Which variables are associated with blood glucose levels outside the target range in surgical critically ill patients? A retrospective observational study

<p>Abstract</p> <p>Background</p> <p>The aim of the present study is to determine the variables affecting blood glucose concentrations outside the target range of 80 and 150 mg/dl in critically ill surgical patients.</p> <p>Methods</p> <p>All critically ill surgical patients admitted to a university ICU, from 01/2007 to 12/2008, were surveyed daily using computer assistance with respect to minimal and maximal daily blood glucose concentrations, application of insulin and demographic/clinical variables. Multiple logistic regression for clustered data with backward elimination was performed to identify variables strongly associated with blood glucose concentrations < 80 mg/dl or ≥ 150 mg/dl in 804 patients with an ICU stay > 72 hours.</p> <p>Results</p> <p>Application of insulin (odds ratio (OR) 2.1, with corresponding 95% confidence interval (CI) 1.7; 2.6), noradrenaline (OR 1.4, 95% CI 1.2 - 1.8) or steroids (1.3, 1.003 - 1.7), and age (per year) (1.02, 1.01 - 1.03) were associated with an increased risk of blood glucose concentrations < 80 mg/dl. In analogy, application of insulin (OR 2.4, 95% CI 2.0 - 2.7), noradrenaline (1.4, 1.2 - 1.6) or steroids (1.4, 1.2 - 1.7), severe sepsis (1.2, 1.1 - 1.4), neurosurgery (OR 1.0) compared to abdominal, vascular and trauma surgery, and age (per year) (1.01, 1.01 - 1.02), were associated with an increased risk of blood glucose concentrations ≥ 150 mg/dl.</p> <p>Conclusions</p> <p>Critically ill surgical patients are at an increased risk for fluctuating blood glucose concentrations ranging < 80 mg/dl or ≥ 150 mg/dl in particular if they are of advanced age and require administration of insulin, noradrenaline, and/or steroids. Patients who underwent neurosurgery and/or presented with severe sepsis/shock are those in particular at risk for blood glucose concentrations ≥ 150 mg/dl.</p

HPM-Detektionssystem mit Frequenzbestimmung

In allen Bereichen unserer Gesellschaft hält moderne und komplexe Elektronik Einzug. Mit zunehmender Komplexität und Vernetzung wächst auch das Potential für Bedrohung solcher kritischer Infrastruktur durch Hochleistungsmikrowellen (HPM), die solche Systeme zeitweise stören oder permanent außer Kraft setzen können. In der Vergangenheit wurde am Fraunhofer INT ein HPM-Detektionssystem entwickelt, dass über die Fähigkeiten einfacher Warnempfänger zur einfachen Anzeige von gefährlichen HPM-Ereignissen hinausgeht. In einem nächsten Schritt wurde mit einem vierkanaligen System die Detektion der Richtung eines HPM-Angriffs realisiert. Der Beitrag gliedert sich wie folgt: Vorüberlegungen für die HPM-Detektion (die zu einer analogen Ausführung des Detektors führen); Konzept zur HPM-Amplitudenmessung: Der Frequenzbereich erstreckt sich von 500 MHz bis etwa 4 GHz, die Messdynamik umfasst 60 dB, beginnend bei etwa 10 V/m. Die Schirmung des Demonstrators wurde erfolgreich bis 1 kV/m ausgemessen. Gepulste Signale konnten bis zu einer Kürze von 10 ns gemessen werden; Konzept zur HPM-Frequenzmessung (Prinzipschaltbild des HPM-Frequenzdiskriminators); Realisierung eines HPM-Detektionssystems mit Frequenzbestimmung (hierzu 5 Abb.: Kennlinie des Frequenzdiskriminators; Ausgangsimpuls des Frequenzdiskriminators, HF-Pulslänge = 100 ns; Blockschaltbild des HF-Teils des HPM-Detektors mit Frequenzmessung; Demonstrator des Konzeptes der Frequenzerkennung und einkanaliger Amplitudenmessung; Blockschaltbild des gesamten HPM-Detektors mit Frequenzmessung) sowie Softwarekonzept (Benutzeroberfläche). Das Konzept eines kompakten Gesamtsystems mit integrierter Spannungsversorgung und Signalübertragung per Lichtwellenleiter wurde im Labor, wie auch bei Freifeldmessungen, erfolgreich bestätigt

Feasibility and acceptance of electronic quality of life assessment in general practice: an implementation study

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Anesthesia advanced circulatory life support

The constellation of advanced cardiac life support (ACLS) events, such as gas embolism, local anesthetic overdose, and spinal bradycardia, in the perioperative setting differs from events in the pre-hospital arena. As a result, modification of traditional ACLS protocols allows for more specific etiology-based resuscitation. Perioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patient's comorbidities and coexisting anesthetic or surgically related pathophysiology. When the health care provider identifies the probable cause of arrest, the practitioner has the ability to initiate medical management rapidly. Recommendations for management must be predicated on expert opinion and physiological understanding rather than on the standards currently being used in the generation of ACLS protocols in the community. Adapting ACLS algorithms and considering the differential diagnoses of these perioperative events may prevent cardiac arrest

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements