Relevant Deviations Research Articles

Current status of 3D EPID-based in vivo dosimetry in The Netherlands Cancer Institute

3D in vivo dose verification using a-Si EPIDs is performed routinely in our institution for almost all RT treatments. The EPID-based 3D dose distribution is reconstructed using a back-projection algorithm and compared with the planned dose distribution using 3D gamma evaluation. Dose-reconstruction and gamma-evaluation software runs automatically, and deviations outside the alert criteria are immediately available and investigated, in combination with inspection of cone-beam CT scans. The implementation of our 3D EPID- based in vivo dosimetry approach was able to replace pre-treatment verification for more than 90% of the patient treatments. Clinically relevant deviations could be detected for approximately 1 out of 300 patient treatments (IMRT and VMAT). Most of these errors were patient related anatomical changes or deviations from the routine clinical procedure, and would not have been detected by pre-treatment verification. Moreover, 3D EPID-based in vivo dose verification is a fast and accurate tool to assure the safe delivery of RT treatments. It provides clinically more useful information and is less time consuming than pre-treatment verification measurements. Automated 3D in vivo dosimetry is therefore a prerequisite for large-scale implementation of patient-specific quality assurance of RT treatments.

Systematic control structure evaluation of two-stage-riser catalytic pyrolysis processes

Control structure selection plays an irreplaceable role in achieving an effective control system. Through the application of steady-state multiplicities and classic control theories such as zero dynamics and relative gain arrays (RGAs), the primary goal of this article is to select the best control structure from the selected candidates based on heuristic reasoning for a demonstration two-stage-riser catalytic pyrolysis process which can maximize propylene yield without any significant losses in gasoline/diesel yields. Extended bifurcation diagrams and RGAs are adopted to preliminarily evaluate candidates from open-loop perspectives. Closed-loop steady-state multiplicity, which is employed to compare control actions associated with each control structure, can provide a solid basis for the synthesis of control loops. Dynamic simulations for tackling disturbances and tracking set points are finally carried out to evaluate the relevant maximum deviations and settling times under various scenarios. It is illustrated that output temperatures from two risers and the regenerator controlled by two recycled catalyst flow rates and the cooling water flow rate, respectively, which have the best controllability characteristic and most superior dynamic behavior, are the most suitable control structure for further control system design of the studied process.

