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2. Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units

Author

Linssen, Rosalie S., Bem, Reinout A., Kapitein, Berber, Rengerink, Katrien Oude, Otten, Marieke H., den Hollander, Bibiche, Bont, Louis, van Woensel, Job B. M., Wösten-van Asperen, Roelie M., Klein, Richard H., Kneyber, Martin C. J., Kuiper, Jan Willem, Verlaat, Carin, van Heerde, Marc, Riedijk, Maaike A., van Waardenburg, Dick A., Paediatric Intensive Care, AII - Infectious diseases, ARD - Amsterdam Reproduction and Development, Paediatric Metabolic Diseases, APH - Personalized Medicine, RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, Kindergeneeskunde, and MUMC+: MA Medische Staf Kindergeneeskunde (9)

Subjects
medicine.medical_specialty, medicine.medical_treatment, INFANTS, CHILDREN, Airway management, Respiratory Syncytial Virus Infections, medicine.disease_cause, Intensive Care Units, Pediatric, DISEASE, OXYGEN, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Intensive care, medicine, Cannula, Humans, Respiratory system, Child, Retrospective Studies, Mechanical ventilation, Pediatric intensive care unit, Respiratory syncytial viruses, business.industry, Vaccination, Infant, medicine.disease, PREVENTION, High flow nasal cannula, INTUBATION, Bronchiolitis, Child, Preschool, Pediatrics, Perinatology and Child Health, Emergency medicine, Breathing, Non-invasive ventilation, Original Article, business, Nasal cannula
Abstract

Respiratory syncytial virus (RSV) bronchiolitis causes substantial morbidity and mortality in young children, but insight into the burden of RSV bronchiolitis on pediatric intensive care units (PICUs) is limited. We aimed to determine the burden of RSV bronchiolitis on the PICUs in the Netherlands. Therefore, we identified all children ≤ 24 months of age with RSV bronchiolitis between 2003 and 2016 from a nationwide PICU registry. Subsequently we manually checked their patient records for correct diagnosis and collected patient characteristics, additional clinical data, respiratory support modes, and outcome. In total, 2161 children were admitted to the PICU for RSV bronchiolitis. The annual number of admissions increased significantly during the study period (β 4.05, SE 1.27, p = 0.01), and this increase was mostly driven by increased admissions in children up to 3 months old. Concomitantly, non-invasive respiratory support significantly increased (β 7.71, SE 0.92, p < 0.01), in particular the use of high flow nasal cannula (HFNC) (β 6.69, SE 0.96, p < 0.01), whereas the use of invasive ventilation remained stable.Conclusion: The burden of severe RSV bronchiolitis on PICUs has increased in the Netherlands. Concomitantly, the use of non-invasive respiratory support, especially HFNC, has increased. What is Known:• RSV bronchiolitis is a major cause of childhood morbidity and mortality and may require pediatric intensive care unit admission.• The field of pediatric critical care for severe bronchiolitis has changed due to increased non-invasive respiratory support options. What is New:• The burden of RSV bronchiolitis for the Dutch PICUs has increased. These data inform future strategic PICU resource planning and implementation of RSV preventive strategies.• There was a significant increase in the use of high flow nasal cannula at the PICU, but the use of invasive mechanical ventilation did not decrease.

Published
2021
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17. Control Characteristics of Alcohol-Impaired Operators

Author

Jex, Henry R, McRuer, Duane T, Allen, R. Wade, and Klein, Richard H

Subjects
Behavioral Sciences
Abstract

Although the operation of vehicles like airplanes, cars, and bicycles involves a complex array of perceptual, decision and control activities, most accident statistics clearly show that intoxicated operators are a dominant cause of accidents, and not the difficulty of the task itself. This paper summarizes some recent research on the nature of the impairment of operator control under blood alcohol concentrations (BAC) up to above 0.16 percent. Alcohol toxicity is shown to be quite specific with respect to visual-motor functions involved in control of a vehicle, and experiments with a generalized workload task and special driving simulator show how these are reflected in terms of changes in operator control parameters such as response latency, gains, stability margins, and coherency.

Published
1974

19. Proposed MIL Standard and Handbook - Flying Qualities of Air Vehicles. Volume I. Proposed MIL Standard

Author

SYSTEMS TECHNOLOGY INC HAWTHORNE CA, Hoh, Roger H, Mitchell, David G, Ashkenas, Irving L, Klein, Richard H, Heffley, Robert K, SYSTEMS TECHNOLOGY INC HAWTHORNE CA, Hoh, Roger H, Mitchell, David G, Ashkenas, Irving L, Klein, Richard H, and Heffley, Robert K

Abstract

This report is a proposed version of the MIL Standard and Handbook developed by Systems Technology, Inc., with the McDonnell Aircraft Co. acting in a consulting role. This report is published to elicit comments, and suggestions, for adopting or revising the material which the Government will incorporate into an official MIL Standard and Handbook. As it stands, the material is preliminary and occasionally controversial, does not in all cases represent the views of the Government or a particular government organization, and should not be used for procurement. This work does not reflect work in progress on flying qualities requirements for large airplanes, direct force controllers or STOL aircraft.

