355 research outputs found
Virtual Calibration Method for Diesel Engine by Software in The Loop Techniques
The calibration of the engine control unit is increased for the development of the whole automotive system. The aim is to calibrate the electronic engine control to match the decreasing emission requirements and increasing fuel economy demands. The reduction of the number of tests on vehicles represents one of the most important requirements for increasing efficiency of the engine calibration process. However, the definition of the design of experiment is not straightforward because the data is not known beforehand, so it is difficult to process and analyse this data to achieve a globally valid model. To reduce time effort and costs the virtual calibration can be a valid solution. This procedure is called software in the loop (SIL) calibration able to develop a process to systematically identify the optimal balance of engine performance, emissions and fuel economy. In this work, a virtual calibration methodology is presented by using a two-stage model to get minimum exhaust emissions of a diesel engine. The data used are from a GT-Power model of a 3L supercharged diesel engine. The model is able to calculate the engine emissions for different engine parameters (such as the start of injection, EGR fraction and rail pressure) and from optimisation process, new injection start maps that reduce pollutant emissions are created
The systemic inflammation hypothesis: Towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis
Acute decompensation (AD) of cirrhosis is defined by the development of ascites, hepatic encephalopathy and/or variceal bleeding. Ascites is traditionally attributed to splanchnic arterial vasodilation and
left ventricular dysfunction, hepatic encephalopathy to hyperammonaemia, and variceal haemorrhage to
portal hypertension. Recent large-scale European observational studies have shown that systemic
inflammation is a hallmark of AD. Here we present a working hypothesis, the systemic inflammation
hypothesis, suggesting that systemic inflammation through an impairment of the functions of one or
more of the major organ systems may be a common theme and act synergistically with the traditional
mechanisms involved in the development of AD. Systemic inflammation may impair organ system
function through mechanisms which are not mutually exclusive. The first mechanism is a nitric oxidemediated accentuation of the preexisting splanchnic vasodilation, resulting in the overactivation of
the endogenous vasoconstrictor systems which elicit intense vasoconstriction and hypoperfusion in
certain vascular beds, in particular the renal circulation. Second, systemic inflammation may cause
immune-mediated tissue damage, a process called immunopathology. Finally, systemic inflammation
may induce important metabolic changes. Indeed, systemic inflammatory responses are energetically
expensive processes, requiring reallocation of nutrients (glucose, amino acids and lipids) to fuel immune
activation. Systemic inflammation also inhibits nutrient consumption in peripheral (non-immune) organs, an effect that may provide one mechanism of reallocation and prioritisation of metabolic fuels for
inflammatory responses. However, the decrease in nutrient consumption in peripheral organs may result
in decreased mitochondrial production of ATP (energy) and subsequently impaired organ functio
An international, multicentre, open randomised parallel group trial comparing a two-step approach for pain relief versus the standard three-step approach of the WHO analgesic ladder in patients with cancer
Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group
Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes
Nursing Care of Patients With Cirrhosis: The LiverHope Nursing Project
Cirrhosis is a complex disease that is associated with disturbances in different organs besides the liver, including kidneys, heart, arterial circulation, lungs, gut, and brain. As a consequence, patients develop a number of complications that result in frequent hospital admissions and high morbidity and mortality. Patients with cirrhosis require constant and rigorous monitoring both in and outside the hospital. In this context, the role of nurses in the care of patients with cirrhosis has not been sufficiently emphasized and there is very limited information about nursing care of patients with cirrhosis compared with other chronic diseases. The current article provides a review of nursing care for the different complications of patients with cirrhosis. Nurses with specific knowledge on liver diseases should be incorporated into multidisciplinary teams managing patients with cirrhosis, both inpatient and outpatient. Conclusion: Nurses play an important role in the management and prevention of complications of the disease and improvement in patients’ quality of life and bridge the gap between clinicians and families, between primary care and hospital care, and provide medical education to patients and caregivers
AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions
Chronic cancer pain is a serious complication of malignancy or its treatment. Currently, no comprehensive, universally accepted cancer pain classification system exists. Clarity in classification of common cancer pain syndromes would improve clinical assessment and management. Moreover, an evidence-based taxonomy would enhance cancer pain research efforts by providing consistent diagnostic criteria, ensuring comparability across clinical trials. As part of a collaborative effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) and the American Pain Society (APS), the ACTTION-APS Pain Taxonomy (AAPT) initiative worked to develop the characteristics of an optimal diagnostic system.59, 65 Following the establishment of these characteristics, a working group consisting of clinicians and clinical and basic scientists with expertise in cancer and cancer-related pain was convened to generate core diagnostic criteria for an illustrative sample of 3 chronic pain syndromes associated with cancer (i.e., bone pain and pancreatic cancer pain as models of pain related to a tumor) or its treatment (i.e., chemotherapy-induced peripheral neuropathy). A systematic review and synthesis was conducted to provide evidence for the dimensions that comprise this cancer pain taxonomy. Future efforts will subject these diagnostic categories and criteria to systematic empirical evaluation of their feasibility, reliability and validity and extension to other cancer-related pain syndromes
Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: an Italian survey
Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research
Objectives: Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes.
Methods: This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme.
Results: 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21–97); median Karnofsky score 70 (10–100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001).
Conclusions: There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research.
Trial registration number: ClinicalTrials.gov Identifier: NCT01362816
Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model—a study based on data from an international multicentre project (EPCRC-CSA)
A cancer cachexia classification into stages is warranted in order to guide treatment decisions and clinical trial inclusion. Weight loss and BMI clearly discriminate between non-cachectic and cachectic patients both with regards to all the domains (Intake, Catabolism and Function) and survival. The precachexia stage might be better defined by additional factors in order to be discriminativ
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