Association Between Use of Lung-Protective Ventilation With Lower Tidal Volumes and Clinical Outcomes Among Patients Without Acute Respiratory Distress Syndrome A Meta-analysis

Context Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. Objective To determine whether use of lower tidal volumes is associated with improved outcomes of patients receiving ventilation who do not have ARDS. Data Sources MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials up to August 2012. Study Selection Eligible studies evaluated use of lower vs higher tidal volumes in patients without ARDS at onset of mechanical ventilation and reported lung injury development, overall mortality, pulmonary infection, atelectasis, and biochemical alterations. Data Extraction Three reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus. Data Synthesis Twenty articles (2822 participants) were included. Meta-analysis using a fixed-effects model showed a decrease in lung injury development (risk ratio [RR], 0.33; 95% CI, 0.23 to 0.47; I-2, 0%; number needed to treat [NNT], 11), and mortality (RR, 0.64; 95% CI, 0.46 to 0.89; I-2, 0%; NNT, 23) in patients receiving ventilation with lower tidal volumes. The results of lung injury development were similar when stratified by the type of study (randomized vs nonrandomized) and were significant only in randomized trials for pulmonary infection and only in nonrandomized trials for mortality. Meta-analysis using a random-effects model showed, in protective ventilation groups, a lower incidence of pulmonary infection (RR, 0.45; 95% CI, 0.22 to 0.92; I-2, 32%; NNT, 26), lower mean (SD) hospital length of stay (6.91 [2.36] vs 8.87 [2.93] days, respectively; standardized mean difference [SMD], 0.51; 95% CI, 0.20 to 0.82; I-2, 75%), higher mean (SD) PaCO2 levels (41.05 [3.79] vs 37.90 [4.19] mm Hg, respectively; SMD, -0.51; 95% CI, -0.70 to -0.32; I-2, 54%), and lower mean (SD) pH values (7.37 [0.03] vs 7.40 [0.04], respectively; SMD, 1.16; 95% CI, 0.31 to 2.02; I-2, 96%) but similar mean (SD) ratios of PaO2 to fraction of inspired oxygen (304.40 [65.7] vs 312.97 [68.13], respectively; SMD, 0.11; 95% CI, -0.06 to 0.27; I-2, 60%). Tidal volume gradients between the 2 groups did not influence significantly the final results. Conclusions Among patients without ARDS, protective ventilation with lower tidal volumes was associated with better clinical outcomes. Some of the limitations of the meta-analysis were the mixed setting of mechanical ventilation (intensive care unit or operating room) and the duration of mechanical ventilation. JAMA. 2012;308(16):1651-1659 www.jama.com

The 1420 Ma Indiavai Mafic Intrusion (SW Amazonian Craton): Paleomagnetic results and implications for the Columbia supercontinent

The configuration and the timing of assembly and break-up of Columbia are still matter of debate. In order to improve our knowledge about the Mesoproterozoic evolution of Columbia, a paleomagnetic study was carried out on the 1420 Ma Indiavai mafic intrusive rocks that crosscut the polycyclic Proterozoic basement of the SW Amazonian Craton, in southwestern Mato Grosso State (Brazil). Alternating field and thermal demagnetization revealed south/southwest ChRM directions with downward inclinations for sixteen analyzed sites. These directions are probably carried by SD/PSD magnetite with high coercivities and high unblocking temperatures as indicated by additional rock magnetic tests, including thermomagnetic data, hysteresis data and the progressive acquisition of isothermal remanent magnetization. Different stable magnetization components isolated in host rocks from the basement 10 km NW away to the Indiavai intrusion, further support the primary origin of the ChRM. A mean of the site mean directions was calculated at Dm = 209.8 degrees, Im = 50.7 degrees (alpha(95) = 8.0 degrees, K = 22.1), which yielded a paleomagnetic pole located at 249.7 degrees E, 57.0 degrees S (A(95) = 8.6 degrees). The similarity of this pole with the recently published 1420 Ma pole from the Nova Guarita dykes in northern Mato Grosso State suggests a similar tectonic framework for these two sites located 600 km apart, implying the bulk rigidity of the Rondonian-San Ignacio crust at that time. Furthermore these data provide new insights on the tectonic significance of the 1100-1000 Ma Nova Brasilandia belt-a major EW feature that cuts across the basement rocks of this province, which can now be interpreted as intracratonic, in contrast to previous interpretation. From a global perspective, a new Mesoproterozoic paleogeography of Columbia has been proposed based on comparison of these 1420 Ma poles and a 1780 Ma pole from Amazonia with other paleomagnetic poles of similar age from Baltica and Laurentia, a reconstruction in agreement with geological correlations. (C) 2012 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Effects of intrusion combined with anterior retraction on apical root resorption

This study evaluated the influence of intrusion mechanics combined with anterior retraction on root resorption of the maxillary incisors. A sample of 56 patients was divided into two groups: group 1 comprised 28 patients (12 females and 16 males), presenting with an increased overjet and deep overbite (6.48 and 4.78 mm, respectively) treated with reverse curve of Spee intrusion mechanics and group 2 comprised 28 patients (12 females and 16 males) with an increased overjet of 5.67 mm and a normal overbite of 1.12 mm. The initial mean ages for groups 1 and 2 were 13.41 and 13.27 years, respectively. Pre- (T1) and post- (T2) treatment periapical radiographs were used to evaluate root resorption. The groups were compared using the Mann- Whitney U- test. Correlation between root resorption and tooth movement was investigated with Spearman's correlation coefficient. The subjects in group 1 had statistically greater root resorption (P < 0.05) than those in group 2. The initial overbite severity and the amount of correction had significant positive correlations with root resorption (r = 0.324 and r = 0.320, respectively). The combination of anterior retraction with intrusive mechanics causes more root resorption than anterior retraction of the maxillary incisors alone.

Tidal perturbations of the rotation of the moon: the creep tide approach

In this communication we report results from the application to the study of the rotation of the Moon of the creeping tide theory just proposed (Ferraz-Mello, Cel. Mech. Dyn. Astron., submitted. ArXiv astro-ph 1204.3957). The choice of the Moon for the first application of this new theory is motivated by the fact that the Moon is one of the best observed celestial bodies and the comparison of the theoretical predictions of the theory with observations i may validate the theory or point out the need of further improvements. Particularly, the tidal perturbations of the rotation of the Moon - the physical libration of the Moon - have been detected in the Lunar Laser Ranging measurements (Williams et al. JGR 106, 27933, 2001). The major difficulty in this application comes from the fact that tidal torques in a planet-satellite system are very sensitive to the distance between the two-bodies, which is strongly affected by Solar perturbations. In the case of the Moon, the main solar perturbations - the Evection and the Variation - are more important than most of the Keplerian oscillations, being smaller only than the first Keplerian harmonic (equation of the centre). Besides, two of the three components of the Moon's libration in longitude whose tidal contributions were determined by LLR are related to these perturbations. The results may allow us to determine the main parameter of a possible Moon's creeping tide. The preliminary results point to a relaxation factor (gamma) 2 to 4 times smaller than the one predicted from the often cited values of thr Moon's quality factor Q (between 30 and 40), and points to larger Q values.

Tidal evolution in co-orbital configurations

We study the orbital evolution of a two co-orbital planet system which undergo tidal interactions with the central star. Our main goal is to investigate the final outcome of a system originally evolving in a 1:1 resonant configuration when the tidal effect acts to change the orbital elements. Preliminary results of the numerical simulations of the exact equations of motions indicate that, at least for equal mass planets, the combined effect of resonant motion and tidal interaction leads the system to orbital instability, including collisions between the planets. We discuss the cases of two hot super-Earths and two hot-Saturn planets, comparing with the results of dynamical maps.

Disruption of endogenous tidal rhythms of larval release linked to food supply and heat stress in an intertidal barnacle

The timing of larval release may greatly affect the survivorship and distribution of pelagic stages and reveal important aspects of life history tactics in marine invertebrates. Endogenous rhythms of breeding individuals and populations are valuable indicators of selected strategies because they are free of the neutral effect of stochastic environmental variation. The high-shore intertidal barnacle Chthamalus bisinuatus exhibits endogenous tidal and tidal amplitude rhythms in a way that larval release would more likely occur during fortnightly neap periods at high tide. Such timing would minimize larval loss due to stranding and promote larval retention close to shore. This fully explains temporal patterns in populations facing the open sea and inhabiting eutrophic areas. However, rhythmic activity breaks down to an irregular pattern in a population within the São Sebastião Channel subjected to large variation of food supply around a mesotrophic average. Peaks of chl a concentration precede release events by 6 d, suggesting resource limitation for egg production within the channel. Also, extreme daily temperatures imposing mortality risk correlate to release rate just 1 d ahead, suggesting a terminal reproductive strategy. Oceanographic conditions apparently dictate whether barnacles follow a rhythmic trend of larval release supported by endogenous timing or, alternatively, respond to the stochastic variation of key environmental factors, resulting in an erratic temporal pattern.

Effects of Resources Exploitation on Water Quality: case studies in Salt Water Intrusion and Acid Mine Drainage

Throughout the world, pressures on water resources are increasing, mainly as a result of human activity. Because of their accessibility, groundwater and surface water are the most used reservoirs. The evaluation of the water quality requires the identification of the interconnections among the water reservoirs, natural landscape features, human activities and aquatic health. This study focuses on the estimation of the water pollution linked to two different environmental issues: salt water intrusion and acid mine drainage related to the exploitation of natural resources. Effects of salt water intrusion occurring in the shallow aquifer north of Ravenna (Italy) was analysed through the study of ion- exchange occurring in the area and its variance throughout the year, applying a depth-specific sampling method. In the study area were identified ion exchange, calcite and dolomite precipitation, and gypsum dissolution and sulphate reduction as the main processes controlling the groundwater composition. High concentrations of arsenic detected only at specific depth indicate its connexion with the organic matter. Acid mine drainage effects related to the tin extraction in the Bolivian Altiplano was studied, on water and sediment matrix. Water contamination results strictly dependent on the seasonal variation, on pH and redox conditions. During the dry season the strong evaporation and scarce water flow lead to low pH values, high concentrations of heavy metals in surface waters and precipitation of secondary minerals along the river, which could be released in oxidizing conditions as demonstrated through the sequential extraction analysis. The increase of the water flow during the wet season lead to an increase of pH values and a decrease in heavy metal concentrations, due to dilution effect and, as e.g. for the iron, to precipitation.

