Cost of extracorporeal life support in pediatric patients with acute respiratory failure

OBJECTIVES: To determine the impact of extracorporeal life support (ECLS) on mortality in pediatric patients with acute hypoxemic respiratory failure (AHRF) at our institution; and to calculate the hospital charges associated with the use of ECLS. DESIGN: Retrospective review of medical records and hospital charges. SETTING: Pediatric intensive care unit (ICU) of a university-affiliated children's hospital. PATIENTS: Twenty patients admitted to the pediatric ICU between 1991 and 1995 for AHRF who received ECLS as a part of their hospital course. INTERVENTIONS: Predicted mortality was calculated using the Pediatric Respiratory Failure score and was compared with survival at the time of hospital discharge. Hospital charges were used as a proxy for resource utilization. Cost-per-life-year-saved calculations were performed based on a normal life expectancy for survivors. MEASUREMENTS AND MAIN RESULTS: Twenty patients were identified. The median age was 4.83 yrs. The median duration of ECLS was 9 days, with 19.5 days in the pediatric ICU and 23.5 days for the entire hospital length of stay. The observed mortality rate for these patients was 20%. Median predicted mortality rate based on the Pediatric Respiratory Failure score calculation was 83%. The hospital charges incurred by these patients was a median of $199,096. Based on a normal life expectancy for survivors, this results in a cost of $4,190/life-year. CONCLUSIONS: ECLS for the pediatric patient with AHRF is done at a considerable cost. However, ECLS affects survival favorably, and compares favorably when considering cost/life-year calculations. The data presented in this study may serve as a benchmark for comparison with newer therapies (i.e., liquid ventilation, nitric oxide). These data also provide a framework for cost-based analyses at other ECLS institutions.     

Surface structure of human mucin using X-ray photoelectron spectroscopy

The stimulating effect of antiparkinsonian drugs, talipexole and bromocriptine, on the striatal postsynaptic dopamine receptors were studied by measuring contralateral rotational behavior in rats. The nigro-striatal dopamine system of rats was degenerated by unilateral injection of 6-hydroxydopamine (6-OHDA, 8 micrograms/rat) into substantia nigra. By subcutaneous administration, talipexole at 0.16 mg/kg and bromocriptine at 10.24 mg/kg induced significantly increased rotational behavior to the contralateral direction to the lesioned side. The onset of the effect was 30 min for talipexole and 90 min for bromocriptine. By intragastric administration, talipexole at 0.4 mg/kg and bromocriptine at 20.48 mg/kg significantly increased the rotational behavior, and the onset of the effect was 60 min for talipexole and 180 min for bromocriptine. Rotational behavior induced by talipexole was suppressed by a D2 antagonist, sulpiride (40 mg/kg, s.c.), but not by a D1 antagonist, SCH23390 (1 mg/kg, s.c.). In contrast, rotational behavior induced by bromocriptine was suppressed by both sulpiride and SCH23390. These results indicated that when the nigrostriatal dopaminergic functions are disrupted, talipexole stimulates the striatal postsynaptic dopamine receptors at much lower doses than bromocriptine. Also it was indicated that the stimulating effect of talipexole is solely mediated by dopamine D2 receptors, whereas the effect of bromocriptine is mediated by both D1 and D2 receptors.     

A priority media access control protocol for video communication support on CSMA/CD LANs

Real-time multimedia communication applications demand performance requirements which differ significantly from conventional data communication applications. Current local area networks (LANs) provide efficient transport for bursty data traffic; however, they cannot necessarily provide quality of service guarantees for real-time communications. In this work we introduce and investigate an experimental priority protocol for supporting real-time communication on Ethernet, a popular implementation of multiple-access broadcast bus LANs. We examine the new protocol, known as Priority Mode-CSMA/CD (PM-CSMA/CD), providing a high priority (HP) class with CSMA/CD employed for standard priority (SP) traffic. PM-CSMA/CD performance is examined through computer simulation of videotelephony workstations operating over the shared bus LAN. Over all observed traffic conditions, the priority protocol provides performance satisfying real-time packet transport requirements of audio and video streams. The primary advantage of our protocol over similar priority schemes is its physical layer compatibility with standard CSMA/CD. The protocol also provides improved channel utilization with increasing high priority load, with no penalty in SP class performance at low to medium network loads.     

