A comparison of seafloor habitats and associated benthic fauna in areas open and closed to bottom trawling along the central California Continental Shelf

Executive Summary: A number of studies have shown that mobile, bottom-contact fishing gear (such as otter trawls) can alter seafloor habitats and associated biota. Considerably less is known about the recovery of these resources following such disturbances, though this information is critical for successful management. In part, this paucity of information can be attributed to the lack of access to adequate control sites – areas of the seafloor that are closed to fishing activity. Recent closures along the coast of central California provide an excellent opportunity to track the recovery of historically trawled areas and to compare recovery rates to adjacent areas that continue to be trawled. In June 2006 we initiated a multi-year study of the recovery of seafloor microhabitats and associated benthic fauna inside and outside two new Essential Fish Habitat (EFH) closures within the Cordell Bank and Gulf of the Farallones National Marine Sanctuaries. Study sites inside the EFH closure at Cordell Bank were located in historically active areas of fishing effort, which had not been trawled since 2003. Sites outside the EFH closure in the Gulf of Farallones were located in an area that continues to be actively trawled. All sites were located in unconsolidated sands at equivalent water depths. Video and still photographic data collected via a remotely operated vehicle (ROV) were used to quantify the abundance, richness, and diversity of microhabitats and epifaunal macro-invertebrates at recovering and actively trawled sites, while bottom grabs and conductivity/temperature/depth (CTD) casts were used to quantify infaunal diversity and to characterize local environmental conditions. Analysis of still photos found differences in common seafloor microhabitats between the recovering and actively trawled areas, while analysis of videographic data indicated that biogenic mound and biogenic depression microhabitats were significantly less abundant at trawled sites. Each of these features provides structure with which demersal fishes, across a wide range of size classes, have been observed to associate. Epifaunal macro-invertebrates were sparsely distributed and occurred in low numbers in both treatments. However, their total abundance was significantly different between treatments, which was attributable to lower densities at trawled sites. In addition, the dominant taxa were different between the two sites. Patchily-distributed buried brittle stars dominated the recovering site, and sea whips (Halipteris cf. willemoesi) were most numerous at the trawled site though they occurred in only five of ten transects. Numerical classification (cluster analysis) of the infaunal samples also revealed a clear difference between benthic assemblages in the recovering vs. trawled areas due to differences in the relative abundances of component species. There were no major differences in infaunal species richness, H′ diversity, or J′ evenness between recovering vs. trawled site groups. However, total infaunal abundance showed a significant difference attributable to much lower densities at trawled sites. This pattern was driven largely by the small oweniid polychaete Myriochele gracilis, which was the most abundant species in the overall study region though significantly less abundant at trawled sites. Other taxa that were significantly less abundant at trawled sites included the polychaete M. olgae and the polychaete family Terebellidae. In contrast, the thyasirid bivalve Axinopsida serricata and the polychaetes Spiophanes spp. (mostly S. duplex), Prionospio spp., and Scoloplos armiger all had significantly to near significantly higher abundances at trawled sites. As a result of such contrasting species patterns, there also was a significant difference in the overall dominance structure of infaunal assemblages between the two treatments. It is suggested that the observed biological patterns were the result of trawling impacts and varying levels of recovery due to the difference in trawling status between the two areas. The EFH closure was established in June 2006, within a month of when sampling was conducted for the present study, however, the stations within this closure area are at sites that actually have experienced little trawling since 2003, based on National Marine Fishery Service trawl records. Thus, the three-year period would be sufficient time for some post-trawling changes to have occurred. Other results from this study (e.g., similarly moderate numbers of infaunal species in both areas that are lower than values recorded elsewhere in comparable habitats along the California continental shelf) also indicate that recovery within the closure area is not yet complete. Additional sampling is needed to evaluate subsequent recovery trends and persistence of effects. Furthermore, to date, the study has been limited to unconsolidated substrates. Ultimately, the goal of this project is to characterize the recovery trajectories of a wide spectrum of seafloor habitats and communities and to link that recovery to the dynamics of exploited marine fishes. (PDF has 48 pages.)

The First Occurrence in the Fossil Record of an Aquatic Avian Twig-Nest with Phoenicopteriformes Eggs: Evolutionary Implication

14 p.

