Pro/con debate: Is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients?

You have decided to develop a protocol for insulin therapy in your intensive care unit (ICU). You wonder about the merit of using intensive insulin therapy (IIT) to maintain tight blood glucose control in your patients

Ten reasons for performing hemodynamic monitoring using transesophageal echocardiography.

International audienc

Dynamic Procedure for Filtered Gyrokinetic Simulations

Large Eddy Simulations (LES) of gyrokinetic plasma turbulence are investigated as interesting candidates to decrease the computational cost. A dynamic procedure is implemented in the GENE code, allowing for dynamic optimization of the free parameters of the LES models (setting the amplitudes of dissipative terms). Employing such LES methods, one recovers the free energy and heat flux spectra obtained from highly resolved Direct Numerical Simulations (DNS). Systematic comparisons are performed for different values of the temperature gradient and magnetic shear, parameters which are of prime importance in Ion Temperature Gradient (ITG) driven turbulence. Moreover, the degree of anisotropy of the problem, that can vary with parameters, can be adapted dynamically by the method that shows Gyrokinetic Large Eddy Simulation (GyroLES) to be a serious candidate to reduce numerical cost of gyrokinetic solvers.Comment: 10 pages, 10 figures, submitted to Physics of Plasma

Highly Dynamic Voltage Control of a Dual Active Bridge over the Full Voltage Range by Operating Point Dependent Manipulated Variable Limitation

This paper presents a highly dynamic voltage control for the Dual Active Bridge over the full operating range. Maximum dynamics is achieved by using the maximum available manipulated variable in combination with a feedforward control of the capacitor current at a setpoint change. Operation within the system limits is ensured by a variable limitation of the manipulated variable considering the current operating point. The simulation results are validated by measurements on a 35 kW Dual Active Bridge test bench

Loss Estimation of a Dual Active Bridge as part of a Solid State Transformer using Frequency Domain Modelling

This paper proposes an improved method for the loss estimation of a Dual Active Bridge (DAB) using frequency domain modelling. The method uses a detailed, frequency depending transformer model to describe even highly utilized DABs. The model is used to estimate the occurring losses of a DAB as part of an modular Solid State Transformer (SST). The influence of the SST\u27s phase power ripple is considered for the loss estimation. The results of the frequency domain model and the loss calculation are validated using measurement data of an SST-cell prototype

Resource use and outcome in critically ill patients with hematological malignancy: a retrospective cohort study

INTRODUCTION: The paucity of data on resource use in critically ill patients with hematological malignancy and on these patients' perceived poor outcome can lead to uncertainty over the extent to which intensive care treatment is appropriate. The aim of the present study was to assess the amount of intensive care resources needed for, and the effect of treatment of, hemato-oncological patients in the intensive care unit (ICU) in comparison with a nononcological patient population with a similar degree of organ dysfunction. METHODS: A retrospective cohort study of 101 ICU admissions of 84 consecutive hemato-oncological patients and 3,808 ICU admissions of 3,478 nononcological patients over a period of 4 years was performed. RESULTS: As assessed by Therapeutic Intervention Scoring System points, resource use was higher in hemato-oncological patients than in nononcological patients (median (interquartile range), 214 (102 to 642) versus 95 (54 to 224), P < 0.0001). Severity of disease at ICU admission was a less important predictor of ICU resource use than necessity for specific treatment modalities. Hemato-oncological patients and nononcological patients with similar admission Simplified Acute Physiology Score scores had the same ICU mortality. In hemato-oncological patients, improvement of organ function within the first 48 hours of the ICU stay was the best predictor of 28-day survival. CONCLUSION: The presence of a hemato-oncological disease per se is associated with higher ICU resource use, but not with increased mortality. If withdrawal of treatment is considered, this decision should not be based on admission parameters but rather on the evolutional changes in organ dysfunctions