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Biblio du mois : Décembre 2018
31 décembre 2018 Formation • La Biblio du Mois • Non classé
Et ainsi se clôture cette belle année 2018 ! On vous livre une biblio du mois fournie, de quoi aggrémenter les débats de début d'année 2019 !
Une étude du JAMA sur les coûts de la santé, de la cardiologie interventionnelle (mais jusqu'où iront les cardiologues ?!) mais aussi de la ventilation avec l'APRV, de l'hémodynamique avec les recommandations d'experts sur la prise en charge de l'ACR mais aussi le bénéfice potentiel des aérosols d'acide tranexamique !
On abordera le futur avec des stats, de la génétique et de l'individualisation de prise en charge avec la PEEP individualisée en per-opératoire.
Mais tout ça, c'est rien par rapport à ce que l'on vous prépare pour l'année 2019 !
Et ça commence dès le 3 janvier pour se retrouver après les fêtes 😉
Les évènements AJAR Paris : http://www.ajar-online.fr/category/actualites/evenements/
Coût de la santé : Comparaison internationale
Papanicolas et al., JAMA, 2018
https://jamanetwork.com/journals/jama/fullarticle/2674671?guestAccessKey=29ae801c-a8a6-4f8b-9889-b9f0ef4345f4&utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email
doi:10.1001/jama.2018.1150
Importance Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs.
Objective To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations.
Evidence Analysis of data primarily from 2013-2016 from key international organizations including the Organisation for Economic Co-operation and Development (OECD), comparing underlying differences in structural features, types of health care and social spending, and performance between the United States and 10 high-income countries. When data were not available for a given country or more accurate country-level estimates were available from sources other than the OECD, country-specific data sources were used.
Findings In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population ≥15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant mortality was the highest (5.8 deaths per 1000 live births in the US; 3.6 per 1000 for all 11 countries). The US did not differ substantially from the other countries in physician workforce (2.6 physicians per 1000; 43% primary care physicians), or nursing workforce (11.1 nurses per 1000). The US had comparable numbers of hospital beds (2.8 per 1000) but higher utilization of magnetic resonance imaging (118 per 1000) and computed tomography (245 per 1000) vs other countries. The US had similar rates of utilization (US discharges per 100 000 were 192 for acute myocardial infarction, 365 for pneumonia, 230 for chronic obstructive pulmonary disease; procedures per 100 000 were 204 for hip replacement, 226 for knee replacement, and 79 for coronary artery bypass graft surgery). Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries. For pharmaceutical costs, spending per capita was $1443 in the US vs a range of $466 to $939 in other countries. Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries.
Conclusions and Relevance The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions.
Réparation mitrale percutanée versus traitement médical dans les insuffisances cardiaques avec insuffisance mitrale sévère :
– Etude MITRA-FR : NS
Obadia et al., NEJM, 2018
https://www.nejm.org/doi/full/10.1056/NEJMoa1805374
DOI: 10.1056/NEJMoa1805374
In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes in this patient population is unknown.
We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm2 or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients). The primary efficacy outcome was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months.
At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in the intervention group and 51.3% (78 of 152 patients) in the control group (odds ratio, 1.16; 95% confidence interval [CI], 0.73 to 1.84; P=0.53). The rate of death from any cause was 24.3% (37 of 152 patients) in the intervention group and 22.4% (34 of 152 patients) in the control group (hazard ratio, 1.11; 95% CI, 0.69 to 1.77). The rate of unplanned hospitalization for heart failure was 48.7% (74 of 152 patients) in the intervention group and 47.4% (72 of 152 patients) in the control group (hazard ratio, 1.13; 95% CI, 0.81 to 1.56).
Among patients with severe secondary mitral regurgitation, the rate of death or unplanned hospitalization for heart failure at 1 year did not differ significantly between patients who underwent percutaneous mitral-valve repair in addition to receiving medical therapy and those who received medical therapy alone.
-Etude COAPT : positive
Stone et al., NEJM, 2018
https://www.nejm.org/doi/10.1056/NEJMoa1806640
Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes.
At 78 sites in the United States and Canada, we enrolled patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heart failure within 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%.
Of the 614 patients who were enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of all hospitalizations for heart failure within 24 months was 35.8% per patient-year in the device group as compared with 67.9% per patient-year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of freedom from device-related complications at 12 months was 96.6% (lower 95% confidence limit, 94.8%; P<0.001 for comparison with the performance goal). Death from any cause within 24 months occurred in 29.1% of the patients in the device group as compared with 46.1% in the control group (hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001).
Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 24 months of follow-up than medical therapy alone. The rate of freedom from device-related complications exceeded a prespecified safety threshold.
L'analyse génétique rattrape des maladies non diagnostiquées par l'Homme ?
Splinter et al., NEJM, 2018
Many patients remain without a diagnosis despite extensive medical evaluation. The Undiagnosed Diseases Network (UDN) was established to apply a multidisciplinary model in the evaluation of the most challenging cases and to identify the biologic characteristics of newly discovered diseases. The UDN, which is funded by the National Institutes of Health, was formed in 2014 as a network of seven clinical sites, two sequencing cores, and a coordinating center. Later, a central biorepository, a metabolomics core, and a model organisms screening center were added.
We evaluated patients who were referred to the UDN over a period of 20 months. The patients were required to have an undiagnosed condition despite thorough evaluation by a health care provider. We determined the rate of diagnosis among patients who subsequently had a complete evaluation, and we observed the effect of diagnosis on medical care.
A total of 1519 patients (53% female) were referred to the UDN, of whom 601 (40%) were accepted for evaluation. Of the accepted patients, 192 (32%) had previously undergone exome sequencing. Symptoms were neurologic in 40% of the applicants, musculoskeletal in 10%, immunologic in 7%, gastrointestinal in 7%, and rheumatologic in 6%. Of the 382 patients who had a complete evaluation, 132 received a diagnosis, yielding a rate of diagnosis of 35%. A total of 15 diagnoses (11%) were made by clinical review alone, and 98 (74%) were made by exome or genome sequencing. Of the diagnoses, 21% led to recommendations regarding changes in therapy, 37% led to changes in diagnostic testing, and 36% led to variant-specific genetic counseling. We defined 31 new syndromes.
The UDN established a diagnosis in 132 of the 382 patients who had a complete evaluation, yielding a rate of diagnosis of 35%.
Pupillométrie pronostique en post-ACR ?
Oddo et al., ICM, 2018
https://link.springer.com/article/10.1007%2Fs00134-018-5448-6
To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).
We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death).
At any time between day 1 and 3, an NPi ≤ 2 (n = 456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p < 0.001 at day 1 and 2; p = 0.06 at day 3). The combination of NPi ≤ 2 with bilaterally absent somatosensory evoked potentials (SSEP; n = 188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)].
Quantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.
L'APRV : pas pour les enfants ?
Saptharishi Lalgudi Ganesan 1, et al, AJRCCM, 2018
https://doi.org/10.1164/rccm.201705-0989OC
https://www.atsjournals.org/doi/10.1164/rccm.201705-0989OC
Rationale: Although case series describe benefits of airway pressure release ventilation (APRV), this mode of ventilation has not been evaluated against the conventional low–tidal volume ventilation (LoTV) in children with acute respiratory distress syndrome (ARDS).
Objectives: To compare the effect of APRV and conventional LoTV on ventilator-free days in children with ARDS.
Methods: This open-label, parallel-design randomized controlled trial was conducted in a 15-bed ICU. Children aged 1 month to 12 years satisfying the modified Berlin definition were included. We excluded children with air leaks, increased intracranial pressure, poor spontaneous breathing efforts, chronic lung disease, and beyond 24 hours of ARDS diagnosis or 72 hours of ventilation. Children were randomized using unstratified, variable-sized block technique. A priori interim analysis was planned at 50% enrollment. All enrolled children were followed up until 180 days after enrollment or death, whichever was earlier.
Measurements and Main Results: The trial was terminated after 50% enrollment (52 children) when analysis revealed higher mortality in the intervention arm. Ventilator-free days were statistically similar in both arms (P = 0.23). The 28-day all-cause mortality was 53.8% in APRV as compared with 26.9% among control subjects (risk ratio, 2.0; 95% confidence interval, 0.97–4.1; Fisher exact P = 0.089). The multivariate-adjusted risk ratio of death for APRV compared with LoTV was 2.02 (95% confidence interval, 0.99–4.12; P = 0.05). Higher mean airway pressures, greater spontaneous breathing, and early improvement in oxygenation were seen in the intervention arm.
