Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients.

PURPOSE: Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice. METHODS: Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted. RESULTS: A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients. CONCLUSIONS: Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

The internal wave field in Sau reservoir : Observation and modeling of a third vertical mode

Water withdrawal from Mediterranean reservoirs in summer is usually very high. Because of this, stratification is often continuous and far from the typical two-layered structure, favoring the excitation of higher vertical modes. The analysis of wind, temperature, and current data from Sau reservoir (Spain) shows that the third vertical mode of the internal seiche (baroclinic mode) dominated the internal wave field at the beginning of September 2003. We used a continuous stratification two-dimensional model to calculate the period and velocity distribution of the various modes of the internal seiche, and we calculated that the period of the third vertical mode is ;24 h, which coincides with the period of the dominating winds. As a result of the resonance between the third mode and the wind, the other oscillation modes were not excited during this period

An ontology to automated learning scenarios? an approach to its knowledge domain

Automation or semi-automation of learning scenariospecifications is one of the least exploredsubjects in the e-learning research area. There isa need for a catalogue of learning scenarios and atechnique to facilitate automated retrieval of stored specifications. This requires constructing anontology with this goal and is justified inthis paper. This ontology must mainlysupport a specification technique for learning scenarios. This ontology should also be useful in the creation and validation of new scenarios as well as in the personalization of learning scenarios or their monitoring. Thus, after justifying the need for this ontology, a first approach of a possible knowledge domain is presented. An example of a concrete learning scenario illustrates some relevant concepts supported by this ontology in order to define the scenario in such a way that it could be easy to automate.

Observation of phonon-induced magnetic deflagration in manganites

Very fast magnetic avalanches in (La, Pr)-based manganites are the signature of a phase transition from an insulating blocked charge-ordered antiferromagnetic state to a charge-delocalized ferromagnetic (CD-FM) state. We report here the experimental observation that this transition does not occur either simultaneously or randomly in the whole sample but there is instead a spatial propagation with a velocity of the order of tens of m/s. Our results show that avalanches originate from the inside of the sample, move to the outside, and occur at values of the applied magnetic field that depend on the CD-FM fraction in the sample. Moreover, upon application of surface acoustic waves at constant magnetic fields, we are able to trigger avalanches at very well-determined values of the temperature and magnetic field. Due to the interaction with the acoustic waves, the number of isolated ferromagnetic clusters in La0.225Pr0.40Ca0.375MnO3 starts to grow across the entire sample in the same way as if it were a magnetic deflagration.

Dialogue in the crisis of representation : realism and antirealism in the context of the conversation between theologians and quantum physicists in Göttingen 1949-1961

The aim of this study is to analyse the content of the interdisciplinary conversations in Göttingen between 1949 and 1961. The task is to compare models for describing reality presented by quantum physicists and theologians. Descriptions of reality indifferent disciplines are conditioned by the development of the concept of reality in philosophy, physics and theology. Our basic problem is stated in the question: How is it possible for the intramental image to match the external object?Cartesian knowledge presupposes clear and distinct ideas in the mind prior to observation resulting in a true correspondence between the observed object and the cogitative observing subject. The Kantian synthesis between rationalism and empiricism emphasises an extended character of representation. The human mind is not a passive receiver of external information, but is actively construing intramental representations of external reality in the epistemological process. Heidegger's aim was to reach a more primordial mode of understanding reality than what is possible in the Cartesian Subject-Object distinction. In Heidegger's philosophy, ontology as being-in-the-world is prior to knowledge concerning being. Ontology can be grasped only in the totality of being (Dasein), not only as an object of reflection and perception. According to Bohr, quantum mechanics introduces an irreducible loss in representation, which classically understood is a deficiency in knowledge. The conflicting aspects (particle and wave pictures) in our comprehension of physical reality, cannot be completely accommodated into an entire and coherent model of reality. What Bohr rejects is not realism, but the classical Einsteinian version of it. By the use of complementary descriptions, Bohr tries to save a fundamentally realistic position. The fundamental question in Barthian theology is the problem of God as an object of theological discourse. Dialectics is Barth¿s way to express knowledge of God avoiding a speculative theology and a human-centred religious self-consciousness. In Barthian theology, the human capacity for knowledge, independently of revelation, is insufficient to comprehend the being of God. Our knowledge of God is real knowledge in revelation and our words are made to correspond with the divine reality in an analogy of faith. The point of the Bultmannian demythologising programme was to claim the real existence of God beyond our faculties. We cannot simply define God as a human ideal of existence or a focus of values. The theological programme of Bultmann emphasised the notion that we can talk meaningfully of God only insofar as we have existential experience of his intervention. Common to all these twentieth century philosophical, physical and theological positions, is a form of anti-Cartesianism. Consequently, in regard to their epistemology, they can be labelled antirealist. This common insight also made it possible to find a common meeting point between the different disciplines. In this study, the different standpoints from all three areas and the conversations in Göttingen are analysed in the frameworkof realism/antirealism. One of the first tasks in the Göttingen conversations was to analyse the nature of the likeness between the complementary structures inquantum physics introduced by Niels Bohr and the dialectical forms in the Barthian doctrine of God. The reaction against epistemological Cartesianism, metaphysics of substance and deterministic description of reality was the common point of departure for theologians and physicists in the Göttingen discussions. In his complementarity, Bohr anticipated the crossing of traditional epistemic boundaries and the generalisation of epistemological strategies by introducing interpretative procedures across various disciplines.

Da Costa on ontology: a naturalistic interpretation

Da Costa's conception of being modifies that of Quine to incorporate relativization to non-classical logics. A naturalistic view of this conception is discussed. This view tries to extend to logic some ideas of Maddy's naturalism concerning mathematics.

The transcendence of time in the epistemology of observation from a phenomenological standpoint

In this article I deal with time as a notion of epistemological content associated though with the notion of a subjective consciousness co-constitutive of physical reality. In this phenomenologically grounded approach I attempt to establish a 'metaphysical' aspect of time, within a strictly epistemological context, in the sense of an underlying absolute subjectivity which is non-objectifiable within objective temporality and thus non-susceptible of any ontological designation. My arguments stem, on the one hand, from a version of quantum-mechanical theory (History Projection Operator theory, HPO theory) in view of its formal treatment of two different aspects of time within a quantum context. The discrete, partial-ordering properties (the notions of before and after) and the dynamical-parameter properties reflected in the wave equations of motion. On the other hand, to strengthen my arguments for a transcendental factor of temporality, I attempt an interpretation of some relevant conclusions in the work of J. Eccles ([5]) and of certain results of experimental research of S. Deahaene et al. ([2]) and others.