Websites and social networks of communes in Slovakia: development and current state

One of the main features of today’s information society is the availability of data of various kinds provided by various companies and organisations. In the following paper, we focus on evaluating the dynamics of development and the current state of existence of websites of communes in Slovakia, which represent a database of their activities and serve as the main communication channel between citizens and self-government representatives. Another important channel is social networks, which are still enjoying huge popularity among Internet users. On the basis of the results of an online questionnaire that involved almost 60% of the addressed self-governments, we will point out the adaptation of self-governments to the use of social networks. One of the important tasks of such research is the distribution of the obtained results to end users. This is achieved through an example of a description of basic technical and functional specifications by using the website created by the authors. This website has the ambition of becoming a sort of central access point for all those interested in information about communes in Slovakia. By means of standard tabular, but also interactive graphic and map outputs, it gives an idea of selected indicators of self-governments in a user-friendly form, thus helping to increase client awareness of this specific issue.

COVID-19 preVIEW: Semantic Search to Explore COVID-19 Research Preprints

During the current COVID-19 pandemic, the rapid availability of profound information is crucial in order to derive information about diagnosis, disease trajectory, treatment or to adapt the rules of conduct in public. The increased importance of preprints for COVID-19 research initiated the design of the preprint search engine preVIEW. Conceptually, it is a lightweight semantic search engine focusing on easy inclusion of specialized COVID-19 textual collections and provides a user friendly web interface for semantic information retrieval. In order to support semantic search functionality, we integrated a text mining workflow for indexing with relevant terminologies. Currently, diseases, human genes and SARS-CoV-2 proteins are annotated, and more will be added in future. The system integrates collections from several different preprint servers that are used in the biomedical domain to publish non-peer-reviewed work, thereby enabling one central access point for the users. In addition, our service offers facet searching, export functionality and an API access. COVID-19 preVIEW is publicly available at https://preview.zbmed.de.

A Comprehensive Portal for Clinical and Translational Data Warehouses

Data-driven methods in biomedical research can help to obtain new insights into the development, progression and therapy of diseases. Clinical and translational data warehouses such as Informatics for Integrating Biology and the Bedside (i2b2) and tranSMART are important solutions for this. From the well-known FAIR data principles, which are used to address the aspects of findability, accessibility, interoperability and reusability. In this paper, we focus on findability. For this purpose, we describe a portal solution that acts as a catalogue for a wide range of data warehouse instances, featuring a central access point and links to training material, such as user manuals and video tutorials. Moreover, the portal provides an overview of the status of multiple warehouses for developers and a set of statistics about the data currently loaded. Due to its modular design and the use of modern web technologies, the portal is easy to extend and customize to reflect different corporate designs and institutional requirements.

Intravenous Insulin Resistance in a Critically Ill Patient Secondary to Decreased Peripheral Perfusion

Introduction: Intravenous (IV) insulin infusion is the preferred treatment modality for hyperglycemia in the intensive care unit (ICU) due to its short duration of action and easy titratability. However, administration of IV insulin has challenges. These include frequent monitoring, site infiltration, and high insulin dose requirements with other ICU medications such as epinephrine. There are, however, limited reports demonstrating an elevated insulin requirement due to poor peripheral perfusion. Below illustrates such a case, necessitating a change from peripheral to central IV insulin administration. Case Presentation: A 50 year old male with well controlled type 2 diabetes and previous aortic valve replacement presented to our facility for prosthetic valve endocarditis complicated by aortic root abscess. He was admitted to the ICU, treated with IV antibiotics, abscess washout and aortic valve replacement. Preoperatively, he was started on IV regular insulin via continuous infusion through a central line. During the pre and intraoperative periods, his hourly IV insulin requirement ranged from 2.4 to 5 units/ hour (hr). His blood glucose (BG) ranged from 107-251mg/dL (n 70-99mg/dL). The patient became hypotensive intraoperatively requiring vasopressor support. Dobutamine and norepinephrine infusions were started via central access and were continued postoperatively at steady rates. Vasopressin was added through central access as the patient failed to meet hemodynamic targets. Postoperatively, the propofol infusion was discontinued and the IV regular insulin infusion was moved to the peripheral line where the propofol had previously been administered. BG increased steadily to a maximum of 402 mg/dL despite an increase in the peripheral IV insulin rate to 152.4 units/hr. The site of the IV insulin drip was changed to another solitary peripheral access without success in decreasing the IV insulin infusion rate. The elevated requirements were deemed secondary to the patient’s lack of peripheral perfusion and should decrease with transition to a central line. A preemptive decrease in insulin drip rate to 10% of the peripheral dose was used to avoid hypoglycemia. The insulin drip was changed to a central access with a rate of 15units/ hr. BG values declined to a range of 140 -180 mg/dL. The patient remained on the multiple vasopressors for hemodynamic support, however, the insulin drip was able to be decreased and ultimately, discontinued. Conclusion: This case illustrates a unique challenge in the treatment of hyperglycemia with multifactorial shock and our approach to management. Elevated IV insulin requirements persisted despite stability in vasopressor dose, change to a solitary peripheral IV site, and lack of interfering medications in the treatment regimen. This is the first case to demonstrate a relationship between high IV insulin requirements and poor peripheral perfusion.

Safe and effective HeRO graft placement: Technique and results

Objectives: Hemodialysis Reliable Outflow (HeRO) grafts are used when venous outflow is inadequate to support conventional access. These have been perceived as complex to implant and being associated with high risk. We have evolved a defined protocol for insertion that minimizes morbidity and maximizes efficiency. Methods: Our protocol includes staged intravenous access versus HeRO graft placement, reverse Trendelenburg positioning, subcutaneous access of the deep portion of the existing catheter, use of a stiff wire placed within the inferior vena cava, dilation of the tract to 8 mm, device lubrication, all insertion procedures directly visualized, and use of immediate access conduits with SuperHeRO connector. Results: From 7/1/18 to 8/13/19, 55 HeRO grafts were placed at our institution following this protocol, average age 58 ± 15 (26–86) years (mean ± SD, range). 53 (96%) had had prior ipsilateral central access (13 by means of “inside out” 2 weeks prior) the other two had on-table access. Mean procedure time was 70 ± 26 (38–148) min. Excluding seven “complex” cases, procedure time for our first 20 cases using this protocol was 72 ± 29 min, while that of the last 28 was 62 ± 18 min ( p < 0.05). One patient suffered acute CHF after unclamping; despite reclamping and ligation he died on POD 3 (mortality rate 2%). 71% were done as outpatients, and 47 of 53 evaluable patients (89%) had their grafts used within 36 h for dialysis. Only one patient (2%) has had an infection within 30 days (cellulitis). At a mean followup of 95 ± 105 (maximum 383) days, three additional patients have had graft infections requiring excision, for a total infection rate of 5/53 (9%). Conclusions: Our results suggest that HeRO graft placement can be performed with minimal morbidity and mortality on an outpatient basis. Short-term infection rates are low and 89% of patients have their grafts immediately accessed and are discharged without a catheter.

Achieving superficial femoral venous access in a critically ill COVID-19 patient in the prone position

A 63-year-old obese male was admitted with acute respiratory failure secondary to COVID-19. Day 13 the patient decompensated, lapsing into a critical stage of severe acute respiratory distress syndrome, requiring immediate prone positioning. The Rapid Response Team managed the emergency intervention for intubation but was unable to establish central access with the patient in the prone position. A consult to the Vascular Access Team succeeded in establishing central catheter placement with an ultrasound-guided mid-thigh superficial femoral 55-centimeter triple lumen catheter. The terminal tip of the catheter was confirmed in the mid portion of the inferior vena cava.

A machine-readable online database for rate coefficients in radical polymerization

An online database created and curated by an IUPAC subcommittee is introduced. It is designed to act as central access point for finding reliable kinetic data on radical polymerizations. The...

Use of intracavitary-ECG for tip location of femorally inserted central catheters

Femorally inserted central catheters (FICCs) are frequently required for central access in children. Ultrasound can accurately locate the catheter tip in most cases and its use is increasing in clinical vascular access practice. In patients with poor acoustic windows, intracavitary electrocardiogram (IC-ECG) is an alternative to ultrasound-guidance for FICC positioning. A case series of three patients demonstrate methods of FICC positioning in children. The first patient had excellent acoustic windows and ultrasound-guided FICC positioning is described in conjunction with IC-ECG measurements. The following two patients had poor acoustic windows, thus IC-ECG guided FICC tip position. The use of FICCs in children has increased in recent years. Ultrasound has emerged as a reliable method of assessing FICC tip location. IC-ECG is an accurate and complementary method of assessing FICC tip location, but can be a primary method when ultrasound is not available or cannot directly visualize the catheter. IC-ECG P-wave characteristics identify optimal tip position at the inferior cavoatrial junction and are different from characteristics at the superior cavoatrial junction.

The Development of a Long Peripheral Catheter Program at a Large Pediatric Academic Center: A Pilot Study

OBJECTIVES: The purpose of this study was to evaluate the feasibility of a new long peripheral catheter (LPC) program at a large academic center in an effort to reduce the use of peripherally inserted central catheters (PICCs) and their related complications. METHODS: The pilot participants were hospitalized children, age &gt;2 years, with a need for noncentral intravenous access for 2 to 29 days, or laboratory blood draw &gt;5 times per day. Patients expected to discharge with intravenous access were excluded. Included in the pilot program development were a literature review, 1-year baseline data analysis, and program design and implementation. A multidisciplinary committee developed and implemented the program from December 2018 to September 2019. LPCs were placed from August to September 2019. RESULTS: Regarding the baseline data, between July 2018 and June 2019, 584 PICCs were placed in 461 patients. Of these, 139 PICCs (24%) did not meet requirements necessitating central access and, potentially, could have been avoided if an LPC alternative were available at the time. For the LPC pilot program, 20 LPCs were placed in 19 patients. The median age was 11 (interquartile range of 7–15). The insertion success rate was 83%. There were no serious complications, such as venous thrombosis or catheter-related bloodstream infection. The total rate of minor complications was 35%: the rate of occlusions was 10% (n = 2), and the rate of dislodgement was 25% (n = 5). The catheter failure rate was 74 per 1000 catheter-days. The mean line duration was 6 days. CONCLUSIONS: There is a role for LPCs in hospitalized children requiring durable vascular access. Multispecialty designed pilot implementation of an LPC program was successful at an academic pediatric hospital.

Hemobilia in percutaneous transhepatic cholangiostomy

Aim. To determine the dependence of the formation of vascular-biliary fistula with the bile ducts bleeding and along the drainage channel on the diameter of the puncture needle and access to the biliary tract.Materials and methods. A retrospective analysis of the results of treatment of 3786 cases of percutaneous transhepatic cholangiostomy using needles 17.5-18 G under Amplatz 0.035’ conductor with a safe J-tip was carried out. In the cholangiostomy in the bile ducts was installed biliary tree drainage shape memory No 8 Fr. In benign lesions of the bile ducts 2066 (54.6%) interventions were performed, 1720 (45.4%) for malignant ones. Central access to the bile ducts was performed in 2442 cases (64.5%), peripheral – in 1344 cases (35.5%).Results. Significant hemobilia was observed in 21 (0.55%) cases: in 8 (0.47%) with a obstructive jaundice of malignant etiology, in 13 (0.63%) – benign etiology. In 3 cases, the cause of hemobilia was arteriobiliary fistula, in 16 – portobiliary, in 2 – biliovenous fistula. Central access was complicated by significant hemobilia in 10 patients, peripheral – in 11.Conclusion. The low frequency of significant hemobilia – 0.55% – when using puncture needles 17.5–18 G for primary access to the bile ducts proves the validity of their use in radiological practice, and also does not allow to consider central access critical for the development of hemorrhagic complications in percutaneous transhepatic biliary drainage.