Generic approach to assess the measuring performance of total-radiated power quantities by multi-channel resistive bolometer diagnostics on fusion experiments.

On present-day magnetic-confinement fusion experiments, the performance of multi-channel bolometer diagnostics has typically evolved over time through experience with earlier versions of the diagnostic and experimental results obtained. For future large-scale fusion experiments and reactors, it is necessary to be able to predict the performance as a function of design decisions and constraints. A methodology has been developed to predict the accuracy with which the volume-integrated total radiated power can be estimated from the measurements by a resistive bolometer diagnostic, considering, in particular, its line-of-sight geometry, étendues of individual lines of sight, bolometer-sensor characteristics, and the expected noise level that can be obtained with its electronics and signal chain. The methodology depends on a number of assumptions in order to arrive at analytical expressions but does not restrict the final implementation of data-processing of the diagnostic measurements. The methodology allows us to predict the performance in terms of accuracy, total-radiated power level, and frequency or time resolution and to optimize bolometer-sensor characteristics for a set of performance requirements. This is illustrated for the bolometer diagnostic that is being designed for the ITER experiment. The reasonableness, consequences, and limitations of the assumptions are discussed in detail.

Diabetes screening by telecentric digital holographic microscopy.

Diabetes is currently the world's fastest growing chronic disease and it is caused by deficient production of insulin by the endocrine pancreas or by abnormal insulin action in peripheral tissues. This results in persistent hyperglycaemia that over time may produce chronic diabetic complications. Determination of glycated haemoglobin level is currently the gold standard method to evaluate and control sustained hyperglycaemia in diabetic people. This measurement is currently made by high-performance liquid chromatography, which is a complex chemical process that requires the extraction of blood from the antecubital vein. To reduce the complexity of that measurement, we propose a fully-optical technique that is based in the fact that there are changes in the optical properties of erythrocytes due to the presence of glucose-derived adducts in the haemoglobin molecule. To evaluate these changes, we propose to perform quantitative phase maps of erythrocytes by using telecentric digital holographic microscopy. Our experiments show that telecentric digital holographic microscopy allows detecting, almost in real time and from a single drop of blood, significant differences between erythrocytes of diabetic patients and healthy patients. Besides, our phase measurements are well correlated with the values of glycated haemoglobin and the blood glucose values.

Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos / Impact of the premature discharge on hospital mortality after a stay in an intensive care unit

Objetivos Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI. Diseño Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI. Ámbito UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas. Pacientes Intervenciones: Ninguna.1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido. Principales variables de interés Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI. Resultados Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR=14,02 [4,6-42,6]), las readmisiones (OR=3,46 [1,76-6,78]), las altas no programadas (OR=2,16 [1,06-4,41]), la puntuación de fallos orgánicos al alta de UCI (OR=1,16 [1,01-1,32]) y la edad (OR=1,03 [1,01-1,05]). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p=0,68 y 16, 7±16,7 frente a 18,7±21,3 días, respectivamente; p=0,162). Conclusiones Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos (AU)

Abstract Objective: To determine the frequency and to evaluate the relationship between prematuredischarge and post-ICU hospital mortality. Design: A prospective registry was made for patients admitted during six consecutive years,performing a retrospective analysis of the data on the first admission of ICU survivors. Setting: A 10-bed general ICU in a 540-bed tertiary-care community hospital. Patients: 1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards withknown hospital outcome. Interventions: None. Main variables: We recorded the patient data, including types of ICU discharge, normal orpremature, and studying their relationship with post-ICU hospital mortality. The types of ICUdischarge were also evaluated versus ICU readmission rate and post-ICU length of stay. Results: There were 165 patients (10.8%) with premature discharge. Mortality rate was11.6% (176 patients). The factors related with mortality were withdrawal and limitation oflife-sustaining treatments (OR=14.02 [4.6-42.6]), readmissions to ICU (OR=3.46 [1.76-6.78]),premature discharge (OR=2.6 [1.06-4.41]), higher organ failure score on discharge from the ICU(OR=1.16 [1.01-1.32]) and age (OR=1.03 [1.01-1.05]). Readmission rates and post-ICU length ofstay were similar among patients with premature and normal discharge (7.3% vs. 8.2%, P=.68and 16.7±16.7 days vs. 18.7±21.3 days, respectively, P=.162). Conclusions: Premature discharges appear to be common in our setting and have a significantimpact on mortality. Types of ICU discharge do not seem to be related with other outcomevariables in the hospital care of critically ill patients (AU)

[Impact of the premature discharge on hospital mortality after a stay in an intensive care unit]. / Impacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos.

