Virtual Grid - New Paradigm of System Resources Dynamic Organization

This paper describes the model and software tools for virtualization of the Grid execution environment. The basic assumption of this study is that Virtual Grid (VG) is constructed dynamically according to application requirements with virtualized computational and communication resources. A VG instance is dynamically created for each application and its initial configuration can be further modified during runtime to satisfy the requested level of resource usage and to maintain the quality of service indexes at agreed-upon values. A VG model that takes into account this approach has been proposed and analyzed in the context of Grid-related technology

Flexible Organization of Repositories for Provisioning Cloud Infrastructures

The paper proposes an architecture of a system automating the provisioning process of cloud computing infrastructures. Its structure and components are specified, based on an analysis of three types of requirements: infrastructure providers, service providers and end users. These considerations have led us to formulate a new infrastructural model, offered to end users as a collection of Virtual Machines (VM) connected by a dedicated Virtual Private Network (VPN) with QoS guarantees. The role of repositories in cloud provisioning systems is specified along with the relevant data acquisition processes. The applicability of the proposed system is illustrated by practical usage scenarios

Epidemiologia zachowań samobójczych pacjentów Kliniki Psychiatrycznej Wydziału Nauki o Zdrowiu Warszawskiego Uniwersytetu Medycznego (kwiecień 2016–marzec 2017 roku)

INTRODUCTION: The purpose of the article is to present the epidemiology of suicidal thoughts and behaviours in patients admitted to the Clinic of Psychiatry at the Faculty of Health Sciences of Medical University of Warsaw. MATERIAL AND METHODS: The study included 452 patients hospitalized between April 2016 and March 2017. The authors investigated the epidemiology of suicide risk in terms of individual demographics, psychiatric diagnosis, psychopathology and substance abuse. RESULTS: The patients diagnosed with mental and behavioral disorders due to psychoactive substance use (ICD-10 F10-F19) represent 30% of the whole analysed psychiatric population and 66% of them had suicide inclinations before or during hospital admission. CONCLUSION: Disorders associated with substance abuse are a major problem for clinicians in the context of suicide prevention.  WSTĘP: Celem niniejszego artykułu jest analiza epidemiologiczna występowania myśli i zachowań samobójczych u pacjentów przyjętych do Kliniki Psychiatrycznej Wydziału Nauki o Zdrowiu Warszawskiego Uniwersytetu Medycznego w Warszawie. MATERIAŁ I METODY: Badanie objęło 452 pacjentów hospitalizowanych w Klinice w okresie od kwietnia 2016 do marca 2017 roku. W przeprowadzonej analizie autorzy uwzględnili dane socjo-demograficzne, diagnozę psychiatryczną, objawypsychopatologiczne oraz używanie substancji psychoaktywnych. WYNIKI: Uzyskane wyniki ujawniły, że pacjenci z rozpoznaniem zaburzeń związanych z używaniem substancji psychoaktywnych (ICD-10 F10-F19) stanowili 30% całej psychiatrycznej populacji pacjentów poddanych analizie, a u 66% z nich obserwowano zjawiska związane z samobójstwem przed lub w trakcie ich przyjęcia do szpitala. WNIOSEK: Tym samym zaburzenia związane z używaniem substancji psychoaktywnych należy uznać za główny problem w praktyce klinicznej w kontekście przeciwdziałania samobójstwom.

The chain of survival in hypothermic circulatory arrest : encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming

BACKGROUND: The prognosis in hypothermic cardiac arrest is frequently good despite prolonged period of hypoperfusion and cardiopulmonary resuscitation. Apart from protective effect of hypothermia itself established protocols of treatment and novel rewarming techniques may influence on outcome. The purpose of the study was to assess the outcome of patients with hypothermic circulatory arrest treated by means of arterio-venous extracorporeal membrane oxygenation (ECMO) according to locally elaborated protocol in Severe Accidental Hypothermia Center in Cracow, Poland. METHODS: Prospective observational case-series study – all patients with confirmed hypothermic cardiac arrest consulted with hypothermia coordinator were accepted for extracorporeal rewarming, unless contraindications for ECMO were observed (active bleeding). RESULTS: The study population consisted of 10 patients (7 male, median age 48.5 years). The core temperature measured esophageally was 16.9–28.4 °C, median 22 °C. On admission 5 patients presented with asystole and 5 with ventricular fibrillation. Duration of circulatory arrest before ECMO implantation was 107 to 345 min (median 156 min). The duration of ECMO support was 1.5 to 91 h (median 22 h). Cardiorespiratory stability and full neurologic recovery was achieved in 7 patients. The duration of mechanical ventilation was 88–437 h (median 177 h) and the length of stay in the ICU was 8–26 days (median 15 days). All survivors had mildly impaired (1 patient, LVEF 40 %) or preserved (6 patients, LVEF 55–65 %) left ventricular systolic function at the time of discharge from ICU. The cause of death of non-survivors (three patients) was acute myocarditis, massive retroperitoneal bleeding, and massive gastrointestinal bleeding. DISCUSSION AND CONCLUSIONS: Our data confirm the high survival rate (70 %) and excellent neurologic outcome in hypothermic cardiac arrest. The following key elements seem to impact the final prognosis: the appropriate coordination of the rescue operation, immediate high-quality CPR (preferably using mechanical chest compression system) and application of ECMO for rewarming and cardiorespiratory support

Should capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? : observational case-series study

BACKGROUND: Severe accidental hypothermia can cause circulatory disturbances ranging from cardiac arrhythmias through circulatory shock to cardiac arrest. Severity of shock, pulmonary hypoperfusion and ventilation-perfusion mismatch are reflected by a discrepancy between measurements of CO(2) levels in end-tidal air (EtCO(2)) and partial CO(2) pressure in arterial blood (PaCO(2)). This disparity can pose a problem in the choice of an optimal ventilation strategy for accidental hypothermia victims, particularly in the prehospital period. We hypothesized that in severely hypothermic patients capnometry should not be used as a reliable guide to choose optimal ventilatory parameters. METHODS: We undertook a pilot, observational case-series study, in which we included all consecutive patients admitted to the Severe Hypothermia Treatment Centre in Cracow, Poland for VA-ECMO in stage III hypothermia and with signs of circulatory shock. We performed serial measurements of arterial blood gases and EtCO(2), core temperature, and calculated a PaCO(2)/EtCO(2) quotient. RESULTS: The study population consisted of 13 consecutive patients (ten males, three females, median 60 years old). The core temperature measured in esophagus was 20.7–29.0 °C, median 25.7 °C. In extreme cases we have observed a Pa-EtCO(2) gradient of 35–36 mmHg. Median PaCO(2)/EtCO(2) quotient was 2.15. DISCUSSION AND CONCLUSION: Severe hypothermia seems to present an example of extremely large Pa-EtCO(2) gradient. EtCO(2) monitoring does not seem to be a reliable guide to ventilation parameters in severe hypothermia

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

ADDITIONAL INFORMATION This article has been co‑published in Kardiologia Polska (doi:10.33963/KP.14904), Arterial Hypertension (doi:10.5603/AH.a2019.0011), and Ginekologia Polska (doi:10.5603/GP.2019.0074). The articles in Kardiologia Polska, Arterial Hypertension, and Ginekologia Polska are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Any citation can be used when citing this article

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia

Background: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. Methods: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. Results: In most of the cases, the actual treatment cost was greater than the funding received by around 10,000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. Conclusion: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment