Does adherence to a quality indicator regarding early weaning from invasive ventilation improve economic outcome? A single-centre retrospective study

ObjectivesTo measure and assess the economic impact of adherence to a single quality indicator (QI) regarding weaning from invasive ventilation.DesignRetrospective observational single-centre study, based on electronic medical and administrative records.SettingIntensive care unit (ICU) of a German university hospital, reference centre for acute respiratory distress syndrome.ParticipantsRecords of 3063 consecutive mechanically ventilated patients admitted to the ICU between 2012 and 2017 were extracted, of whom 583 were eligible adults for further analysis. Patients’ weaning protocols were evaluated for daily adherence to quality standards until ICU discharge. Patients with <65% compliance were assigned to the low adherence group (LAG), patients with ≥65% to the high adherence group (HAG).Primary and secondary outcome measuresEconomic healthcare costs, clinical outcomes and patients’ characteristics.ResultsThe LAG consisted of 378 patients with a median negative economic results of −€3969, HAG of 205 (−€1030), respectively (p<0.001). Median duration of ventilation was 476 (248; 769) hours in the LAG and 389 (247; 608) hours in the HAG (p<0.001). Length of stay (LOS) in the LAG on ICU was 21 (12; 35) days and 16 (11; 25) days in the HAG (p<0.001). LOS in the hospital was 36 (22; 61) days in the LAG, and within the HAG, respectively, 26 (18; 48) days (p=0.001).ConclusionsHigh adherence to this single QI is associated with better clinical outcome and improved economic returns. Therefore, the results support the adherence to QI. However, the examined QI does not influence economic outcome as the decisive factor

Developing ecosystem service indicators: experiences and lessons learned from sub-global assessments and other initiatives

People depend upon ecosystems to supply a range of services necessary for their survival and well-being. Ecosystem service indicators are critical for knowing whether or not these essential services are being maintained and used in a sustainable manner, thus enabling policy makers to identify the policies and other interventions needed to better manage them. As a result, ecosystem service indicators are of increasing interest and importance to governmental and inter-governmental processes, including amongst others the Convention on Biological Diversity (CBD) and the Aichi Targets contained within its strategic plan for 2011-2020, as well as the emerging Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES). Despite this growing demand, assessing ecosystem service status and trends and developing robust indicators is o!en hindered by a lack of information and data, resulting in few available indicators. In response, the United Nations Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), together with a wide range of international partners and supported by the Swedish International Biodiversity Programme (SwedBio)*, undertook a project to take stock of the key lessons that have been learnt in developing and using ecosystem service indicators in a range of assessment contexts. The project examined the methodologies, metrics and data sources employed in delivering ecosystem service indicators, so as to inform future indicator development. This report presents the principal results of this project

Antarctica and the Strategic Plan for Biodiversity 2011–2020

The Strategic Plan for Biodiversity, adopted under the auspices of the Convention on Biological Diversity, provides the basis for taking effective action to curb biodiversity loss across the planet by 2020—an urgent imperative. Yet, Antarctica and the Southern Ocean, which encompass 10% of the planet’s surface, are excluded from assessments of progress against the Strategic Plan. The situation is a lost opportunity for biodiversity conservation globally. We provide such an assessment. Our evidence suggests, surprisingly, that for a region so remote and apparently pristine as the Antarctic, the biodiversity outlook is similar to that for the rest of the planet. Promisingly, however, much scope for remedial action exists

Macrothelypteris polypodioides

Pteridophyte

Modeling and Parallel Operation of Exchange-Biased Delta-E Effect Magnetometers for Sensor Arrays