Hydrogeochemical monitoring and modelling of saltwater intrusion in lowlands (Ferrara, IT)

Because of the potentially irreversible impact of groundwater quality deterioration in the Ferrara coastal aquifer, answers concerning the assessment of the extent of the salinization problem, the understanding of the mechanisms governing salinization processes, and the sustainability of the current water resources management are urgent. In this light, the present thesis aims to achieve the following objectives: Characterization of the lowland coastal aquifer of Ferrara: hydrology, hydrochemistry and evolution of the system The importance of data acquisition techniques in saltwater intrusion monitoring Predicting salinization trends in the lowland coastal aquifer Ammonium occurrence in a salinized lowland coastal aquifer Trace elements mobility in a saline coastal aquifer

On a Microcomputer Implementation of an Intrusion-detection Algorithm

The main objective of this paper is to discuss various aspects of implementing a specific intrusion-detection scheme on a micro-computer system using fixed-point arithmetic. The proposed scheme is suitable for detecting intruder stimuli which are in the form of transient signals. It consists of two stages: an adaptive digital predictor and an adaptive threshold detection algorithm. Experimental results involving data acquired via field experiments are also included.

Tidal volume single breath washout of two tracer gases--a practical and promising lung function test

Background Small airway disease frequently occurs in chronic lung diseases and may cause ventilation inhomogeneity (VI), which can be assessed by washout tests of inert tracer gas. Using two tracer gases with unequal molar mass (MM) and diffusivity increases specificity for VI in different lung zones. Currently washout tests are underutilised due to the time and effort required for measurements. The aim of this study was to develop and validate a simple technique for a new tidal single breath washout test (SBW) of sulfur hexafluoride (SF6) and helium (He) using an ultrasonic flowmeter (USFM). Methods The tracer gas mixture contained 5% SF6 and 26.3% He, had similar total MM as air, and was applied for a single tidal breath in 13 healthy adults. The USFM measured MM, which was then plotted against expired volume. USFM and mass spectrometer signals were compared in six subjects performing three SBW. Repeatability and reproducibility of SBW, i.e., area under the MM curve (AUC), were determined in seven subjects performing three SBW 24 hours apart. Results USFM reliably measured MM during all SBW tests (n = 60). MM from USFM reflected SF6 and He washout patterns measured by mass spectrometer. USFM signals were highly associated with mass spectrometer signals, e.g., for MM, linear regression r-squared was 0.98. Intra-subject coefficient of variation of AUC was 6.8%, and coefficient of repeatability was 11.8%. Conclusion The USFM accurately measured relative changes in SF6 and He washout. SBW tests were repeatable and reproducible in healthy adults. We have developed a fast, reliable, and straightforward USFM based SBW method, which provides valid information on SF6 and He washout patterns during tidal breathing.

End-tidal CO(2). An important parameter for a correct interpretation in functional brain studies using speech tasks

The aim was to investigate the effect of different speech tasks, i.e. recitation of prose (PR), alliteration (AR) and hexameter (HR) verses and a control task (mental arithmetic (MA) with voicing of the result on end-tidal CO2 (PETCO2), cerebral hemodynamics and oxygenation. CO2 levels in the blood are known to strongly affect cerebral blood flow. Speech changes breathing pattern and may affect CO2 levels. Measurements were performed on 24 healthy adult volunteers during the performance of the 4 tasks. Tissue oxygen saturation (StO2) and absolute concentrations of oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]) and total hemoglobin ([tHb]) were measured by functional near-infrared spectroscopy (fNIRS) and PETCO2 by a gas analyzer. Statistical analysis was applied to the difference between baseline before the task, 2 recitation and 5 baseline periods after the task. The 2 brain hemispheres and 4 tasks were tested separately. A significant decrease in PETCO2 was found during all 4 tasks with the smallest decrease during the MA task. During the recitation tasks (PR, AR and HR) a statistically significant (p < 0.05) decrease occurred for StO2 during PR and AR in the right prefrontal cortex (PFC) and during AR and HR in the left PFC. [O2Hb] decreased significantly during PR, AR and HR in both hemispheres. [HHb] increased significantly during the AR task in the right PFC. [tHb] decreased significantly during HR in the right PFC and during PR, AR and HR in the left PFC. During the MA task, StO2 increased and [HHb] decreased significantly during the MA task. We conclude that changes in breathing (hyperventilation) during the tasks led to lower CO2 pressure in the blood (hypocapnia), predominantly responsible for the measured changes in cerebral hemodynamics and oxygenation. In conclusion, our findings demonstrate that PETCO2 should be monitored during functional brain studies investigating speech using neuroimaging modalities, such as fNIRS, fMRI to ensure a correct interpretation of changes in hemodynamics and oxygenation.