Primjena dijagnostičke metode za IGBT grešku otvorenog kruga u asinkronom motornom pogonu s vektorskom modulacijom i izravnim upravljanjem momentom

In this paper a simple diagnostic method of a single IGBT open-circuit fault is presented, it is dedicated for three-phase two-level voltage-inverter-fed vector controlled induction motor drive systems. A failure diagnosis is based on a transient analysis of a reference voltage space vector in stationary coordinates, without additional sensors. The diagnostic algorithm ensures detection and localization of single IGBT failures in time shorter than one period of a stator current fundamental harmonic, without regard to a drive operation point. The presented scheme of the diagnostic system can be easily applicable in the electric drives that use voltage space vector modulation algorithms. The main achievement of the research, whose results have been presented in this paper, is an experimental validation of the analyzed IGBT faults diagnosis technique in the drive with the Direct Torque Control algorithm.U ovom radu prikazana je jednostavna dijagnostička metoda jedne IGBT pogreške otvorenog kruga, namijenjena je za sustave asinkronog motornog pogona s trofaznim dvorazinskim pretvaračem s vektorskim upravljanjem. Dijagnoza pogreške zasnovana je na analizi tranzijenta referentnog vektora napona u stacionarnim koordinatama bez dodatnih senzora. Dijagnostički algoritam osigurava detekciju i lokalizaciju jedne IGBT greške u vremenu kraćem od jedne periode fundamentalnog harmonika struje statora neovisno o trenutnom operacijskom stanju pogona. Prezentirana shema dijagnostičkog sustava može se jednostavno primijeniti u električnim pogonima koji koriste algoritme vektorske modulacije naponskih vektora. Glavno postignuće istraživanja, čiji su rezultati prikazani u ovom radu, je eksperimentalna validacija analiziranih dijagnostički tehnika za IGBT greške u pogonu s algoritmom za izravno upravljanje momentom

A patient with intractable pain on high dose opioid therapy. Could we manage not to escalate the opioid dose?

Prolonged opioid treatment reveals problems, like opioid tolerance and opioid induced hyperalgesia. On every stage of disease it should be remembered to use procedures that can have opioid dose sparing effect. We describe a patient with severe mixed neuropathic and nociceptive pain who despite complex medication embracing high dose of morphine suffered from untractable pain. He responded to opioid antagonist with sequential opioid rotation and a simple minimally invasive procedure.Prolonged opioid treatment reveals problems, like opioid tolerance and opioid induced hyperalgesia. On every stage of disease it should be remembered to use procedures that can have opioid dose sparing effect. We describe a patient with severe mixed neuropathic and nociceptive pain who despite complex medication embracing high dose of morphine suffered from untractable pain. He responded to opioid antagonist with sequential opioid rotation and a simple minimally invasive procedure

Palliative care provision for people living with heart failure: The Geneva model

As life expectancy rises and the survival rate after acute cardiovascular events improves, the number of people living and dying with chronic heart failure is increasing. People suffering from chronic ischemic and non-ischemic heart disease may experience a significant limitation of their quality of life which can be addressed by palliative care. Although international guidelines recommend the implementation of integrated palliative care for patients with heart failure, models of care are scarce and are often limited to patients at the end of life. In this paper, we describe the implementation of a model designed to improve the early integration of palliative care for patients with heart failure. This model has enabled patients to access palliative care when they normally would not have and given them the opportunity to plan their care in line with their values and preferences. However, the effectiveness of this interdisciplinary model of care on patients' quality of life and symptom burden still requires evaluation

The presence of mu-, delta-, and kappa-opioid receptors in human heart tissue

Functional evidence suggests that the stimulation of peripheral and central opioid receptors (ORs) is able to modulate heart function. Moreover, selective stimulation of either cardiac or central ORs evokes preconditioning and, therefore, protects the heart against ischemic injury. However, anatomic evidence for OR subtypes in the human heart is scarce. Human heart tissue obtained during autopsy after sudden death was examined immunohistochemically for mu- (MOR), kappa- (KOR), and delta- (DOR) OR subtypes. MOR and DOR immunoreactivity was found mainly in myocardial cells, as well as on sparse individual nerve fibers. KOR immunoreactivity was identified predominantly in myocardial cells and on intrinsic cardiac adrenergic (ICA) cell-like structures. Double immunofluorescence confocal microscopy revealed that DOR colocalized with the neuronal marker PGP9.5, as well as with the sensory neuron marker calcitonin gene-related peptide (CGRP). CGRP-immunoreactive (IR) fibers were detected either in nerve bundles or as sparse individual fibers containing varicose-like structures. Our findings offer the first hint of an anatomic basis for the existence of OR subtypes in the human heart by demonstrating their presence in CGRP-IR sensory nerve fibers, small cells with an eccentric nucleus resembling ICA cells, and myocardial cells. Taken together, this suggests the role of opioids in both the neural transmission and regulation of myocardial cell function

Validation of the German version of the needs assessment tool: progressive disease-heart failure.

