to study a language to GCSE level, suggesting that schools who do not comply will be unable to gain the top inspection grade. This paper reviews the state of the debate examining divergent and contradictory perspectives within education policy and in the literature. It concludes by setting out six conditions for achieving this policy goal for enabling secondary schools to successfully implement a coherent and relevant languages curriculum for all young people, such that they can develop the linguistic and intercultural competencies needed to contribute to and thrive in increasingly diverse local and global communities

International recommendations for glucose control in adult non diabetic critically ill patients

The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.Comparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishedPour la Société Française d'Anesthésie-Réanimation (SFAR); Société de Réanimation de langue Française (SRLF) and the Experts grou

Promoting community socio-ecological sustainability through technology: A case study from Chile

The importance of community learning in effecting social change towards ecological sustainability has been recognised for some time. More recently, the use of Information and Communication Technology (ICT) tools to promote socio-ecological sustainability has been shown to have potential in community education for sustainable development (ESD). The effective design and use of technology for community learning implies an understanding of a range of cross- dimensional factors including: socio-cultural characteristics and needs of the target audience; considerations of available and culturally responsive types of technology; and non-formal pedagogical ESD strategies for community empowerment. In addition, both technology itself and social communities are dynamically evolving and complex entities. This article presents a case study which evaluated the potential of ICT for promoting ecological literacy and action competence amongst community members in southern Chile. The case study addressed the ecological deterioration of a lake, which is having deep social, economic, recreational and cultural implications locally. The authors’ research involved developing a theoret- ical framework for the design, implementation and use of ICT for community learning for sustainability. The framework was based on key ideas from ESD, ICT and community education, and was underpinned by a systems thinking approach to account for the dynamism and complexity of such settings. Activity theory provided a frame to address overarching socio-cultural elements when using technology as a mediating tool for community learning. The authors’ findings suggest that the use of an ICT tool, such as a website, can enhance ecological literacy in relation to a local socio-ecological issue

Chemical looping combustion – a sustainable combustion technology for negative emission energy production

Kommulative Dissertation aus vier ArtikelnChemical looping combustion (CLC) is considered as a sustainable combustion Technology for negative emission energy production. Thereby an inherent CO2 separation is one of the main benefits of this technology. Unlike a conventional combustion, the combustion process is separated into two areas, so that fuel and combustion air are never mixed. To realize that, a metal oxide, the so-called oxygen carrier (OC), is used to deliver the necessary Oxygen for oxidizing the fuel. The typical CLC system consist of two reactors which are designed as circulating fluidized beds. The oxidation of the OC takes place in the so-called air reactor and is reduced in combination with the used fuel in the so-called fuel reactor. The Technology readiness level (TRL) is high for gaseous fuels, but when using solid fuels, such as biomass or coal, the developments are not so far advanced. To contribute to the development of CLC of biomass, in this thesis experiments on two different scales of reactor systems have been conducted. Especially to evaluate the influence of fuel impurities typical for solid fuels in CLC, such as sulfur or nitrogen, investigation in a pilot plant for gaseous fuels have been performed. Additionally a novel batch reactor for gaseous and solid fuels have been developed and build, to accelerate the screening of suitable OCs with both kind of fuels. The experiments included experiments with a cooper based oxygen carrier (Cu15), perovskite and ilmenite. Experiments in the pilot plant with natural gas as fuel and gaseous impurities, such as hydrogen sulfide (H2S) and ammonia (NH3) showed that, concentration of impurities and solid inventory have a big influence on the performance. During all experiments a stable operation was possible regardless which OC or impurity have been combined. Only with large amounts of H2S the long-term operation suffer when using perovskite as OC. Fuel conversion and CO2 yield decreased from the presence of sulfur in the system with Cu15 and perovskite. On the other hand NH3 caused no effect on the fuel conversion or CO2 yield with both OCs. Separate evaluation of the emissions of the air and fuel reactor showed that, at any time of the experiments the air reactor exhaust gas was not polluted. The only emissions have been in the fuel reactor off gas as SO2 when using Cu15 and perovskite or NO only when using perovskite. To further assess the capability of potential OCs, experiments in a novel fluidized bed Batch reactor with ilmenite as OC have been performed using biomass as fuel. During the commissioning and the very first experiments, methane has been used as fuel. In a second step wood and chicken manure pellets have been used to investigate the influence of bed temperature, fluidization rate and solid fuel dosing speed on the performance of the OC. To conclude from the batch reactor to the pilot plant, a method have been developed to evaluate the results. Due to the carbon loss in the exhaust gas, the in- and outgoing carbon could not be properly balanced. The carbon loss varies from 11 % when using methane, up to 15 % with chicken manure and 18 % with wood pellets as solid fuel. Higher hydrocarbons such as ethylene, ethane and acetylene could be confirmed, using a gas chromatograph in additional to the online gas analysis.Chemical looping combustion (CLC) is considered as a sustainable combustion Technology for negative emission energy production. Thereby an inherent CO2 separation is one of the main benefits of this technology. Unlike a conventional combustion, the combustion process is separated into two areas, so that fuel and combustion air are never mixed. To realize that, a metal oxide, the so-called oxygen carrier (OC), is used to deliver the necessary Oxygen for oxidizing the fuel. The typical CLC system consist of two reactors which are designed as circulating fluidized beds. The oxidation of the OC takes place in the so-called air reactor and is reduced in combination with the used fuel in the so-called fuel reactor. The Technology readiness level (TRL) is high for gaseous fuels, but when using solid fuels, such as biomass or coal, the developments are not so far advanced.14