Psicopatología y delimitación clínica de la esquizofrenia

La demencia precoz o esquizofrenia, psicosis frecuente en la edad juvenil y condicionada fundamentalmente por factores hereditarios, se distingue por aparecer sin causa exterior notoria y manifestar un conjunto especial de síntomas orgánicos y mentales. Entre los últimos se encuentran algunos característicos. De ahí el interés del estudio psicopatológico de esta psicosis. Las manifestaciones psicopatológicas más importantes de la esquizofrenia Son las siguientes: 1° En el campo de la actividad perceptiva: la impresión de extrañeza del mundo, las pseudopercepciones de la sensibilidad corporal, las alucinaciones o pseudoalucinaciones verbales y verbomotrices, sobre todo el pensamiento que se hace sonoro, el eco del pensamiento, las voces dialogantes y las de comentario de la propia acción. En general, las pseudopercepciones genuinamente esquizofrénicas se distinguen por ser experiencias que el sujeto vive sin asimilarlas en su existir autónomo. 2° En materia de pensamiento: la disgregación, la forma precategorial (simbolismo arcaico, autismo, participación en el ser ajeno), los pensamientos hechos, la substracción, la publicación y el bloqueo del pensamiento y las delusiones o delirios primarios (por falla directa del juicio, estableciendo relaciones sin motivo). En conjunto, el pensamiento esquizofrénico se puede caracterizar así: descabal el contenido concreto, frustráneo el aliento de la función activa, impersonal y mediata la substancia primaria. 3° El sentimiento se apaga hasta el vacío afectivo con alguna frecuencia y manifiesta anormalidades cualitativas como las siguientes: ambivalencia, sentimientos de (falsa) anafectividad, de imposición, de privación etc. 4° En materia de instinto, lo más significativo es la emergencia de obscuras fuerzas titánicas a la vez que la reanimación desconcertada de actitudes afectivas y valorativas del pasado personal, manifestándose las infantiles no como infantiles e inocentes sino, adulteradas, como actuales y perversas, a causa de que la conciencia del adulto enfermo reacciona con una mezcla de malicia y grosería, mezcla anexa al espíritu conmovido y violentado en su inserción existencial por la sexualidad desatada. 5° La acción en la esquizofrenia tiene como desviaciones relevantes: actos impulsivos, estereotipias, amaneramiento, estupor, ambitendencia, negativismo, ecopraxia, fenómenos catatónicos etc. 6° La conciencia del yo muestra una alienación del albedrío casi específica de la esquizofrenia, que puede llegar a la completa despersonalización y a la parálisis del yo. 7° La personalidad pierde su unidad y su perspectiva de valores, de motivos eficaces y evidentes: la objetividad espiritual perenne es sustituida por el capricho subjetivo que cambia con el instante y no se funda en nada. Los desórdenes de la memoria, de la atención, de la conciencia, salvo la impotencia del acto intencional, son raros y poco característicos; los de la conciencia del tiempo son mal conocidos todavía. La esquizofrenia no es una entidad nosológica sino un tipo clínico, con varias formas, susceptible de convertirse en un grupo de psicosis semejantes. Su diagnóstico diferencial tiene tres frentes: 1° el de la psicosis orgánicas de origen conocido, en que pueden presentarse cuadros clínicos con síntomas esquizofrénicos y aún "pseudoesquizofrenias" o "esquizofrenias sintomáticas"; 2° el de las psicosis de origen desconocido, sobre todo la psicosis maníaco-represiva; 3° las neurosis o reacciones pseudoesquizofrénicas, que aparecen en personalidades anormales o predispuestas. De las primeras difiere por la carencia de etiología manifiesta, de las segundas por la diversidad del cuadro de conjunto y la evolución, de las últimas en que no es comprensible en relación con las vicisitudes exteriores y la personalidad premórbida.

The Octavius1500 2D ion chamber array and its associated phantoms: dosimetric characterization of a new prototype.

The purpose of the study is to characterize the prototype of the new Octavius1500 (PTW, Freiburg, Germany) 2D ion chamber array, covering its use in different phantom setups, from the most basic solid water sandwich setup to the more complex cylindrical Octavius® 4D (Oct4D) (PTW) phantom/detector combination. The new detector houses nearly twice the amount of ion chambers as its predecessors (Seven29 and Octavius729), thereby tackling one of the most important limitations of ion chamber (or diode) arrays, namely the limited detector density. The 0.06 cm3 cubic ion chambers are now arranged in a checkerboard pattern, leaving no lines (neither longitudinally nor laterally) without detectors. All measurements were performed on a dual energy (6 MV and 18 MV) iX Clinac (Varian Medical Systems, Palo Alto, CA) and all calculations were done in the Eclipse treatment planning system (Varian) with the Anisotropic Analytical Algorithm. First, the basic characteristics of the 2D array, such as measurement stability, dose rate dependence and dose linearity were investigated in the solid water sandwich setup. Second, the directional dependence was assessed to allow the evaluation of the new Octavius2D phantom (Oct2D(1500)) for planar verification measurements of composite plans. Third, measurements were performed in the Oct4D phantom to evaluate the impact of the increased detector density on the accuracy of the volumetric dose reconstruction. While showing equally good dose linearity and dose rate independence, the Octavius1500 outperforms the previous models because of its instantaneous measurement stability and its twofold active area coverage. Orthogonal field-by-field measurements immediately benefit from the increased detector density. The 3.9 cm wide compensation cavity in the new Oct2D(1500) phantom prototype adequately corrects for directional dependence from the rear, resulting in good agreement within the target dose. Discrepancies may arise towards the sides of the array because of uncompensated lateral beam incidence. The beneficial impact of the detector density is most prominent in the Oct4D system, for which the average pass rate (PR) is now nearly 100% (99.31±0.37) when using gamma criteria of 2%G,2 mm (10% dose threshold). In search of gamma analysis criteria that are not too lenient to detect possibly relevant deviations, the authors conclude that for our radiotherapy environment, the authors choose to adopt 3%L,3 mm PR97% (threshold 10%) criteria for the Oct2D(1500)/Octavius1500 system and 2%L,3 mm PR97% (threshold 10%) for the Oct4D/Octavius1500 system. These are first line pass/check criteria and plans that fail are not necessarily rejected, but submitted to a more detailed investigation. When irradiated from the front, the Octavius1500 array has two main advantages over its 729 predecessors: its instantaneous measurement stability and--most importantly-its twofold detector density. In the Oct2D1500 phantom, these advantages are counterbalanced by the more pronounced directional dependence. The measurement-based 3D dose reconstruction in the Oct4D system, however, benefits considerably from the higher detector density in the checkerboard panel design.

