Helium in the adult critical care setting

Helium is a low-density inert gas whose physical properties are very different from those of nitrogen and oxygen. Such properties could be clinically useful in the adult critical care setting, especially in patients with upper to more distal airway obstruction requiring moderate to intermediate levels of FiO2. However, despite decades of utilization and reporting, it is still difficult to give any firm clinical recommendation in this setting. Numerous case reports are available in the context of upper airway obstruction of different origins, but there is a lack of controlled studies for this indication. One study reported a helium-induced beneficial effect on surrogates of work of breathing after extubation in non-COPD patients, possibly in relation to laryngeal consequences of tracheal intubation. Physiological benefits of helium-oxygen breathing have been demonstrated in the context of acute severe asthma, but there is a lack of large controlled studies demonstrating an effect on pertinent clinical endpoints, except for a study reported only as an abstract, which mentioned a reduction in the intubation rate in helium-treated patients. Finally, there are a number of physiological studies in the context of COLD-COPD patients demonstrating a beneficial effect, mainly by a reduction in the resistive inspiratory work of breathing but also by a reduction in hyperinflation. Reduction of hypercapnia was mainly observed in spontaneously breathing and noninvasively ventilated helium-treated patients but not in intubated patients during controlled ventilation, suggesting that the decrease in PaCO2 was mainly in relation to a diminution in CO2 production, related to the diminution in work of breathing and not an improved alveolar ventilation. Moreover, there is little evidence that helium-oxygen could improve parameters of heterogeneity in such patients. Two RCTs were unable to demonstrate a reduction in the intubation rate in such setting, but they were likely underpowered. An adequately powered international multicentric study is ongoing and will help to determinate the exact place of the helium-oxygen mixture in the future. The place of the mixture during the weaning period will deserve further evaluation

International and Scientific Activities of the Lithuanian Road Administration are the Source of Experience

International cooperation and close relations with scientific institutions assist the Lithuanian Road Administration under the Ministry of Transport and Communications of Lithuania in implementing the policy of road network development, road building and maintenance, infrastructure development, and traffic safety organization. Fostering of cooperation in the region and abroad, exchange of best practices, improvement of professional skills, also the scientific research works and studies and dissemination of their results play an important role in the improvement of road infrastructure. The article outlines representation of Lithuanian Road Administration in international road organizations and the main fields of its scientific activities and research

Analysis of Lithuanian Gravel Roads Paving Programme Implementation in 1998–2005

The article presents the research based on economic feasibility evaluation of model KAMIS developed for paving* of gravel roads. The model is built for Lithuanian climatic, economic and technological conditions, but it could be adopted in other regions, especially regions with “freezing and thawing climates”. After 8 years of model application for appraisal of Lithuanian Gravel Roads Paving Programme it was estimated that consequences after the presented Lithuanian Gravel Roads Conditions Research and KAMIS model application have accumulated 1,09 billion LTL (316 million €) gain for Lithuanian society. Conclusions and findings of the Analysis of Lithuanian Gravel Roads Paving Programme implementation from 1998 to 2005 are presented at the end of the article

Lithuanian gravel roads and feasibility of their paving/Lietuvos žvyrkeliai ir jų asfaltavimo tikslingumas

Straipsnyje pateikiami ir analizuojami Lietuvos žvyrkelių techninės būkles tyrimų rezultatai. Moksliškai pagrindžiamas dangos lygumo—svarbiausio žvyrkeliij būklės techninio bei ekonominio rodiklio—taikymas žvyrkelių asfaltavimo ekonominiam tikslingumui vertinti. Asfaltinės dangos įrengimo tikslingumui nustatyti žvyrkeliuose buvo atlikti eismo stebėjimai, kelio pločio, žvyro dangos sluoksnio storio, žvyro misinio granuliometrinės sudėties, molio, dulkių ir dumblo kiekio, vandens nuleidimo sistemos įrenginiq, kelio sankasos buklės, reikalingo sustojimo matomumo bei dangos lygumo tyrimai. Pažymima, kad tyrimuose pirmą kartą Lietuvoje žvyro bei asfaltinės dangos lygumas buvo nustatytas pagai tarptautinę nelygumų indekso IRI skalę. Tyrimų duomenij pagrindu apskaičiuota žvyro dangos nelygumų didėjimo, išlyginus greideriu, kreivė, taikytina vidutiniam žvyrkelio lygumui nustatyti. Antroje straipsnio dalyje aprašomas teoriniais bei eksperimentiniais tyrimais pagrįstas Lietuvos ekonomines bei klimatines sąlygas atitinkantis žvyrkelių renovacijos ekonominio tikslingumo vertinimo modelis KAMIS. Pateikiami trumpi išlaidų bei santaupų submodelių bei modelio esmės aprašymai, modelio matematinė išraiska ir algoritmo schema. Nustatytas pagrindinis žvyrkelių renovacijos ekonominio tikslingumo vertinimo kriterijus riboto biudžeto sąlygomis—vidinės grąžos norma. Tyrimų metu gauti tarpiniai rezultatai Lietuvos kelių įmonėse naudojami nuo 1995 m., o modelis įdiegtas 1997 m. Pagai KAMIS, 1997 bei 1998 metų žvyrkelių asfaltavimo programų bendras ekonominis efektas 20-ies būsimų metų laikotarpiu 1997 m. kainomis turėtų viršyti 174 mln.Lt. First Published Online: 26 Jul 201

Strategic Road Maintenance and Development Programme of the Republic of Lithuania for 2030 – a Tool for Using National Funds to Create a Sustainable and Viable Road Network

Road are significant national assets which provides a fundamental foundation to the performance of all national economies, delivering conditions for social and economic development of countries and international communities. It is of at most importance to ensure a mobile and safe movement of inhabitants with the lowest time and pollution costs. In order to reach the goals the planning processes are implemented on a national and international scale to rationally justify the efficiency of urgent measures. In the Republic of Lithuania, seeking to efficiently use funds allocated to the road sector the Road Maintenance and Development Programmes are developed by the road manager defining a short-term and long-term vision of the road network and measures to achieve it. However, due to the anticipated insufficient financing of the road sector the Road Maintenance and Development Programmes aim to rationally combine preservation of the road network and its perspective development depending on the existing financing. The Road Maintenance and Development Programme of the Republic of Lithuania for 2030 assesses the existing condition of the road network and defines the goals and measures how to implement a sustainable development in the road network. With the help of review analysis this paper studies: road safety assurance, road pavement deterioration degree, social welfare assurance, road maintenance, infrastructure development, assurance of sustainable development