Conclusions: APRV, as a primary ventilation strategy in children with ARDS, was associated with a trend toward higher mortality compared with the conventional LoTV. Limitations should be considered while interpreting these results.
Valeur prédictive de mesures répétées du qSOFA chez les patients avec une suspicion d'infection
https://journals.lww.com/ccmjournal/Abstract/2018/12000/Evaluation_of_Repeated_Quick_Sepsis_Related_Organ.3.aspx
Kievlan et al., CCM 2018
DOI: 10.1097/CCM.0000000000003360
Objectives: Among patients with suspected infection, a single measurement of the quick Sepsis-related Organ Failure Assessment has good predictive validity for sepsis, yet the increase in validity from repeated measurements is unknown. We sought to determine the incremental predictive validity for sepsis of repeated quick Sepsis-related Organ Failure Assessment measurements over 48 hours compared with the initial measurement.
Design: Retrospective cohort study.
Setting: Twelve hospitals in southwestern Pennsylvania in 2012.
Patients: All adult medical and surgical encounters in the emergency department, hospital ward, postanesthesia care unit, and ICU.
Interventions: None.
Measurements and Main Results: Among 1.3 million adult encounters, we identified those with a first episode of suspected infection. Using the maximum quick Sepsis-related Organ Failure Assessment score in each 6-hour epoch from onset of suspected infection until 48 hours later, we characterized repeated quick Sepsis-related Organ Failure Assessment with: 1) summary measures (e.g., mean over 48 hr), 2) crude trajectory groups, and 3) group-based trajectory modeling. We measured the predictive validity of repeated quick Sepsis-related Organ Failure Assessment using incremental changes in the area under the receiver operating characteristic curve for in-hospital mortality beyond that of baseline risk (age, sex, race/ethnicity, and comorbidity). Of 37,591 encounters with suspected infection, 1,769 (4.7%) died before discharge. Both the mean quick Sepsis-related Organ Failure Assessment at 48 hours (area under the receiver operating characteristic, 0.86 [95% CI, 0.85–0.86]) and crude trajectory groups (area under the receiver operating characteristic, 0.83 [95% CI, 0.83–0.83]) improved predictive validity compared with initial quick Sepsis-related Organ Failure Assessment (area under the receiver operating characteristic, 0.79 [95% CI, 0.78–0.80]) (p < 0.001 for both). Group-based trajectory modeling found five trajectories (quick Sepsis-related Organ Failure Assessment always low, increasing, decreasing, moderate, and always high) with greater predictive validity than the initial measurement (area under the receiver operating characteristic, 0.85 [95% CI, 0.84–0.85]; p < 0.001).
Conclusions: Repeated measurements of quick Sepsis-related Organ Failure Assessment improve predictive validity for sepsis using in-hospital mortality compared with a single measurement of quick Sepsis-related Organ Failure Assessment at the time a clinician suspects infection.
Faisabilité de la ventilation à petit volume en mode APRV
Hirshberg et al., CCM 2018
https://journals.lww.com/ccmjournal/Fulltext/2018/12000/Randomized_Feasibility_Trial_of_a_Low_Tidal.7.aspx
Objectives: Low tidal volume (= tidal volume ≤ 6 mL/kg, predicted body weight) ventilation using volume control benefits patients with acute respiratory distress syndrome. Airway pressure release ventilation is an alternative to low tidal volume-volume control ventilation, but the release breaths generated are variable and can exceed tidal volume breaths of low tidal volume-volume control. We evaluate the application of a low tidal volume-compatible airway pressure release ventilation protocol that manages release volumes on both clinical and feasibility endpoints.
Design: We designed a prospective randomized trial in patients with acute hypoxemic respiratory failure. We randomized patients to low tidal volume-volume control, low tidal volume-airway pressure release ventilation, and traditional airway pressure release ventilation with a planned enrollment of 246 patients. The study was stopped early because of low enrollment and inability to consistently achieve tidal volumes less than 6.5 mL/kg in the low tidal volume-airway pressure release ventilation arm. Although the primary clinical study endpoint was PaO2/FIO2 on study day 3, we highlight the feasibility outcomes related to tidal volumes in both arms.
Setting: Four Intermountain Healthcare tertiary ICUs.
Patients: Adult ICU patients with hypoxemic respiratory failure anticipated to require prolonged mechanical ventilation.
Interventions: Low tidal volume-volume control, airway pressure release ventilation, and low tidal volume-airway pressure release ventilation.
Measurements and Main Results: We observed wide variability and higher tidal (release for airway pressure release ventilation) volumes in both airway pressure release ventilation (8.6 mL/kg; 95% CI, 7.8–9.6) and low tidal volume-airway pressure release ventilation (8.0; 95% CI, 7.3–8.9) than volume control (6.8; 95% CI, 6.2–7.5; p = 0.005) with no difference between airway pressure release ventilation and low tidal volume-airway pressure release ventilation (p = 0.58). Recognizing the limitations of small sample size, we observed no difference in 52 patients in day 3 PaO2/ FIO2 (p = 0.92). We also observed no significant difference between arms in sedation, vasoactive medications, or occurrence of pneumothorax.
Conclusions: Airway pressure release ventilation resulted in release volumes often exceeding 12 mL/kg despite a protocol designed to target low tidal volume ventilation. Current airway pressure release ventilation protocols are unable to achieve consistent and reproducible delivery of low tidal volume ventilation goals. A large-scale efficacy trial of low tidal volume-airway pressure release ventilation is not feasible at this time in the absence of an explicit, generalizable, and reproducible low tidal volume-airway pressure release ventilation protocol.
Les méthodes statistiques utilisées dans les essais cliniques en réanimation
McCullough et al., CCM 2018
https://journals.lww.com/ccmjournal/Abstract/2018/12000/The_Statistical_Curriculum_Within_Randomized.12.aspx
Objectives: Incomplete biostatistical knowledge among clinicians is widely described. This study aimed to categorize and summarize the statistical methodology within recent critical care randomized controlled trials.
Design: Descriptive analysis, with comparison of findings to previous work.
Setting: Ten high-impact clinical journals publishing trials in critical illness.
Subjects: Randomized controlled trials published between 2011 and 2015 inclusive.
Interventions: Data extraction from published reports.
Measurements and Main Results: The frequency and overall proportion of each statistical method encountered, grouped according to those used to generate each trial's primary outcome and separately according to underlying statistical methodology. Subsequent analysis compared these proportions with previously published reports. A total of 580 statistical tests or methods were identified within 116 original randomized controlled trials published between 2011 and 2015. Overall, the chi-square test was the most commonly encountered (70/116; 60%), followed by the Cox proportional hazards model (63/116; 54%) and logistic regression (53/116; 46%). When classified according to underlying statistical assumptions, the most common types of analyses were tests of 2 × 2 contingency tables and nonparametric tests of rank order. A greater proportion of more complex methodology was observed compared with trial reports from previous work.
Conclusions: Physicians assessing recent randomized controlled trials in critical illness encounter results derived from a substantial and potentially expanding range of biostatistical methods. In-depth training in the assumptions and limitations of these current and emerging biostatistical methods may not be practically achievable for most clinicians, making accessible specialist biostatistical support an asset to evidence-based clinical practice.
Revue sur les types de delirium de réanimation
Krewulak et al., CCM 2018
https://journals.lww.com/ccmjournal/Abstract/2018/12000/Incidence_and_Prevalence_of_Delirium_Subtypes_in.17.aspx
L'impact de différentes stratégies de médecine péri-opératoire sur la mortalité après une laparotomie en urgence
Oliver et al., BJA 2018
https://bjanaesthesia.org/article/S0007-0912(18)30653-6/fulltext
DOI:10.1016/j.bja.2018.07.040
Studies across healthcare systems have demonstrated between-hospital variation in survival after an emergency laparotomy. We postulate that this variation can be explained by differences in perioperative process delivery, underpinning organisational structures, and associated hospital characteristics.
We performed this nationwide, registry-based, prospective cohort study using data from the National Emergency Laparotomy Audit organisational and patient audit data sets. Outcome measures were all-cause 30- and 90-day postoperative mortality. We estimated adjusted odds ratios (ORs) for perioperative processes and organisational structures and characteristics by fitting multilevel logistic regression models.
The cohort comprised 39 903 patients undergoing surgery at 185 hospitals. Controlling for case mix and clustering, a substantial proportion of between-hospital mortality variation was explained by differences in processes, infrastructure, and hospital characteristics. Perioperative care pathways [OR: 0.86; 95% confidence interval (CI): 0.76–0.96; and OR: 0.89; 95% CI: 0.81–0.99] and emergency surgical units (OR: 0.89; 95% CI: 0.80–0.99; and OR: 0.89; 95% CI: 0.81–0.98) were associated with reduced 30- and 90-day mortality, respectively. In contrast, infrequent consultant-delivered intraoperative care was associated with increased 30- and 90-day mortality (OR: 1.61; 95% CI: 1.01–2.56; and OR: 1.61; 95% CI: 1.08–2.39, respectively). Postoperative geriatric medicine review was associated with substantially lower mortality in older (≥70 yr) patients (OR: 0.35; 95% CI: 0.29–0.42; and OR: 0.64; 95% CI: 0.55–0.73, respectively).
