Volume Setting Research Articles

Monitoring Infusion Pump Via Wireless (Occlusion part)

Infuse pump is a medical equipment which is design to control and regulate the administration of intravenous fluids in the treatment.. This module uses the L298N motor driver as a stepper motor controller. The choice of the infuse pump setting is the volume setting from 100 ml to 500 ml and the speed setting of 30 ml / hour, 60 ml / hour, and 90 ml / hour. The author uses the Atmega 328 microcontroller as a droplet controller per minute, volume and speed. Occlusion in this device is in the detector of the droplets that are alerted in the presence of a sound buzzer. This tool is also equipped with monitoring volume, tpm and speed on a wireless-based PC using HC-11 as a transmission from module to PC. This tool is equipped with oclusion. The flow rate data processing in IDA from infusion got the highest error result at the setting of 30 ml / hour which was equal to 5.97%. the highest error for the calculation of droplets in the module is the setting of 30 ml / hour which is equal to 32% and manually at setting 60 which is 23%.

Social Noise Exposure in a Sample of Slovak University Students.

Purpose: Social noise exposure is currently an emerging problem in adolescents and young adults. Various leisure time activities may be responsible for hearing impairment (temporary or permanent hearing threshold shift or hearing loss). The study aimed to quantify environmental noise from various sources—voluntary (social) noise (personal music players (PMPs), high-intensity noise exposure events), and road traffic noise and to detect hearing disorders in relation to individual listening to PMPs in the sample of young adults living and studying in Bratislava, the capital city of Slovakia. Methods: The study included 1003 university students (306 men and 697 women, average age 23.1 ± 2) living in Bratislava for 4 or more years; 347 lived in the student housing facility exposed to road traffic noise (LAeq = 67.6 dB) and 656 in the control one (LAeq = 53.4 dB). Respondents completed a validated ICBEN 5-grade scale “noise annoyance questionnaire”. In the exposed group a significant source of annoyance was road traffic noise (p < 0.001), noise from entertainment facilities (p < 0.001), industrial noise (p < 0.001), and noise from neighboring flats (p = 0.003). The exposure to PMPs was objectified by the conversion of the subjective evaluation of the volume setting and duration. With the cooperation of the Ear, Nose and Throat (ENT)specialist, we arranged audiometric examinations on the pilot sample of 41 volunteers. Results: From the total sample of respondents, 79.2% reported the use of a PMP in the course of the last week, and the average time was 285 min. There was a significant difference in PMP use between the road traffic noise-exposed (85.6%) and the control group (75.8%) (p = 0.01). Among PMP users 30.7% exceeded the lower action value (LAV) for industry (LAeq,8h = 80 dB). On a pilot sample of volunteers (n = 41), audiometry testing was performed indicating a hearing threshold shift at higher frequencies in 22% of subjects. Conclusions: The results of the study on a sample of young healthy individuals showed the importance of exposure to social noise as well as to road traffic noise and the need for prevention and intervention.

1003: Optimizing fetal aneuploidy screening in an austere military clinical environment: A cost of care analysis

Austere clinical settings within the military healthcare system pose unique challenges in screening for fetal aneuploidy. The objective of this study is to compare aneuploidy screening strategies in a military treatment facility with limited in-house perinatal resources. We identified Naval Hospital Guantanamo Bay as a surrogate for an austere prenatal clinical environment and performed a cost of care analysis to compare two aneuploidy screening strategies: the serum integrated and cell free DNA. The baseline screen opt-in rate was determined by reviewing all low risk subjects who presented for prenatal care < 20 weeks gestation over a six year period (2013-2018, n=48). Rates of diagnostic testing following a positive screen for trisomy 18/21 were derived from the literature. Test performance characteristics and costs were provided by the reference lab. Over the five year period, the screen opt-in rate was calculated at 90%. Screening using the serum integrated would cost $3,332.91 over six years versus $17,756.89 with cell free DNA. Traditional screening would result in 2.2 positive tests versus 0.2 using cell free DNA, leading to 0.87 versus 0.14 diagnostic testing procedures. The integrated screen will detect 90% and 88% of fetuses with Trisomy 18 and 21 respectively versus 98% and 99% for cell free DNA. As an initial screening strategy, cell free DNA for low risk women offers enhanced detection rates for Trisomy 18/21 with a lower false positive rate and need for confirmatory diagnostic testing but costs five times more than traditional screening. In a low volume setting with limited resources, the added cost may be justified given the implications of unrecognized aneuploidy.

Prevalence of loud leisure noise activities among a representative sample of Canadians aged 6-79 years.

This population-based study estimates the prevalence of loud leisure noise exposure and hearing protection usage among Canadians, as well as the population potentially at-risk using an occupational limit of 85 dBA, LEX 40 h, which denotes a typical occupational noise limit for a 40 hour work week. A total of 10 460 participants, aged 6-79 years, completed a Canadian Health Measures Survey household questionnaire. Loud leisure noise was defined by vocal effort required while communicating at arm's length except for loud personal listening device (PLD) usage with earbuds/headphones, which included both volume setting and vocal effort. The most prevalent loud leisure noise activities were amplified music, car/home stereo listening, and power tools, with 40% reporting each source, followed by sporting/entertainment (25%), gasoline engines (23%), and loud PLD listening (19.5%). Loud leisure noise was more prevalent among 12-39 year olds and males. Hearing protection usage was uncommon, from 44.2% (firearms) to 20.3% (power tools) and below 3% during amplified music and sporting/entertainment events. Calculations using self-reported duration of loud leisure noise activities estimated that 6.6 × 106 Canadians were in the high cumulative noise exposure category. A large proportion of Canadians would be expected to develop some degree of noise-induced hearing loss should this pattern persist over years.

2069. A Unique Approach to Outpatient Antibiotic Stewardship in Rural Southern Ohio

BackgroundA five county rural community in southern Ohio was identified as having significantly higher than average rates of antibiotic use. The hospital system serving this area, Southern Ohio Medical Center (SOMC), began initial efforts in antimicrobial stewardship focusing on inpatient prescribing. However, most antimicrobial consumption occurs in the outpatient setting. Early attempts to improve antibiotic prescribing focused on only provider education and resulted in little change. Providers felt they were performing well, or their patients were more complex and prescribing the antibiotics was warranted. SOMC partnered with the state Quality Improvement Organization, HSAG, to design an intervention to address these challenges.MethodsAll outpatient and emergency room encounters with acute bronchitis and upper respiratory infection (URI) (ICD-10 codes [J00, J06.9, and J20.X]) were included in the analysis. Using criteria from a National Quality Forum measure, concomitant diagnoses were excluded to identify encounters where an associated condition may indicate the case is more complex. A 6-month baseline and two additional 6-month remeasurement periods were analyzed. Providers were given letters, peer-to-peer antimicrobial data comparison, and in-person feedback with guideline-driven recommendations for these conditions.ResultsBaseline analysis indicated 50% of all encounters without a coded concomitant diagnosis resulted in antibiotic prescriptions. There was a reduction in the overall rate at each remeasurement period, to 34% and then 12%. This resulted in a 76% relative improvement rate (RIR) overall at the final remeasurement period. At baseline, the highest volume setting, urgent care, had a prescribing rate of 71%. Urgent-care prescriptions reduced each remeasurement to 45% and 13%, resulting in an 81% RIR.ConclusionImplementing a robust outpatient stewardship program in a rural nonacademic setting is not without unique challenges. By using peer comparison of provider performance data on prescribing habits in uncomplicated patients with URI and acute bronchitis in addition to education, the rate of appropriate antibiotic use improved. Disclosures All authors: No reported disclosures.

Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting.

The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. A retrospective analysis was conducted of all FFFs performed over a 20-year period at a low-volume single tertiary center to identify risk factors and postoperative complications. A total of 129 FFFs were included (122 mandible, 7 maxilla). Complete flap failure occurred in 12.4% and partial flap failure in 7.8% of patients. A significant relation was found between younger age and flap failure, and most failures were associated with venous thrombosis. In-hospital surgical complications occurred in 60.5%, in-hospital medical complications in 49.6%, and out-of-hospital complications in 77.5% of patients. The in-hospital reintervention rate was 27.1%, and including salvaged flaps, flap survival rate was 87.6%. Osteomyocutaneous FFF failure (complete 12.4%; partial 7.8%) is an important clinical reality in a low-volume head and neck reconstruction center resulting in an in-hospital reintervention rate of 27.1%. Postoperative complications are frequent, both surgical and out-hospital complications. These results provide a better understanding of the limitations of the FFF in a low-volume center and can be used to optimize care in this kind of setting.

Does Hospital Volume Affect Outcomes in Spine Surgeries? A Systematic Review.

Systematic review. To assess the impact of hospital volume on postoperative outcomes in spine surgery. Several strategies have recently been proposed to optimize provider outcomes, such as regionalization to higher volume centers and setting volume benchmarks. We performed a systematic review examining the association between hospital volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior/posterior cervical fusions, anterior/posterior lumbar fusions, laminectomies, discectomies, spinal deformity surgeries, and surgery for spinal malignancies. We searched the Pubmed, OVID MEDLINE (1966-2018), Google Scholar, and Web of Science (1900-2018) databases in January 2018 using the search criteria ("Hospital volume" OR "volume" OR "volume-outcome" OR "volume outcome") AND ("spine" OR "spine surgery" OR "lumbar" OR "cervical" OR "decompression" OR "deformity" OR "fusions"). There were no restrictions placed on study design, publication date, or language. The studies were evaluated with respect to the quality of methodology as outlined by the Grading of Recommendations Assessment, Development, and Evaluation system. Twelve studies were included in the review. Studies were variable in defining hospital volume thresholds. Higher hospital volume was associated with statistically significant lower risks of postoperative complications, a shorter length of stay, lower cost of hospital stay, and a lower risk of readmissions and reoperations/revisions. Our findings suggest a trend toward better outcomes for higher volume hospitals; however, further study needs to be carried out to define objective volume thresholds for specific spine surgeries for hospitals to use as a marker of proficiency.

Risk Assessment of Recreational Noise-Induced Hearing Loss from Exposure through a Personal Audio System-iPod Touch.

Recreational noise-induced hearing loss (RNIHL) is a major health issue and presents a huge economic burden on society. Exposure to loud music is not considered hazardous in our society because music is thought to be a source of relaxation and entertainment. However, there is evidence that regardless of the sound source, frequent exposure to loud music, including through personal audio systems (PAS), can lead to hearing loss, tinnitus, difficulty processing speech, and increased susceptibility to age-related hearing loss. Several studies have documented temporary threshold shifts (TTS) (a risk indicator of future permanent impairment) in subjects that listen to loud music through their PAS. However, there is not enough information regarding volume settings that may be considered to be safe. As a primary step toward quantifying the risk of RNIHL through PAS, we assessed changes in auditory test measures before and after exposure to music through the popular iPod Touch device set at various volume levels. This project design incorporated aspects of both between- and within-subjects and used repeated measures to analyze individual groups. A total of 40 adults, aged 18-31 years with normal hearing were recruited and randomly distributed to four groups. Each group consisted of five males and five females. Subjects underwent two rounds of testing (pre- and postmusic exposure), with a 30-min interval, where they listened to a playlist consisting of popular songs through an iPod at 100%, 75%, 50%, or 0% volume (no music). Based on our analysis on the Knowles Electronic Manikin for Acoustic Research, with a standardized 711 coupler, it was determined that listening to the playlist for 30 min through standard earbuds resulted in an average level of 97.0 dBC at 100% volume, 83.3 dBC at 75% volume, and 65.6 dBC at 50% volume. Pure-tone thresholds from 500-8000 Hz, extended high-frequency pure tones between 9-12.5 kHz, and distortion product otoacoustic emissions (DPOAE) were obtained before and after the 30-min music exposure. Analysis of variance (ANOVA) was performed with two between-subjects factors (volume and gender) and one within-subjects factor (frequency). Change (shift) in auditory test measures was used as the outcome for the ANOVA. Results indicated significant worsening of pure-tone thresholds following music exposure only in the group that was exposed to 100% volume at the following frequencies: 2, 3, 4, 6 and 8 kHz. DPOAEs showed significant decrease at 2000 and 2822 Hz, also only for the 100% volume condition. No significant changes were found between pre- and postmusic exposure measures in groups exposed to 75%, 50%, or 0% volume conditions. Follow-up evaluations conducted a week later indicated that pure-tone thresholds had returned to the premusic exposure levels. These results provide quantifiable information regarding safe volume control settings on the iPod Touch with standard earbuds. Listening to music using the iPod Touch at 100% volume setting for as little as 30 min leads to TTS and worsening of otoacoustic emissions, a risk for permanent auditory damage.

Effects of micro-nano-lime (CaCO3) particles on the strength and resilience of road clay beds

Increasing land value and the importance of modern and high-rise buildings have made it inevitable to strengthen weak or low-strength clay beds for construction. Due to its low cost, high availability, and positive strength effects, lime has long been utilized for stabilizing weak soils. However, extensive consumption, a long initial setting time, operating risks, and damaging environmental effects are among the disadvantages of using lime for this purpose. Nanotechnology is the understanding and application of the new properties of nanoscale materials. This interdisciplinary knowledge had considerable positive effects on various engineering trends with the discovery of nanoparticles. In this research, lime powder with specific dry weight percentages of 2, 4, 8, and 16, and lime nanoparticles with specific dry weight percentages of 0.5, 1, 2, and 4 were combined with clay. To analyze soil parameters in terms of engineering, changes in the Atterberg limits, optimal moisture content for soil compaction, maximum dry density, unconfined compressive strength, and the California Bearing Ratio (CBR) were investigated. Based on the results, the optimal weight percentages for lime powder and lime nanoparticles were approximately 4 and 1, respectively. A significant increase in the results of strength tests pointed to the improved performance of lime nanoparticles, compared to lime powder, in terms of both consumption volume and initial setting time. Also, a six-fold increase in CBR reduced the thickness of the pavement layer by 20% by increasing the roadbed resilient modulus (MR).

DIGITAL TONE CONTROL MENGGUNAKAN MIKROKONTROLLER 8-BIT

AbstractThe quality of the audio sound system that is generated depends on the tone control. Good audio tone control signal output produces an audio signal that approaches the input audio signal. Tone controls are generally used on audio sound system devices using potentiometers as regulating devices. Potentiometers are done in charcoal powder which has varying and linear barriers. Problems that often arise in potentiometers in the form of quick wear due to frequent friction, the output of the tone control will produce a noise when the relationship between the powder charcoal and the sweeping lever is not well connected, and linearity will change if the potentiometer is dirty due to dust. Microcontroller is electronic equipment that can be programmed according to user need. With a collaboration push button, Multiplexer and Analog to digital converter (ADC), can be utilized instead of a potentiometer. Setting the potentiometer is done by pressing the digital control tune up / down button. Based on the testing of the tone control on the volume setting, the input signal has strengthened 6.02 dB. In the bass setting, a signal with a frequency of 100-1 khz is passed, while the frequency of 2.5 khz is muted. In the treble setting, the frequency passed is 2.5 khz to 16 khz.

The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients

ObjectiveTo measure effects of ED crowding on lung-protective ventilation (LPV) utilization in critically ill ED patients. MethodsThis is a retrospective cohort study of adult mechanically ventilated ED patients admitted to the medical intensive care unit (MICU), over a 3.5-year period at a single academic tertiary care hospital. Clinical data, including reason for intubation, severity of illness (MPM0-III), acute respiratory distress syndrome (ARDS) risk score (EDLIPS), and ventilator settings were extracted via electronic query of electronic health record and standardized chart abstraction. Crowding metrics were obtained at 5-min intervals and averaged over the ED stay, stratified by acuity and disposition. Multivariate logistic regression was used to predict likelihood of LPV prior to ED departure. ResultsMechanical ventilation was used in 446 patients for a median ED duration of 3.7 h (interquartile ratio, IQR, 2.3, 5.6). Mean MPM0-III score was 32.5 ± 22.7, with high risk for ARDS (EDLIPS ≥5) seen in 373 (82%) patients. Initial and final ED ventilator settings differed in 134 (30.0%) patients, of which only 47 (35.1%) involved tidal volume changes. Higher percentages of active ED patients (workup in-progress) and those requiring eventual admission were associated with lower odds of LPV utilization by ED departure (OR 0.97, 95%CI 0.94–1.00; OR 0.97, 95%CI 0.94–1.00, respectively). In periods of high volume, ventilator adjustments to settings other than the tidal volume were associated with higher odds of LPV utilization. Reason for intubation, MPM0-III, and EDLIPS were not associated with LPV utilization, with no interactions detected in times of crowding. ConclusionsED patients remain on suboptimal tidal volume settings with infrequent ventilator adjustments during the ED stay. Hospitals should focus on both systemic factors and bedside physician and/or respiratory therapist interventions to increase LPV utilization in times of ED boarding and crowding for all patients.

Comparison of the ventilation characteristics in two adult oscillators: a lung model study

BackgroundTwo recent large randomized controlled trials did not show the superiority of high-frequency oscillatory ventilation (HFOV) in adults with ARDS. These two trials had differing results, and possible causes could be the different oscillators used and their different settings, including inspiratory time % (IT%). The aims of this study were to obtain basic data about the ventilation characteristics in two adult oscillators and to elucidate the effect of the oscillator and IT% on ventilation efficiency.MethodsThe Metran R100 or SensorMedics 3100B was connected to an original lung model internally equipped with a simulated bronchial tree. The actual stroke volume (aSV) was measured with a flow sensor placed at the Y-piece. Carbon dioxide (CO2) was continuously insufflated into the lung model ( dot{mathrm{V}} CO2), and the partial pressure of CO2 (PCO2) in the lung model was monitored. Alveolar ventilation ( dot{mathrm{V}} A; L/min) was estimated as dot{mathrm{V}} CO2 divided by the stabilized value of PCO2. dot{mathrm{V}} A was evaluated with several stroke volume settings in the R100 (IT = 50%) or several airway pressure amplitude settings in the 3100B (IT = 33%, 50%) at a frequency of 6 and 8 Hz, a mean airway pressure of 25 cmH2O, and a bias flow of 30 L/min. Assuming that dot{mathrm{V}} A = frequencya × aSVb, values of a and b were determined. Ventilation efficiency was calculated as dot{mathrm{V}} A divided by actual minute ventilation.ResultsThe relationship between aSV and dot{mathrm{V}} A or ventilation efficiency were different depending on the oscillator and IT%. The values of a and b were 0 < a < 1 and 1 < b < 2 and were different for three conditions at both frequencies. dot{mathrm{V}} A and ventilation efficiency were highest with R100 (IT = 50%) and lowest with 3100B (IT = 33%) for high aSV ranges at both frequencies.ConclusionsIn this lung model study, ventilation characteristics were different depending on the oscillator and IT%. Ventilation efficiency was highest with R100 (IT = 50%) and lowest with 3100B (IT = 33%) for high aSV ranges.

Infinite distance networks in field space and charge orbits

The Swampland Distance Conjecture proposes that approaching infinite distances in field space an infinite tower of states becomes exponentially light. We study this conjecture for the complex structure moduli space of Calabi-Yau manifolds. In this context, we uncover significant structure within the proposal by showing that there is a rich spectrum of different infinite distance loci that can be classified by certain topological data derived from an associated discrete symmetry. We show how this data also determines the rules for how the different infinite distance loci can intersect and form an infinite distance network. We study the properties of the intersections in detail and, in particular, propose an identification of the infinite tower of states near such intersections in terms of what we term charge orbits. These orbits have the property that they are not completely local, but depend on data within a finite patch around the intersection, thereby forming an initial step towards understanding global aspects of the distance conjecture in field spaces. Our results follow from a deep mathematical structure captured by the so-called orbit theorems, which gives a handle on singularities in the moduli space through mixed Hodge structures, and is related to a local notion of mirror symmetry thereby allowing us to apply it also to the large volume setting. These theorems are general and apply far beyond Calabi-Yau moduli spaces, leading us to propose that similarly the infinite distance structures we uncover are also more general.

62: Robotic-assisted laparoscopy versus conventional laparoscopy for the treatment of endometriosis in New York state, 2009-2016

To describe the effect of patient and physician factors on utilization trends and short-term outcomes of robotic versus laparoscopic surgery for endometriosis in New York State. Using the Statewide Planning and Research Cooperative System (SPARCS) database, an all-payer administrative system on all hospital discharges in New York State, we identified patients undergoing minimally invasive surgery with a diagnosis of endometriosis from 2009 to 2016. Primary outcomes of interest were facility type, surgeon characteristics, patient demographics, and complications. Pearson chi-square, Mann-Whitney U test, and logistic regression analyses were performed. In a total cohort of 9,871 patients who underwent surgery for endometriosis, 49% of cases were performed utilizing a minimally invasive approach (35% conventional laparoscopy and 14% with robotic assistance). While the total number of surgeries has decreased by as much as 50% over the course of eight years, the proportion of cases done by a minimally invasive approach has almost doubled; 36% to 60%. There was a threefold increase in the number or robotic cases while the number of laparoscopic cases declined by 35%. The percentage of procedures performed robotically was significantly higher among female surgeons and younger physicians. On a multivariate analysis surgeon’s age remained a significant predictor of the type of minimally invasive surgery performed. Over 60% of all robotic cases were performed in New York City and Finger Lakes Area, 95% of which were performed at teaching affiliated institutions. A significantly higher percentage of patients in the robotic group were white and privately insured. No difference in complication rates were observed between the two groups irrespective of physician gender, surgical volume, experience or practice setting. Patients who underwent laparoscopic surgery were more likely to have a prolonged hospital stay than those who underwent robotic surgery. Prolonged stay was also noted among surgeons with a low surgical volume. Robotic cases had higher 30-day re-admission rate compared to cases done laparoscopically. Close to 60 percent of surgical procedures for endometriosis in New York State is performed using a minimally invasive approach. While numerous studies show no improvement in perioperative outcomes with robotic platform utilization, the number of robotic procedures in New York has increased over time in particularly among younger, less experienced surgeons. Surgeon gender does not appear to influence the type of the approach. No difference in complication rates were observed between the two groups.

Laparoscopic Surgeons' Perspectives on Risk Factors for and Prophylaxis of Trocar Site Hernias: A Multispecialty National Survey.

Background and Objectives:Although trocar site hernias (TSHs) occur in only 1.5% to 1.8% of all laparoscopic procedures, TSHs can present serious postoperative complications. The purpose of this study was to survey surgeons who are active members of the Society of Laparoendoscopic Surgeons (SLS) to elicit their experiences with TSHs, including fascial closure preferences.Methods:After reviewing the clinical and epidemiological literature to compile relevant questions, an anonymous survey was designed using Qualtrics web-based software. The survey link was emailed to all SLS members. Descriptive analyses included frequencies, percentages, and χ2 or Fisher's exact tests to assess statistical associations.Results:There were 659 SLS members who completed the survey: 323 general surgeons, 242 gynecologists, 45 colorectal surgeons, 25 bariatric surgeons, and 24 urologists. Nearly 7 in 10 respondents (68.4%) reported at least 1 patient developing a TSH within the previous decade. Compared with other specialties, bariatric surgeons had the smallest proportion of respondents reporting fascial closure for 10- to 12-mm trocars (68%) and the largest proportion indicating no fascial closure for trocars of any size (28%) (P < .01). Among all respondents, 86.6%, 15.3%, and 2.4% close 10- to 12-mm, 8-mm, and 5-mm ports, respectively, without differences according to surgical volume or practice setting. Approximately 6% reported no fascial closure for any size.Conclusion:Port size remains one of the main risk factors for TSH development, with most respondents closing only 10- to 12-mm ports regardless of surgical volume or practice setting. The general trend for port closure for bariatric surgeons is significantly different from that of other surgeons.

Evaluation of droplet deposition and effect of variable-rate application by a manned helicopter with AG-NAV Gu韆 system

The variable-rate application is an important aspect of precision agriculture. In order to determine the regular patterns of droplet deposition and compare the actual variable-rate spraying effect of the AS350B3e helicopter with the AG-NAV Guía system, spray tests were conducted with different operating parameters and operating methods. In this study, the deposition distribution of droplets in the effective swath area was evaluated for six single-pass applications at four different flight velocities. The effects of adding adjuvant on droplet deposition, drift and droplet size were compared, and the actual variable effect of the forth-back application was verified. The analysis results showed that the position of the effective swath area was affected by natural wind velocity and wind direction, and would shift to the downwind direction area from the helicopter route of a different degree. The effective swath width increased slowly and then decreased sharply with the increase of flight velocity. It was found that flight velocity of 100 km/h was the peak inflection point of effective spray width variation. Moreover, the effect of flight velocity on the distribution uniformity of droplet deposition in the effective swath area was not significant. In the single-pass application of 90 km/h, adding adjuvant could increase droplet size in the effective swath area. The deposition increased by 8.98%, and the total drift decreased by 28.65%, of which the upwind drift decreased by 28.31% and the downwind drift decreased by 29.06%. In the forth-back application of 90 km/h, the error between actual application volume and system setting dose was 12%. The results of this study can provide valuable references for future research and practices on variable-rate aerial applications by manned helicopters. Keywords: manned helicopter, precision agriculture, variable-rate aerial application, spray test, adjuvant, droplet deposition DOI: 10.25165/j.ijabe.20191201.4039 Citation: Yao W X, Lan Y B, Wen S, Zhang H H, Zhang Y L, Wang J, et al. Evaluation of droplet deposition and effect of variable-rate application by a manned helicopter with AG-NAV Guía system. Int J Agric & Biol Eng, 2019; 12(1): 172–178.

Evaluating Delivery of Low Tidal Volume Ventilation in Six ICUs Using Electronic Health Record Data.

Mechanical ventilation with low tidal volumes is recommended for all patients with acute respiratory distress syndrome and may be beneficial to other intubated patients, yet consistent implementation remains difficult to obtain. Using detailed electronic health record data, we examined patterns of tidal volume administration, the effect on clinical outcomes, and alternate metrics for evaluating low tidal volume compliance in clinical practice. Observational cohort study. Six ICUs in a single hospital system. Adult patients who received invasive mechanical ventilation more than 12 hours. None. Tidal volumes were analyzed across 1,905 hospitalizations. Although mean tidal volume was 6.8 mL/kg predicted body weight, 40% of patients were exposed to tidal volumes greater than 8 mL/kg predicted body weight, with 11% for more than 24 hours. At a patient level, exposure to 24 total hours of tidal volumes greater than 8 mL/kg predicted body weight was associated with increased mortality (odds ratio, 1.82; 95% CI, 1.20-2.78), whereas mean tidal volume exposure was not (odds ratio, 0.87/1 mL/kg increase; 95% CI, 0.74-1.02). Initial tidal volume settings strongly predicted exposure to volumes greater than 8 mL/kg for 24 hours; the adjusted rate was 21.5% when initial volumes were greater than 8 mL/kg predicted body weight and 7.1% when initial volumes were less than 8 mL/kg predicted body weight. Across ICUs, correlation of mean tidal volume with alternative measures of low tidal volume delivery ranged from 0.38 to 0.66. Despite low mean tidal volume in the cohort, a significant percentage of patients were exposed to a prolonged duration of high tidal volumes which was correlated with higher mortality. Detailed ventilator records in the electronic health record provide a unique window for evaluating low tidal volume delivery and targets for improvement.

Evaluation of mechanical ventilators' accuracy in clinical settings: A quality control study

Background: A mechanical ventilator (MV) is one of the most important devices in critical care units. Improper ventilator settings may adversely affect patients' health. The objective of this study is to evaluate the accuracy of volume, pressure, and flow delivered by the ventilators in clinical settings. Materials and Methods: Thirty randomly chosen MVs from four randomly selected main hospitals in the eastern province of Saudi Arabia were included in this study. All types of modern intensive care unit ventilators brands along with all versions were targeted. Pressure, volume, and flow were evaluated at two levels by using Fluke Biomedical VT PLUS HF Gas Flow Analyzer. Results: High-pressure mean was 28.7 ± 4.9 cm H2O and low-pressure mean was 14.6 ± 1.3 cm H2O. 95% limits of agreement (LA95%) between the measured and setting in high pressure was −0.74–2.86 cm H2O and −0.114–0.84 cm H2O in low pressure. The mean of volume measurements was 676.9 ± 45.5 ml in high setting and 342.9 ± 24 ml in low setting. In high volume setting, LA95%of 104.76–138.05 ml, wherein low volume LA95%of 47.7–65.3 ml. High flow mean was 53.4 ± 4.6 lpm with LA95%of 3.3–6.8 lpm and low flow mean was 36 ± 3.7 lpm with LA95%of 1.87–4.6 lpm. Conclusion: The present data reveal that MVs in clinical settings have some variations in their performance. The delivered flow and volume might not be accurate as it might be anticipated. These differences should be considered while their use in critically ill patients.

Influence of occupant behavior on the energy performance of variable refrigerant flow systems for office buildings: A case study

Currently, the controversies on the energy saving potential of Variable refrigerant flow (VRF) systems compared with other heating, ventilation, and air conditioning (HVAC) systems for office buildings still exist. In this study, a VRF system for an office building is investigated in field. The actual occupant behavior (OB) was presented statistically and imported to the energy model of VRF systems developed by the authors to compare the energy performance of VRF systems, with and without considering OB. The statistical results indicate the diversity in the on-duration periods and on-off times of each indoor unit (IU) is highly significant. According to the simulated results, the energy consumption of the VRF system under a continuous operation scheme is approximately 1.8 times that of the actual operation scheme owing to the OB. The total energy consumption of IUs with high air volume setting could be more than three times that of the actual operation scheme with a low air volume setting. In addition, the energy consumption intensity of the VRF system was presented by the parametric analysis on the different occupant thermostat setting temperature. Therefore, the OB contributes significantly to the energy performance of VRF systems, which should be considered for comparison with other HVAC systems.

Decreased Tidal Volume With Increased Height, but not Colloid Transfusion, is Associated With Worse Outcomes and Postoperative Pneumonia After Coil Embolization of Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study.

The tidal volume setting as well as colloid transfusion during the peri-operative period after intracranial aneurysm is controversial. A multicenter retrospective study was conducted to determine whether or not an increased tidal volume setting and colloid transfusion are associated with poor outcomes and postoperative pulmonary complications after intracranial aneurysm. Data from endovascular coiling to treat intracranial aneurysms that took place between 30 March 2014 and 30 March 2016 were collected in a multicenter chart. The primary outcomes were better (defined as a Modified Rankin scores [MRS] ≤2) and worse outcomes (MRS ≥3). Secondary outcomes included pneumonia and non-pneumonia in patients with intracranial aneurysms. Univariate analysis, bivariate logistic regression, Spearman correlation, and a linear regression model were performed to account for the association between peri-operative risk factors and different outcomes. Bivariate logistic analysis showed that worse outcomes were correlated with height, Hunt and Hess scores (HHS), and Fisher grade (P < 0.05). There was no significant association between colloid transfusion and worse outcomes and postoperative pneumonia (P > 0.05). Postoperative pneumonia incidence was associated with increased height in a population with intracranial aneurysms (P < 0.05). The Spearman correlation and a linear regression model suggested that increased height was significantly correlated with lower tidal volume setting (per unit of body weight; P < 0.05). Decreased tidal volume with increased height, but not colloid transfusion, was independently associated with worse outcomes and postoperative pneumonia across a spectrum of risk profiles. These findings may help to improve practice decisions regarding tidal volume settings.