Reliability of delivered dialysate sodium concentration

BACKGROUND: The results of studies investigating the effects of hyponatraemic dialysates have been mixed, with some reporting positive effects including reduction in blood pressure and inter-dialytic weight gains, whereas others have not been able to demonstrate any effect. These studies assume that setting a lower dialysate sodium results in the delivery of a hyponatraemic dialysate. We therefore measured delivered sodium to determine reliability. METHODS: We measured dialysate sodium in 10 BBraun Dialog+® and 6 Fresenius 4008H dialysis machines, which had been set up to deliver a sodium of 136 mmol/L, using flame photometry and indirect ion selective electrode (ISE) methods. RESULTS: Dialysate conductivity was 13.85 ± 0.05 mS/cm, but dialysate sodium measured by flame photometry was 141.8 ± 2.9 mmol/L, and 142.5 ± 2.4 mmol/L by ISE. Both dialysis machines delivered a dialysate sodium in excess of the 136 mmol/L set, with a mean bias of 7.0 ±2.1 mmol/L for the Dialog+®, and 3.7 ± 2.6 for the 4008 with the flame photometer method, and a mean bias of 6.3 ± 1.3 mmol/L for the Dialog+®, and 6.8 ± 3.7 for the 4008 by ISE. CONCLUSION: It is assumed when setting a dialysate sodium concentration that this sodium concentration is delivered. However we found that the dialysate sodium concentration delivered was greater than that set, despite the dialysis machines reporting a conductivity measurement in keeping with a lower sodium dialysate. Trials of lowered dialysate sodium therefore need to measure dialysate sodium concentrations to ensure what has been set is delivered

Anaphora resolution for bengali: An experiment with domain adaptation

In this paper we present our first attempt on anaphora resolution for a resource poor language, namely Bengali. We address the issue of adapting a state-of-the-art system, BART, which was originally developed for English. Overall performance of co-reference resolution greatly depends on the high accurate mention detectors. We develop a number of models based on the heuristics used as well as on the particular machine learning employed. Thereafter we perform a series of experiments for adapting BART for Bengali. Our evaluation shows, a language-dependant system (designed primarily for English) can achieve a good performance level when re-trained and tested on a new language with proper subsets of features. The system produces the recall, precision and F-measure values of 56.00%, 46.50% and 50.80%, respectively. The contribution of this work is two-fold, viz. (i). attempt to build a machine learning based anaphora resolution system for a resource-poor Indian language; and (ii). domain adaptation of a state-of-the-art English co-reference resolution system for Bengali, which has completely different orthography and characteristics

Uncertainty handling in named entity extraction and disambiguation for informal text

Social media content represents a large portion of all textual content appearing on the Internet. These streams of user generated content (UGC) provide an opportunity and challenge for media analysts to analyze huge amount of new data and use them to infer and reason with new information. A main challenge of natural language is its ambiguity and vagueness. To automatically resolve ambiguity, the grammatical structure of sentences is used. However, when we move to informal language widely used in social media, the language becomes more ambiguous and thus more challenging for automatic understanding.\ud Information Extraction (IE) is the research field that enables the use of unstructured text in a structured way. Named Entity Extraction (NEE) is a sub task of IE that aims to locate phrases (mentions) in the text that represent names of entities such as persons, organizations or locations regardless of their type. Named Entity Disambiguation (NED) is the task of determining which correct person, place, event, etc. is referred to by a mention.\ud The goal of this paper is to provide an overview on some approaches that mimic the human way of recognition and disambiguation of named entities especially for domains that lack formal sentence structure. The proposed methods open the doors for more sophisticated applications based on users’ contributions on social media. We propose a robust combined framework for NEE and NED in semi-formal and informal text. The achieved robustness has been proven to be valid across languages and domains and to be independent of the selected extraction and disambiguation techniques. It is also shown to be robust against the informality of the used language. We have discovered a reinforcement effect and exploited it a technique that improves extraction quality by feeding back disambiguation results. We present a method of handling the uncertainty involved in extraction to improve the disambiguation results

The anion study: effect of different crystalloid solutions on acid base balance, physiology, and survival in a rodent model of acute isovolaemic haemodilution

Background: Commercially available crystalloid solutions used for volume replacement do not exactly match the balance of electrolytes found in plasma. Large volume administration may lead to electrolyte imbalance and potential harm. We hypothesised that haemodilution using solutions containing different anions would result in diverse biochemical effects, particularly on acid-base status, and different outcomes. Methods: Anaesthetised, fluid-resuscitated, male Wistar rats underwent isovolaemic haemodilution by removal of 10% blood volume every 15 min, followed by replacement with one of three crystalloid solutions based on acetate, lactate, or chloride. Fluids were administered in a protocolised manner to achieve euvolaemia based on echocardiography-derived left ventrical volumetric measures. Removed blood was sampled for plasma ions, acid-base status, haemoglobin, and glucose. This cycle was repeated at 15-min intervals until death. The primary endpoint was change in plasma bicarbonate within each fluid group. Secondary endpoints included time to death and cardiac function. Results: During haemodilution, chloride-treated rats showed significantly greater decreases in plasma bicarbonate and strong ion difference levels compared with acetate- and lactate-treated rats. Time to death, total volume of fluid administered: chloride group 56 (3) ml, lactate group 62 (3) ml, and acetate group 65 (3) ml; haemodynamic and tissue oxygenation changes were, however, similar between groups. Conclusions: With progressive haemodilution, resuscitation with a chloride-based solution induced more acidosis compared with lactate- and acetate-based solutions, but outcomes were similar. No short-term impact was seen from hyperchloraemia in this model