Usability of devices for self-injection: results of a formative study on a new disposable pen injector.

This article presents a late-stage formative usability study of a pen-injector platform device. Such devices are used for the subcutaneous delivery of biopharmaceuticals, primarily for self-administration by the patient. The study was conducted with a broad user population, defined to represent user characteristics across a range of indications. The goals of the study were to confirm that the pen could be used without recurring patterns of use errors leading to hazardous situations, to evaluate the comprehension of the instructions for use (IFU), and to determine if training is necessary. In the study, a total of 36 participants in six groups (health care providers, caregivers, adolescents, diabetics with retinopathy, diabetics with neuropathy, and patients with arthritis) each read the IFU, prepared the device, and performed two simulated injections into an injection pad. Any use errors, near misses, or deviations from the IFU procedure were recorded. The overall success rate (injection completed by the participant without need for assistance) was 94% for the first and 100% for the second injection. Ninety-two percent of the participants reported that they felt confident using the device, 100% found the IFU helpful, and 75% found the device positively comfortable to use. Overall, a total average of 3.35 deviations and errors per user and injection were recorded (there were no near misses). Subtracting the errors without any potential for negative consequences for the injection or the user (trivial deviations), as well as those related to attaching and removing the pen needle (independent of the design of the pen itself), led to an average of 1.31 potentially relevant deviations per user and injection. It was concluded that the pen injector together with the IFU could be safely and efficiently used by all user groups without any training, and thus that the device and IFU in their current form are well suited for use in a range of specific applications.

Extreme value laws for dynamical systems under observational noise

In this paper we prove the existence of extreme value laws for dynamical systems perturbed by the instrument-like-error, also called observational noise. An orbit perturbed with observational noise mimics the behavior of an instrumentally recorded time series. Instrument characteristics–defined as precision and accuracy–act both by truncating and randomly displacing the real value of a measured observable. Here we analyze both these effects from a theoretical and a numerical point of view. First we show that classical extreme value laws can be found for orbits of dynamical systems perturbed with observational noise. Then we present numerical experiments to support the theoretical findings and give an indication of the order of magnitude of the instrumental perturbations which cause relevant deviations from the extreme value laws observed in deterministic dynamical systems. Finally, we show that the observational noise preserves the structure of the deterministic attractor. This goes against the common assumption that random transformations cause the orbits asymptotically fill the ambient space with a loss of information about the fractal structure of the attractor.