Published
1982

20. Proposed MIL Standard and Handbook - Flying Qualities of Air Vehicles. Volume 2. Proposed MIL Handbook

Author

SYSTEMS TECHNOLOGY INC HAWTHORNE CA, Hoh, Roger H, Mitchell, David G, Ashkenas, Irving L, Klein, Richard H, Heffley, Robert K, SYSTEMS TECHNOLOGY INC HAWTHORNE CA, Hoh, Roger H, Mitchell, David G, Ashkenas, Irving L, Klein, Richard H, and Heffley, Robert K

Abstract

MIL-F-8785C, Military Specification -- Flying Qualities of Piloted Airplanes, has been reformatted into a MIL Standard and a supporting MIL handbook. This report is a draft of the proposed MIL Standard, which has been developed by Systems Technology, Inc., with the McDonnell Aircraft Company acting in a consulting role. It is presented to industry and the United States armed forces for comments and proposed revisions. The responsibility for the legal MIL Standard and Handbook rests within the armed forces. This draft will be considered and form the basis for revisions, industry and government comments and a tri-service review in the process of developing the MIL Standard and Handbook. Suggested values and background information are contained in this volume. MIL-F-8785C and the backup documents to both it and its predecessor, MIL-F-8785B, were reviewed extensively. Much of the material contained therein is still considered to be valid and relevant and has been retained in this document., Prepared in cooperation with McDonnell Aircraft Co., St. Louis, MO.

Published
1982

21. Application of Manual Control Display Theory to the Development of Flight Director Systems for STOL Aircraft.

Author

SYSTEMS TECHNOLOGY INC HAWTHORNE CA, Klein, Richard H., Clement, Warren F., SYSTEMS TECHNOLOGY INC HAWTHORNE CA, Klein, Richard H., and Clement, Warren F.

Abstract

This report represents an application of pilot models and closed-loop system methods to the analysis and design of three-axis flight director systems for STOL aircraft in the landing approach mode. The basic principle is that there are effective flight director plus vehicle controlled element dynamics that are preferred from the standpoint of pilot response and system performance. This leads to requirements and analytical procedures which define how to select, weight, and equalize the potential feedbacks. A summary of the design procedure and estimates of the necessary feedback quantities (with their associated weighting and equalization), pilot dynamics, pilot commentary, and closed-loop system performance represent the output of the analytical procedure. (Modified author abstract)

Published
1973

26. LETTER TO EDITOR.

Author

Klein, Richard H.

Subjects
LETTERS to the editor, TRUCK trailers
Abstract

A letter to the editor is presented in response to an article by Rick Weber on Dave Decker's Work Truck Show presentation in the August 2009 issue.

Published
2009

27. [COVID-19-associated hyperinflammatory state in a 15-year-old female patient].

Author

Blink M, Buddingh' EP, Filippini LHPM, Brinkman DMC, Joosten SA, and Klein RH

Subjects
Adolescent, Anti-Inflammatory Agents administration & dosage, COVID-19 Serological Testing methods, Cardiotonic Agents administration & dosage, Dose-Response Relationship, Drug, Female, Heart Failure diagnosis, Heart Failure etiology, Humans, Treatment Outcome, Aspirin administration & dosage, COVID-19 immunology, COVID-19 physiopathology, Immunoglobulins, Intravenous administration & dosage, Methylprednisolone administration & dosage, Milrinone administration & dosage, SARS-CoV-2 isolation & purification, Systemic Inflammatory Response Syndrome immunology, Systemic Inflammatory Response Syndrome physiopathology, Vasoconstrictor Agents administration & dosage
Abstract

Paediatric Multisystem Inflammatory Syndrome Temporally Related to SARS-CoV-2 (PIMS-TS) is a rare novel clinical entity observed in children and adolescents with evidence of a recent COVID-19 infection, and is characterized by a marked hyperinflammatory state with involvement of multiple organ systems.We report a case of a previously healthy 15-year-old female patient, who was admitted to paediatric intensive care with cardiac failure and was subsequently shown to have positive COVID-19 serology. The presenting symptoms were fever, cough, chest pain and gastro-intestinal symptoms. She was supported with milrinone and a low dose of vasopressors. Her hyperinflammatory state was treated with intravenous immunoglobulins, high dose aspirin and high-dose methylprednisolone. PIMS-TS is a rare, potentially life threatening novel clinical entity in children and adolescents with evidence of a COVID-19 infection. Clinicians need to be aware of the possibility of this new disease, to ensure prompt recognition and treatment.

Published
2020

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