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Acute kidney injury is the most common major complication after cardiac surgery. The incidence of cardiac surgery-associated AKI (CSA-AKI) varies between 5% to 40% and leads to dramatically worse outcomes. The incidence of CSA-AKI requiring renal replacement therapy after coronary artery bypass grafting alone is roughly 1%. After valve surgery or combined CABG plus valve surgery the risk of requiring RRT increases to 1.7 and 3.3% respectively. Regardless of its reversibility, CSA-AKI has been associated with increased mortality and risk of developing chronic or end-stage renal disease, and consequently generating substantial cost.
Zero runoff subirrigation (ZRS) technology can effectively manage fertilizer input while improving greenhouse production efficiency. However, high capital investment costs and inadequate technical information to growers are impediments for adoption. A Monte Carlo simulation was used to compare the profitability and risks of alternative ZRS system investments for greenhouse operations in the northeastern and north central United States. Results showed that the Dutch movable tray system and the flood floor system were most profitable and least risky for small potted plant and bedding crop flat production, respectively. The trough bench system was least favorable because its profitability was low and highly volatile.
The key to metabolic management during cardiopulmonary bypass (CPB) is the maintenance of adequate blood flow and oxygen delivery to the body's tissues. Utilizing the CPB machine, the perfusionist provides the optimum conditions necessary for operations on the heart, lungs or major vessels, while supporting the patient's physiological and metabolic needs. The perfusionist calculates a CPB blood flow utilizing the patient's body surface area (BSA) and cardiac index (CI). Metabolic acidosis during CPB is almost always the result of hypoperfusion leading to oxygen delivery inadequate to meet metabolic demands for aerobic respiration. Oxygen consumption is thus a major determinant of CPB flow requirements. Deep hypothermic circulatory arrest (DHCA) is used to dramatically lower the body's metabolic demand while protecting organs, particularly the brain, during a period in which perfusion is suspended. Some in-line devices provide a continuous calculation of oxygen consumption based on pump flow and the arterio-venous oxygen differential.