HUMAN IDENTIFICATION SYSTEM BASED ON BRAINPRINT USING MACHINE LEARNING ALGORITHMS

In the medical field, due to the development of neuroimaging, several new methods of the biometric     field have been attending and favorable candidates for the identification of people. These methods are part of "covert biometrics" that involve the use of measures of clinical and medical images to identify them. The prime motivation to use an invisible (Hidden biometric) is the fact that attacks of a system can be very hard to deal with. This privacy strongly contributes to the increased strongest in the topic of person's verification and identification. In this article, he extracted a brain signature, called a "brain fingerprint" from brain (MRI) Magnetic Resonance Image, obtained from 30 healthy subjects as images (1739), these real data sets from Yarmok Medical Hospital. These brainprint in this work are considered to be a hallmark of the brain. The objective of this proposed work which is design a robust, accurate human identification using human brain print, the brain classification based on several phases, included Data acquisition, Feature extraction processing depend on linear discrimination analysis (LDA) to gain important and interesting features of every image calculated by (number of features in the class). The proposed system shows rise detection precision with the features extracted based on LDA with automatical classifier learning by K nearest neighbor (K-NN) and logistic regression (LR) from the LDA method gained with the LR algorithm of (93%) while LDA method gained (91%) with K-NN

Active Expert Learning for the Digital Humanities

Current platforms for paper sharing among scholars, such as Research Gate, could support Active Expert Learning, whereby the paper being uploaded is processed using human language technology techniques, and feedback is asked of the scholar doing the upload using active learning techniques to minimize the amount of feedback requested. We show that this approach could outperform traditional active learning as well as randomly asking for feedback

A REVIEW OF CURRENT NURSING PRACTICE AND EVIDENCE-BASED GUIDELINES IN ENTERAL NUTRITION IN THE CRITICALLY ILL PATIENT

Objectives: to provide an overview of evidence-based guidelines regarding some clinical practices related to enteral nutrition along with nursing adherence to these guidelines in the critically ill. Background: evidence-based guidelines for enteral nutrition curtailing the incidence of complications through managing gastric residual volumes, minimizing feeding interruption/under-feeding, confirming tube placement and preventing feeding system contamination. Design: an integrative literature review was employed to include various quantitative methodologies; however, RCTs predominated. Methods: electronic searching of CINAHL, Medline and Cochrane Library databases between 1995- 2011. Of 599 retrieved studies, 87 were included in the review. Results: The studies showed an inadequacy in nursing adherence to enteral nutrition evidence-based. Gastric residual volume should be strictly controlled using prokinetic agents, appropriate head of bed elevation and proper endo-tracheal tube cuff pressure. Feeding interruption should be avoided whenever is possible and an intentional increase to feeding rates/volumes are recommended to avoid under-feeding. X-ray and pH methods of confirming tube placement are more reliable and superior to capnometry and auscultatory methods. Feeding system hanging time should not exceed four consecutive days to prevent infection by endogenous source in addition to delivering formulae at closer body core temperature. Conclusion: evidence-based protocols should be employed effectively and consistently to eradicate discrepancies in nursing practice. Relevance to clinical practice: this paper highlights nursing role in prohibiting the majority of enteral nutrition complications through adhering to evidence-based guidelines

Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

OBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact. RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock

A prolonged run-in period of standard subcutaneous microdialysis ameliorates quality of interstitial glucose signal in patients after major cardiac surgery

We evaluated a standard subcutaneous microdialysis technique for glucose monitoring in two critically ill patient populations and tested whether a prolonged run-in period improves the quality of the interstitial glucose signal. 20 surgical patients after major cardiac surgery (APACHE II score: 10.1 ± 3.2) and 10 medical patients with severe sepsis (APACHE II score: 31.1 ± 4.3) were included in this investigation. A microdialysis catheter was inserted in the subcutaneous adipose tissue of the abdominal region. Interstitial fluid and arterial blood were sampled in hourly intervals to analyse glucose concentrations. Subcutaneous adipose tissue glucose was prospectively calibrated to reference arterial blood either at hour 1 or at hour 6. Median absolute relative difference of glucose (MARD), calibrated at hour 6 (6.2 (2.6; 12.4) %) versus hour 1 (9.9 (4.2; 17.9) %) after catheter insertion indicated a significant improvement in signal quality in patients after major cardiac surgery (p < 0.001). Prolonged run-in period revealed no significant improvement in patients with severe sepsis, but the number of extreme deviations from the blood plasma values could be reduced. Improved concurrence of glucose readings via a 6-hour run-in period could only be achieved in patients after major cardiac surgery