室温下稳定的多波长掺铒光纤激光器的研究

通过在线形谐振腔中引入一段缠绕在压电陶瓷上的单模光纤作为正弦相位调制器，使得激射波长的损耗不固定，抑制由于掺铒光纤的均匀展宽效应引起的模式竞争，从而避免了在室温下不稳定的单波长激射，实现了多波长掺铒光纤激光器的稳定输出。为了获得平坦的多波长输出，在谐振腔里使用了一个损耗峰位于1530nm处的长周期光纤光栅，以获得较为平坦的增益谱。通过两个3dB耦合器制成的反射型梳状滤波器的滤波作用，实验中观察到稳定的多波长激射，相邻波长间隔约为0．45nm。中心9个波长的输出功率平坦度为10dB，边模抑制比大于25dB。

Uptake and factors that influence the use of 'sit less, move more' occupational intervention strategies in Spanish office employees

Background: Little is known about the types of 'sit less, move more' strategies that appeal to office employees, or what factors influence their use. This study assessed the uptake of strategies in Spanish university office employees engaged in an intervention, and those factors that enabled or limited strategy uptake. Methods: The study used a mixed method design. Semi-structured interviews were conducted with academics and administrators (n = 12; 44 +/- 12 mean SD age; 6 women) at three points across the five-month intervention, and data used to identify factors that influenced the uptake of strategies. Employees who finished the intervention then completed a survey rating (n = 88; 42 +/- 8 mean SD age; 51 women) the extent to which strategies were used [never (1) to usually (4)]; additional survey items (generated from interviewee data) rated the impact of factors that enabled or limited strategy uptake [no influence (1) to very strong influence (4)]. Survey score distributions and averages were calculated and findings triangulated with interview data. Results: Relative to baseline, 67% of the sample increased step counts post intervention (n = 59); 60% decreased occupational sitting (n = 53). 'Active work tasks' and 'increases in walking intensity' were the strategies most frequently used by employees (89% and 94% sometimes or usually utilised these strategies); 'walk-talk meetings' and ` lunchtime walking groups' were the least used (80% and 96% hardly ever or never utilised these strategies). 'Sitting time and step count logging' was the most important enabler of behaviour change (mean survey score of 3.1 +/- 0.8); interviewees highlighted the motivational value of being able to view logged data through visual graphics in a dedicated website, and gain feedback on progress against set goals. 'Screen based work' (mean survey score of 3.2 +/- 0.8) was the most significant barrier limiting the uptake of strategies. Inherent time pressures and cultural norms that dictated sedentary work practices limited the adoption of 'walk-talk meetings' and ` lunch time walking groups'. Conclusions: The findings provide practical insights into which strategies and influences practitioners need to target to maximise the impact of 'sit less, move more' occupational intervention strategies.

Análise, imputação de dados e interfaces computacionais em estudos de séries temporais epidemiológicas

efeitos são frequentemente observados na morbidade e mortalidade por doenças respiratórias e cardiovasculares, câncer de pulmão, diminuição da função respiratória, absenteísmo escolar e problemas relacionados com a gravidez. Estudos também sugerem que os grupos mais suscetíveis são as crianças e os idosos. Esta tese apresenta estudos sobre o efeito da poluição do ar na saúde na saúde na cidade do Rio de Janeiro e aborda aspectos metodológicos sobre a análise de dados e imputação de dados faltantes em séries temporais epidemiológicas. A análise de séries temporais foi usada para estimar o efeito da poluição do ar na mortalidade de pessoas idosas por câncer de pulmão com dados dos anos 2000 e 2001. Este estudo teve como objetivo avaliar se a poluição do ar está associada com antecipação de óbitos de pessoas que já fazem parte de uma população de risco. Outro estudo foi realizado para avaliar o efeito da poluição do ar no baixo peso ao nascer de nascimentos a termo. O desenho deste estudo foi o de corte transversal usando os dados disponíveis no ano de 2002. Em ambos os estudos foram estimados efeitos moderados da poluição do ar. Aspectos metodológicos dos estudos epidemiológicos da poluição do ar na saúde também são abordados na tese. Um método para imputação de dados faltantes é proposto e implementado numa biblioteca para o aplicativo R. A metodologia de imputação é avaliada e comparada com outros métodos frequentemente usados para imputação de séries temporais de concentrações de poluentes atmosféricos por meio de técnicas de simulação. O método proposto apresentou desempenho superior aos tradicionalmente utilizados. Também é realizada uma breve revisão da metodologia usada nos estudos de séries temporais sobre os efeitos da poluição do ar na saúde. Os tópicos abordados na revisão estão implementados numa biblioteca para a análise de dados de séries temporais epidemiológicas no aplicativo estatístico R. O uso da biblioteca é exemplificado com dados de internações hospitalares de crianças por doenças respiratórias no Rio de Janeiro. Os estudos de cunho metodológico foram desenvolvidos no âmbito do estudo multicêntrico para avaliação dos efeitos da poluição do ar na América Latina o Projeto ESCALA.

