Ports and Waterways @ TU Delft 2019

Video material for a masters level course on functional design and capacity planning of the various elements of ports and waterways, such as terminals and locks. The learning in this series of videos is essential for planning and designing the overall system

Comparison of the effects of inhalational anesthesia with desflurane and total intravenous anesthesia on cardiac biomarkers after aortic valve replacement

Objective (s): The aim of this study was to compare the effects of using inhalational anesthesia with desflurane with that of a total intravenous (iv) anesthetic technique using midazolam-fentanyl-propofol on the release of cardiac biomarkers after aortic valve replacement (AVR) for aortic stenosis (AS). The specific objectives included (a) determination of the levels of ischemia-modified albumin (IMA) and cardiac troponin I (cTnI) as markers of myocardial injury, (b) effect on mortality, morbidity, duration of mechanical ventilation, length of Intensive Care Unit (ICU) and hospital stay, incidence of arrhythmias, pacing, cardioversion, urine output, and serum creatinine. Methodology and Design: Prospective randomized clinical study. Setting: Operation room of a cardiac surgery center of a tertiary teaching hospital. Participants: Seventy-six patients in New York Heart Association classification II to III presenting electively for AVR for severe symptomatic AS. Interventions: Patients included in the study were randomized into two groups and subjected to either a desflurane-fentanyl based technique or total IV anesthesia (TIVA). Blood samples were drawn at preordained intervals to determine the levels of IMA, cTnI, and serum creatinine. Measurements and Main Results: The IMA and cTnI levels were not found to be significantly different between both the study groups. Patients in the desflurane group were found to had significantly lower ICU and hospital stays and duration of postoperative mechanical ventilation as compared to those in the TIVA group. There was no difference found in mean heart rate, urine output, serum creatinine, incidence of arrhythmias, need for cardioversion, and 30-day mortality between both groups. The patients in the TIVA group had higher mean arterial pressures on weaning off cardiopulmonary bypass as well as postoperatively in the ICU and recorded lower inotrope usage. Conclusion: The result of our study remains ambiguous regarding the overall protective effect of desflurane in patients undergoing AVR although some benefit in terms of shorter duration of postoperative mechanical ventilation, ICU and hospital stays, as well as cTnI, were seen. However, no difference in overall outcome could be clearly established between patients who received desflurane and those that were managed solely with IV anesthetic technique using propofol

Ports and Waterways Design videos -Functional Design of Liquid Bulk Terminals

Video material for a masters level course on functional design and capacity planning of the various elements of ports and waterways, such as terminals and locks. The learning in this series of videos is essential for planning and designing the overall system

Ports and Waterways Design videos -Planning and Design of Port Water Areas

Video material for a masters level course on functional design and capacity planning of the various elements of ports and waterways, such as terminals and locks. The learning in this series of videos is essential for planning and designing the overall system

Ports and Waterways Design videos -Functional Design of Marinas

Video material for a masters level course on functional design and capacity planning of the various elements of ports and waterways, such as terminals and locks. The learning in this series of videos is essential for planning and designing the overall system

Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass

Background: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Material and Method: Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO 2 ), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac™ , PreSep™ , and EV-1000 ® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study. Result: Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. Conclusion: The length of stay in hospital (LOS-H) (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001) and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0.73 vs. 2.89 ± 0.68 h, P = 0.005) was also significantly lower in the GDT group. The two groups did not differ in duration of ventilated hours, mortality, and other complications. The parameters such as ScVO 2 , CI, and EVLW had a strong negative and positive correlation with the LOS-H with r values of − 0.331, −0.319, and 0.798, respectively. The study elucidates the role of a goal-directed hemodynamic optimization for improved outcome in high-risk cardiac patients undergoing OPCAB

Identifying ecosystem-based alternatives for the design of a seaports marine infrastructure : The case of tema port expansion in Ghana

Long-term sustainable port development requires accounting for the intrinsic values of ecosystems. However, in practice, ecosystem considerations often only enter the planning and design process of ports when required by an Environmental Impact Assessment. At this late stage, most of the design is already fixed and opportunities to minimize and restore ecosystem impacts are limited. In this paper, we adopt a large-scale, ecosystem perspective on port development with the aim to identify ecosystem-based design alternatives earlier and throughout the planning and design of a port's marine infrastructure. We present a framework, termed the 'ecosystem-based port design hierarchy' (EPDH), to identify ecosystem-based alternatives at four hierarchical design levels: 1) alternatives to port developments, 2) port site selection, 3) port layout design, and 4) design of structures and materials. In applying the EPDH framework retrospectively to a case study of port expansion in Tema, Ghana, we establish that ecosystem considerations played only a limited role in identifying and evaluating alternatives at all four design levels in the case study, whereas more eco-friendly alternatives in terms of port layouts, structures, and materials are identified using the EPDH framework. This reveals that opportunities for ecosystem-friendly port designs may have been missed and demonstrates the need for and the potential added value of our framework. The framework can assist practitioners in earlier and wider identification of ecosystem-based alternatives for a port's marine infrastructure in future seaport developments and, hence, represents an important step towards more sustainable port designs.</p