The Role of Intensive Insulin Therapy on Superoxide Dismutase (Sod), Tumor Necrosis Factor-? (Tnf-?), and Interleukin-6 (Il-6) on Hyperglycemia in Critically Ill Patients

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients'prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 – 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients

Anaesthesia and Intensive Care

The anaesthetist has seen his role steadily expand and it is hard to think of one medical specialty in which anaesthetists are not involved at least to some extent. We present a range of papers which demonstrates the breadth of anaesthesia: from its traditional realm in the operating theatre to critical care and resuscitation onto chronic pain and obstetric analgesia.peer-reviewe

Capital-intensive projects induce more effort than labor-intensive projects

Central governments often subsidize capital spending by local governments, instead of subsidizing operating expenses or labor-intensive projects. This paper offers one explanation, focusing on the incentive effects for local officials. a local official can more easily shift the cost of optimizing a project to his successor on a labor-intensive project than on a capital-intensive project.

Towards Coordination-Intensive Visualization Software

Most coordination realizations in current visualization systems are ''last-minute'' ad-hoc and rely on the richness of the chosen implementation language. Moreover, very few visualization models implicitly consider coordination. If coordination is contemplated from the design point of view, it is usually only regarded as part of the communication protocol and is generally dealt with within that restricted domain. Coordinated multiple views are beneficial and a flexible model for coordination will ensure easy embedding of coordination in such exploratory environments. This paper compares different approaches to coordination in exploratory visualization (EV). We recognize the need for a coordination model and for that we formalize aspects of coordination in EV. Furthermore, our work draws on the findings of the interdisciplinary study of coordination by various researchers

ACCCN Workforce Standards for Intensive Care Nursing: Systematic and evidence review, development, and appraisal

Background: The intensive care nursing workforce plays an essential role in the achievement of positive healthcare outcomes. A growing body of evidence indicates that inadequate nurse staffing and poor skill mix are associated with negative outcomes for patients, and potentially compromises nurses’ ability to maintain the safety of those in their care. In Australia, the Australian College of Critical Care Nurses (ACCCN) has previously published a position statement on intensive care staffing. There was a need for a stronger more evidence based document to support the intensive nursing workforce. Objectives: To undertake a systematic and evidence review of the evidence related to intensive care nurse staffing and quality of care, and determine evidence-based professional standards for the intensive care nursing workforce in Australia. Methods: The National Health and Medical Research Council standard for clinical practice guidelines methodology was employed. The English language literature, for the years 2000-2015 was searched. Draft standards were developed and then peer- and consumer-reviewed. Results: A total of 553 articles was retrieved from the initial searches. Following evaluation, 231 articles met the inclusion criteria and were assessed for quality using established criteria. This evidence was used as the basis for the development of ten workforce standards, and to establish the overall level of evidence in support of each standard. All draft standards and their subsections were supported multi-professionally (median score >6) and by consumers (85–100% agreement). Following minor revisions, independent appraisal using the AGREE II tool indicated that the standards were developed with a high degree of rigour. Conclusion: The ACCCN intensive care nursing nurse workforce standards are the first to be developed using a robust, evidence-based process. The standards represent the optimal nurse workforce to achieve the best patient outcomes and to maintain a sustainable intensive care nursing workforce for Australia

Engineering Trust-based Software Intensive Systems

Abstract of a keynote speech given at the Strategic Research Workshop on Engineering Software Intensive Systems

The Employment Retention and Advancement Project: Results from the Substance Abuse Case Management Program in New York City

Participants in an intensive care management program for public assistance recipients with substance abuse problems were slightly more likely to enroll in treatment than participants in less intensive services. However, the intensive program had no effects on employment or public benefit receipt among the full sample

Carbon assessment for Robusta coffee production systems in Vietnam: a case study in Dak Lak

Carbon assessments have proliferated to identify climate friendly practices in Arabica producing systems, though little attention is given to Robusta. In this study, we evaluated the climate impact of Robusta production via quantification of carbon stock and greenhouse gas (GHG) emissions in the intensive shaded and unshaded coffee farms of the world’s largest Robusta producing region, Vietnam’s Central Highlands. We find due to the linear relationship between fertilizer use and yields, emissions from input use on a per unit product basis are not significantly different between the intensive and less intensive systems. However, when accounting for carbon sequestered in shade and coffee trees, the less intensive systems are carbon positive (sequestering more than they emit) per unit of green coffee bean produced

The Role of Intensive Insulin Therapy on Superoxide Dismutase (Sod), Tumor Necrosis Factor-? (Tnf-?), and Interleukin-6 (Il-6) on Hyperglycemia in Critically Ill Patients

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients'prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 – 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients

Factor proportions and international business cycles

Positive investment comovements across OECD economies as observed in the data are difficult to replicate in open-economy real business cycle models, but also vary substantially in degree for individual country-pairs. This paper shows that a two-country stochastic growth model that distinguishes sectors by factor intensity (capital-intensive vs. labor-intensive) gives rise to an endogenous channel of the international transmission of shocks that first, can substantially ameliorate the “quantity anomalies” that mark large open-economy models, and second, generate a cross-sectional prediction that is strongly supported by the data: investment correlations tend to be stronger for country-pairs that exhibit greater disparity in the factor-intensity of trade. In addition, three new pieces of evidence support the central mechanism: (1) the production composition of capital versus labor-intensive sectors changes over the business cycle; (2) the prices of capital-intensive goods and labor-intensive goods are respectively, procyclical and countercyclical; (3) a positive productivity shock in the U.S. tilts the composition of production towards capital-intensive sectors in other countries