Negociando significados: coerção sexual em narrativas de jovens brasileiros

Esta dissertação enfoca o tema a partir da análise de narrativas de jovens (homens e mulheres, entre 18 e 24 anos), residentes em três capitais brasileiras (Rio de Janeiro, Porto Alegre e Salvador), acerca de experiências envolvendo sexo por constrangimento ou forçado. Os relatos são examinados à luz de uma produção internacional que discute a questão da coerção sexual. Os dados analisados correspondem a uma sub-amostra de 46 entrevistas com jovens pertencentes a camadas médias e populares, selecionadas do conjunto de 123 entrevistas que integraram a fase qualitativa da pesquisa GRAVAD (Gravidez na Adolescência: Estudo Multicêntrico sobre Jovens, Sexualidade e Reprodução no Brasil). A leitura do material empírico buscou situar os episódios narrados nas biografias individuais e refletir sobre as representações dos sujeitos sobre gênero e sexualidade e os aspectos dessas trajetórias capazes de conduzir a um entendimento de tais eventos. Moças e rapazes relataram distintas experiências de sexo contra vontade, que variavam de acordo com o contexto e o tipo de coerção utilizada e/ou sofrida. As dinâmicas das relações entre os gêneros revelam que, na negociação sexual, consentimento e desejo nem sempre andam juntos. Em determinadas condições, certos modos de constrangimento são tidos como constitutivos dos jogos de sedução. A análise das narrativas evidencia o caráter relacional e contextual das interações afetivo-sexuais entre os gêneros e do que pode ser qualificado como violência. Tal conclusão, conduziu ao questionamento acerca da positividade atribuída a certas atitudes e comportamentos sexuais categorizados como violentos por diversos estudos dedicados ao tema.

The impacts of past land-use on the ecology of an ancient woodland in south-west Ireland

A multi-disciplinary study was conducted to compare stands of ancient and secondary origin within a single wood, the Gearagh woodland, County Cork. These sites were compared with adjacent areas of grassland, which provided a reference for the former land-use (pasture) of the secondary woodland. A historical study confirmed that while the core of the Gearagh has been subject to minimal human interference, other sections have been cleared in the past for agricultural purposes. Investigations into soil structure and composition showed that soil properties in these secondary woodland areas were significantly altered by this past woodland clearance and conversion to agriculture, while the soil of the ancient woodland showed little signs of disturbance. The vegetation community also differed between the two woodland areas, partly due to altered environmental conditions. Many of the ancient woodland plant species were unable to form a persistent seed bank, while there was increased representation of species associated with more open-habitat conditions in the seed bank of the secondary woodland. While germination of woodland species was low in all sites, overall, seeds tended to germinate more successfully in the ancient woodland. The ancient woodland also provided a suitable habitat for many soil and ground detritivores, most notably enchytraeids, although earthworms were not abundant. Past agricultural use, however, changed the decomposer community considerably, with increased representation of earthworm species and a decline in the abundance of enchytraeids in the secondary stands. In conclusion, the legacies of historical agricultural activities can continue to significantly affect the structure and composition of present-day woodlands so that they may differ considerably from undisturbed ancient woodland stands, even within the same woodland. A greater understanding of the origin, development and ecological functioning of ancient woodlands should aid in determining future conservation and management requirements.

