failure assessment
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2022 ◽  
Vol 11 (2) ◽  
pp. 342
Author(s):  
Sejoong Ahn ◽  
Jonghak Park ◽  
Juhyun Song ◽  
Jooyeong Kim ◽  
Hanjin Cho ◽  
...  

Detecting sepsis patients who are at a high-risk of mechanical ventilation is important in emergency departments (ED). The respiratory rate oxygenation (ROX) index is the ratio of tissue oxygen saturation/fraction of inspired oxygen to the respiratory rate. This study aimed to investigate whether the ROX index could predict mechanical ventilator use in sepsis patients in an ED. This retrospective observational study included quick sequential organ failure assessment (qSOFA) ≥ 2 sepsis patients that presented to the ED between September 2019 and April 2020. The ROX and ROX-heart rate (HR) indices were significantly lower in patients with mechanical ventilator use within 24 h than in those without the use of a mechanical ventilator (4.0 [3.2–5.4] vs. 10.0 [5.9–15.2], p < 0.001 and 3.9 [2.7–5.8] vs. 10.1 [5.4–16.3], p < 0.001, respectively). The area under the receiver operating characteristic (ROC) curve of the ROX and ROX-HR indices were 0.854 and 0.816 (both p < 0.001). The ROX and ROX-HR indices were independently associated with mechanical ventilator use within 24 h (adjusted hazard ratio = 0.78, 95% CI: 0.68–0.90, p < 0.001 and adjusted hazard ratio = 0.87, 95% CI 0.79–0.96, p = 0.004, respectively). The 28-day mortality was higher in the low ROX and low ROX-HR groups. The ROX and ROX-HR indices were associated with mechanical ventilator use within 24 h in qSOFA ≥ 2 patients in the ED.


Author(s):  
Stelios Ploumis ◽  
Ronan Boitard ◽  
Anders Ballestad ◽  
Gerwin Damberg ◽  
Panos Nasiopoulos
Keyword(s):  

2022 ◽  
pp. 002199832110619
Author(s):  
Sebastian Rosini ◽  
Mark N Mavrogordato ◽  
Tsuneo Takano ◽  
Naoki Sugiura ◽  
S Mark Spearing ◽  
...  

In situ synchrotron radiation computed tomography (SRCT) was used to compare the fibre damage progression in five configurations of (902/02)s carbon-epoxy coupons loaded to failure. The effects of different sizing types, surface treatments and fibre diameters on the macroscopic properties, for example, ultimate tensile strength (UTS), and on the damage accumulation at a microscopic scale, for example, fibre break accumulation, were assessed. A semi-automated approach was adopted to process the large amount of data obtained from the SRCT scans and further method applicability areas can be envisaged. Single fibre break accumulation was seen to be influenced by the fibre type, while the formation of interacting fibre break groups by the surface treatment and the sizing type. For the materials presented, it can be suggested that an increased defect tolerance can be obtained by moving from stronger to weaker fibre-matrix adhesion, with sub-critical multiplet behaviour emerging as independent of the average UTS value.


2022 ◽  
Vol 8 ◽  
Author(s):  
Kai Zhang ◽  
Weidong Qin ◽  
Yue Zheng ◽  
Jiaojiao Pang ◽  
Ning Zhong ◽  
...  

Background and Aim: Lymphocytes play an important role in fighting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Low total lymphocyte count (TLC), which contributes to poor clinical outcomes, is common in persons with coronavirus disease 2019 (COVID-19). The current explanation for the cause of low TLC is that it is directly related to the invasiveness of SARS-CoV-2, which attacks lymphocytes. We hypothesized that malnutrition contributes to the development of low TLC in early-stage COVID-19.Methods: We prospectively enrolled 101 patients with confirmed COVID-19. On their first day of hospitalization, we collected baseline and laboratory data, including clinical symptoms; the Sequential Organ Failure Assessment, Nutrition Risk Screening 2002 and Subjective Global Assessment were used to assess the malnutrition status of the patients. Multivariable logistic regression was used to identify independent risk factors for low TLC and severe COVID-19.Results: Malnutrition was associated with lower TLC in COVID-19. Fifty-nine (58.4%) of the patients showed low TLC, 41 (40.6%) were at risk for malnutrition, and 18 of them were malnourished. Low TLC was an independent risk factor for severe COVID-19. Compared to patients with normal TLC, those with low TLC more often presented with anorexia, malnutrition, higher SOFA scores (P &lt; 0.05) and comorbidities (diabetes and malignancies). Malnutrition (OR: 3.05, 95% CI: 1.5–6.19, P = 0.006) and SOFA scores (OR: 1.51, 95% CI: 1.04-2.43, P = 0.042) were identified as independent risk factors for low TLC.Conclusions: Malnutrition was common among our patients with early-stage COVID-19, and it contributed to the occurrence of low TLC.


2022 ◽  
Vol 12 (1) ◽  
pp. 44
Author(s):  
Yutaka Umemura ◽  
Kazuma Yamakawa ◽  
Shuhei Murao ◽  
Yumi Mitsuyama ◽  
Hiroshi Ogura ◽  
...  

The Sequential Organ Failure Assessment (SOFA) score is predominantly used to assess the severity of organ dysfunction in sepsis. However, differences in prognostic value between SOFA subscores have not been sufficiently evaluated. This retrospective observational study used a large-scale database containing about 30 million patients. Among them, we included 38,869 adult patients with sepsis from 2006 to 2019. The cardiovascular and neurological subscores were calculated by a modified method. Associations between the biomarkers of the SOFA components and mortality were examined using restricted cubic spline analyses, which showed that an increase in the total modified SOFA score was linearly associated with increased mortality. However, the prognostic association of subscores varied widely: platelet count showed a J-shaped association, creatinine showed an inverted J-shaped association, and bilirubin showed only a weak association. We also evaluated interaction effects on mortality between an increase of one subscore and another. The joint odds ratios on mortality of two modified SOFA subscores were synergistically increased compared to the sum of the single odds ratios, especially in cardiovascular-neurological, coagulation-hepatic, and renal-hepatic combinations. In conclusion, total modified SOFA score was associated with increased mortality despite the varied prognostic associations of the subscores, possibly because interactions between subscores synergistically enhanced prognostic accuracy.


Pomorstvo ◽  
2021 ◽  
Vol 35 (2) ◽  
pp. 275-286
Author(s):  
Samson Nitonye ◽  
Sidum Adumene ◽  
Charles Ugochukwu Orji ◽  
Anietie Effiong Udo

For an effective integrity assessment of marine robotic in offshore environments, the elements’ failure characteristics need to be understood. A structured probabilistic methodology is proposed for the operational failure assessment (OFA) characteristics of ROV. The first step is to assess the likely failure mode of the ROV system and its support systems. This captures the interaction and failure induced events during operation. The identified potential failure modes are further developed into logical connectivity based on the cause-effect relationship. The logical framework is modeled using the fault tree analysis technique to predict the ROV operational failure probability in an uncertain harsh environment. The fault tree analysis captured the logical relationship between the primary, intermediate, and top events probability. The importance measure criteria were adopted to identify the most probable events, links, and their importance on the failure propagation. The model was demonstrated with an ROV for deep arctic water subsea operations. The result identified the control system, communication linkages, human factor, among others, as most critical in the ROV operational failure. The methodology’s application provides core information on the Mean time between failure (MTBF) of the ROV system that could aid integrity management and provides a guide on early remedial action against total failure.


Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 10
Author(s):  
Daniel Puhr-Westerheide ◽  
Jakob Reich ◽  
Bastian O. Sabel ◽  
Wolfgang G. Kunz ◽  
Matthias P. Fabritius ◽  
...  

(1) Background: Respiratory insufficiency with acute respiratory distress syndrome (ARDS) and multi-organ dysfunction leads to high mortality in COVID-19 patients. In times of limited intensive care unit (ICU) resources, chest CTs became an important tool for the assessment of lung involvement and for patient triage despite uncertainties about the predictive diagnostic value. This study evaluated chest CT-based imaging parameters for their potential to predict in-hospital mortality compared to clinical scores. (2) Methods: 89 COVID-19 ICU ARDS patients requiring mechanical ventilation or continuous positive airway pressure mask ventilation were included in this single center retrospective study. AI-based lung injury assessment and measurements indicating pulmonary hypertension (PA-to-AA ratio) on admission CT, oxygenation indices, lung compliance and sequential organ failure assessment (SOFA) scores on ICU admission were assessed for their diagnostic performance to predict in-hospital mortality. (3) Results: CT severity scores and PA-to-AA ratios were not significantly associated with in-hospital mortality, whereas the SOFA score showed a significant association (p < 0.001). In ROC analysis, the SOFA score resulted in an area under the curve (AUC) for in-hospital mortality of 0.74 (95%-CI 0.63–0.85), whereas CT severity scores (0.53, 95%-CI 0.40–0.67) and PA-to-AA ratios (0.46, 95%-CI 0.34–0.58) did not yield sufficient AUCs. These results were consistent for the subgroup of more critically ill patients with moderate and severe ARDS on admission (oxygenation index <200, n = 53) with an AUC for SOFA score of 0.77 (95%-CI 0.64–0.89), compared to 0.55 (95%-CI 0.39–0.72) for CT severity scores and 0.51 (95%-CI 0.35–0.67) for PA-to-AA ratios. (4) Conclusions: Severe COVID-19 disease is not limited to lung (vessel) injury but leads to a multi-organ involvement. The findings of this study suggest that risk stratification should not solely be based on chest CT parameters but needs to include multi-organ failure assessment for COVID-19 ICU ARDS patients for optimized future patient management and resource allocation.


Author(s):  
Yuebao Lei ◽  
Peter Budden

Abstract In R6, the J-based failure assessment diagram (FAD) method is used in the fracture assessment, and is underpinned by the reference stress J scheme. Therefore, an assessment using the R6 FAD method is equivalent to a J prediction using the reference stress method. In this paper, the effect of global and local limit load solutions for defective elbows on the reference stress and hence the J predictions is investigated using published three dimensional elastic-plastic finite element (FE) J results, in order to create guidance for users to follow when performing structural integrity assessments of defective elbows using the R6 procedure. The results show that using the global limit load solutions recommended in this paper can lead to good and reasonably conservative J predictions. However, the availability of global limit load solutions is very limited. The results also show that using the local limit load evaluated from the local limit load model recommended in this paper can lead to conservative J predictions for most of the cases considered.


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