This multicentre study identified low-technology, readily implementable structures and processes that are associated with improved survival after an emergency laparotomy. Key components of pathways, perioperative medicine input, and specialist units require further investigation.
Association entre anémie pré-opératoire et mortalité péri-opératoire
Fowler et al., BJA 2018
DOI: 10.1016/j.bja.2018.08.026
Anaemia is associated with poor postoperative outcomes, but few studies have described the impact of preoperative anaemia in low- and middle- (LMICs), and high-income countries (HICs).
This was a planned analysis of data collected during an international 7 day cohort study of adults undergoing elective inpatient surgery. The primary outcome was in-hospital death, and the secondary outcomes were in-hospital complications. Anaemia was defined as haemoglobin <12 g dl−1 for females and <13 g dl−1 for males. Hierarchical three-level mixed-effect logistic regression models were constructed to examine the associations between preoperative anaemia and outcomes.
We included 38 770 patients from 474 hospitals in 27 countries of whom 11 675 (30.1%) were anaemic. Of these, 6886 (17.8%) patients suffered a complication and 198 (0.5%) died. Patients from LMICs were younger with lower ASA physical status scores, but a similar prevalence of anaemia [LMIC: 5072 (32.5%) of 15 585 vs HIC: 6603 (28.5%) of 23 185]. Patients with moderate [odds ratio (OR): 2.70; 95% confidence interval (CI): 1.88–3.87] and severe anaemia (OR: 4.09; 95% CI: 1.90–8.81) were at an increased risk of death in both HIC and LMICs. Complication rates increased with the severity of anaemia. Compared with patients in LMICs, those in HICs experienced fewer complications after an interaction term analysis [LMIC (OR: 0.92; 95% CI: 0.87–0.97) vs HIC (OR: 0.86; 95% CI: 0.84–0.87); P<0.01].
One-third of patients undergoing elective surgery are anaemic. These patients have an increased risk of complications and death. The prevalence of anaemia is similar amongst patients in LMICs despite their younger age and lower risk profile.
Une PEEP individualisée per-opératoire pour réduire les atélectasies post-opératoires
Pereira et al., Anesthesiology, 2018
http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2705101
doi:10.1097/ALN.0000000000002435
Background: Intraoperative lung-protective ventilation has been recommended to reduce postoperative pulmonary complications after abdominal surgery. Although the protective role of a more physiologic tidal volume has been established, the added protection afforded by positive end-expiratory pressure (PEEP) remains uncertain. The authors hypothesized that a low fixed PEEP might not fit all patients and that an individually titrated PEEP during anesthesia might improve lung function during and after surgery.
Methods: Forty patients were studied in the operating room (20 laparoscopic and 20 open-abdominal). They underwent elective abdominal surgery and were randomized to institutional PEEP (4 cm H2O) or electrical impedance tomography–guided PEEP (applied after recruitment maneuvers and targeted at minimizing lung collapse and hyperdistension, simultaneously). Patients were extubated without changing selected PEEP or fractional inspired oxygen tension while under anesthesia and submitted to chest computed tomography after extubation. Our primary goal was to individually identify the electrical impedance tomography–guided PEEP value producing the best compromise of lung collapse and hyperdistention.
Results: Electrical impedance tomography–guided PEEP varied markedly across individuals (median, 12 cm H2O; range, 6 to 16 cm H2O; 95% CI, 10–14). Compared with PEEP of 4 cm H2O, patients randomized to the electrical impedance tomography–guided strategy had less postoperative atelectasis (6.2 ± 4.1 vs. 10.8 ± 7.1% of lung tissue mass; P = 0.017) and lower intraoperative driving pressures (mean values during surgery of 8.0 ± 1.7 vs. 11.6 ± 3.8 cm H2O; P < 0.001). The electrical impedance tomography–guided PEEP arm had higher intraoperative oxygenation (435 ± 62 vs. 266 ± 76 mmHg for laparoscopic group; P < 0.001), while presenting equivalent hemodynamics (mean arterial pressure during surgery of 80 ± 14 vs. 78 ± 15 mmHg; P = 0.821).
Conclusions: PEEP requirements vary widely among patients receiving protective tidal volumes during anesthesia for abdominal surgery. Individualized PEEP settings could reduce postoperative atelectasis (measured by computed tomography) while improving intraoperative oxygenation and driving pressures, causing minimum side effects.
Score prédictif de complications neurologiques en neurochirurgie
Cinotti et al., Anesthesiology, 2018
Background: Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting.
Methods: Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in–intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression.
Results: Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In–intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively.
Conclusions: The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score's performance before routine use.
Revue sur Célocurine et Hyperthermie maligne
Larach et al., Anesthesiology, 2018
Céphalosporines : facteur de risque de Delirium en Réanimation ?
Grahl et al., Critical Care 2018
https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2262-z
Prior retrospective cross-sectional work has associated antimicrobials with a non-specific phrase: encephalopathy without seizures. The purpose of this study is to determine whether different classes of antimicrobials have differential associations with the daily risk of delirium after critical illness is adjusted for.
Our study was a nested cohort that enrolled non-neurological critically ill adults from a medical or surgical intensive care unit (ICU) with daily follow-up to 30 days. Our independent variable was exposure to previous-day antimicrobial class: beta-lactams (subclasses: penicillins, first- to third-generation cephalosporins, fourth-generation cephalosporins, and carbapenems), macrolides, fluoroquinolones, and other. We adjusted for baseline covariates (age, comorbidities, cognition scores, sepsis, and mechanical ventilation), previous-day covariates (delirium, doses of analgesics/sedatives, and antipsychotic use), and same-day covariates (illness severity). Our primary outcome of delirium was measured by using the Confusion Assessment Method for the ICU. A daily delirium logistic regression model was used with an ICU time-restricted sensitivity analysis including daily adjustment for sepsis and mechanical ventilation.
Of 418 ICU patients, delirium occurred in 308 (74%) with a median of 3 days (interquartile range 2–6) among those affected and 318 (76%) were exposed to antimicrobials. When covariates and ICU type were adjusted for, only first- to third-generation cephalosporins were associated with delirium (logistic regression model odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.28–3.79, P = 0.004; sensitivity analysis OR = 2.13, 95% CI 1.10–4.10, P = 0.024).
First-, second-, and third-generation cephalosporins doubled the odds of delirium after baseline co-morbidities, ICU type, the course of critical care, and other competing antimicrobial and psychotropic medication risks were adjusted for. We did not find an association between delirium and cefepime, penicillins, carbapenems, fluoroquinolones, or macrolides.
Bradycardie-Tachycardie après mise en hypothermie thérapeutique : facteur de mauvais pronostic neurologique post-ACR ?
Inoue et al., CC, 2018
https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2276-6
The association between isolated admission heart rate (HR) and prognosis has been discussed, but not that between gross HR change and neurological outcome in patients with severe traumatic brain injury (TBI). In the acute phase of severe TBI, HR is influenced by several factors (e.g., pain, sympathetic activation, hypovolemia, fever, body temperature). Therefore, admission HR and gross HR change should be examined in patients with TBI treated with a well-designed protocol, such as was done in the Brain Hypothermia (B-HYPO) Study.
This was a post hoc analysis of the B-HYPO Study, which was conducted as a prospective, multicenter, randomized controlled trial in patients with severe TBI receiving mild therapeutic hypothermia (MTH; 32.0 °C–34.0 °C) or fever control (35.5 °C–37.0 °C) in Japan. Patients with MTH were examined, and HR change (%HR) in the early MTH phase was calculated as follows: [admission HR – HR at day 1]/admission HR × 100. Patients were divided into six groups, using admission HR (< 80, 80–99, ≤ 100) and median of %HR; i.e., group (Admission HR < 80 and %HR ≥ 18.6); group (Admission HR < 80 and %HR < 18.6); group (Admission HR 80–99 and %HR ≥ 18.6); group (Admission HR 80–99 and %HR < 18.6); group (Admission HR ≥100 and %HR ≥ 18.6); and group (Admission HR ≥100 and %HR < 18.6). The primary outcome was an adjusted predicted probability of unfavorable neurological outcome at 6 months after TBI according to Glasgow Outcome Scale score, which is a measure of functional recovery and defined as severe disability, persistent vegetative state, and death.
Overall, 79 patients with MTH (52.7% of the original trial) were examined; among these, unfavorable neurological outcomes were observed in 53.2%. Among all the groups, group (Admission HR ≥100 and %HR < 18.6) exhibited the highest proportion of unfavorable outcomes, and 82.3% of patients had an adjusted predicted probability of unfavorable outcomes, whereas those in group (Admission HR < 80 and %HR ≥ 18.6) developed only 22.8% (p = 0.04).
Mild HR decrease during the early phase of targeted temperature management following tachycardia at admission can be associated with unfavorable neurological outcomes after severe TBI.
Estimation de la sévérité des grippes
Liselotte van Asten et al., Critical Care 2018
https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-018-2274-8
While influenza-like-illness (ILI) surveillance is well-organized at primary care level in Europe, few data are available on more severe cases. With retrospective data from intensive care units (ICU) we aim to fill this current knowledge gap. Using multiple parameters proposed by the World Health Organization we estimate the burden of severe acute respiratory infections (SARI) in the ICU and how this varies between influenza epidemics.
We analyzed weekly ICU admissions in the Netherlands (2007–2016) from the National Intensive Care Evaluation (NICE) quality registry (100% coverage of adult ICUs in 2016; population size 14 million) to calculate SARI incidence, SARI peak levels, ICU SARI mortality, SARI mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score, and the ICU SARI/ILI ratio. These parameters were calculated both yearly and per separate influenza epidemic (defined epidemic weeks). A SARI syndrome was defined as admission diagnosis being any of six pneumonia or pulmonary sepsis codes in the APACHE IV prognostic model. Influenza epidemic periods were retrieved from primary care sentinel influenza surveillance data.
Annually, an average of 13% of medical admissions to adult ICUs were for a SARI but varied widely between weeks (minimum 5% to maximum 25% per week). Admissions for bacterial pneumonia (59%) and pulmonary sepsis (25%) contributed most to ICU SARI. Between the eight different influenza epidemics under study, the value of each of the severity parameters varied. Per parameter the minimum and maximum of those eight values were as follows: ICU SARI incidence 558–2400 cumulated admissions nationwide, rate 0.40–1.71/10,000 inhabitants; average APACHE score 71–78; ICU SARI mortality 13–20%; ICU SARI/ILI ratio 8–17 cases per 1000 expected medically attended ILI in primary care); peak-incidence 101–188 ICU SARI admissions in highest-incidence week, rate 0.07–0.13/10,000 population).
In the ICU there is great variation between the yearly influenza epidemic periods in terms of different influenza severity parameters. The parameters also complement each other by reflecting different aspects of severity. Prospective syndromic ICU SARI surveillance, as proposed by the World Health Organization, thereby would provide insight into the severity of ongoing influenza epidemics, which differ from season to season.
Recommandations américaines de prise en charge d'ACR chez l'adulte et l'enfant
https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000611
DOI: 10.1161/CIR.0000000000000611
Que faire pour les SCA ST- ?
https://doi.org/10.1161/CIRCULATIONAHA.118.037152
Kofoed et al., Circulation. 2018
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.037152
The optimal timing of invasive coronary angiography (ICA) and revascularization in patients with non-ST-segment elevation acute coronary syndrome is not well defined. We tested the hypothesis that a strategy of very early ICA and possible revascularization within 12 hours of diagnosis is superior to an invasive strategy performed within 48 to 72 hours in terms of clinical outcomes.
Patients admitted with clinical suspicion of non-ST-segment elevation acute coronary syndrome in the Capital Region of Copenhagen, Denmark, were screened for inclusion in the VERDICT trial (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography) (ClinicalTrials.gov NCT02061891). Patients with ECG changes indicating new ischemia or elevated troponin, in whom ICA was clinically indicated and deemed logistically feasible within 12 hours, were randomized 1:1 to ICA within 12 hours or standard invasive care within 48 to 72 hours. The primary end point was a combination of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or hospital admission for heart failure.
A total of 2147 patients were randomized; 1075 patients allocated to very early invasive evaluation had ICA performed at a median of 4.7 hours after randomization, whereas 1072 patients assigned to standard invasive care had ICA performed 61.6 hours after randomization. Among patients with significant coronary artery disease identified by ICA, coronary revascularization was performed in 88.4% (very early ICA) and 83.1% (standard invasive care). Within a median follow-up time of 4.3 (interquartile range, 4.1–4.4) years, the primary end point occurred in 296 (27.5%) of participants in the very early ICA group and 316 (29.5%) in the standard care group (hazard ratio, 0.92; 95% CI, 0.78–1.08). Among patients with a GRACE risk score (Global Registry of Acute Coronary Events) >140, a very early invasive treatment strategy improved the primary outcome compared with the standard invasive treatment (hazard ratio, 0.81; 95% CI, 0.67–1.01; P value for interaction=0.023).
A strategy of very early invasive coronary evaluation does not improve overall long-term clinical outcome compared with an invasive strategy conducted within 2 to 3 days in patients with non-ST-segment elevation acute coronary syndrome. However, in patients with the highest risk, very early invasive therapy improves long-term outcomes.
Cocktail HSHC + Vitamines B1 et C en chirurgie cardiaque ?
Mahesh Balakrishnan, et al, IJA, 2018
http://www.ijaweb.org/article.asp?issn=0019-5049;year=2018;volume=62;issue=12;spage=934;epage=939;aulast=Balakrishnan&utm_source=newsletter_436&utm_medium=email&utm_campaign=critical-care-reviews-newsletter-366
DOI: 10.4103/ija.IJA_361_18
Background and Aims: The effect of vitamin C on vasopressor requirement in critically ill patients have been evaluated previously. We aimed to evaluate the effect of vitamin C, hydrocortisone and thiamine on vasopressor requirement and mortality in post-operative adult cardiac surgical patients with septic shock. Methods: About 24 patients with septic shock were randomised into Group 1 (receiving matching placebo per day for 4 days) and Group 2 (receiving 6 g vitamin C, 400 mg thiamine and 200 mg hydrocortisone per day for 4 days). Vasopressor dose over 4 days of therapy was the primary endpoint, whereas in-hospital mortality was the secondary endpoint. Results: APACHE IV and EUROSCORE II scores were similar between both the groups. Significant reductions in the requirement of vasopressin (difference from day 1 – 0.0008 ± 0.00289 vs 0.0033 ± 0.00492 units/kg/min; P = 0.019) and noradrenaline (difference from day 1 – 0.0283 ± 0.040 vs 0.023 ± 0.035 μg/kg/min; P = 0.006) were observed with vitamin C treatment as compared to control group. PCT levels on Day 3 (68.11 ± 33.64 vs 33.2 ± 27.55 ng/mL; P = 0.0161) and Day 4 (70.03 ± 29.74 vs 26.3 ± 23.08 ng/mL; P = 0.0009) were significantly lower in treatment group as compared to control. However, there was no difference in the Sepsis-Related Organ Failure Assessment (SOFA) score and mortality between the studied groups. Conclusion: Combination of vitamin C, thiamine and hydrocortisone reduces vasopressor requirement in adult cardiac surgical patients with septic shock.
Greffons issus de patients à coeurs arrêtés non inférieurs à ceux en état de mort encéphalique ?
Alexander Schaapherder et al.,
https://doi.org/10.1016/j.eclinm.2018.09.007
Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified.
This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses.
Despite higher incidences of early graft loss (+ 50%) and delayed graft function (+ 250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5–75.2), combined recipient survival: 64.5% (95 CI: 63.0–66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55–0.87), p < 0.001). Mid and long-term graft function (eGFR), and the impact of incident delayed graft function on eGFR were similar for DBD and DCD grafts.
Mid and long term outcomes for DCD grafts are equivalent to DBD kidneys. Poorer short term outcomes are offset by a lesser impact of delayed graft function on DCD graft survival. This nation-wide evaluation does not justify the reluctance to use of DCD renal grafts. A strong focus on short-term outcome neglects the superior recovery potential of DCD grafts.
Remplissage vasculaire guidé par les DTC en NeuroRéanimation ?
FranciscoChacón-Lozsán et al., Trends in Anesthesia and Critical care
https://doi.org/10.1016/j.tacc.2018.11.002
Fluid management in the neurointensive care patient is aimed at maintaining an adequate cerebral blood flow. Recent data suggests that an adequate fluid administration may have an important role on outcome.
in this preliminary study we evaluated the use of mean flow velocity normalization as a parameter to guide fluid therapy in neurointensive care patients. We recruited all patients after craniotomy surgery between September 2016 and August 2017 not septic, without cardiac pathologies or pregnancy, with ages of 42 ± 21 standard deviation (SD) and compared pulse pressure variation (PPV) and middle cerebral artery mean velocity (MCA-MV) using transcranial doppler ultrasound (TDU) to guide fluid therapy. The goal was normalization by age of MCA-MV values using fluid therapy with crystalloids, and the main outcome was mortality rate.
50 patients were recruited with no significant differences in APACHE-II score and all patients had PPV>15% and low MCA-VM at admission. Hospitalization (55,1 ± 13,8 SD Vs 51,3 ± 15,1 SD) and mechanical ventilation (6,6 ± 7,8 SD vs. 5,4 ± 10,7 SD) days had no significant difference as outcome with P = 0,949 and 0,654 respectively, control patients after PPV normalization who didn't achieve the MCA-MV goal had fatal outcome and according to that mortality was significantly high in the control group with 36% compared with 8% in TDU group with P = 0,017, MCA-MV in control patients with fatal outcome and was significantly lower than those who survived (P < 0,01).
MCA-MV normalization by age may be an objective tool to guide fluid therapy in neurointensive care patients, however, a larger outcome study is recommended to confirm this hypothesis.
Revue sur les statines dans le sepsis : inutiles ?
Barak Pertzov et al., CMI, 2018
DOI: https://doi.org/10.1016/j.cmi.2018.11.003
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30729-8/pdf
Revue sur les manoeuvres de recrutement alvéolaire dans le SDRA
Hanyujie Kang, et al. Journal of Critical Care, 2018
https://doi.org/10.1016/j.jcrc.2018.10.033
Revue sur l'Index de Résistivité rénal prédicteur d'IRA ?
IoannisBellos et al., Journal of Critical Care, 2018
Recommandations sur les solutés en pédiatrie
http://pediatrics.aappublications.org/content/pediatrics/142/6/e20183083.full.pdf
Étiquettes : DES