Lower extremity amputation in people with diabetes: Trends and determinants

Introduction: The prevalence of diabetes is rising rapidly. Assessing quality of diabetes care is difficult. Lower Extremity Amputation (LEA) is recognised as a marker of the quality of diabetes care. The focus of this thesis was first to describe the trends in LEA rates in people with and without diabetes in the Republic of Ireland (RoI) in recent years and then, to explore the determinants of LEA in people with diabetes. While clinical and socio-demographic determinants have been well-established, the role of service-related factors has been less well-explored. Methods: Using hospital discharge data, trends in LEA rates in people with and without diabetes were described and compared to other countries. Background work included concordance studies exploring the reliability of hospital discharge data for recording LEA and diabetes and estimation of diabetes prevalence rates in the RoI from a nationally representative study (SLAN 2007). To explore determinants, a systematic review and meta-analysis assessed the effect of contact with a podiatrist on the outcome of LEA in people with diabetes. Finally, a case-control study using hospital discharge data explored determinants of LEA in people with diabetes with a particular focus on the timing of access to secondary healthcare services as a risk factor. Results: There are high levels of agreement between hospital discharge data and medical records for LEA and diabetes. Thus, hospital discharge data was deemed sufficiently reliable for use in this PhD thesis. A decrease in major diabetes-related LEA rates in people with diabetes was observed in the RoI from 2005-2012. In 2012, the relative risk of a person with diabetes undergoing a major LEA was 6.2 times (95% CI 4.8-8.1) that of a person without diabetes. Based on the systematic review and meta-analysis, contact with a podiatrist did not significantly affect the relative risk (RR) of LEA in people with diabetes. Results from the case-control study identified being single, documented CKD and documented hypertension as significant risk factors for LEA in people with diabetes whilst documented retinopathy was protective. Within the seven year time window included in the study, no association was detected between LEA in patients with diabetes and timing of patient access to secondary healthcare for diabetes management. Discussion: Many countries have reported reduced major LEA rates in people with diabetes coinciding with improved organisation of healthcare systems. Reassuringly, these first national estimates in people with diabetes in the RoI from 2005 to 2012 demonstrated reducing trends in major LEA rates. This may be attributable to changes in diabetes care and also, secular trends in smoking, dyslipidaemia and hypertension. Consistent with international practice, LEA trends data in Ireland can be used to monitor quality of care. Quantifying this improvement precisely, though, is problematic without robust denominator data on the prevalence of diabetes. However, a reduction in major diabetes-related LEA rates suggests improved quality of diabetes care. Much controversy exists around the reliability of hospital discharge data in the RoI. This thesis includes the first multi-site study to explore this issue and found hospital discharge data reliable for the reporting of the procedure of LEA and diagnosis of diabetes. This project did not detect protective effects of access to services including podiatry and secondary healthcare for LEA in people with diabetes. A major limitation of the systematic review and meta-analysis was the design and quality of the included studies. The data available in the area of effect of contact with a podiatrist on LEA risk are too sparse to say anything definitive about the efficacy of podiatry on LEA. Limitations of the case-control study include lack of a diabetes register in Ireland, restricted information from secondary healthcare and lack of data available from primary healthcare. Due to these issues, duration of disease could not be accounted for in the study which limits the conclusions that can be drawn from the results. The model of diabetes care in the RoI is currently undergoing a re-configuration with plans to introduce integrated care. In the future, trends in LEA rates should be continuously monitored to evaluate the effectiveness of changes to the healthcare system. Efforts are already underway to improve the availability of routine data from primary healthcare with the recent development of the iPCRN (Irish Primary Care Research Network). Linkage of primary and secondary healthcare records with a unique patient identifier should be the goal for the future.

Nursing resources and patient outcomes in intensive care: a systematic review of the literature

Objectives: To evaluate the empirical evidence linking nursing resources to patient outcomes in intensive care settings as a framework for future research in this area. Background: Concerns about patient safely and the quality of care are driving research on the clinical and cost-effectiveness of health care interventions, including the deployment of human resources. This is particularly important in intensive care where a large proportion of the health care budget is consumed and where nursing staff is the main item of expenditure. Recommendations about staffing levels have been trade but may not be evidence based and may not always be achieved in practice. Methods: We searched systematically for studies of the impact of nursing resources (e.g. nurse-patient ratios, nurses' level of education, training and experience) on patient Outcomes, including mortality and adverse events, in adult intensive care. Abstracts of articles were reviewed and retrieved if they investigated the relationship between nursing resources and patient Outcomes. Characteristics of the studies were tabulated and the quality of the Studies assessed. Results: Of the 15 studies included in this review, two reported it statistical relationship between nursing resources and both mortality and adverse events, one reported ail association to mortality only, seven studies reported that they Could not reject the null hypothesis of no relationship to mortality and 10 studies (out of 10 that tested the hypothesis) reported a relationship to adverse events. The main explanatory mechanisms were the lack of time for nurses to perform preventative measures, or for patient surveillance. The nurses' role in pain control was noted by One author. Studies were mainly observational and retrospective and varied in scope from 1 to 52 units. Recommendations for future research include developing the mechanisms linking nursing resources to patient Outcomes, and designing large multi-centre prospective Studies that link patient's exposure to nursing care oil a shift-by-shift basis over time. (C) 2007 Elsevier Ltd. All rights reserved.