Detailed Analysis of the Genetic and Epigenetic Signatures of iPSC-Derived Mesodiencephalic Dopaminergic Neurons

SummaryInduced pluripotent stem cells (iPSCs) hold great promise for in vitro generation of disease-relevant cell types, such as mesodiencephalic dopaminergic (mdDA) neurons involved in Parkinson’s disease. Although iPSC-derived midbrain DA neurons have been generated, detailed genetic and epigenetic characterizations of such neurons are lacking. The goal of this study was to examine the authenticity of iPSC-derived DA neurons obtained by established protocols. We FACS purified mdDA (Pitx3Gfp/+) neurons derived from mouse iPSCs and primary mdDA (Pitx3Gfp/+) neurons to analyze and compare their genetic and epigenetic features. Although iPSC-derived DA neurons largely adopted characteristics of their in vivo counterparts, relevant deviations in global gene expression and DNA methylation were found. Hypermethylated genes, mainly involved in neurodevelopment and basic neuronal functions, consequently showed reduced expression levels. Such abnormalities should be addressed because they might affect unambiguous long-term functionality and hamper the potential of iPSC-derived DA neurons for in vitro disease modeling or cell-based therapy.

XG-102 administered to healthy male volunteers as a single intravenous infusion: a randomized, double-blind, placebo-controlled, dose-escalating study.

The aim of the study is to evaluate the safety, tolerability and pharmacokinetics (PK) of the JNK inhibitor XG-102 in a randomized, double blind, placebo controlled, sequential ascending dose parallel group Phase 1 Study. Three groups of male subjects received as randomly assigned ascending single XG-102 doses (10, 40, and 80 μg/kg; 6 subjects per dose) or placebo (2 subjects per dose) as an intravenous (IV) infusion over 60 min. Safety and tolerability were assessed by physical examination, vital signs, electrocardiography, eye examination, clinical laboratory tests and adverse events (AEs). PK was analyzed using noncompartmental methods. All reported AEs were mild to moderate and neither their number nor their distribution by System Organ Class suggest a dose relationship. Only headache and fatigue were considered probably or possibly study drug related. Headache frequency was similar for active and placebo, consequently this was not considered to be drug related but probably to study conditions. The other examinations did not show clinically relevant deviations or trends suggesting a XG-102 relationship. Geometric mean half-life was similar among doses, ranging from 0.36 to 0.65 h. Geometric mean XG-102 AUC0–last increased more than linearly with dose, 90% confidence intervals (CIs) did not overlap for the two highest doses. Geometric mean dose normalized Cmax values suggest a more than linear increase with dose but 90% CIs overlap. It may be concluded that XG-102 single IV doses of 10–80 μg/kg administered over 1 h to healthy male subjects were safe and well tolerated.

Analysis of Parabolic Trough Concentrator Mirror Shape Accuracy in different Measurement Setups

Mirror shape accuracy as a key optical performance parameter for parabolic trough collectors can be assessed accurately by common measurement systems proving the high quality of state-of-the-art mirror panels. However, measurement results cannot always be compared directly because critical boundary conditions are not yet standardized. This paper quantifies the differences in shape accuracy results between the most common measurement setups for parabolic trough mirror panels and identifies measurement position, mounting mode and support frame employed for the measurement as relevant boundary conditions.Deflectometric measurements of mirror panels of RP3 geometry were performed at DLR's QUARZ Center Cologne in vertical (mounting points vertically and curved direction horizontally aligned) and horizontal measurement position (mirrors facing upward with mounting points horizontally aligned), both with and without tightening the mirrors to a support frame with screws. Finite element models were applied to calculate gravity-induced deformation and resulting slope and focus deviation on three different types of support frame: an ideally rigid support frame, a laboratory support frame, and an ideal support frame with elastic brackets.The measurement results demonstrate that the difference in position and mounting mode can lead to relevant deviations of the shape accuracy results higher than the uncertainty of the employed deflectometric measurement system. For RP3 inner mirror panels a difference of up to 0.7 mrad in root mean square slope deviation (SDx) and 3.3mm in root mean square focus deviation (FDx) from vertical to horizontal position was measured. Mirror shape specifications may thus not be applicable in all positions. Concerning the mounting onto different types of modeled support frame (in horizontal position) a variation of 0.5 mrad (SDx) and 1.8mm (FDx) was calculated for perfectly shaped RP3 inner mirrors mounted onto an ideally rigid support frame compared to the case when mounted to a support frame with elastic brackets.