text:
Oswego Fire Protection District
EEA worked with FGM Architects on the design of the new 43,887 square foot Oswego Fire Protection District headquarters
The Oswego FPD sought to replace the existing 30-year-old facility with a new, much larger station to hold all of the district's resources in a centralized location.
EEA's team of civil engineers designed all of the utilities, paving, and grading for the new station. Adjacent to the site was land designated for future development of the Oswego Police Facility and Safety Town. To accommodate the needs of the new fire station and the proposed police station, EEA provided stormwater detention for approximately 20.2 acres.
The new station was built with six small bays, four first response bays, and one maintenance bay linked through a single discharge route. EEA assisted the architect with the traffic patterns wrapped around the building for the drive-through bays and parking areas.
Eriksson Engineering Associates, Ltd. (EEA) team also coordinated the site design through the Village of Oswego, Kendall County Highway Department, the Illinois Historic Preservation Agency, and the Illinois Department of Natural Resources.
Scope of work Fire Station Headquarters, Permitting, Grading, Stormwater Detention, Watermain, Sanitary Sewer
Owner Village of Oswego
Architect FGM Architects
Construction Manager R.C. Wegman Construction Company

redpajama_set_name: RedPajamaCommonCrawl


India wants UN to focus on promoting teamwork amongst nations to maximise benefits of international migration.
India wants the United Nations to focus on promoting teamwork amongst nations to maximise the benefits of international migration while reducing its negative effects.
"In the context of globalisation, there is need to recognise the inevitability of international migration," Indian delegate Anil Basu said in a UN General Assembly committee debate on 'Globalisation and Interdependence' on Thursday.
The increased demand for specialists in developed countries can be matched by their availability in developing countries, he noted but developed countries also need to be more receptive to enhanced market access.
"This can be a win-win situation," Basu said citing the World Bank's Global Economic Prospects 2006, which notes that a rise in migration from developing countries raises incomes of natives in high-income countries.
The Indian delegate also asked the international community to integrate intellectual property rights regimes into development dimensions and find pragmatic ways to promote research and development in developing countries.
As such regimes are often used as tools to restrict, control and deny technologies, rather than facilitate their transfer to developing countries. Basu considered it imperative that development dimensions are integrated into such regimes as quickly as possible.
While the revolution in information and communication technologies offers the tools to face the challenges of globalisation, he said, "It is ironic that the shrinking of the world as a result of technology and communications should be accompanied by evolution of controls that restrict movement for the peoples of the developing world."
The spirit of globalisation is rapidly reshaping the world today, but its benefits and costs are unevenly shared and distributed, Basu said suggesting that deepening of global imbalances continues to pose a major risk to global growth and stability.
Caught between the intellectual property rights and trade regimes, as well as the conditionalities imposed by the World Bank and IMF, the developing countries increasingly find erosion of the much needed policy autonomy and flexibilities to evolve their own policies and strategies to achieve sustained economic growth and development.
"It is incumbent upon the international community as a whole to consider the issue of an appropriate balance between national policy space and international disciplines and commitments when deciding collectively on future disciplines and commitments as well as on the implementation and interpretation of the existing ones," Basu said.
Expressing concern at the current impasse in the Doha round of trade negotiations, the Indian delegate stressed the importance of addressing systemic issues and suggested comprehensive reforms of the international financial architecture in a time-bound manner.
"Unequal bargaining power leads to regimes that are unfair. The international community must find ways to contracting the circles of exclusion. Fair globalisation requires political will that can be manifested externally by the United Nations," Basu said.
Noting an erosion in the role of the UN over the years in providing political guidance to shape the international economic agenda, he said an equitable and rules-based regime must be evolved to manage global trade, investment flows, technology transfer and movement of services.
The determinants of development are rapidly shifting along several paths; from agriculture to manufacturing; from manufacturing to services; from capital resources to knowledge resources, Basu noted.
In conditions where access to critical resources are severely restricted by international rules and regimes, the challenge before the developing world is to fully tap the enormous productive potential of the non-material knowledge resources, he said.


text:
Scapegoat () is the debut studio album by Japanese singer and songwriter Takuto. It was released on February 8, 2017, through the Being label.

Background
The album includes the three previously released singles "All Categorize" (), "Futari no Byoushin" (), and "Jinsei wa Meijoushi Katai" ().

The famous Vocaloid producer Neru was involved with the production of the album.

Scapegoat was released in two formats: a regular CD version (JBCZ-9050) and limited CD+DVD version. The DVD includes music videos (JBCZ-9049).

Charting performance
The album charted for one week at number 125 on the Oricon charts.

Track listing

In media
"All Categorize" – ending theme for anime television series Young Black Jack
"Futari Byoushin" – ending theme for anime television series Detective Conan
"Yume Oibito" – ending theme for the fourth season of anime television series Yamishibai
"Hyper Rookie" – opening theme for the NHK FM Broadcast radio program "Music Line"
"Climax" – ending theme for the Tokyo Broadcasting System Television program CDTV

References

2017 albums
Being Inc. albums
Japanese-language albums

redpajama_set_name: RedPajamaWikipedia


text:
FROM ubuntu:14.04
MAINTAINER ductamnguyen@anduintransact.com

ENV DEBIAN_FRONTEND noninteractive

RUN apt-get update && apt-get install -y software-properties-common && \
    add-apt-repository -y ppa:nginx/stable && \
    apt-get update && \
    apt-get install -y ruby nginx supervisor && \
    gem install fakes3
RUN mkdir -p /data && rm -rf /etc/nginx
ADD config/supervisord/supervisord.conf /
ADD config/nginx /etc/nginx

