Characteristics of intensive care units in Michigan: Not an open and closed case

OBJECTIVE: Delivery of critical care by intensivists has been recommended by several groups. Our objective was to understand the delivery of critical care physician services in Michigan and the role of intensivists and nonintensivist providers in providing care. DESIGN: Descriptive questionnaire. PARTICIPANTS AND SETTING: Intensive care unit (ICU) directors and nurse managers at 96 sites, representing 115 ICUs from 72 hospitals in Michigan. MEASUREMENTS AND RESULTS: The primary outcome measure was the percentage of sites utilizing a closed vs. an open model of ICU care. Secondary outcome measures included the percentage of ICUs utilizing a high-intensity service model, hospital size, ICU size, type of clinician providing care, and clinical activities performed. Twenty-four (25%) sites used a closed model of intensive care, while 72 (75%) had an open model of care. Hospitals with closed ICUs were larger and had larger ICUs than sites with open ICUs ( P < 0.05). Hospitalists serving as attending physicians were strongly associated with an open ICU (odds ratio [OR] = 12.2; 95% confidence interval [CI] = 2.5-60.2), as was the absence of intensivists in the group (OR = 12.2; 95%CI = 1.4-105.8), while ICU and hospital size were not associated. At 18 sites (20%) all attendings were board certified in Critical Care. Sixty sites had less than 50% board-certified attending physicians. CONCLUSIONS: The closed intensivist-led model of intensive care delivery is not in widespread use in Michigan. In the absence of intensivists, alternate models of care, including the hospitalist model, are frequently used. Journal of Hospital Medicine 2010;5:4–9. © 2010 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64903/1/567_ftp.pd

Sheet metal forming of piezoceramic-metal-laminar structures: simulation and experimental analysis

Adaptive systems with peizoelectric components offer significant opportunities for the active control of dynamic behaviour. Vibration and acoustic control as well as structural health monitoring are also possible. However, ineffective production technologies prevent industrial applications. The authors are therefore proposing the integration of piezo-modules inside a double-layer sheet. The use of semi-cured adhesive avoids shear-forces being transferred to the piezo-modules during forming. After forming, the adhesive will cure and transfer of piezoelectric strain to the sheet is made possible. A detailed finite-element-model incorporating the electro-mechanical characteristics of the piezo-modules has been developed. The simulation results were validated experimentally

Lokale Identitaet und lokale Identifikation

SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Lokale Identitaet als Element der Stadtentwicklung Pilotstudie. Endbericht

SIGLETIB: RN 5905 (1410) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman