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Open AccessAvailable online http://ccforum.com/content/12/5/R120Page 1 of 9(page number not for citation purposes)Vol 12 No 5ResearchStrict glycaemic control in patients hospitalised in a mixed medical and surgical intensive care unit: a randomised clinical trialGisela Del Carmen De La Rosa1, Jorge Hernando Donado2, Alvaro Humberto Restrepo1, Alvaro Mauricio Quintero3, Luis Gabriel González3, Nora Elena Saldarriaga4, Marisol Bedoya1, Juan Manuel Toro5, Jorge Byron Velásquez4, Juan Carlos Valencia4, Clara Maria Arango5, Pablo Henrique Aleman1, Esdras Martin Vasquez4, Juan Carlos Chavarriaga4, Andrés Yepes4, William Pulido4, Carlos Alberto Cadavid1 and Grupo de Investigacion en Cuidado intensivo: GICI-HPTU1Department of Critical Care, Hospital Pablo Tobon Uribe, Calle 78B 69-240, Medellin, Colombia2Department of Epidemiology, Hospital Pablo Tobon Uribe, Calle 78B 69-240, Medellin, Colombia3Department of Internal Medicine, Universidad Pontificia Bolivariana, Cq 1 70-01, Medellin, Colombia4Department of Internal Medicine, Hospital Pablo Tobon Uribe, Calle 78B 69-240, Medellin, Colombia5Department of Internal Medicine, Universidad de Antioquia, Hospital Pablo Tobon Uribe, Calle 78B 69-240, Medellin, ColombiaCorresponding author: Gisela Del Carmen De La Rosa, giseladlr@une.net.coReceived: 12 Jun 2008 Revisions requested: 7 Jul 2008 Revisions received: 5 Sep 2008 Accepted: 17 Sep 2008 Published: 17 Sep 2008Critical Care 2008, 12:R120 (doi:10.1186/cc7017)This article is online at: http://ccforum.com/content/12/5/R120© 2008 De La Rosa et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction Critically ill patients can develop hyperglycaemiaeven if they do not have diabetes. Intensive insulin therapydecreases morbidity and mortality rates in patients in a surgicalintensive care unit (ICU) and decreases morbidity in patients ina medical ICU. The effect of this therapy on patients in a mixedmedical/surgical ICU is unknown. Our goal was to assesswhether the effect of intensive insulin therapy, compared withstandard therapy, decreases morbidity and mortality in patientshospitalised in a mixed ICU.Methods This is a prospective, randomised, non-blinded, single-centre clinical trial in a medical/surgical ICU. Patients wererandomly assigned to receive either intensive insulin therapy tomaintain glucose levels between 80 and 110 mg/dl (4.4 to 6.1mmol/l) or standard insulin therapy to maintain glucose levelsbetween 180 and 200 mg/dl (10 and 11.1 mmol/l). The primaryend point was mortality at 28 days.Results Over a period of 30 months, 504 patients wereenrolled. The 28-day mortality rate was 32.4% (81 of 250) in thestandard insulin therapy group and 36.6% (93 of 254) in theintensive insulin therapy group (Relative Risk [RR]: 1.1; 95%confidence interval [CI]: 0.85 to 1.42). The ICU mortality in thestandard insulin therapy group was 31.2% (78 of 250) and33.1% (84 of 254) in the intensive insulin therapy group (RR:1.06; 95%CI: 0.82 to 1.36). There was no statisticallysignificant reduction in the rate of ICU-acquired infections:33.2% in the standard insulin therapy group compared with27.17% in the intensive insulin therapy group (RR: 0.82;95%CI: 0.63 to 1.07). The rate of hypoglycaemia (≤ 40 mg/dl)was 1.7% in the standard insulin therapy group WELCOME TO OUR CLASS! GRADE UNIT 8: BREAKFAST Mixed ricepaper GROUND As you know Vietnam has many famous food Some of them are traditional foods and some of them are fast foods and some are famous foods for breakfast There are soo many… Some traditional foods are bitter melon soup with pork filling, steamed sweet herbal chicken soup,… Some fast foods are bread, hamburger,… And some famous foods for breakfast is pho, noodles, rice,… But today I just can introduce for you one of them is mixed ricepaper To make mixed ricepaper we have to have some ingredients such as: + A package of ricepaper + A green mango + A few of laksa leaves, kumquat + Dry beef + Small shrimp + Quail eggs + Salt and pepper Steps to make mixed ricepaper are: + Use scissors cut ricepaper into small pieces to eat + Hew the green mango, shredded into fibers + Hard-boiled the eggs and pare + Tear off the dry beef, keep aside + Rinse laksa leaves, chopped + Put roasted shrimp into a bowl + Put all into a bowl together + Put a spoon of salt, a kumquat into that bowl + Fanilly put laksa leaves into the bowl and mix all together Some pictures of ingredients to make mixed ricepaper and ricepaper after we finished Our presentation here is end Thank you