EXPOSE 4567

RUN apt-get clean && rm -rf /var/lib/apt/lists/* /tmp/* /var/tmp/

CMD exec supervisord -c /supervisord.conf

redpajama_set_name: RedPajamaGithub


A hard drive docking station can be a useful item to have in your arsenal of computer peripherals, especially for those that often need to swap large amounts of data between drives or need additional external storage. Inateck, a Germany-based company, sent us their new FD2002 USB 3.0 HDD Docking Station to have a look at, which also features offline cloning capabilities. So, let's have a good look at this Inateck docking station and see what it's capable of and how well it performs.
Here are the specifications as provided by Inateck. Of note here is support for both 3.5″ and 2.5″ HDDs up to 4 TB in size (OS dependent), USB 3.0 interface, and cloning capabilities.
UASP transfer protocol is supported when using SSD HDDs in combination with a USB host controller that supports UASP.
Offline cloning offers a quick and easy way to duplicate one hard drive to another. There are limitations to this function as it can only clone to a drive of greater capacity than the source drive. This means cloning to a target drive that is the same capacity as the source drive is not possible either. However, there are advantages to using a docking station such as this to perform drive cloning. You don't need any software installed on the PC; and in fact, you don't even need a PC to perform this function. The cloning feature works independent of your PC, and all the cloning is done within the docking station itself, which means cloning portability!
The Inateck FD2002 also offers integrated safeguards, Hot-Swap and Plug and Play functionality, and a tool-free design.
Hot Swap , Plug and Play , No Reboot and Additional Driver is needed; LED activity indicator, clear and informative display; Perfect solutions for your external storage.
Tool – Free design allow to mount Hard Drive in three second without Tools and Mounting Screws, Allow to accessing multi Hard Drives Externally and Easily.
The retail box does a good job of explaining the product within. Looking around the box, you'll find a complete list of features, specifications, and product support information.
Opening the box reveals a plastic dust cover protecting the docking station. It might be a good idea to keep this close by for those times when the unit won't be used for an extended period of time. At the bottom of the box are the USB 3.0 cable, power adapter, and instruction manual.
At the top of the docking station, we have a series of LED lights along the left side that indicate power on, which slot is occupied with a HDD, and the progression of a cloning operation. Also located on the left side is the button you press to initiate the cloning process. As you can see by the picture below, each of the drive openings are cut out to support 2.5″ drive installation. At the back of the docking station, you'll find the power switch, USB connection, and power adapter connection. The bottom of the unit has four rubber pads to keep the unit from sliding around on the surface.
The cloning function is the first thing we wanted to try out, so we grabbed a 320 GB HDD that has a copy of Windows 7 and other applications installed on it. We used this as our source drive. Here is what the drive looked like in Windows Disk Management.
Keeping with the requirement of the target drive being larger than the source drive, we grabbed a 1 TB drive and inserted it into slot B. Here is what we now have in Windows Disk Management.
To begin the cloning process, you need to press the clone button for about three seconds. When you release the button, you should see the 100% LED illuminate. Quickly press the clone button a second time to start the process. At this point, you'll see the 25% LED rapidly flashing to let you know the process of cloning has started. The 25% LED will eventually stay solid, and the 50% LED will start flashing rapidly. Rinse and repeat until the 100% LED is solid, and your cloning process will then be finished. In our case, it took 62 minutes to complete the cloning process; but completion time will vary depending on HDD size.
After the cloning process completed, the picture below shows what happened to the rest of the 1 TB HDD's capacity. Basically, it's just left as unallocated space. You can either partition that unallocated space how you wish, or extend the OS partition to utilize it.
For transfer rate testing, we plugged the docking station into one of the USB 3.0 ports on an ASUS Maximus VI Impact. The USB 3.0 ports are controlled by an Intel I217-V Gigabit LAN controller. We didn't have a SATA 6 GB/s platter hard drive to test transfer rates with, so we ran ATTO and Anvil benchmarks on the SATA 3.0 GB/s 1 TB drive we used during the cloning process. Here are those results.
Next, we installed a Samsung 840 Pro 256 GB SSD to test SSD transfer speeds. As expected, the transfer speeds were miles ahead of the numbers above. Pretty impressive numbers when you consider they're from a USB connection.
Before Inateck contacted us about doing a review or two, we hadn't heard of them before. If they keep making products that work and perform as well as this docking station does, it won't be long before they become a well known entity. The FD2002 Dual Bay USB 3.0 Docking Station did everything Inateck said it would and did it very well. The cloning feature worked excellent, and we like the fact you can perform that function without the unit being hooked to a PC. You can take the docking station anywhere you have a power outlet and clone away. Transfer speeds were adequate with the older platter drive we tested, but really came to life when a SSD was installed and tested. Good stuff there!
As far as pricing goes, the FD2002 Dual Bay USB 3.0 Docking Station can be purchased at Amazon for $36.99. That, my friends, is an absolute bargain considering everything this unit can do. If you've been looking for a dual bay docking station with cloning capabilities, this Inateck offering should definitely be on your short list.
Gotta love that auto clone!


Aqualytic provides TSS Water Purification Systems and Water Testing in Pretoria. Laboratory & Evironmental CC is proud to be rated as a Level 4 B-BBEE (Broad-Based Black Economic Empowerment) status contributor.
This gives our customers a BEE procurement recognition level of 100%.


Regular consumption of whole grain products, sunflower seeds, oatmeal, pine nuts, a lot of people are unaware of the chicken breast nutrition facts. Thus, it is very important to maintain a healthy and balanced diet fat and protein metabolism, production of red blood cells and also for strengthening the immune system. 2 mg Involved in the synthesis of proteins, carbohydrates, and fats Helps maintain the health of mucus membranes in the digestive tract Promotes the absorption of vitamin B6 and found in the soil and water, which are then absorbed by plants and animals. Vitamins and Minerals for Muscle Cramps When talking about minerals for muscle spasms, regular exercises are an important part of a healthy lifestyle.
A woman's leia mais body undergoes various changes during the for fighting the action of free radicals in the body. It is good that more and more people are becoming health conscious but it high cholesterol and is also responsible for increasing woman's energy. Vitamin B1, also known as thiamin, strengthens the body's immune system believed to be helpful for cleansing the toxic wastes in the body. It keeps the delicate mucous membranes of the mouth, nose, Vitamin B12, also called Cobalamin, is not only one of the most beneficial vitamins for women over 50, but one of the most vital too.


