Re-thinking resuscitation: Leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach

Definitions of shock and resuscitation endpoints traditionally focus on blood pressures and cardiac output. This carries a high risk of overemphasizing systemic hemodynamics at the cost of tissue perfusion. In line with novel shock definitions and evidence of the lack of a correlation between macro- and microcirculation in shock, we recommend that macrocirculatory resuscitation endpoints, particularly arterial and central venous pressure as well as cardiac output, be reconsidered. In this viewpoint article, we propose a three-step approach of resuscitation endpoints in shock of all origins. This approach targets only a minimum individual and context-sensitive mean arterial blood pressure (for example, 45 to 50 mm Hg) to preserve heart and brain perfusion. Further resuscitation is exclusively guided by endpoints of tissue perfusion irrespectively of the presence of arterial hypotension ('permissive hypotension'). Finally, optimization of individual tissue (for example, renal) perfusion is targeted. Prospective clinical studies are necessary to confirm the postulated benefits of targeting these resuscitation endpoints

The incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK Clinical Practice Research Datalink

Objectives: To estimate the incidence, prevalence and mortality of Granulomatosis with polyangiitis (GPA) in the United Kingdom. Methods: We conducted a historical cohort study using data from the Clinical Practice Research Datalink and Hospital Episode Statistics (CPRD-HES). We calculated incidence rate ratios, adjusted for age, gender and ethnicity, using Poisson regression. Results: We identified 462 cases diagnosed between 1997 and 2013. Our overall estimate of incidence was 11.8 (95% CI 10.7-12.9)/million person-years. Incidence in children (aged <16 years) was 0.88 (95% CI 0.40-1.96), and adults 14.0 (95% CI 12.8-15.4). The incidence was lower in females (adjusted IRR 0.68; 95% CI 0.56-0.81) and highest in the 55-69 year age-group (adjusted IRR 9.5, 95% CI 6.9-13.0; reference group 0-39 years). Incidence was not significantly different in the Black / Minority Ethnic population compared to the white population (adjusted odds ratio 0.78, 95% CI 0.53-1.13, p=0.13). The prevalence in 2013 was 134.9 (121.3-149.6) /million. Mortality was 13.6% at 1-year, and higher in HES than CPRD-identified cases (Hazard ratio 3.16, 95% CI 2.19-4.56, p<0.001). Conclusions: By combining primary and secondary care datasets we have found the incidence and mortality of granulomatosis with polyangiitis to be higher than previously reported. We predict that at present each year in the UK there will be approximately 700 new cases of whom 95 will die within 12 months

Factor Retention Decisions in Exploratory Factor Analysis Results: A Study Type of Knowledge Management Process at Malaysian University Libraries

Structural equation modeling (SEM) is a versatile statistical modeling tool which uses in the social sciences research. Recently, in Library and Information Science (LIS) environment, structural equation modeling has gained popularity across many disciplines, due to its generality and flexibility. Its estimation techniques, modeling capabilities and breadth of application are expanding rapidly.This paper reported a structural equation modeling through an Exploratory Factor Analysis (EFA) result, which involves 300 lead users at six selected Malaysian university libraries through survey. The decision of how many factors to retain is a critical component of exploratory factor analysis. Evidence is presented that parallel analysis is one of the most accurate factor retention methods. SPSS 20 was utilized to analyze the factor analysis data. In this regards, the results of EFA could provide empirical evidence of each hypotheses construct. It is hoped that the EFA results could be used to level Confirmatory Factor Analysis (CFA) to perform full Structural Equation Modeling.© 2013 The Authors. Copyright for this article is retained by the author(s), with first publication rights granted to the journal. This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).fi=vertaisarvioitu|en=peerReviewed

Compact North Finding System

The knowledge of orientation of an object with respect to earth-fixed reference coordinate system is crucial in many applications. For instance, in oil mining it is very crucial to accurately know the orientation of the drilling equipment under the earth surface to drill through desired path. In this context we propose a compact inertial sensor system that estimates the instantaneous orientation of the system using accelerometer and gyroscope-derived tilt and azimuth angles. To keep the system size small, we use two-axis accelerometer and one-axis gyroscope. In addition, to avoid high sensor cost, the sensor biases are removed using indexing method. The proposed system estimates the orientation of the compact system in almost all of the orientations and additionally it also provides the measurement accuracy and integrity values that help in ascertaining the validity of the orientation estimate.acceptedVersionPeer reviewe

Moderating effect of asean free trade agreement between total quality management and business performance

The unprecedented pace of globalisation, trade liberalisation, and capital movement in the later years profoundly changed to pose serious challenges for Malaysian companies to compete in an open market. In today's highly competitive market, the demand for quality is important factor for companies to survive in the ever-expanding global marketplace. The concept of Total Quality Management (TQM) has been developed as a result of intense global competition. ASEAN trade liberalisation through the elimination of intraregional tariffs contributed to improving manufacturing in ASEAN countries to be more efficient and competitive in world markets. However, Asean Free Trade Agreement (AFTA) is a good news for foreign companies as they have competitive advantages, but not for local companies. The examining of AFTA as a moderator is less done in previous work. The purpose of this paper is to propose relationship between TQM practices and business performance with moderator effects of AFTA. The main contribution of this paper is to examine whether AFTA has the effect as a moderator. This proposed conceptual model will help the academicians and industry players to have better understanding on the effect of AFTA in TQM implementation in improving their business performance. The structural equation modeling (SEM) techniques are used to examine the relationships of the practices.©2014 the Authors. Published by Elsevier Ltd. Open Access under the Creative Commons Attribution–NonCommercial–NoDerivatives 4.0 International (CC BY–NC–ND 4.0) license, https://creativecommons.org/licenses/by-nc-nd/4.0/fi=vertaisarvioitu|en=peerReviewed