The Lived Experiences of Professional Engineers over the Life-Cycle of a Technological Device

One of the goals of this study was to pose the engineering role in a way that allows engineers to understand the impact that professional requirements have on their career. For engineers making medical devices, requirements come from three principal sources, professional engineering, regulatory agencies, and their own organization. Engineering requires an application of knowledge in technology, mathematics and science; and the application of gut judgment . When knowledge and judgment come together in their practice engineers achieve artistry . Regulatory requirements from FDA or ISO must be fulfilled. Finally, organizational requirements must also be met, for it is to the organization that engineers contract their labor to receive payment for their work. When fulfilling the requirements from all sources, engineers follow an honorable way of making a living, and importantly they get to enact on a regular basis, within their organization, the key points of what it is to be an engineer. This is how engineers gather a moral career , a term conceptualized and described by Ervin Goffman. Additionally, I used the term professional/reflective practice, as described by Donald Schön, to present the salient features of engineering. By posing the engineering profession in this manner, it will help engineers and future engineers make better decisions about their career. It is important to do their due diligence when contemplating working for an organization and ask about the life-cycle stage on those products they will be working with. Engineers should be allowed to use their judgement to make the difficult call on technical and science matters and it is important to understand the organization’s commitment to this. By having this knowledge, engineers learn how not to be a victim because in many organizations, engineers are often thrown to the dogs because they are untrained on how to think as the leaders of the organization do and become easy victims. This study also shows a direct connection between a product’s life-cycle stage and the conditions of the engineer’s practice. During the growth stage, great satisfaction and autonomy prevail. However, with product maturity and decline, dissatisfaction and a substantial curtailing of autonomy appeared

The adjusted global antiphospholipid syndrome score (aGAPSS) and the risk of recurrent thrombosis: Results from the APS ACTION cohort

Objectives: To assess whether patients with antiphospholipid syndrome (APS) and history of recurrent thrombosis have higher levels of adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) when compared to patients without recurrent thrombosis

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease