Lung Rest During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure-Practice Variations and Outcomes.

OBJECTIVE: Describe practice variations in ventilator strategies used for lung rest during extracorporeal membrane oxygenation for respiratory failure in neonates, and assess the potential impact of various lung rest strategies on the duration of extracorporeal membrane oxygenation and the duration of mechanical ventilation after decannulation. DATA SOURCES: Retrospective cohort analysis from the Extracorporeal Life Support Organization registry database during the years 2008-2013. STUDY SELECTION: All extracorporeal membrane oxygenation runs for infants less than or equal to 30 days of life for pulmonary reasons were included. DATA EXTRACTION: Ventilator type and ventilator settings used for lung rest at 24 hours after extracorporeal membrane oxygenation initiation were obtained. DATA SYNTHESIS: A total of 3,040 cases met inclusion criteria. Conventional mechanical ventilation was used for lung rest in 88% of cases and high frequency ventilation was used in 12%. In the conventional mechanical ventilation group, 32% used positive end-expiratory pressure strategy of 4-6 cm H2O (low), 22% used 7-9 cm H2O (mid), and 43% used 10-12 cm H2O (high). High frequency ventilation was associated with an increased mean (SEM) hours of extracorporeal membrane oxygenation (150.2 [0.05] vs 125 [0.02]; p \u3c 0.001) and an increased mean (SEM) hours of mechanical ventilation after decannulation (135 [0.09] vs 100.2 [0.03]; p = 0.002), compared with conventional mechanical ventilation among survivors. Within the conventional mechanical ventilation group, use of higher positive end-expiratory pressure was associated with a decreased mean (SEM) hours of extracorporeal membrane oxygenation (high vs low: 136 [1.06] vs 156 [1.06], p = 0.001; mid vs low: 141 [1.06] vs 156 [1.06]; p = 0.04) but increased duration of mechanical ventilation after decannulation in the high positive end-expiratory pressure group compared with low positive end-expiratory pressure (p = 0.04) among survivors. CONCLUSIONS: Wide practice variation exists with regard to ventilator settings used for lung rest during neonatal respiratory extracorporeal membrane oxygenation. Use of high frequency ventilation when compared with conventional mechanical ventilation and use of low positive end-expiratory pressure strategy when compared with mid positive end-expiratory pressure and high positive end-expiratory pressure strategy is associated with longer duration of extracorporeal membrane oxygenation. Further research to provide evidence to drive optimization of pulmonary management during neonatal respiratory extracorporeal membrane oxygenation is warranted

Estimation of Vehicle Damage Cost Involved in Road Traffic Accidents in Karachi, Pakistan: A Geospatial Perspective

AbstractRoad Traffic Accidents (RTAs) are serious but ignored problem in Pakistan. Now this problem is under limelight due to disastrous impacts over society in general and over economy in particular. Karachi is considered to be the most income generating city of Pakistan. This city holds a typical feature of most road traffic accidents facing in the country and the fourth highest RTA fatalities in the world. More than 26,000 road accidents occur on the arteries of Karachi every year making it a worrisome place. Outcome of RTAs could be measured in tangible manner i.e., in term of number of life loss but intangible losses are very difficult to measure. In this paper an attempt has been made to capture the potential flaws in road geometry through Remote Sensing and embedding the land use data through the inventory of Geographic Information Systems. Moreover, overlay analysis techniques helps in identifying the high accident cost areas. In Karachi, over 35,000 vehicles are involved in crashes every year, resulting in loss of life as well as wealth. The overall repair cost over the vehicles involved in all types of RTAs in year2012 is more than 20,000,000 PKR with Landhi Town showing the highest cost. Shah Faisal Town showed the minimum repair cost of over 300,000 due to its small aerial extent and lesser number of economic land use making it a safer place for vehicle users. Moreover, map of Karachi showing the spatial pattern of vehicle repair cost. It is suggested that the serious measures need to be undertaken to combat this problem

Evaluating the Utility of Diagnostic Workups for Biliary Atresia in Neonates with Cholestatic Jaundice Following Prolonged TPN

Introduction: Parenteral nutrition associated cholestasis (PNAC) develops in 40-60% of premature infants following TPN for 2-4+ weeks. The incidence of biliary atresia is low and there is a 60-day, post-term window for corrective surgery. There is limited data on both the natural history of PNAC in premature infants following prolonged TPN, as well as the utility of diagnostic tools investigating biliary atresia in these patients. Methods: A retrospective chart review using EMR data from the Intensive Care Nursey was performed with the following criteria: premature babies diagnosed with cholestasis, born at \u3c1500 grams, and received TPN for 14 days. Ultimately 61 babies met criteria and data was collected and pooled to produce descriptive statistics and graphs describing laboratory trends. Results: Median gestational age was 26 [IQR 25, 28] weeks, birth weight was 732 [650, 930] grams and 60% (36/60) were male. After being on TPN for a median of 51 [38, 73] days and developing cholestasis, 12/61 (19.7%) babies underwent hepatobiliary scintigraphy, three of which also underwent repeat scans, 29/61 (47.5%) received GI consults and 32/61 (52.5%) underwent abdominal ultrasounds. No babies were diagnosed with biliary atresia. Graphical depiction of laboratory trends demonstrates an initial spike in direct bilirubin after TPN cessation, followed by a gradual decline 3-4 weeks later. Discussion: Despite many diagnostic procedures and consults, PNAC was the only observed diagnosis at discharge for this cohort of babies. Based on the laboratory trends, delaying the investigation of elevated bilirubin until 3-4 weeks after ceasing TPN might prevent unnecessary diagnostics and improve resource allocation

A New Weibull-G Family of Distributions

Statistical analysis of lifetime data is an important topic in reliability engineering, biomedical and social sciences and others. We introduce a new generator based on the Weibull random variable called the new Weibull-G family. We study some of its mathematical properties. Its density function can be symmetrical, left-skewed, right-skewed, bathtub and reversed-J shaped, and has increasing, decreasing, bathtub, upside-down bathtub, J, reversed-J and S shaped hazard rates. Some special models are presented. We obtain explicit expressions for the ordinary and incomplete moments, quantile and generating functions, Renyi entropy, order statistics and reliability. Three useful characterizations based on truncated moments are also proposed for the new family. The method of maximum likelihood is used to estimate the model parameters. We illustrate the importance of the family by means of two applications to real data sets

The Kumaraswamy Marshal-Olkin Family of Distributions

We introduce a new family of continuous distributions called the Kumaraswamy Marshal-Olkin generalized family of distributions. We study some mathematical properties of this family. Its density function is symmetrical, left-skewed, right-skewed and reversed-J shaped, and has constant, increasing, decreasing, upside-down bathtub, bathtub and S-shaped hazard rate. We present some special models and investigate the asymptotics and shapes of the family. We derive a power series for the quantile function and obtain explicit expressions for the moments, generating function, mean deviations, two types of entropies and order statistics. Some useful characterizations of the family are also proposed. The method of maximum likelihood is used to estimate the model parameters. We illustrate the importance of the family by means of two applications to real data sets

Effect of entropy generation on the performance of humidification-dehumidification desalination cycles

This paper applies irreversibility analysis to characterize humidification-dehumidification (HD) desalination cycles and to identify how to further improve cycles and components. It is shown that minimizing specific entropy generation of the cycle maximizes the gained output ratio (GOR). It is also shown that each cycle has one limiting component that cannot be substantially improved and a second component that should be the target of efforts to minimize entropy generation. Finally, the failure of exergy analysis to yield conclusive results for on-design HD cycle analysis is discussed briefly.Center for Clean Water and Clean Energy at MIT and KFUP

Formulation of Seawater Flow Exergy Using Accurate Thermodynamic Data

Seawater is a complex electrolyte solution of water and salts with sodium chloride as the major constituent. However, the thermodynamic properties of seawater are considerably different from those of aqueous sodium chloride solution. In the literature, exergy analyses of seawater desalination systems have sometimes modeled seawater by sodium chloride solutions of equivalent salt content or salinity; however, such matching does not bring all important properties of the two solutions into agreement. Furthermore, some published studies attempt to represent sodium chloride solutions as a specific model for an ideal mixture of liquid water and solid sodium chloride, which is shown to have serious shortcomings. In this paper, the most up-to-date thermodynamic properties of seawater are compared with those of aqueous sodium chloride solution as well as the ideal mixture model. The flow exergy is calculated using various models and the results are compared. In addition, the minimum work required to desalinate a unit mass of fresh water from seawater of varying salinity is calculated using these models. The flow exergy calculated using the ideal mixture model in question is about 50% less than that of seawater. Accordingly, the minimum desalination work is underpredicted by about 50% when calculating it using that ideal mixture model. This consequently shows that exergy analysis and the second law efficiency calculations performed using the ideal mixture model is comparatively far from the actual values.Center for Clean Water and Clean Energy at MIT and KFUP

ANALISIS KINERJA SIMPANG JALAN UNTUNG SUROPATI–JALAN IR.SUTAMI KOTA SAMARINDA

Salah satu simpang yang mengalami permasalahan lalu-lintas di Kota Samarinda adalah simpang JalanUntung Suropati-Jalan Ir. Sutami. Pada saat jam sibuk sering terjadi kepadatan lalu lintas. Hal ini terjadikarena Jalan Untung Suropati dan Jalan Ir. Sutami merupakan salah satu jalur utama yang sering dilaluioleh masyarakat Kota Samarinda. Selain itu, cukup banyak volume kendaraan yang melakukan putar arahdisimpangtersebutsehingga menambah titik konflik pada simpang.Analisis kinerja simpang dilakukan menggunakan MKJI 1997 dan PTVVissim. Dari hasil analisisdiperoleh nilai derajat kejenuhan sebesar 1,27, dan tundaan simpang sebesar 71,43 detik dengan tingkatpelayanan F. Sedangkan untuk hasil simulasi menggunakanVissimdiperoleh tundaan tertinggi 56,27 detikdengan tingkat pelayanan F.Alternatif perbaikan yang direkomendasikan adalah alternatif 3 yaitu menerapkan pengaturan simpangbersinyal 4 fase dengan penyesuaian geometrik pada simpang Jalan Untung Suropati–Jalan Ir. Sutami.Hasilnya diperoleh derajat kejenuhan tertinggi 0,69, dan tundaan rata-rata untuk seluruh simpang adalah19,94 detik dengan tingkat pelayanan simpang adalah C. Hasil simulasi simpang menggunakanVissim,diperoleh tundaan rata-rata simpang sebesar 18,03 detik dengan tingkatpelayanan B.Kata Kunci:Simpang,Analisis Kinerja,PTVVissi