Determining factors of the innovative behavior of cooperatives: an analysis of the case of Castilla y León

Cooperatives have a long historical experience in the Spanish economy and have demonstrated their ability to compete against traditional firms in the market. To maintain this capability, while taking advantage of the competitive advantages associated with their idiosyncrasies as social economy enterprises, they should take into consideration that the economy is increasingly globalized and increasingly knowledge-based, especially with regards to technological content. As a consequence, the innovative capacity appears to be a key aspect in order to be able to challenge competitors. This article characterizes the innovative behavior of cooperatives in the region of Castile and Leon and analyses the internal and external factors affecting their innovative performance, based on data from a survey of 581 cooperatives. The results of the empirical analysis, which is performed by multivariate binary logistic regression on various types of innovation, lead us to identify the size of the organizations, the existence of planning, the R & D activities and the human capital as the main determining factors.

Determining the Sun's influence on Lateglacial and Holocene climates: a focus on climate response to centennial-scale solar forcing at 2800 cal. BP

The influence of solar variability on the climate of the Lateglacial and Holocene periods has been the subject of increasing discussion during the last decade. In the Mid-Holocene, several studies have identified cold/wet events that occur at ca 2800 cal. BP and a link with a reduction in solar activity, inferred from the C-14 record, has been postulated. We present results from a multi-proxy study of peat humification, plant macrofossils and testate amoebae from a raised bog at Glen West, northwest Ireland, that indicate that dry bog surface conditions were experienced in the north of Ireland at the time of the solar anomaly starting at 2800 cal. BP. With the aid of C-14 wiggle-matching and tephrochronology, an abrupt shift to wetter conditions is dated to ca 2700 cal. BP, coinciding with a C-14 maximum but clearly post-dating the 2800 cal. BP event identified elsewhere in Europe. We explore the significance of this apparent lag in the Irish record, considering the possible role of the ocean in generating spatial and temporal complexities in the climate patterns of the North Atlantic region. We conclude that these complexities are likely to give rise to time-transgressive climate responses around the North Atlantic that will only be recognised by more critical chronological approaches.

LRP-1 variation is not associated with risk of Alzheimer's disease

Alzheimer's disease (AD) is characterised by the extensive deposition of amyloid beta (Aß) within the parenchyma and vasculature of the brain. It is hypothesised that a dysfunction in Aß degradation and/or its removal from the brain may result in accumulation as plaques. Low density lipoprotein receptor-related protein-1 (LRP-1) is a multifunctional receptor shown to be involved in cholesterol metabolism but also the removal of Aß from the brain. Its ability to transport Aß from the brain to the periphery has made it an attractive candidate for involvement in Alzheimer's disease (AD). We have assessed the frequencies of 9 tag- SNPs and the commonly studied synonymous SNP within exon 3 (rs1799986) in a multi-centre AD/control cohort and performed haplotype analysis. We found no evidence from a combined total of 412 controls and 1057 AD patients to support the involvement of LRP-1 variation, including the most commonly studied variant in rs1799986 in conferring genetic susceptibility to increased risk of AD.

Holocene environmental changes in northeast Thailand as reconstructed from a tropical wetland

Geochemical variables (TOC, C/N, TS, delta C-13) and diatom assemblages were analyzed in a lake sediment sequence from Nong (Lake) Han Kumphawapi in northeast Thailand to reconstruct regional climatic and environmental history during the Holocene. By around c. 10,000-9400 cal yr BP, a large shallow freshwater lake had formed in the Kumphawapi basin. Oxygenated bottom waters and a well-mixed water column were characteristic of this early lake stage, which was probably initiated by higher effective moisture and a stronger summer monsoon. Decreased run-off after c. 6700 cal yr BP favored increased aquatic productivity in the shallow lake. Multiple proxies indicate a marked lowering of the lake level around 5900 cal yr BP, the development of an extensive wetland around 5400 cal yr BP, and the subsequent transition to a peatland. The shift from shallow lake to wetland and later to a peatland is interpreted as a response to lower effective moisture. A hiatus at the transition from wetland to peatland suggests very low accumulation rates, which may result from very dry climatic conditions. A rise in groundwater and lake level around 3200 cal yr BP allowed the re-establishment of a wetland in the Kumphawapi basin. However, the sediments deposited between c. 3200 and 1600 cal yr BP provide evidence for at least two hiatuses at c. 2700-2500 cal yr BP, and at c. 1900-1600 cal yr BP, which would suggest surface dryness and consequently periods of low effective moisture. Around 1600 cal yr BP a new shallow lake became re-established in the basin. Although the underlying causes for this new lake phase remain unclear, we hypothesize that higher effective moisture was the main driving force. This shallow lake phase continued up to the present but was interrupted by higher nutrient fluxes to the lake around 1000-600 cal yr BP. Whether this was caused by intensified human impact in the catchment or, whether this signals a lowering of the lake level due to reduced effective moisture, needs to be corroborated by further studies in the region. The multi-proxy study of Kumphawapi's sediment core CP3A clearly shows that Kumphawapi is a sensitive archive for recording past shifts in effective moisture, and as such in the intensity of the Asian summer monsoon. Many more continental paleorecords, however, will be needed to fully understand the spatial and temporal patterns of past changes in Asian monsoon intensity and its ecosystem impacts. (C) 2012 Elsevier B.V. All rights reserved.

