Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile

Diarrhoea is common in Intensive Care Unit (ICU) patients, with a reported prevalence of 15-38%. Many factors may cause diarrhoea, including Clostridium difficile, drugs (e.g. laxatives, antibiotics) and enteral feeds. Diarrhoea impacts on patient dignity, increases nursing workload and healthcare costs, and exacerbates morbidity through dermal injury, impaired enteral uptake and subsequent fluid imbalance. We analysed a cohort of 9331 consecutive patients admitted to a mixed general intensive care unit to establish the prevalence of diarrhoea in intensive care unit patients, and its relationship with infective aetiology and clinical outcomes. We provide evidence that diarrhoea is common (12.9% (1207/9331) prevalence) in critically ill patients, independently associated with increased intensive care unit length of stay (mean (standard error) 14.8 (0.26) vs 3.2 (0.09) days, p < 0.001) and mortality (22.0% (265/1207) vs 8.7% (705/8124), p < 0.001; adjusted hazard ratio 1.99 (95% CI 1.70-2.32), p < 0.001) compared to patients without diarrhoea even after adjusting for potential confounding factors, and infrequently caused by infective aetiology (112/1207 (9.2%)) such as Clostridium difficile (97/1048 (9.3%) tested) or virological causes (9/172 (5.7%) tested). Our findings suggest non-infective causes of diarrhoea in ICU predominate and pathophysiology of diarrhoea in critically ill patients warrants further investigation

Feasible Products for Double-Feed Reactive Distillation Columns

We have developed a quick and effective method to predict the feasible products from a double-feed reactive distillation column. The method relies on the prediction of the pinch point for the middle section, using a cross-flow arrangement of vapor−liquid continuously stirred tank reactors (CSTRs). The cross-flow model substantially simplifies the prediction of the compositions at both ends of the middle section of a two-feed column, which are then used to predict the feasible distillate and bottoms compositions, using existing methods. The cross-flow arrangement can also be used to predict minimum and maximum flows for double-feed reactive distillation columns

Natural gas conversion to liquid fuels in a zone reactor

A process for conversion of natural gas to liquid fuels is described. The process can be conducted in a "zone reactor" in which oxygen or air is first contacted with solid metal bromide, producing bromine and metal oxide. The bromine passes into a second zone, in which it reacts with natural gas, producing alkyl bromides and hydrogen bromide. The products of the second zone pass into a third zone, in which they react with metal oxide, producing metal bromide and liquid product. At the end of the cycle the oxygen feed and product streams are switched and the flow reversed. The advantages of the process including safety and capital cost reduction are presented and results discussed

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