Recently, Delta-E effect magnetic field sensors based on exchange-biased magnetic multilayers have shown the potential of detecting low-frequency and small-amplitude magnetic fields. Their design is compatible with microelectromechanical system technology, potentially small, and therefore, suitable for arrays with a large number N of sensor elements. In this study, we explore the prospects and limitations for improving the detection limit by averaging the output of N sensor elements operated in parallel with a single oscillator and a single amplifier to avoid additional electronics and keep the setup compact. Measurements are performed on a two-element array of exchange-biased sensor elements to validate a signal and noise model. With the model, we estimate requirements and tolerances for sensor elements using larger N. It is found that the intrinsic noise of the sensor elements can be considered uncorrelated, and the signal amplitude is improved if the resonance frequencies differ by less than approximately half the bandwidth of the resonators. Under these conditions, the averaging results in a maximum improvement in the detection limit by a factor of N. A maximum N&asymp;200 exists, which depends on the read-out electronics and the sensor intrinsic noise. Overall, the results indicate that significant improvement in the limit of detection is possible, and a model is presented for optimizing the design of delta-E effect sensor arrays in the future

Impact of volume and surface processes on the pre-ionization of dielectric barrier discharges: advanced diagnostics and fluid modeling

The phenomenology and breakdown mechanism of dielectric barrier discharges are strongly determined by volume and surface memory effects. In particular, the pre-ionization provided by residual species in the volume or surface charges on the dielectrics influences the breakdown behavior of filamentary and diffuse discharges. This was investigated by advanced diagnostics such as streak camera imaging, laser photodetachment of negative ions and laser photodesorption of electrons from dielectric surfaces in correlation with 1D fluid modeling. The streak camera images show that an increasing number of residual charges in the volume changes the microdischarge breakdown in air-like gas mixtures from a cathode-directed streamer to a simultaneous propagation of cathode- and anode-directed streamers. In contrast, seed electrons are important for the pre-ionization if the density of residual charges in the volume is low. One source of seed electrons are negative ions, whose density exceeds the electron density during the pre-phase of diffuse helium–oxygen barrier discharges as indicated by the laser photodetachment experiments. Electrons desorbed from the cathodic dielectric have an even larger influence. They induce a transition from the glow-like to the Townsend-like discharge mode in nominally pure helium. Apart from analyzing the importance of the pre-ionization for the breakdown mechanism, the opportunities for manipulating the lateral structure and discharge modes are discussed. For this purpose, the intensity and diameter of a diffuse discharge in helium are controlled by an illuminated semiconducting barrier

A framework to identify enabling and urgent actions for the 2020 Aichi Targets

In 2010, the parties of the Convention on Biological Diversity (CBD) adopted the Strategic Plan for Biodiversity 2011–2020 with the mission of halting biodiversity loss and enhance the benefits it provides to people. The 20 Aichi Biodiversity Targets (Aichi Targets), which are included in the Strategic Plan, are organized under five Strategic Goals, and provide coherent guidance on how to achieve it. Halfway through the Strategic Plan, it is time to prioritize actions in order to achieve the best possible outcomes for the Aichi Targets in 2020. Actions to achieve one target may influence other targets (downstream interactions);in turn a target may be influenced by actions taken to attain other targets (upstream interactions). We explore the interactions among targets and the time-lags between implemented measures and desired outcomes to develop a framework that can reduce the overall burden associated with the implementation of the Strategic Plan. We identified the targets addressing the underlying drivers of biodiversity loss and the targets aimed at enhancing the implementation of the Strategic Plan as having the highest level of downstream interactions. Targets aimed at improving the status of biodiversity and safeguarding ecosystems followed by targets aimed at reducing the direct pressures on biodiversity and enhancing the benefits to all from biodiversity and ecosystem services, were identified as having the highest levels of upstream interactions. Perhaps one of the most challenging aspects of the Strategic Plan is the need to balance actions for its long-term sustainability with the need for urgent actions to halt biodiversity loss

Simulating Coulomb gases and log-gases with hybrid Monte Carlo algorithms

International audienceCoulomb and log-gases are exchangeable singular Boltzmann-Gibbs measures appearing in mathematical physics at many places, in particular in random matrix theory. We explore experimentally an efficient numerical method for simulating such gases. It is an instance of the Hybrid or Hamiltonian Monte Carlo algorithm, in other words a Metropolis-Hastings algorithm with proposals produced by a kinetic or underdamped Langevin dynamics. This algorithm has excellent numerical behavior despite the singular interaction, in particular when the number of particles gets large. It is more efficient than the well known overdamped version previously used for such problems