Integrating petrography, mineralogy and hydrochemistry to constrain the influence and distribution of groundwater contributions to baseflow in poorly productive aquifers: Insights from Gortinlieve catchment, Co. Donegal, NW Ireland

Identifying groundwater contributions to baseflowforms an essential part of surfacewater body characterisation. The Gortinlieve catchment (5 km2) comprises a headwater stream network of the Carrigans River, itself a tributary of the River Foyle, NW Ireland. The bedrock comprises poorly productive metasediments that are characterised by fracture porosity. We present the findings of a multi-disciplinary study that integrates new hydrochemical and mineralogical investigations with existing hydraulic, geophysical and structural data to identify the scales of groundwater flow and the nature of groundwater/bedrock interaction (chemical denudation). At the catchment scale, the development of deep weathering profiles is controlled by NE-SW regional scale fracture zones associated with mountain building during the Grampian orogeny. In-situ chemical denudation of mineral phases is controlled by micro- to meso-scale fractures related to Alpine compression during Palaeocene to Oligocene times. The alteration of primary muscovite, chlorite (clinochlore) and albite along the surfaces of these small-scale fractures has resulted in the precipitation of illite, montmorillonite and illite/montmorillonite clay admixtures. The interconnected but discontinuous nature of these small-scale structures highlights the role of larger scale faults and fissures in the supply and transportation of weathering solutions to/from the sites of mineral weathering. The dissolution of primarily mineral phases releases the major ions Mg, Ca and HCO3 that are shown to subsequently formthe chemical makeup of groundwaters. Borehole groundwater and stream baseflow hydrochemical data are used to constrain the depths of groundwater flow pathways influencing the chemistry of surface waters throughout the stream profile. The results show that it is predominantly the lower part of the catchment, which receives inputs from catchment/regional scale groundwater flow, that is found to contribute to the maintenance of annual baseflow levels. This study identifies the importance
of deep groundwater in maintaining annual baseflow levels in poorly productive bedrock systems.

Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children: a cochrane systematic review and meta-analysis

IntroductionAutomated weaning systems may improve adaptation of mechanical support for a patient’s ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation. Our objective was to compare mechanical ventilator weaning duration for critically ill adults and children when managed with automated systems versus non-automated strategies. Secondary objectives were to determine differences in duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), mortality, and adverse events.MethodsElectronic databases were searched to 30 September 2013 without language restrictions. We also searched conference proceedings; trial registration websites; and article reference lists. Two authors independently extracted data and assessed risk of bias. We combined data using random-effects modelling.ResultsWe identified 21 eligible trials totalling 1,676 participants. Pooled data from 16 trials indicated that automated systems reduced the geometric mean weaning duration by 30% (95% confidence interval (CI) 13% to 45%), with substantial heterogeneity (I2 = 87%, P <0.00001). Reduced weaning duration was found with mixed or medical ICU populations (42%, 95% CI 10% to 63%) and Smartcare/PS™ (28%, 95% CI 7% to 49%) but not with surgical populations or using other systems. Automated systems reduced ventilation duration with no heterogeneity (10%, 95% CI 3% to 16%) and ICU LOS (8%, 95% CI 0% to 15%). There was no strong evidence of effect on mortality, hospital LOS, reintubation, self-extubation and non-invasive ventilation following extubation. Automated systems reduced prolonged mechanical ventilation and tracheostomy. Overall quality of evidence was high.ConclusionsAutomated systems may reduce weaning and ventilation duration and ICU stay. Due to substantial trial heterogeneity an adequately powered, high quality, multi-centre randomized controlled trial is needed.