Influence of Partial Pressure of Oxygen in Blood Samples on Measurement Performance in Glucose-Oxidase-Based Systems for Self-Monitoring of Blood Glucose

Partial pressure of oxygen (pO2) in blood samples can affect blood glucose (BG) measurements, particularly in systems that employ the glucose oxidase (GOx) enzyme reaction on test strips. In this study, we assessed the impact of different pO2 values on the performance of five GOx systems and one glucose dehydrogenase (GDH) system. Two of the GOx systems are labeled by the manufacturers to be sensitive to increased blood oxygen content, while the other three GOx systems are not. Aliquots of 20 venous samples were adjusted to the following pO2 values: <45, ~70, and ≥150 mmHg. For each system, five consecutive measurements on each sample aliquot were performed using the same test strip lot. Relative differences between the mean BG results at pO2 ~70 mmHg, which is considered to be similar to pO2 in capillary blood samples, and the mean BG result at pO2 <45 and ≥150 mmHg were calculated. For all tested GOx systems, mean relative differences in the BG measurement results were between 6.1% and 22.6% at pO2 <45 mmHg and between -7.9% and -14.9% at pO2 ≥150 mmHg. For both pO2 levels, relative differences of all tested GOx systems were significant (p < .0001). The GDH system showed mean relative differences of -1.0% and -0.4% at pO2 values <45 and ≥150 mmHg, respectively, which were not significant. These data suggest that capillary blood pO2 variations lead to clinically relevant BG measurement deviations in GOx systems, even in GOx systems that are not labeled as being oxygen sensitive.

Fatigue assessment of vibrating rail vehicle bogie components under non-Gaussian random excitations using power spectral densities

The assessment of fatigue load under random vibrations is usually based on load spectra. Typically they are computed with counting methods (e.g. Rainflow) based on a time domain signal. Alternatively methods are available (e.g. Dirlik) enabling the estimation of load spectra directly from power spectral densities (PSDs) of the corresponding time signals; the knowledge of the time signal is then not necessary. These PSD based methods have the enormous advantage that if for example the signal to assess results from a finite element method based vibration analysis, the computation time of the simulation of PSDs in the frequency domain outmatches by far the simulation of time signals in the time domain. This is especially true for random vibrations with very long signals in the time domain. The disadvantage of the PSD based simulation of vibrations and also the PSD based load spectra estimation is their limitation to Gaussian distributed time signals. Deviations from this Gaussian distribution cause relevant deviations in the estimated load spectra. In these cases usually only computation time intensive time domain calculations produce accurate results. This paper presents a method dealing with non-Gaussian signals with real statistical properties that is still able to use the efficient PSD approach with its computation time advantages. Essentially it is based on a decomposition of the non-Gaussian signal in Gaussian distributed parts. The PSDs of these rearranged signals are then used to perform usual PSD analyses. In particular, detailed methods are described for the decomposition of time signals and the derivation of PSDs and cross power spectral densities (CPSDs) from multiple real measurements without using inaccurate standard procedures. Furthermore the basic intention is to design a general and integrated method that is not just able to analyse a certain single load case for a small time interval, but to generate representative PSD and CPSD spectra replacing extensive measured loads in time domain without losing the necessary accuracy for the fatigue load results. These long measurements may even represent the whole application range of the railway vehicle. The presented work demonstrates the application of this method to railway vehicle components subjected to random vibrations caused by the wheel rail contact. Extensive measurements of axle box accelerations have been used to verify the proposed procedure for this class of railway vehicle applications.

