A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartcareTM/PS

Objective
Preliminary assessment of an automated weaning system (SmartCare™/PS) compared to usual management of weaning from mechanical ventilation performed in the absence of formal protocols.


Design and setting
A randomised, controlled pilot study in one Australian intensive care unit.


Patients
A total of 102 patients were equally divided between SmartCare/PS and Control.

Interventions
The automated system titrated pressure support, conducted a spontaneous breathing trial and provided notification of success (“separation potential”).

Measurements and results
The median time from the first identified point of suitability for weaning commencement to the state of “separation potential” using SmartCare/PS was 20 h (interquartile range, IQR, 2–40) compared to 8 h (IQR 2–43) with Control (log-rank P = 0.3). The median time to successful extubation was 43 h (IQR 6–169) using SmartCare/PS and 40 (14–87) with Control (log-rank P = 0.6). Unadjusted, the estimated probability of reaching “separation potential” was 21% lower (95% CI, 48% lower to 20% greater) with SmartCare/PS compared to Control. Adjusted for other covariates (age, gender, APACHE II, SOFAmax, neuromuscular blockade, corticosteroids, coma and elevated blood glucose), these estimates were 31% lower (95% CI, 56% lower to 9% greater) with SmartCare/PS. The study groups showed comparable rates of reintubation, non-invasive ventilation post-extubation, tracheostomy, sedation, neuromuscular blockade and use of corticosteroids.

Conclusions
Substantial reductions in weaning duration previously demonstrated were not confirmed when the SmartCare/PS system was compared to weaning managed by experienced critical care specialty nurses, using a 1:1 nurse-to-patient ratio. The effect of SmartCare/PS may be influenced by the local clinical organisational context.

Radiocarbon dating of bulk peat samples from raised bogs: nonexistence of a previously reported 'reservoir effect'?

In 1995. an unexpected reservoir effect was reported in sequences of bulk C-14 dates of raised bog peat. In most peat Studies bulk C-14 dates are used for obtaining chronologies. Therefore it is important to confirm and quantify such a C-14 reservoir effect. Five bulk peat samples from the raised bog Engbertsdijksveen were conventionally C-14 dated. The same core had previously been precisely dated by C-14 AMS dates of carefully selected above-ground plant remains. The existence of a reservoir effect in bulk peat C-14 samples could not be confirmed. Other explanations for the reported reservoir effect are discussed. (C) 2004 Elsevier Ltd. All rights reserved.

Marine reservoir corrections: St Helena, South Atlantic Ocean

We present the first marine reservoir age and Delta R determination for the island of St. Helena using marine mollusk radiocarbon dates obtained from an historical context of known age. This represents the first marine reservoir a.-c and Delta R determination in the southern Atlantic Ocean within thousands of kilometers of the island. The depletion of C-14 in the shells indicates a rather larger reservoir age for that portion of the surface Atlantic than models indicate. The implication is that upwelling old water along the Namibian coast is transported for a considerable distance, although it is likely to be variable on a decadal timescale. An artilleryman's button, together with other artifacts found in a midden, demonstrate association of the mollusk shells with a narrow historic period of AD 1815-1835.

Bit error rate performance enhancement of a retrodirective array over a conventional fixed beam array in a dynamic multipath environment

In this paper, we provide experimental evidence to show that enhanced bit error rate (BER) performance is possible using a retrodirective array operating in a dynamically varying multipath environment. The operation of such a system will be compared to that obtained by a conventional nonretrodirective array. The ability of the array to recover amplitude shift keyed encoded data transmitted from a remote location whose position is not known a priori is described. In addition, its ability to retransmit data inserted at the retrodirective array back to a spatially remote beacon location whose position is also not known beforehand is also demonstrated. Comparison with an equivalent conventional fixed beam antenna array utilizing an identical radiating aperture arrangement to that of the retrodirective array are given. These show that the retrodirective array can effectively exploit the presence of time varying multipath in order to give significant reductions in BER over what can be otherwise achieved. Additionally, the retrodirective system is shown to be able to deliver low BER regardless of whether line of sight is present or absent.

The Evolving Role of the UNCHR: Should the Conventional Role of UNHCR Be Expanded?

This paper focuses on the question of whether the UNHCR should be governed only by its original 1950 mandate to provide international protection to refugees or should its role be re-defined in order to cover those who are not refugees, yet in refugee-like conditions. The purpose of this study is to scrutinize what rights UNHCR already possesses with regards to its newly-evolved tasks and what sort of legal framework is required today.