for listening! Open AccessAvailable online http://ccforum.com/content/10/1/R11Page 1 of 7(page number not for citation purposes)Vol 10 No 1ResearchThe clinical value of daily routine chest radiographs in a mixed medical–surgical intensive care unit is lowMarleen E Graat1, Goda Choi1,2, Esther K Wolthuis1,3, Johanna C Korevaar4, Peter E Spronk5, Jaap Stoker6, Margreeth B Vroom1 and Marcus J Schultz1,7,81Medical student, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands2Resident, Departments of Intensive Care Medicine and Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands3Resident, Departments of Intensive Care Medicine and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands4Clinical Epidemiologist, Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands5Internist-intensivist, Department of Intensive Care Medicine, Gelre Hospital (Location Lukas), Apeldoorn, The Netherlands6Radiologist, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands7Anaesthsiologist-intensivist, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands8Internist-intensivist, Research Coordinator, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsCorresponding author: Marcus J Schultz, m.j.schultz@amc.uva.nlReceived: 3 Oct 2005 Revisions received: 24 Nov 2005 Accepted: 28 Nov 2005 Published: 30 Dec 2005Critical Care 2006, 10:R11 (doi:10.1186/cc3955)This article is online at: http://ccforum.com/content/10/1/R11© 2005 Graat et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction The clinical value of daily routine chestradiographs (CXRs) in critically ill patients is unknown. Weconducted this study to evaluate how frequently unexpectedpredefined major abnormalities are identified with daily routineCXRs, and how often these findings lead to a change in care forintensive care unit (ICU) patients.Method This was a prospective observational study conductedin a 28-bed, mixed medical–surgical ICU of a university hospital.Results Over a 5-month period, 2,457 daily routine CXRs weredone in 754 consecutive ICU patients. The majority of theseCXRs did not reveal any new predefined major finding. In only5.8% of daily routine CXRs (14.3% of patients) was one or morenew and unexpected abnormality encountered, including largeatelectases (24 times in 20 patients), large infiltrates (23 in 22),severe pulmonary congestion (29 in 25), severe pleural effusion(13 in 13), pneumothorax/pneumomediastinum (14 in 13), andmalposition of the orotracheal tube (32 in 26). Fewer than halfof the CXRs with a new and unexpected finding were ultimatelyclinically relevant; in only 2.2% of all daily routine CXRs (6.4%of patients) did these radiologic abnormalities result in a changeto therapy. Subgroup analysis Journal of Water and Environment Technology, Vol. 7, No. 2, 2009 - 67 - Analysis on the Optimal Dispatching of Mixed-pump Stations and the Operating-mode Adaptability Based on Safety Water Supply Dong Shen *, Lu Mou*, Ren Li** *Department of Environmental and Municipal Engineering, Qingdao Technological University, Qingdao 266033 China ** Maanshan Capital Water Co. Ltd., Maanshan 243000 China ABSTRACT At present, constant speed pumps and variable speed pumps always run in parallel in pump stations of most water supply companies in China. Research on the frequency control characteristic for the mixed-pump station based on the two-stage optimal operation is performed. Firstly, the ratio of the variable speed pump is calculated inversely according to the outlet pressure of the pump station, and then the speed range can be determined dynamically, so that the variable speed pump can play the role of energy saving as far as possible in safe and rational running status. Secondly, the two-stage optimal operation model for mixed-pump stations of multi-source is established, which is of the operating-mode adaptability, and it is solved by the intelligent genetic algorithm. Furthermore, when the operation mode of multi-source pump stations is transformed, the optimal dispatching of water distribution system in corresponding operation mode can be realized through adjusting the variable parameters in the model. At last, the utility and superiority of the optimal operation method for mixed-pump stations of multiple resources is verified by means of the application in certain urban in China. Keywords: mixed-pump stations, dynamic determination of speed range, operating-mode adaptability, safety water supply, genetic algorithm INTRODUCTION Many optimization models and mathematical algorithms have been developed to support the