326 research outputs found
Electro-encephalographic surrogate measures fail to describe the pharmacodynamic interaction between ketamine and propofol.
Comparison of the ability of two pharmacokinetic-dynamic models to maintain a predicted effect-site concentration of propofol compatible with loss of consciousness
Analytical study of coupling between subsystems of a vehicule NVH model
International audienceThe design of an automotive powertrain mounting system plays an important role in improving vehicle noise, vibration and harshness (NVH). One of the main problems encountered in the automotive design remains the isolation of the low frequencies vibrations of the engine from the rest of the vehicle. Several engine mounting schemes have been developed to deal with this problem. Most of these strategies stem from arranging the rigid body modes of the engine mounted on resilient supports to have certain coupled or decoupled characteristics. It is currently admitted in literature that a decoupled powertrain mounting system improves NVH characteristics. The significant engine mass makes the right frequencies and modes arrangement a critical design decision. But it can not be stated that decoupling the on-ground rigid body modes of the engine will systematically reduce chassis vibrations. In this paper, a new analytical method is proposed to examine the mechanisms of coupling between the engine and the vehicle body structure. The analytical procedure enable to define the domain of validity of the mounting schemes based on a 6 degreesof- freedom engine model and to assess NVH improvement
New analytical method to evaluate the powerplant and chassis coupling in the improvement vehicle NVH
International audienceThe design of an automotive powerplant mounting system is an essential part in vehicle safety and improving the vehicle noise, vibration and harshness (NVH) characteristics. One of the main problems encountered in the automotive design is isolating low frequency vibrations of the powerplant from the rest of the vehicle. The significant powerplant mass makes the choice of frequency and mode arrangements a critical design decision. Several powerplant mounting schemes have been developed to improve NVH properties concentrating on the positioning and design of resilient supports. However these methods are based on decoupling rigid body modes from a grounded powerplant model which ignores chassis and suspension system interactions. But it cannot be stated that decoupling the grounded rigid body modes of the powerplant will systematically reduce chassis vibrations. In this paper, a new analytical method is proposed to examine the mechanisms of coupling between the powerplant and the vehicle chassis and subsystems. The analytical procedure expands the equation of motion of the vehicle components to such that a domain of boundary conditions used in the 6 degrees-of-freedom powerplant mounting model can be defined. An example of this new procedure is given for improving NVH chassis response at idle speed using the torque roll axis decoupling strategy
Multi-objective robust design optimization of an engine mounting system
International audienceThis paper introduces a new method to support designers to find optimal and robust solutions of engine mounting system. The mounting system design is a compromise between isolation of the vehicle from engine vibration and constraining the motion of the powertrain within vehicle packaging. Based on the classical pendulum mounting system of a front wheel drive vehicle with a transversely four-cylinder engine, this study deals with the definition of a new global engine mounting concept for the NVH (Noise Vibration and Harshness) improvement of the vehicle characteristics at idle speed. The practical application of the numerical optimization is complicated by the fact that engine mounting system is a stochastic system. Its characteristics have a probabilistic nature. Multi-Objective Genetic Algorithm (MOGA), i.e. Pareto-optimization, is taken as the appropriate framework for the definition and the solution of the addressed multi-objective robust optimization problem. An experimental correlation analysis has been conducted on a Pareto-optimal solution to show the model accuracy
Early phase pharmacokinetics but not pharmacodynamics are influenced by propofol infusion rate
Background: Conventional compartmental pharmacokinetic models wrongly assume instantaneous drug mixing in the central compartment, resulting in a flawed prediction of drug disposition for the first minutes, and the flaw affects pharmacodynamic modeling. This study examined the influence of the administration rate and other covariates on early phase kinetics and dynamics of propofol by using the enlarged structural pharmacokinetic model.
Methods: Fifty patients were randomly assigned to one of five groups to receive 1.2 mg/kg propofol given with the rate of 10 to 160 mg . kg(-1) . h(-1). Arterial blood samples were taken frequently, especially during the first minute. The authors compared four basic pharmacokinetic models by using presystemic compartments and the time shift of dosing, LAG time. They also examined a sigmoidal maximum possible drug effect pharmacodynamic model. Patient characteristics and dose rate were obtained to test the model structure.
Results: Our final pharmacokinetic model includes two conventional compartments enlarged with a LAG time and six presystemic compartments and includes following covariates: dose rate for transit rate constant, age for LAG time, and weight for central distribution volume. However, the equilibration rate constant between central and effect compartments was not influenced by infusion rate.
Conclusions: This study found that a combined pharmacokinetic-dynamic model consisting of a two-compartmental model with a LAG time and presystemic compartments and a sigmoidal maximum possible drug effect model accurately described the early phase pharmacology of propofol during infusion rate between 10 and 160 mg . kg(-1) . h(-1). The infusion rate has an influence on kinetics, but not dynamics. Age was a covariate for LAG time
Organizing health care networks : balancing markets, government and civil society
Much is changing in health care organization today. A perspective or paradigm that is gaining ever increasing momentum is that of translational, extramural and integrated care. Current research suggests many potential benefits for integrated care and health care networks but the ethical issues are less frequently emphasized. Showing that integrated care can be beneficial, does not mean it is automatically 'ethically' justified. We will argue for three ethical requirements such health care networks should meet. Subsequently we will look at the mechanisms driving the formation of networks and examine how these can cause networks to meet or fail to meet these ethical requirements or obligations. The three mechanisms we will examine are government, civil society and market mechanisms, which, we argue, should be balanced properly. Each mechanism is able to provide a relevant ethical perspective to health care networks. However, when the balance is skewed towards a single mechanism, health care networks might fail to promote one or more of the ethical requirements
The patient perspective in health care networks
Background: Health care organization is entering a new age. Focus is increasingly shifting from individual health care institutions to interorganizational collaboration and health care networks. Much hope is set on such networks which have been argued to improve economic efficiency and quality of care. However, this does not automatically mean they are always ethically justified. A relevant question that remains is what ethical obligations or duties one can ascribe to these networks especially because networks involve many risks. Due to their often amorphous and complex structure, collective responsibility and accountability may increase while individual responsibility goes down.
Main body: We argue that a business ethics approach to ethical obligations for health care networks, is problematic and we propose to opt for a patient perspective. Using the classic four principles of biomedical ethics (justice, nonmaleficence, beneficence and autonomy) it is possible to identify specific ethical duties. Based on the principle of justice, health care networks have an ethical duty to provide just and fair access for all patients and to be transparent to patients about how access is regulated. The principle of nonmaleficence implies an obligation to guarantee patient safety, whereas the principle of beneficence implies an obligation for health care networks to guarantee continuity of care in all its dimensions. Finally, the principle of autonomy is translated into a specific obligation to promote and respect patient choice. Networks that fail to meet any of these conditions are suspect and cannot be justified ethically.
Conclusions: Faced with daunting challenges, the health care system is changing rapidly. Currently many hopes ride on integrated care and broad health care networks. Such networks are the topic of empirical debate, but more attention should be given to the ethical aspects. Health care networks raise new and pressing ethical issues and we are in need of a framework for assessing how and when such networks are justified
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