Outcomes of pancreatic resection: Analysis of the french national database on 6436 patients

Outcomes of pancreatic resection: Analysis of the french national database on 6436 patients

Extension of the Sussman–Bathe spline-based hyperelastic model to incompressible transversely isotropic materials

In this paper we extend the Sussman–Bathe spline-based hyperelastic isotropic model to predict the behavior of transversely isotropic isochoric materials. The model is based on an uncoupled decomposition of the stored energy function and a generalization of the inversion formula used by Sussman and Bathe. The present extension introduces some approximations that, in all studied cases, do not yield relevant deviations from the experimental data. The isotropic model results in a particular case of the present formulation. Several possibilities of user-prescribed experimental data are addressed. The model is used to predict experiments of calendered rubber and of biological tissues.

ADVANTAGES AND DISADVANTAGES OF ARSENAZO III AND CHLOROPHOSPONAZO III UTILIZATION FOR SPECTROPHOTOMETRIC Th DETERMINATION

The paper is devoted to the evaluation of important validation descriptors concerning the spectrophotometric determination of thorium using Arsenazo III and Chlorophosponazo III. In diluted hydrochloric acid the complex between Th and Arsenazo III is formed instantly and remains stable for 25 minutes with constant absorbance. Beer’s law is obeyed in the range from 0.70 to 11.64 mmol ∙ L -1 . The molar absorptivity at 660 nm is equal to 9.74(±0.09)∙10 4 cm −1 ∙ mol −1 ∙ L (data in parentheses stands for standard deviation).The relevant relative standard deviations (RSD) reached ±1.48 %, ±4.34 % and ±3.07, respectively. Thorium concentration can be quantified using Chlorophosphonazo III in media of diluted nitric acid. The linear range of the proposed method was from 1.59 to 18.10 mmol ∙ L -1 of thorium. The experimentally determined values of molar absorptivity reached e 691 =3.76(± 0.05)∙10 4 cm -1 ∙ mol -1 ∙ L. The repeatability and trueness of determination in the linear range did not exceed ±2.2% and 3.3%, respectively. Color stability of the Th-Chlorophosphonazo III complex maintained a constant value for at least two hours. LOD and LOQ values for both methods were established applying three approaches – the 3-σ, the ULA2 and the Hubaux-Vos ones.

WE-G-BRB-03: On the Detectability of Jaw Decalibrations with the DAVID System.

To evaluate if the recently described problems with the calibration of jaws at Varian linear accelerators can be detected with the DAVID system. Recently Varian Clinac field size issues resulted in a widespread medical device correction notice, stating that incorrect jaw positioning due to excessive connector resistances may result in clinically relevant deviations from the intended field size. Since field size checks via the light field, separately for each administered field segment, are not practicable, it might be helpful to know that an independent, permanently active field size surveillance system is routinely used in our department since four years. The DAVID system (PTW-Freiburg, Germany) is a translucent multiwire transmission ionisation chamber, placed in the linac accessory holder. Each detection wire of the chamber is positioned in theprojection of the midline of the associated MLC leaf pair, resulting in a signal proportional to the leaf pair aperture. High lateral resolution has been achieved by a deconvolution software (Looe et al, PMB 55, 2010, 3981- 3992). MLC decalibrations are detected by comparison between measured and reference signal profiles. The side wings of the DAVID system signal profiles are sensibly influenced by the position of the backup jaw blocks limiting the field size in the direction at right angles to the MLC travel direction. Systematic variation of the backup jaw positions for several field sizes and IMRT plans has revealed high sensitivity of the signal profile side wings with respect to jaw decalibrations. The DAVID system is able to detect, without any delay, suddenly appearing jaw decalibrations down to positioning errors less than 1mm. Use of the DAVID system provides the independent and permanent surveillance of correct field sizes including the position of the backup jaws, making checks of light-field congruence for each field segment unnecessary.

Comparison between SAPS II and SAPS 3 in predicting hospital mortality in a cohort of 103 Italian ICUs. Is new always better?

More recent severity scores should be more reliable than older ones because they account for the improvement in medical care over time. To provide more insight into this issue, we compared the predictive ability of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 (originally developed from data collected in 1991-1992 and 2002, respectively) on a sample of critically ill patients. This was a prospective observational study on 3,661 patients from 103 Italian intensive care units. Standardized mortality ratios (SMRs) were calculated. Assessment of calibration across risk classes was performed using the GiViTI calibration belt. Discrimination was evaluated by means of the area under the receiver operating characteristic analysis. Both scores were shown to discriminate fairly. SAPS 3 largely overpredicted mortality, more than SAPS II (SMR 0.63, 95 % CI 0.60-0.66 vs. 0.87, 95 % CI 0.83-0.91). This result was consistent and statistically significant across all risk classes for SAPS 3. SAPS II did not show relevant deviations from ideal calibration in the first two deciles of risk, whereas in higher-risk classes it overpredicted mortality. Both scores provided unreliable predictions, but unexpectedly the newer SAPS 3 turned out to overpredict mortality more than the older SAPS II.

Colonic carcinogenesis along different genetic routes: glycophenotyping of tumor cases separated by microsatellite instability/stability

Different genetic routes account for colonic carcinogenesis. However, when analyzing colon cancer specimens, separation into different groups based on genetic alterations is commonly not performed. Thus, we here initiate the comparative phenotyping considering microsatellite instability/stability for clinical specimens. The focus is given to glycan epitopes, expression of which is known to be modulated by signal-transducing proteins that act as key regulators of normal colon epithelial growth and differentiation. In addition to six plant lectins used as sensors, the presence of two adhesion/growth-regulatory galectins is studied. Overall, a considerable level of intra- and interindividual heterogeneity is revealed. Alterations in the proportion of stained cells between tumor-adjacent and malignant epithelia concerned plant lectins, which bind substituted N-glycan cores, α2,6-sialylated branch ends, core 1 O-glycans and N-acetylgalactosamine. A tendency for changes was noted between microsatellite-unstable and microsatellite-stable cases for core substitution (bisected N-glycan, presence of β1,6-branching) and status of α2,6-sialylation. Statistical significance was reached for presence of galectin-3, found to be elevated in microsatellite-stable compared to microsatellite-unstable tumors. These results emphasize the potential of distinct signaling pathways to regulate certain aspects of the glycophenotype in vivo and thus delineate a perspective to discern functionally relevant deviations in expression of endogenous lectins and their counter-receptors.

Comparative analysis as a management tool for broiler breeder farms: Simulated individual farm analysis (IFAS)

The objective of this study was to develop a management information system to evaluate the tactical management of a breeder flock using individual farm analysis with a deterministic simulation model (IFAS). Individual farm analysis is a method that evaluates the performance of individual farms by comparing them with standards. In the first step of IFAS, a farm accounting system is used to compare performance indicators of a flock with the same performance indicators of the average of a group of flocks that produced in the same time period. In the next step, a deterministic simulation model is used to determine the factors causing the traced deviations in performances. Then, relevant deviations are determined based on the economic and statistical importance of each traced deviation. Finally, the deviations are identified by relevance to give farmers an indication of their strong and weak management practices.

Erweitertes medizinisches Qualitätsmanagement am Beispiel der Tracer-Diagnose Polytrauma. Eine Pilotstudie aus dem Bereich des Luftrettungsdienstes

BackgroundAdequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality.MethodsA retrospective study of primary rescue missions of the Helicopter Emergency Medical Service (HEMS) Christoph 22 in Ulm over a period of 2.5 years was performed. In a detailed analysis of filter criteria, in which relevant deviations from the recommendations (not fulfilled in > 10% of the cases) occurred, process data was included (vital data, measurements and events).ResultsIn the study population (n = 298, males 71.8%, mean age 39.8 ± 21.8 years) 2 filter criteria were identified in which relevant deviations where observed: time management where prehospital treatment time ≤ 60 min in 36% of the cases was not fulfilled and circulatory management where the systolic blood pressure, detected with Riva-Rocci method (RR sys ) ≥ 120 mmHg on hospital admission in patients with severe head trauma was not fulfilled in 45% of the cases. In patients with deviations in time management, prehospital treatment time was prolonged (75.6 ± 18.3 min versus 50.5 ± 6.7 min; p < 0.01) caused by a prolonged on scene attendance time (34.1 ± 22.1 min versus 20.6 ± 9.2 min; p < 0.01) and transport time (17.3 ± 9.4 min versus 13.3 ± 4.8 min; p < 0.01). In entrapment trauma prehospital treatment time was expanded (44% versus10%; p < 0.01). Patients in whom circulatory management deviations were observed were more often in shock on arrival at the scene (RR sys ≤ 90 mmHg: 60% versus 30%; p < 0.01), more often hypoxemic [pulse oximeter oxygen saturation (S p O 2 ) ≤ 90%: 36% versus 19%; p < 0.05] and more often sustained a trauma to the chest as well as to chest and abdomen/pelvis (69% versus 52% and 42% versus 28%, respectively; p < 0.05). Furthermore, the infusion volume of colloids was higher (1241 ± 810 ml versus 753 ± 359 ml; p < 0.05) and the combined usage of small volume resuscitation and catecholamines was more often necessary (42% versus 25%; p < 0.05).ConclusionsIncluding process data of prehospital mission data recording facilitates an extended medical quality management.

Erweitertes medizinisches Qualitätsmanagement am Beispiel der „Tracer“-Diagnose „Polytrauma“

Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality. A retrospective study of primary rescue missions of the Helicopter Emergency Medical Service (HEMS) Christoph 22 in Ulm over a period of 2.5 years was performed. In a detailed analysis of filter criteria, in which relevant deviations from the recommendations (not fulfilled in > 10% of the cases) occurred, process data was included (vital data, measurements and events). In the study population (n = 298, males 71.8%, mean age 39.8 ± 21.8 years) 2 filter criteria were identified in which relevant deviations where observed: time management where prehospital treatment time ≤ 60 min in 36% of the cases was not fulfilled and circulatory management where the systolic blood pressure, detected with Riva-Rocci method (RR(sys)) ≥ 120 mmHg on hospital admission in patients with severe head trauma was not fulfilled in 45% of the cases. In patients with deviations in time management, prehospital treatment time was prolonged (75.6 ± 18.3 min versus 50.5 ± 6.7 min; p < 0.01) caused by a prolonged on scene attendance time (34.1 ± 22.1 min versus 20.6 ± 9.2 min; p < 0.01) and transport time (17.3 ± 9.4 min versus 13.3 ± 4.8 min; p < 0.01). In entrapment trauma prehospital treatment time was expanded (44% versus 10%; p < 0.01). Patients in whom circulatory management deviations were observed were more often in shock on arrival at the scene (RR(sys) ≤ 90 mmHg: 60% versus 30%; p < 0.01), more often hypoxemic [pulse oximeter oxygen saturation (S(p)O(2)) ≤ 90%: 36% versus 19%; p < 0.05] and more often sustained a trauma to the chest as well as to chest and abdomen/pelvis (69% versus 52% and 42% versus 28%, respectively; p < 0.05). Furthermore, the infusion volume of colloids was higher (1241 ± 810 ml versus 753 ± 359 ml; p < 0.05) and the combined usage of small volume resuscitation and catecholamines was more often necessary (42% versus 25%; p < 0.05). Including process data of prehospital mission data recording facilitates an extended medical quality management.