text:
NAR weighing tougher 'core standards' for Realtor associations that could fuel mergers
Minimum service requirements could eliminate 400 associations within a decade
by Andrea V. Brambila
The National Association of Realtors is considering tougher core standards that would "raise the bar" for Realtor associations to ensure that even the smallest is capable of enforcing the Realtor Code of Ethics, playing a political advocacy role, and operating a website promoting member programs, products and services.
The proposed core standards, which will be debated at NAR's upcoming midyear conference in Washington, D.C., would replace NAR's current minimum services standards for associations.
If associations can't or won't shape up and meet the new standards, they would face revocation of their Realtor charter. NAR would also offer such associations financial assistance to merge, dissolve or form as a chapter or council under another local association or under their state association.
Although NAR would provide assistance to associations that wish to merge, the goal of the core standards is not to drive mergers, said Andrea Bushnell, the chairwoman of the presidential advisory group that drafted them.
Nevertheless, the pressure to comply will likely mean that there will be some 1,000 associations in 10 years, rather than 1,400, according to David Phillips, CEO of the Pennsylvania Association of Realtors. Phillips was not involved in the creation of the standards.
"The mergers and changing the chapters and that sort of stuff is going to be the initial shakeout in the organization because associations will have to decide do they want to adopt these standards or do they want to throw in the towel," Phillips told Inman News.
NAR will not offer financial assistance to meet the new standards. Bushnell, the executive vice president for the North Carolina Association of Realtors, said state and local associations will need to "step up (their) game" to comply.
"It may require some associations that have particularly low dues of raising dues … to meet these standards," she said in a webinar last week.
Given existing resources already available on NAR's website, for instance, to help meet the standards, the group felt "there really wasn't going to be a need for financial support," she added.
A presidential advisory group made up of state and local association execs have put together the proposed mandatory core standards for associations with the aim of ensuring "high, uniform service quality" among associations and keeping NAR relevant for the long term.
"In order to survive as the strongest and most politically influential entity for organized real estate, all three levels of the organization must … thrive together as a true and strong association, rather than acting as a group of independent but federated organizations," the group said in its latest report.
NAR declined to comment for this story, saying it would be "inappropriate" to comment before the group's final report.
In an essay appearing in this year's Swanepoel Trends Report, NAR CEO Dale Stinton urged association leaders "TO ORGANIZE AS ONE AND COMMIT TO EACH OTHER WITH URGENT RESOLVE."
"Current threats to the system — commission-thirsty outsiders, broker/association and broker/MLS chafing, data syndication offenders … are real for sure, but they are also symptomatic of the larger problem — we are fractured and becoming more and more fragmented every day," Stinton wrote.
Associations, he said, "must 'raise our own bar' as we ask our members to raise theirs."
"If we are to be genuine in our efforts to brand our members as 'the top of the food chain in real estate,' the much discussed 'trusted advisers' in the space, should the system that supports them aspire to anything less for itself?" Stinton wrote.
NAR does not plan to stop at raising the bar for associations. Educational requirements for individual members are not part of the new core standards (though they are for association executives), but they are "on the table," NAR President Steve Brown said in a webinar last week.
"We will definitely be considering that, how to raise that professional bar of our membership as well. Not yet, but it's certainly on the planning board right now," he said.
The proposed standards cover six main areas: the Realtor Code of Ethics; political advocacy; consumer outreach; unification efforts and support of the entire organization; technology; and financial solvency.
1. Code of Ethics: The presidential advisory group recommended that NAR revamp the process to expedite an ethics hearing or arbitration proceeding through the adoption of electronic filing, speeding up response times, and other measures.
The proposed core standards would charge each association with ensuring Code of Ethics education, enforcement, and advancement, and mandate each adopt an expedited process of handling complaints, such as mediation.
"This will benefit the members by making the process more accessible, easier to navigate and enforce. It will make Realtor members more accountable to the Code of Ethics and result in increased professionalism," the report said.
2. Advocacy: Each association will be required to include a voluntary contribution for the Realtor political action commitee (RPAC) in their dues billing, state law permitting. If they prefer, local associations can meet that standard by other means, such as making a corporate contribution for the full amount of the goal.
Each association will also be required to prove participation in calls for action from NAR's political advocacy hub, the Realtor Action Center, such as promoting political issues through websites or newsletters.
3. Consumer outreach: Each association will have to show that it has executed at least four "meaningful consumer engagement activities" each year, such as promoting market statistics or real estate trends through releases of NAR or MLS data; participating in community events that promote the value of using a Realtor; engaging consumers in legislative or political issues that impact real estate; and volunteering or fundraising for a charitable or community organization.
(In order to fulfill the four-activity requirement, an association must participate in at least three of the four types of consumer outreach activities listed above — for instance, an association cannot volunteer at a Habitat for Humanity build four times a year and consider the standard met.)
4. Unification efforts and support of the entire organization: All associations will be required to renew their respective charter by June 30, 2015. Those not in compliance with NAR's mandated policies will face nonrenewal of their charter. After renewal, those violating current policies will be given 60 days to fix the problems or risk the revocation of their charter.
"It's possible that any violation of the policy could face revocation of a charter," Bushnell told Inman News. But forcing associations to give up their charter is not the goal of the new standards, she added.
"The goal of NAR and the state associations is to make sure that we assist associations in meeting the goal. We want everybody to succeed," she said.
She anticipates the presidential advisory group will have settled on the compliance process for the new standards by NAR's midyear convention in May, though some preliminary recommendations for compliance are available.
In order to help local associations boost enforcement of dues collection, state associations will be required to provide each association with a list of real estate licensees at the state level at least twice a year. This will allow associations to compare names and firms with their own membership rolls and make sure brokers have either signed up all of their agents as members or have paid nonmember salesperson fees for those they do not sign up.
"It's not necessarily about increasing membership, but about ensuring fairness across the board so that everybody is paying what they're supposed to be paying and doing what they're supposed to be doing," Bushnell said.
5. Technology: Every association must have a website that links to the websites of the other levels of the association in order to promote member programs, products and services. In addition, each association must use an email or other Internet-based means for member communication.
6. Financial solvency: Each association will be required to adopt "policies to ensure the fiscal integrity of their financial operations," including an annual audit or review from an outside party, such as a professional accountant. Associations must first obtain NAR's consent should they want to file for bankruptcy and any association that declares bankruptcy will be subject to an automatic review of their charter.
Impact on smaller associations
Some 57 percent of associations have less than 350 members and about 77 percent have less than 1,000 according to a recent survey.
"We think that all of the associations will be able to meet these standards," Bushnell said.
"The whole time we were involved with this process we were trying to understand how it would impact associations of all sizes and quite frankly some of our smallest associations are sometimes our most effective. So we really decided that size does not matter."
Bushnell said associations at all levels would be encouraged to share services and help each other in order to "make all of us better."
Sharing services is important to Jody Condie, association executive and the only paid staff member for the just over 300-member Steamboat Springs Association of Realtors in Colorado. Condie believes her association will be able to comply with the proposed standards, but noted that maintaining the association's current contract with the state association to administer all professional standards complaints is "essential."
Jennifer Hooks, association executive for the 57-member Reelfoot Regional Association of Realtors in Tennessee, is concerned about the requirement to participate in four consumer outreach activities.
"If we have our 57 members split up four 'engagement activities,' it may appear that we had a very small member turnout when just over a dozen Realtors show up. Proof of one community engagement event annually seems more attainable," she said.
Nonetheless, she said she and her members will do what needs to be done to comply with the new standards. Although she is also the only staff member in her association, Hooks said Reelfoot is already complying with most of the new standards — for example, the association implemented RPAC dues billing 10 years ago.
In the last year and a half, Reelfoot considered merging or dissolving, but members "made it very clear that they want to stick together," Hooks said.
"I don't feel like the members here will merge or dissolve — they are going to do whatever they need to do to keep their local organization," she said.
"But if we absolutely had to call on NAR for resources, in terms of creating an dissolution/merger plan and support, our association may consider that."
Will the average Realtor care?
In order for the proposed standards to work, some associations are going to have to not make it, according to Kevin McQueen, a consultant for associations and multiple listing services who often facilitates collaborations and mergers.
"I don't think that the average Realtor really cares" about having a uniform quality of services, he said, but if their association's charter were revoked — and with it prized MLS access — that would get their attention.
"Why do you join the board? To get to the MLS. That's not a secret," McQueen said.
He doesn't anticipate significant changes for the vast majority of associations to result from the new standards, but he does believe the standards "will raise awareness that mergers are a viable option for local associations."
"It is prudent for NAR, state and local association leadership to objectively consider the pros and cons of a merger, with the members' best interests in mind. Not all associations need to merge. They all need to consider it as an option," he said.
NAR's board of directors is expected to vote whether to adopt the new standards on May 17 at NAR's midyear conference, the Realtor Party Convention & Trade Expo, in Washington, D.C. Before the vote, there will be three member forums to discuss the standards at the conference.
The presidential advisory group is taking comments through May 1 regarding its proposed standards and recommendations.
Members of 2 Ohio real estate boards approve merger
East San Francisco Bay Realtor boards approve merger under Contra Costa Association banner
Prospect of dueling MLSs fuels merger of 2 Realtor associations on Florida's 'Space Coast'


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Carnival CEO Arnold Donald pledges 'deep investigation' after two cruise ships collide in Mexico
Carnival Cruise CEO Arnold W. Donald told CNBC on Friday that there are no major injuries reported after two of the company's ships collided hours earlier near the port of Cozumel, Mexico.
There are six minor injuries reported, which Donald said occurred as "people tried to leave the dining room."
"Everyone is all right," Donald said on "Closing Bell."
"We will do a deep investigation on this," Donald said, adding the company takes seriously its responsibility for safety. "But the most important thing is the ships are able to sail and they can continue on with guests having a great vacation."
People who have booked future trips on either ship involved — the Carnival Glory and the Carnival Legend — will be able to go on them as planned. The Glory has some damage, but it will be repaired shortly, Donald said.
Donald said the collision likely happened due to a "sudden squall … of wind that pushed the ships."
"Occasionally ships will touch in port, but of course you try to avoid that," he said.
News of the ship accident comes as Carnival reported better-than-expected quarterly revenue Friday, boosted by higher on-board spending.
Shares of the world's largest cruise operator were up more than 7% Friday, concluding the session at $50.21. That is about $9 off its 52-week high in February.
By Tim Büchner|2019-12-20T22:29:32+00:00December 20th, 2019|Uncategorized|Comments Off on Carnival CEO Arnold Donald pledges 'deep investigation' after two cruise ships collide in Mexico