BACKGROUND The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study, we aimed to (1) Translate the tool into German and culturally adapt it. (2) Assess internal consistency, inter-rater reliability, and test-retest reliability of the German NAT: PD-HF. (3) Evaluate whether and how patients and health care personnel understand the tool and its utility. (4) Assess the tool's face validity, applicability, relevance, and acceptability among health care personnel. METHODS Single-center validation study. The tool was translated from English into German using a forward-backward translation. To assess internal consistency, we used Cronbach´s alpha. To assess inter-rater reliability and test-retest reliability, we used Cohen´s kappa, and to assess validity we used face validity. RESULTS The translated tool showed good internal consistency. Raters were in substantial agreement on a majority of the questions, and agreement was almost perfect for all the questions in the test-retest analysis. Face validity was rated high by health care personnel. CONCLUSION The German NAT: PD-HF is a reliable, valid, and internally consistent tool that is well accepted by both patients and health care personnel. However, it is important to keep in mind that effective use of the tool requires training of health care personnel

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

adwokat dr Piotr Sobanski - Dobre uslugi jako wykonywanie funkcji panstwa

W artykule została omówiona instytucja dobrych usług, które są jednym ze środków pokojowego załatwiania sporów między państwami, a także podstawy prawnomiędzynarodowe ich stosowania. Przedstawione zostały także przykłady skutecznego świadczenia dobrych usług przez państwa, które doprowadziły do zakończenia sporów między państwami pozostającymi w konflikcie. The paper discusses the institution of good offices. They are means for the pacific settlement of disputes. The paper focuses on the international legal basis for the use of good offices. There are also examples of successful good offices provided by states.Adwokat dr Piotr Sobański LL.M.Uniwersytet ZielonogórskiORCID [email protected]@wpa.uz.zgora.pl</p

End-of-life matters in chronic heart failure patients

Purpose of review Until recently, concepts of care for people with heart failure had rarely included preparation for unavoidable imminent death or caring for the dying. The purpose of this review is to provide an update on current end-of-life issues specific to heart failure patients. Recent findings Mortality in the heart failure population remains high, especially shortly after the first acute heart failure hospitalization. Patients with systolic heart failure die more frequently from progressive heart failure or sudden cardiac death; patients with diastolic heart failure for noncardiovascular reasons and sudden cardiac death. The mode of haemodynamic decline leading to heart failure death can be characterised by low cardiac output (with or without secondary end-organ dysfunction), congestion, or a combination of both. A new model of end-of-life trajectories has been proposed which takes into account influence of comorbidities on the prognosis of heart failure. Advance care planning for patients with implanted cardiac devices has been shown to be unsatisfactory. A recent strategy for managing implantable cardioverter defibrillators in patients approaching death is presented. Summary There is an emerging need to define specific challenges for end-of-life care for approaching death in heart failure patients. More research and education are needed to improve care for dying heart failure patients, including those with implanted cardiac devices

Regular, low-dose methadone for reducing breathlessness in people experiencing or at risk of neurotoxic effects from morphine: A single-center case series

Breathlessness is a common symptom suffered by people living with advanced malignant and non-malignant diseases, one which significantly limits their quality of life. If it emerges at minimal exertion, despite the maximal, guidelines-directed, disease-specific therapies, it should be considered persistent and obliges clinicians to prescribe symptomatic, non-pharmacological, and pharmacological treatment to alleviate it. Opioids are recommended for the symptomatic treatment of persistent breathlessness, with morphine most extensively studied for this indication. It is extensively metabolized in the liver into water-soluble 3- and 6-glucuronides, excreted by the kidneys. In the case of advanced renal failure, the glucuronides accumulate, mainly responsible for toxicity 3-glucuronides. Some people, predominantly those with advanced renal failure, develop neurotoxic effects after chronic morphine, even when prescribed at a very low dose. A single-center case series of consecutive patients experiencing neurotoxic effects after long-term, low-dose morphine or at risk of such effects were transferred to methadone to avoid the accumulation of neurotoxic metabolites. Over the course of 4.5 years, 26 patients have been treated with methadone in the median dose of 3.0 mg/24 h p.o., for persisting breathlessness. Sixteen of them had been treated previously with an opioid (usually morphine) at the median dose of 7.0 mg/24 h (morphine oral daily dose equivalent). They were transferred to methadone, with the median dose of 3.0 mg/24 h orally (methadone oral daily dose equivalent), and the median morphine-to-methadone dose ratio was 2.5:1. All patients experienced a meaningful improvement in breathlessness intensity after methadone, by a median of 5 points (range 1–8) on the 0–10 numerical rating scale (NRS) in the whole group, and by 2 points (range 0–8) in those pretreated with other opioids, mainly morphine. Low-dose methadone can be considered an efficient alternative to morphine for reducing breathlessness in people experiencing neurotoxic effects or at risk of developing them following treatment with morphine