Channel access and interference issues in multi-code DS-CDMA wireless packet (ATM) networks

Multi-Code Direct-Sequence Code-Division-Multiple-Access (MC-CDMA) has been proposed as a flexible multiple access scheme for wireless packet networks that support a large variety of mobiles with different and even time-varying rates. Using MC-CDMA, traffic streams with significantly different transmission rates can be easily integrated into a unified architecture, with all the transmissions occupying the same bandwidth and having the same spread spectrum processing gain. In this paper, we address medium-access and interference issues in MC-CDMA wireless packet networks. For medium access, we propose and study Multi-Code CDMA (MC-CDMA) with Distributed-Queueing Request Update Multiple Access (DQRUMA) to form a unified bandwidth-on-demand fair-sharing platform for multi-rate wireless services. DQRUMA is an efficient demand-assignment multiple access protocol for wireless access and scheduling. Pseudo-Noise (PN) codes (primary codes) and optimal power levels are allocated to the mobiles on a slot-by-slot basis, and a Maximum Capacity Power Allocation (MCPA) criterion exploits the sub-code concatenation property of the MC-CDMA transmission. Simulation results show that the system provides close to ideal-access performance for multi-rate mobiles, both with homogeneous traffic characteristics and with a mix of heterogeneous traffic characteristics. Finally, we analyze the effects of MC-CDMA intercell interference on the reverse link (i.e., mobile to cell site) and investigate interference reduction by using the Maximum Capacity Power Allocation (MCPA) criterion. Our results show significant reduction in reverse-link MC-CDMA intercell interference is possible using the MCPA criterion.     

Multivariable computer control of a butane hydrogenolysis reactor: Part II: Design and on-line implementation of a stochastic controller using an identified multivariate noise model

A multivariable stochastic controller is implemented on a pilot scale, plug flow, butane hydrogenolysis reactor. In the synthesis of the controller, a multivariate time series model of the process disturbances is used. The success of this controller is compared to a previous controller where the process disturbances are not directly modeled.     

The economic potential of rural water supply projects in Tanzania

The rationale behind the decision to invest in the development of rural water supply in Tanzania is discussed. It is shown that theoretically economic as well as social benefits are supposed to influence investment decisions. In practice, however, choice of projects to be developed are made solely on the basis of social rather than economic factors. Economic potential of such projects are generally not considered. Examples of small scale irrigation, fish farming and village afforestation are discussed. It is concluded that economic potential of rural water supply projects should be considered together with the social benefits during the planning stages of such projects.     

Anaerobic toxicity and biodegradability of pulp mill waste constituents

Batch bioassays have been conducted to characterize the response of methanogenic bacteria to several constituents of sulfite evaporator condensate. The results can be grouped into three ranges with increasingly severe consequences to anaerobic reactors: a low concentration, no effect range; a medium concentration range where methanogenesis is temporarily interrupted or slowed down, but may return to normal; and a high concentration range where methanogenesis is permanently inhibited. In some cases the toxicant was metabolized when present in the lower concentration ranges. There was also evidence that mechanisms other than fermentation to methane were significant in accounting for removal of the toxicants from solution. Organisms acclimated to low concentrations of a toxicant are better able to withstand a shock load of that toxicant than are unacclimated organisms.     

Continuum based modeling of silicon integrated circuit processing: An object oriented approach

Continuum based integrated circuit process modeling is the dominant tool used to investigate and understand integrated circuit (IC) development. This paper describes the commonly used models for implantation, diffusion, and material growth. In addition, the supporting numerical techniques are described. This paper focuses on the implementation in object oriented code, Florida Object Oriented Process Simulator (FLOOPS). The software architecture is described for implementing models and numerics. A number of process examples are introduced and discussed.     

Visual variant of Alzheimer's disease: Distinctive neuropsychological features.

A subgroup of patients with probable Alzheimer disease (AD) reported a history of isolated visual disturbances (VS) early in the course of disease, without the characteristic memory complaints. Brain imaging and neuropathologic studies indicated that this subgroup had larger involvement of visual cortical areas and relative sparing of temporal. frontal, and limbic structures compared with classic AD. Consistent with these findings, the authors hypothesized that the cognitive deficits in this subgroup would be distinctly different from those seen in more typical AD patients. The authors studied 10 probable AD patients with VS (AD&±&|S), 22 patients without VS (AD–), and 25 healthy controls with a neuropsychological test battery. Compared with AD–, AD&±&|S patients performed significantly better on tests of verbal memory and had greater impairment on tests of visuospatial skills, suggesting a distinct pattern of cognitive dysfunction consistent with metabolic and neuropathologic reports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)