Comparison of gastric mucosal pH and clinical judgement in critically ill patients

OBJECTIVES: To compare gastric tonometry (pHi) with estimates of pHi in ill injured patients, and to correlate pHi with haemodynamic variables. DESIGN: Prospective, non-interventional study. SETTING: ICU of Level I trauma centre, USA. MAIN OUTCOME MEASURES: 154 gastric tonometry measurements were compared with physicians' estimates of adequacy of resuscitation. Resuscitation was categorised as inadequate (pHi < 7.35) or adequate (pHi> or = 7.35). Measured and estimated pHi were also compared with oxygen delivery, oxygen consumption, cardiac index, mixed venous O2 saturation, and critical illness scores. RESULTS: Estimated pHi was often higher than measured pHi in the judgement of all four surgical intensive care physicians. Measured pHi correlated positively with mixed venous O2 tension (r = 0.21). There were significant negative correlations between measured pHi and both oxygen delivery (r = -0.25) and oxygen consumption (r = 0.28). Estimated pHi correlated positively with mean arterial pressure (r = 0.21) and hospital day (r = 0.26); it correlated negatively with pulmonary arterial elastance (r = -0.35). CONCLUSION: Experienced intensive care physicians tended to overestimate visceral perfusion, which suggests that gastric tonometry adds useful information over and above routine haemodynamic indices. Arterial blood pressure and mixed venous oxygen saturation correlated better with measured pHi than with other indices of perfusion.     

Acute erythroleukemia: evaluation of 48 cases with reference to classification, cell proliferation, cytogenetics, and prognosis

We evaluated 48 archival cases of acute erythroleukemia and divided them into 3 groups: M6a, corresponding to the traditional French-American-British M6 category; M6b, which is pure erythroleukemia; and M6c, in which myeloblasts and pronormoblasts each account for more than 30% of cells by the French-American-British exclusion criteria. No significant differences were noted among the subtypes for ratio of males to females; age; or exposure to toxins, alcohol, or both. However, compared with the patients in the M6a group, patients in the M6b and M6c groups demonstrated a statistically significant increase in cytogenetic aberrations, proliferation markers (proliferating cell nuclear antigen and Ki67), and ringed (type III) sideroblasts. Marked survival differences were noted between the M6a (30.1 +/- 29.5 months) and M6b (3.15 +/- 4.2 months) groups, with patients in the M6c group demonstrating an intermediate prognosis (10.5 +/- 12.7 months). Chemotherapeutic regimens induced remission in all treated patients in the M6a and M6c groups but did not appear to affect the M6b group. However, the patients in the M6c group remained in remission for a significantly shorter period of time than did patients in the M6a group. Overall, survival appeared to depend on the ratio of pronormoblasts to myeloblasts at diagnosis and demonstrated a rapid decline with increasing pronormoblast and decreasing myeloblast counts. We must, therefore, devise chemotherapeutic regimens that target both blastic components of this disease.     

An efficient microfluidic sorter: implementation of double meandering micro striplines for magnetic particles switching

The ability to trap, manipulate, and separate magnetic beads has become one of the key requirements in realizing an integrated magnetic lab-on-chip biosensing system. In this article, we present the design and fabrication of an integrated magneto-fluidic device for sorting magnetic particles with a sorting efficiency of up to 95%. The actuation and manipulation of magnetic beads are realized using microfabricated square meandering current-carrying micro striplines. The current is alternated between two neighboring micro striplines to switch the magnetic beads to either one of the two outlets. We performed a series of parametric study to investigate the effect of applied current, flow rate, and switching frequency on the sorting efficiency. Experimental results reveal that the sorting efficiency is proportional to the square of current applied to the stripline, and decreases with increasing buffer flow rate and switching frequency. Such phenomena agree well with our theoretical analysis and simulation result. The fastest switching rate, which is limited by the microchannel geometry and bead velocity, is 2 Hz.     

Operability analysis of nonlinear processes based on incremental dissipativity

Process operability can be defined as the ability of a process to reject disturbances at a specified operating point and/or to move quickly and smoothly from one operating point to another operating point using a feedback control system. Unlike linear processes, the properties of nonlinear processes (e.g., stability, minimum phase condition, etc.) are different around different equilibria. Most existing operability analysis for nonlinear systems focuses on one particular operating point of interest. This paper addresses the issues of dynamic process operability at various operating points, including the reachability of all equilibrium points or output trajectories in an operating region, regardless of initial conditions. In this work, a nonlinear analysis approach is developed based on the concept of incremental stability. Conditions for incremental stability are derived based on incremental dissipativity. The links between input and output multiplicities and incremental dissipativity are explored. The dynamic control performance achievable in terms of the speed of the response of the closed-loop system and offset minimization is studied. A method for determination of incremental dissipativity using Linear Differential Inclusion (LDI) is also presented, to facilitate the dissipativity based operability analysis.     

Intelligent decision support for effectively evaluating and selecting ships under uncertainty in marine transportation

This paper presents an intelligent decision support system for evaluating and selecting specific ships under uncertainty. A task-oriented procedure is developed for determining the relative importance of the evaluation and selection criteria with respect to a specific shipping task. A fuzzy multicriteria analysis algorithm is developed for determining the overall performance of each ship across all the selection criteria and their associated sub-criteria. An intelligent decision support system capable of integrating the developments above is proposed for facilitating the ship evaluation and selection process. An example is presented to demonstrate the effectiveness of the proposed intelligent decision support system.     