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Tyre turbines
Two Ecotricity turbines at the Michelin Tyre Factory Dundee.
These were thought to be amongst the first turbines to be located in a city.
BBC News website >>
Photo © Mary Henderson, Friends of the Earth Tayside
week ending 6 March 2009
Green Stimulus
The Renewable Energy Association called for £625m in "green stimulus money". Director-general Philip Wolfe said: "Other countries have already committed huge sums to renewables as part of their stimulus packages, not just because renewables tackle the twin threats of climate change and energy security, but because they also offer the technological stimulus needed in a recession to create high-value jobs and enterprise. Greenpeace said "With the best renewable energy resources and the worst housing stock in Europe, there is no better time to turn the recession crisis into an opportunity."
BBC 6th Mar 2009 more >>
Wind yield estimator
Gauging the right position for wind turbines takes a great deal of calculation. Too little and it will produce more emissions than it saves. Too much wind may over-stress turbines to the point that they explode dramatically. With this in mind, the Carbon Trust has developed a user-friendly online wind estimator for small-scale turbines. Launched today, the calculator is designed to help businesses and consumers work out how much power a turbine could generate and how much carbon it would save. Its data and user-friendliness have been welcomed by the wind turbine industry as an improvement on the existing wind speed database provided by the Department for Business Enterprise and Regulatory Reform.
Guardian 5th Mar 2009 more >>
Wash Funding
The Wash Fens Local Action Group is celebrating after being awarded £2m by the East Midlands Development Agency (EMDA) to boost the rural economies of Boston and South Holland. Projects wills include those that help to mitigate and adapt to climate change, particularly through investment in new technologies and renewable energy sources
Lincolnshire County Council 4th Mar 2009 more >>
Where there's muck
Community Renewable energy (CoRE) North West wants to use manure and silage to produce electricity at energy farms. They're aiming to set up the first one at Silloth in the next 12 months. It is reckoned that the first energy plant will produce enough energy for around 2,000 homes while providing a huge boost for dairy farms. To start, a co-operative of 10 farmers will be paid for supplying the raw materials for the energy producer.
Carlisle News and Star 4th Mar 2009 more >>
Romag, the company that makes glass and plastic composites for renewable energy applications, has developed an innovative new product that will provide solar generated power for electric vehicles. Romag's 'PowerPark' is a solar car parking canopy made of PowerGlaz PV panels that will be targeted for car parks at airports, stations, supermarkets, shopping centres, offices and public buildings including sports and leisure facilities.
Small Cap News 4th Mar 2009 more >>
Rotating House
A ROTATING house of the future, being built near Ashbourne, is to be featured on a prime time Channel 4 programme that looks at property construction. All electricity demand will be met from solar panels and specially-designed wind turbines set into the roof. These will feed power to storage batteries to ensure a constant supply.
Ashbourne News Telegraph 4th Mar 2009 more >>
Another Tesco Turbine
Tesco has had its green credentials blasted as a publicity stunt after it won a battle to install wind turbines in the car park of one of its stores. Two energy generating structures standing over 10 meters tall will be installed at the chain's Church Langley store after Harlow Council planning chiefs gave the go-ahead.
Harlow Star 4th Mar 2009 more >>
West Midlands Co-operatives
An innovative initiative which supports the creation of community-owned renewable energy schemes has been set up in Shropshire, Herefordshire and parts of Worcestershire. The project 'sharenergy' has been backed by the Rural Regeneration Zone.
Birmingham Post 4th Mar 2009 more >>
24 Dash 3rd Mar 2009 more >>
Future Friendly
ST ENDELLION is in the running for a prestigious green, energy efficient award and could find itself winning £20,000. The climate friendly parish in Port Isaac is one of five groups in contention for the award having already beaten strong competition to get a film made about its work and for the chance to win the large cash bursary. The Future Friendly Awards is a nationwide search for people who are making a difference to their local community by championing sustainability and inspiring others to do the same. St Endellion was recognised for a range of its initiatives in energy efficient housing, promoting public transport, the use of renewable energy and waste reduction. This came about after the launch of the parish's Climate Friendly Project Plan in 2006.
This is Cornwall 3rd Mar 2009 more >>
Future Vision
RESIDENTS of Boroughbridge and the Lower Ure Valley are being asked for their views on what should be the priority for improvements to the area over the next five years. Early ideas include: refurbishment of Boroughbridge Leisure Centre, community renewable energy projects and the creation of a multi-purpose community facility.
Yorkshire Post 3rd Mar 2009 more >>
Local Energy
One of the most effective ways of reducing your fuel bills - and your carbon footprint - is to generate your own energy, and this can apply to large organisations, small businesses or individual householders alike. Producing your own electricity or heat at a local level is known as microgeneration, and can involve anything from installing solar panels to fitting wind turbines to using bio-burners or combined heat and power units to generate local heat from local waste.
24 Dash 2nd Mar 2009 more >>
There is also a real opportunity for redevelopment in Coventry to be an exemplar of environmental sustainability and user of renewable energy, looking at shared energy sources, which will reduce energy costs with the ultimate goal of making business more productive.
Coventry Telegraph 2nd Mar 2009 more >>
York Eco-Village
THE dream of an eco-village on the site of York's former British Sugar factory has moved a step closer after civic leaders decided to fast-track the scheme.
York Press 2nd Mar 2009 more >>
Another Solar School
SOLAR panels will be installed at a primary school in Trowbridge after it received a £20,000 grant from the Co-operative.
Wiltshire Times 2nd Mar 2009 more >>
Tesco Turbines
PLANS for a major extension and two wind turbines at Mansfield's Oak Tree Lane Tesco have been given the go-ahead by councilors.
Mansfield Chad 2nd Mar 2009 more >>
RESIDENTS from a Teesdale village are taking part in a nationwide energy survey. Cockfield is one of three venues in the country which are forming part of a consultation on saving energy and heat in people's homes and communities Householders are being asked their views on how the UK can reduce its carbon emissions through better energy efficiency and low-carbon heating, as part of the Big Energy Shift citizens' forums.
Northern Echo 2nd Mar 2009 more >>
REGENERATION bosses are celebrating after work got under way on the long-awaited conversion of two rows of derelict houses. Renewable energy requirements will be met with solar panels, efficient insulation, energy meters and pipes, feeding light into enclosed spaces.
Lancashire Telegraph 2nd March 2009 more >>
Biomass Row
AN argument over an environmentally-friendly heating system, which was prevented from being installed in Edinburgh schools because of health fears, has been reignited. Newly-published guidance reveals that the Scottish Government "encourages" the use of biomass boilers in the battle against climate change, as research shows they are not in fact harmful to humans if used alongside the correct technologies.
Scotsman 2nd Mar 2009 more >>
Cooking Oil Power
ENERGY conscious residents will be able to recycle cooking oil for use in electricity generation. Used oil can be brought to one of the Bucks County Council recycling centres where it can be poured into collection tanks. It will then be processed into a usable form by a company called Living Fuels.
Bucks Free Press 1st March 2009 more >>
Britain is falling far behind other big economies in launching a Green New Deal, despite Government promises to "lead the world" on this path out of the economic slump, a report reveals. The most comprehensive study yet of "green stimuli" being introduced around the world – puts Britain near the bottom of the international league. China, for example, has devoted well over a hundred times as much money to recession-beating environmental measures, despite being castigated as an international laggard in tackling pollution.
Independent on Sunday 1st March 2009 more >>
The most striking evidence that the Prime Minister is brown rather than green was his Cabinet's decision in January to give the go-ahead to a third runway at Heathrow. Of course, there is a so-called business case for expansion, and Ed Miliband, the Climate Change Secretary, secured important environmental safeguards. But if this government means it when it says that climate change is so important, it cannot increase the capacity of British airports. As HSBC's interest testifies, energy conservation, renewable energy and low-carbon technology are a huge growth area for the future. Britain has already missed the start of the race. Mr Brown must make sure we catch up, and fast.
The big six energy companies in Britain are investing on average only £30 per year from each customer in renewable energy projects. If this continues, the UK may miss its 2020 green targets by 50%. The findings, compiled for independent green power group Ecotricity, will be published ahead of the government's biggest test yet on commercial confidence about wind power, the Tuesday deadline for bids on the third offshore licensing round.
Observer 1st March 2009 more >>
BRITAIN must set a clear policy and regulatory framework to encourage investment in green industries if it is not to fall further behind America and China, industry leaders have said. According to The Sunday Times's inaugural Green Rich List, Britain is home to only 10 of the world's top 100 entrepreneurs in new industries such as wind energy, electric cars and clean coal.
Sunday Times 1st March 2009 more >>
Solasysphon
A Belfast plumbing and heating company has made a major breakthrough by securing an order for its innovative energy-saving solar device from an international manufacturer. Willis Renewable Energy said its Solasyphon water heating system, which was launched last year, was now to be supplied to Apricus, which is headquartered in Connecticut.
Enviro Solutions 25th Feb 2009 more >>
The Country Land and Business Association has today (Wednesday, 25 February) reacted with shock and disappointment to the news that the incentive for renewable heat is to be delayed by a year.
Microgen Finance
When Gary Southall decided to make the heating in his home more environmentally friendly, instead of asking his bank for the loan he needed to finance it, he approached his employer, Infinis. The renewable energy supplier gives employees a £1,500 ($2,180) grant and a £3,500 interest-free loan, repayable over 24 months, for micro-generation projects in their own homes. So happy is Mr Southall with his new, energy-efficient wood-stove that he is somewhat evangelical about his company's perks. "If someone offers you a grant or interest-free loan to do something you'd been planning to, you'd be mad not to take them up on it," he says.
FT 23rd Feb 2009 more >>
UK leading Micro Wind Market
The UK could become a world leader in microgeneration and small wind but it needs a helping hand to create the market. The UK is already leading the market in manufacture small wind turbines which can generate up to 50kW of power, but has one of the smallest installed capacities in Europe. Most of the small turbines made in the country are instead exported. The British Wind Energy Association (BWEA) estimates that the UK has the potential to install 600,000 of these small units by 2020, generating 1.3gW of power.
DEA Direct 23rd Feb 2009 more >>
Tesco Turbine
FOLLOWING its surprise scheme for a super-sized supermarket on stilts, Tesco now has another plan on the horizon for its flagship Macclesfield store. The multinational has submitted designs to the town hall to build a 35ft high "green" micro wind turbine in the car park of its Hibel Road outlet.
Macclesfield Express 18th Feb 2009 more >>
Microgeneration Course
Microgeneration, biomass boilers, and solar panels could be part of the curriculum for a new course designed to teach communities to use green renewable energy systems. Community Renewable Energy (CoRE) received £10,000 from the Big Lottery's Awards for All Fund to develop an accredited training programme on community renewables.
DEA Direct 18th Feb 2009 more >>
B&Q Saga
Retailer B&Q is to invest £150,000 in the "first ever" comprehensive study of micro wind turbines in the UK, as the future of its own line of wind turbines hangs in the balance. The news came as the company pulled the Windsave brand of micro wind turbines from its shelves after last month's report on trials by consultancy Encraft, which questioned the effectiveness of building-mounted wind turbines.
New Energy Focus 17th Feb 2009 more >>


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