OBJECTIVE: To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality. DESIGN: A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors. SETTING: A 10-bed general ICU in a 540-bed tertiary-care community hospital. PATIENTS: 1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome. INTERVENTIONS: None. MAIN VARIABLES: We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay. RESULTS: There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of life-sustaining treatments (OR=14.02 [4.6-42.6]), readmissions to ICU (OR=3.46 [1.76-6.78]), premature discharge (OR=2.6 [1.06-4.41]), higher organ failure score on discharge from the ICU (OR=1.16 [1.01-1.32]) and age (OR=1.03 [1.01-1.05]). Readmission rates and post-ICU length of stay were similar among patients with premature and normal discharge (7.3% vs. 8.2%, P=.68 and 16.7±16.7 days vs. 18.7±21.3 days, respectively, P=.162). CONCLUSIONS: Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of critically ill patients.

Yellow fever vaccine-associated viscerotropic disease and death in Spain.

Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) is a recently described severe adverse event after yellow fever vaccination, and some cases have been reported in different countries [Anonymous. Effects of yellow fever and vaccination. Lancet 2001;358(9296):1907-9]. Herein we describe a YEL-AVD case in a young woman, who died after vaccination with 17D-204 strain. Clinical, serological and immunochemical analysis as well as virus detection, quantification, sequence analysis and cytokine release, were performed. Further investigations on yellow fever vaccine adverse events, and carefully analysis of the immune response elicited are important tasks for the future.

Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival.

BACKGROUND: The purpose of our study was to analyze prognostic factors associated with mortality for patients with severe community-acquired pneumonia (CAP). METHODS: We conducted a prospective multicenter study including all patients with CAP admitted to the intensive care unit during a 15-month period in 33 Spanish hospitals. Admission data and data on the evolution of the disease were recorded. Multivariate analysis was performed using the SPSS statistical package (SPSS). RESULTS: A total of 529 patients with severe CAP were enrolled; the mean age (+/-SD) was 59.9+/-16.1 years, and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/-SD) was 18.9+/-7.4. Overall mortality among patients in the intensive case unit was 27.9% (148 patients). The rate of adherence to Infectious Diseases Society of America (IDSA) guidelines was 57.8%. Significantly higher mortality was documented among patients with nonadherence to treatment (33.2% vs. 24.2%). Multivariate analysis identified age (odds ratio [OR], 1.7), APACHE II score (OR, 4.1), nonadherence to IDSA guidelines (OR, 1.6), and immunocompromise (OR, 1.9) as the variables present at admission to the intensive care unit that were independently associated with death in the intensive care unit. In 15 (75%) of 20 cases of Pseudomonas aeruginosa infection, the antimicrobial treatment at admission was inadequate (including 8 of 15 cases involving patients with adherence to IDSA guidelines). Chronic obstructive pulmonary disease (OR, 17.9), malignancy (OR, 11.0), previous antibiotic exposure (OR, 6.2), and radiographic findings demonstrating rapid spread of disease (OR, 3.9) were associated with P. aeruginosa pneumonia. CONCLUSIONS: Better adherence to IDSA guidelines would help to improve survival among patients with severe CAP. Pseudomonas coverage should be considered for patients with chronic obstructive pulmonary disease, malignancy, or recent antibiotic exposure.

Successful diaphragmatic pacing for idiopathic alveolar hypoventilation.

We describe the case of a 17-year-old woman noted to have idiopathic alveolar hypoventilation, with multiple Intensive Care Unit (ICU) admissions because of acute respiratory failure (ARF) due to respiratory infections. After two years of diaphragmatic pacing arterial blood gases have substantially improved, without obstructive apnoea. Signs of right ventricular enlargement and pulmonary hypertension have decreased. Morning headache and diurnal somnolence have disappeared, and she is also able to perform more physical and mental activity, allowing her to enjoy a better quality of life.

Mouth occlusion pressure (P0.1) in acute respiratory failure.

We studied 20 unselected patients admitted to our Intensive Care Unit (ICU) suffering from acute respiratory failure (ARF), who needed mechanical ventilatory support. In all of them we followed a prospective protocol to investigate the value of mouth occlusion pressure (P0.1) as an indicator for weaning. Fifty-two tests were classified into three groups: a need to be reconnected to mechanical ventilation (MV), stable on intermittent mandatory ventilation (IMV), or spontaneous breathing on a T-tube (TT). The results showed that at increased values of P0.1 there were more difficulties in weaning patients from MV. Seventy-eight percent (78%) of the occasions where weaning was successful, values of P0.1 were less than or equal to 4.2 cm H2O, in chronic or non-chronic patients. Eighty-nine percent (89%) of the times when P0.1 values were higher than 4.2 cm H2O the same patients required ventilatory support, total (MV) or partial (IMV). These differences were statistically significant (p less than 0.01). We conclude that the P0.1 is an easily obtained non-invasive parameter, that can contribute along with other more conventional measurements to a superior indication for weaning.