The construction site as a multicultural workplace: a perspective of minority migrant workers in Brunei

Construction projects have become progressively multicultural, especially for countries with limited labour force where there is need to depend on migrant workers. This multicultural environment can easily create problems related to unfair treatment or discrimination. Focus group discussions were conducted with migrant workers from Indonesia and Thailand to examine factors directly and indirectly related to construction activities that need to be considered in a diverse nationality construction site, with a focus on the minority group. The study suggested that communication, wage segmentation, task assignment and trust, scapegoatism, and belief and religion are the important aspects needing to be carefully taken into account to have a constructive working and living environment in a multicultural project. Management should not overlook the above factors to avoid disenfranchizing minority workers.     

Prototype and Chimera-Type Galectins in Placentas with Spontaneous and Recurrent Miscarriages

Galectins are galactose binding proteins and, in addition, factors for a wide range of pathologies in pregnancy. We have analyzed the expression of prototype (gal-1, -2, -7, -10) and chimera-type (gal-3) galectins in the placenta in cases of spontaneous abortions (SPA) and recurrent abortions (RA) in the first trimester. Fifteen placental samples from healthy pregnancies were used as a control group. Nine placentas were examined for spontaneous abortions, and 12 placentas for recurrent abortions. For differentiation and evaluation of different cell types of galectin-expression in the decidua, immunofluorescence was used. For all investigated prototype galectins (gal-1, -2, -7, -10) in SPA and RA placenta trophoblast cells the expression is significantly decreased. In the decidua/extravillous trophoblast only gal-2 expression was significantly lowered, which could be connected to its role in angiogenesis. In trophoblasts in first-trimester placentas and in cases of SPA and RA, prototype galectins are altered in the same way. We suspect prototype galectins have a similar function in placental tissue because of their common biochemical structure. Expression of galectin 3 as a chimera type galectin was not found to be significantly altered in abortive placentas.     

Strategy for robot motion and path planning in robot taping

Covering objects with masking tapes is a common process for surface protection in processes like spray painting, plasma spraying, shot peening, etc. Manual taping is tedious and takes a lot of effort of the workers. The taping process is a special process which requires correct surface covering strategy and proper attachment of the masking tape for an efficient surface protection. We have introduced an automatic robot taping system consisting of a robot manipulator, a rotating platform, a 3D scanner and specially designed taping end-effectors. This paper mainly talks about the surface covering strategies for different classes of geometries. The methods and corresponding taping tools are introduced for taping of following classes of surfaces: Cylindrical/extended surfaces, freeform surfaces with no grooves, surfaces with grooves, and rotational symmetrical surfaces. A collision avoidance algorithm is introduced for the robot taping manipulation. With further improvements on segmenting surfaces of taping parts and tape cutting mechanisms, such taping solution with the taping tool and the taping methodology can be combined as a very useful and practical taping package to assist humans in this tedious and time costly work.     

Quality assurance of Chinese herbal medicines: Procedure for multiple‐herb extraction

A quality assurance (QA) procedure for multiple‐herb extraction, which takes into account the existence of common chemical markers and multiple‐herb‐extraction effects, has been developed for producing Chinese herbal medicines (CHMs) of consistent quality. The experimental method for determining related correlation function of the multiple‐herb‐extraction effect was designed. A systematic solution strategy was also developed to appropriately decompose the multiple‐herb extraction system into several subsystems for obtaining solution(s) and determining the overall behavior of the system. An example of QA of Danshen–Gegen (DG) decoction was used to demonstrate the QA procedure. An H9c2 cell assay was used to test the efficacy of consistent quality DG decoctions prepared by different herb combinations with different material costs of herbs. It was observed that a multiple‐herb‐extraction effect was present in the aqueous extraction of Danshensu and this effect was depended on the extraction solvent. The possible mechanism of this multiple‐herb‐extraction effect in the aqueous DG extraction was speculated to be the change of initial pH value of the aqueous extraction solvent by an unknown component from Gegen. The experimental chemical marker concentrations fell within ±10% of the specified chemical marker compositions by using the amount of herb from each herb class as predicted by the QA model. Furthermore, an H9c2 cell assay was used to test the efficacy of three consistent quality DG extracts, which were produced by different herb combinations with different material costs of herbs. The results showed that the three DG extracts provided consistent biological efficacy against menadione‐induced toxicity. This study extended a recently developed QA procedure of single‐herb extraction to multiple‐herb extraction. It provides a solution of QA in extraction, which is one of the most important unresolved problems in the modernization of traditional Chinese medicines. With this modified model and the companion experiments, the amount of herbs needed from different quality classes to produce a multiple‐herb formula CHM product decoction with consistent quality can be exactly determined. © 2014 American Institute of Chemical Engineers AIChE J 60: 4014–4026, 2014     

Consensus-based decision support for multicriteria group decision making

Consensus decision making is complex and challenging in multicriteria group decision making due to the involvement of several decision makers, the presence of multiple, and often conflicting criteria, and the existence of subjectiveness and imprecision in the decision making process. To ensure effective decisions being made, the interest of all the decision makers usually represented by the degree of consensus in the decision making process has to be adequately considered. This paper presents a consensus-based approach for effectively solving the multicriteria group decision making problem. The subjectiveness and imprecision of the decision making process is adequately handled by using intuitionistic fuzzy numbers. An interactive algorithm is developed for consensus building in the group decision making process. A decision support system framework is presented for improving the effectiveness of the consensus building process. An example is presented for demonstrating the applicability of the proposed approach for solving the multicriteria group decision making problem in real world situations.