Severe sepsis and septic shock are associated with significant mortality. Effective management of this clinical syndrome includes early resuscitation with fluids and vasoactive drugs to maintain ...vital organ perfusion and oxygen delivery. Understanding the different approach to the management of sepsis during the resuscitation and ongoing management phases is essential to initiate context- and time-specific interventions. Manipulation of hemodynamic variables to achieve a balance between oxygen delivery and consumption forms the cornerstone of hemodynamic optimisation. Minimally invasive and completely non-invasive cardiac output monitors have been developed, but require validation in this specific cohort of patients. The trend in hemodynamic parameters is particularly important when any intervention to augment cardiac output is carried out (functional hemodynamic monitoring). Cardiac output monitors and surrogates of tissue oxygenation are only able to guide management, as patient outcome is determined by acquisition and interpretation of accurate data, and suitable management decisions.
The recent Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study showed that the use of a specific care bundle reduced mortality in patients undergoing emergency laparotomy. However, ...the costs of implementation of the ELPQuiC bundle remain unknown. The aim of this study was to assess the in-hospital and societal costs of implementing the ELPQuiC bundle.
The ELPQuiC study employed a before-after approach using quality improvement methodology. To assess the costs and cost-effectiveness of the bundle, two models were constructed: a short-term model to assess in-hospital costs and a long-term model (societal decision tree) to evaluate the patient's lifetime costs (in euros).
Using health economic modelling and data collected from the ELPQuiC study, estimated costs for initial implementation of the ELPQuiC bundle were €30 026·11 (range 1794·64-40 784·06) per hospital. In-hospital costs per patient were estimated at €14 817·24 for standard (non-care bundle) treatment versus €15 971·24 for the ELPQuiC bundle treatment. Taking a societal perspective, lifetime costs of the patient in the standard group were €23 058·87, compared with €19 102·37 for patients receiving the ELPQuiC bundle. The increased life expectancy of 4 months for patients treated with the ELPQuiC bundle was associated with cost savings of €11 410·38 per quality-adjusted life-year saved.
Implementation of the ELPQuiC bundle is associated with lower mortality and higher in-hospital costs but reduced societal costs.
Today’s focused ion beam (FIB) systems enable the fast and flexible fabrication of 3D structures with dimensions well below 100
nm. Due to secondary effects like redeposition of sputtered material, ...however, the fabrication of a targeted shape of the structure is not simple at all. In this work, the influence of the patterning strategy during the sputtering on the shape of a 3D structure with rotational symmetry is studied. Highly different shapes of 3D structures are achieved only due to different rastering strategies or duration times of the ion beam at each raster pixel. The final structure shape can be properly modeled with IonShaper® simulations. These results clearly prove that the selection of the patterning strategy is the key for appropriate FIB processing of 3D structures. Besides, it is shown that unconventional patterning strategies might enable new types of 3D shapes.
The main assumption of existing efficient topography simulations is that sputtering is a local process that depends only on the angle of incidence and not on the detailed shape of the surface. If ...redeposition is considered, sputtered atoms are redeposited and cause no further sputtering when they hit another part of the surface. Furthermore the angular distribution of sputtered atoms follows a cosine law. If ion reflection is considered, ions do not lose energy during backscattering. Using binary collision simulations (IMSIL) and comparing them with results obtained by a topography simulator (IonShaper®) we show that all these assumptions need refinement for the simulation of nanostructures except the neglect of sputtering by sputtered atoms. In addition we show that a nonlocal model is essential for ion beam induced deposition of narrow structures.
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