decision-making process of water distribution system, as shown in literature surveys by F. Fallsid (1975), 0rmsbee (1989), and more recently Sakarya (2000), among others. Genetic Algorithm has been applied to optimal operation of water distribution system by G.Mackle and D.A.Savic(1995), at the same time, many constrains were added into the optimization model to satisfy the actual demand. In China, the pump status and ratios of the variable speed pumps have been taken as decision variables for water supply control by Zhang Tuqiao and Lu Mou(2001). At present, the variable speed control is considered as the most ideal operation mode in the pump station. However, compared with the price of pump, the speed regulating device is too expensive. Therefore, in order to save the first investment, the mode that constant speed pumps and variable speed pumps run in parallel is always adopted in most of the water supply companies in China. Among them, one or more pumps run with the variable speed control mode, so as to maintain high efficient in different flow ranges, while the self-coupled antihypertensive starting mode is still adopted by other constant speed pumps. Therefore, research on the optimal operation of mixed-pump Project supported by the National Natural Science Foundation I NTERNATIONAL J OURNAL OF E NERGY AND E NVIRONMENT Volume 3, Issue 3, 2012 pp.323-332 Journal homepage: www.IJEE.IEEFoundation.org ISSN 2076-2895 (Print), ISSN 2076-2909 (Online) ©2012 International Energy & Environment Foundation. All rights reserved. Simultaneous hydrogen production and consumption in Anaerobic mixed culture fermentation Carlos Dinamarca, Rune Bakke Department of Process, Energy and Environmental Technology, Faculty of Technology, Telemark University College. Kjølnes ring 56, 3918 Porsgrunn, Norway. Abstract The aim of the present study is to investigate the relevance of homoacetogenic H 2 consumption on the bio-hydrogen yield and products distribution in mixed culture fermentation. A hybrid anaerobic reactor was operated for 93 days with variable pH and organic loads between 8-16 g glucose/L . d for this purpose. High initial H 2 yield decreased gradually to an equivalent of 0.02-0.4 mol H 2 /mol glucose consumed. The distribution of the dissolved organic products was influenced strongly by reactor pH, while the overall H 2 yield was not. Low H 2 yield is attributed mainly to homoacetogenesis at pH > 4.6 and to reduced products formation at pH < 4.6. Simultaneous hydrogen production and consumption occurred and at least 22 % of the produced molecular hydrogen, mainly from butyrate fermentation, was used for the reduction of CO 2 to acetate. Copyright © 2012 International Energy and Environment Foundation - All rights reserved. Keywords: Fermentation; Homoacetogenesis; Hydrogen production; Hydrogen consumption; Products distribution. 1. Introduction The use of mixed cultures in biotechnology offer several advantages compared to the use of pure cultures, such as: higher product yields and growth rates, stable culture (by stable associations between microorganisms), better substrate utilization and diverse metabolic capabilities [1]. Mixed cultures are widely applied for the treatment of wastewater and organic solid waste. The energy output as methane from anaerobic processes is advantageous compared to the energy requirement of aerobic treatment. By inhibiting methanogenic bacteria a variety of organic acids (formate, acetate, lactate, propionate, butyrate, valerate) and solvents (ethanol, butanol, acetone) can also be produced through anaerobic fermentation, products that are useful as industrial substrates for various processes, including microbial electrohydrogenesis. Identification of criteria to control product formation is required to better exploit the biotechnological potential in mixed culture fermentation [2]. Mixed cultures have also been applied for direct hydrogen production by anaerobic fermentation. Several advantages compared with other methods to produce hydrogen are described and has been studied for different conditions and reactor designs [3]. Hydrogen yield, however, often do not exceed the equivalent of two mol H 2 /mol glucose, even though theoretically glucose can provide 2 or 4 mol hydrogen per mol glucose consumed for facultative anaerobes and strictly anaerobes, respectively [4]. Several reviews [5, 6] have mentioned that due to “inefficient metabolic pathways” the viability of macro-scale production of hydrogen is limited. Dinamarca and Bakke [7] attributed low hydrogen yields to the combined effects of International Journal of Energy and Environment (IJEE), Volume 3, Issue 3, 2012, pp.323-332 ISSN 2076-2895 (Print), ISSN 2076-2909 (Online) ©2012 International Energy & Environment Foundation. All rights reserved. 324 reduced products formation, molecular I NTERNATIONAL J OURNAL OF E NERGY AND E NVIRONMENT Volume 1, Issue 4, 2010 pp.657-666 Journal homepage: www.IJEE.IEEFoundation.org ISSN 2076-2895 (Print), ISSN 2076-2909 (Online) ©2010 International Energy & Environment Foundation. All rights reserved. Thermo-acidophillic biohydrogen production from rice bran de-oiled wastewater by Selectively enriched mixed culture D.Sivaramakrishna 1 , D.Sreekanth 1 , V.Himabindu 1 , M.Lakshmi Narasu 2 1 Centre for Environment, Institute of Science and Technology, Jawaharlal Nehru Technological University Hyderabad, Kukatpally Hyderabad-500 085, India. 2 Centre for Biotechnology, Institute of Science and Technology, Jawaharlal Nehru Technological University Hyderabad, Kukatpally Hyderabad-500 085, India. Abstract The present study focuses on the biohydrogen production in an anaerobic batch reactor operated at thermophillic (57 0 C) and acidophilic conditions (pH 6) with rice bran de-oiled wastewater (RBOW) as substrate. The hydrogen generating mixed microflora was enriched from slaughter house sludge (SHS) through acid treatment (pH 3-4, for 24h) coupled with heat treatment (1h at 100 0 C) to eliminate non- spore forming bacteria and to inhibit the growth of methanogenic bacteria (MB) prior to inoculation in the reactor. The hydrogen production rate was maximum at 57 0 C (1861±14ml/L-WW/d) compared to 37 0 C (651±30ml/L-ww/d). The Hydrogen yield increased with temperature from 1.1 to 2.2 molH2/mol of substrate respectively. The optimum pH range for hydrogen production in this system was observed in between 5.5 to 6. Acid-forming pathway with butyric acid as a major metabolite dominated the metabolic flow during the hydrogen production. Copyright © 2010 International Energy and Environment Foundation - All rights reserved. Keywords: Biohydrogen, Rice bran de-oiled wastewater, Pre-treatment, Thermophilic temperature, PH control. 1. Introduction Today, most of the energy demands were met by nonrenewable energy sources, resulting in resource depletion, environmental deterioration, and public health problems. Therefore, a demand to develop novel renewable energy-harvesting technologies and introduce sustainable energy carrier exists [1]. Hydrogen was expected to be cleanest energy source of the future, since its sole product is water, and it does not release CO 2 and other harmful gases into the natural environment when it is used for energy production. Recently, great progress has-been achieved in the technological development of fuel cells and in the storage and transportation of hydrogen [2].Currently, hydrogen is produced by chemical, thermal, and electrical processes, which are neither sustainable nor cost-effective. Hydrogen production by biological methods is attractive because it is an energy-saving production process compared with chemical process. Recently, dark fermentative hydrogen production has been reported to have great potential for development as a practical biohydrogen system [3]. Few studies on dark fermentative hydrogen production have been reported with authentic wastewaters, such as cheese processing waste water [4], Olive Pulp [5] and food processing wastewaters [6]. Wastewaters show great potential for International Journal of Energy and Environment (IJEE), Volume 1, Issue 4, 2010, pp.657-666 ISSN 2076-2895 (Print), ISSN 2076-2909 (Online) ©2010 International Energy & Environment Foundation. All rights reserved. 658 economical production of hydrogen because producing a product from a waste could reduce waste treatment and disposal costs. Rice Bran De-oiled Wastewater (RBOW) is the carbohydrate rich and easily hydrolysable wastewater. Wastewater has a high chemical ... today I just can introduce for you one of them is mixed ricepaper To make mixed ricepaper we have to have some ingredients such as: + A package of ricepaper + A green mango + A few of laksa leaves,... kumquat + Dry beef + Small shrimp + Quail eggs + Salt and pepper Steps to make mixed ricepaper are: + Use scissors cut ricepaper into small pieces to eat + Hew the green mango, shredded into fibers... laksa leaves into the bowl and mix all together Some pictures of ingredients to make mixed ricepaper and ricepaper after we finished Our presentation here is end Thank you for listening!