Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation

Background: The rapid shallow breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. Objective: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. Method: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (Drager (TM) Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH(2)O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). Results: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79 +/- 4.67 and 60.95 +/- 24.64) and FG (38.64 +/- 12.31 and 80.09 +/- 20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79 +/- 14.67 and 38.64 +/- 12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95 +/- 24.64) and FG (80.09 +/- 20.71; p<0.05). Conclusion: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient breathing spontaneously without the aid of pressure support.

Effects of excess body mass on strength and fatigability of quadriceps in postmenopausal women

Objective: Obesity is a major public health problem leading to, among other things, reduced functional capacity. Moreover, obesity-related declines in functional capacity may be compounded by the detrimental consequences of menopause. The aim of this study was to understand the potential effects of excess body mass on measures of functional capacity in postmenopausal women. Methods: Forty-five postmenopausal women aged 50 to 60 years were divided into two groups according to body mass index (BMI): obese (BMI, >= 30 kg/m(2); n = 19) and nonobese (BMI, 18.5-29.9 kg/m(2); n = 26). To determine clinical characteristics, body composition, bone mineral density, and maximal exercise testing was performed, and a 3-day dietary record was estimated. To assess quadriceps function, isokinetic exercise testing at 60 degrees per second (quadriceps strength) and at 300 degrees per second (quadriceps fatigue) was performed. Results: The absolute value of the peak torque was not significantly different between the groups; however, when the data were normalized by body mass and lean mass, significantly lower values were observed for obese women compared with those in the nonobese group (128% +/- 25% vs 155% +/- 24% and 224% +/- 38% vs 257% +/- 47%, P < 0.05). The fatigue index did not show any significant difference for either group; however, when the data were normalized by the body mass and lean mass, significantly lower values were observed for obese women (69% +/- 16% vs 93% +/- 18% and 120% +/- 25% vs. 135% +/- 23%, P < 0.01). Conclusions: Our results show that despite reduced muscle force, the combination of obesity and postmenopause may be associated with greater resistance to muscle fatigue.

Relationship between body mass index with dietary fiber intake and skinfolds-differences among bodybuilders who train during morning and nocturne period

Background: The prevalence of overweight individuals has increased in recent years. Moreover, the importance of a healthy diet is associated with the practice of physical activity and attempt to verify the achievement of physical exercise influences on food choice. However, it relationship between food intake and physical activity have not been studied. Aim: To evaluate if the period in which the trainings are conducted, morning and nocturne, interfere qualitatively and quantitatively in food consumption as well as verify possible associations between anthropometric profiles and dietary habits. Methods: We collected data from 33 adult volunteers, between men and women, practitioners of bodybuilding. Results: A total of 33 volunteers were interviewed (18 (54.5%) were men and 15 (45.5%) were women). Regarding anthropometric data, it turns out that that the volunteers of the two periods had similar characteristics, differentiating only weight. The consumption of nutritional supplements was observed in 30.77% of the practitioners in the morning period vs. 35% for the nocturne. Considering macronutrient intake, there was a significant difference in the consumption of protein between the periods. The consumption during nocturne period was greater (126 +/- 5% of the daily requirement) than the morning period (115.7 +/- 2%). As for micro-nutrients, calcium intake was greater among men when compared to women. There was a positive correlation between the BMI, and arm circumference for practitioners of the morning period. Conclusion: This study show that the practitioners who train in the morning have quietly better eating habits than those in the nocturne period, however both are inappropriate.

Validation and comparison of two soil-vegetation-atmosphere transfer models for tropical Africa

This study aims to compare and validate two soil-vegetation-atmosphere-transfer (SVAT) schemes: TERRA-ML and the Community Land Model (CLM). Both SVAT schemes are run in standalone mode (decoupled from an atmospheric model) and forced with meteorological in-situ measurements obtained at several tropical African sites. Model performance is quantified by comparing simulated sensible and latent heat fluxes with eddy-covariance measurements. Our analysis indicates that the Community Land Model corresponds more closely to the micrometeorological observations, reflecting the advantages of the higher model complexity and physical realism. Deficiencies in TERRA-ML are addressed and its performance is improved: (1) adjusting input data (root depth) to region-specific values (tropical evergreen forest) resolves dry-season underestimation of evapotranspiration; (2) adjusting the leaf area index and albedo (depending on hard-coded model constants) resolves overestimations of both latent and sensible heat fluxes; and (3) an unrealistic flux partitioning caused by overestimated superficial water contents is reduced by adjusting the hydraulic conductivity parameterization. CLM is by default more versatile in its global application on different vegetation types and climates. On the other hand, with its lower degree of complexity, TERRA-ML is much less computationally demanding, which leads to faster calculation times in a coupled climate simulation.

STRUCTURAL CHARACTERIZATION OF CANOPIES OF Eucalyptus spp. USING RADIOMETRIC DATA FROM TM/Landsat 5

Empirical approaches and, more recently, physical approaches, have grounded the establishment of logical connections between radiometric variables derived from remote data and biophysical variables derived from vegetation cover. This study was aimed at evaluating correlations of dendrometric and density data from canopies of Eucalyptus spp., as collected in Capao Bonito forest unit, with radiometric data from imagery acquired by the TM/Landsat-5 sensor on two orbital passages over the study site (dates close to field data collection). Results indicate that stronger correlations were identified between crown dimensions and canopy height with near-infrared spectral band data (rho(s)4), irrespective of the satellite passage date. Estimates of spatial distribution of dendrometric data and canopy density (D) using spectral characterization were consistent with the spatial distribution of tree ages during the study period. Statistical tests were applied to evaluate performance disparities of empirical models depending on which date data were acquired. Results indicated a significant difference between models based on distinct data acquisition dates.

Normalized Frobenius condition number of the orthogonal projections of the identity

[EN]This paper deals with the orthogonal projection (in the Frobenius sense) AN of the identity matrix I onto the matrix subspace AS (A ? Rn×n, S being an arbitrary subspace of Rn×n). Lower and upper bounds on the normalized Frobenius condition number of matrix AN are given. Furthermore, for every matrix subspace S ? Rn×n, a new index bF (A, S), which generalizes the normalized Frobenius condition number of matrix A, is defined and analyzed...

Emissions of volatile organic compounds from tropical savanna vegetation and biomass burning

This dissertation focuses on characterizing the emissions of volatile organic compounds (VOCs) from grasses and young trees, and the burning of biomass mainly from Africa and Indonesia. The measurements were performed with a proton-transfer-reaction mass spectrometer (PTR-MS). The biogenic emissions of tropical savanna vegetation were studied in Calabozo (Venezuela). Two field campaigns were carried out, the first during the wet season (1999) and the second during the dry season (2000). Three grass species were studied: T. plumosus, H. rufa and A. canescens, and the tree species B. crassifolia, C. americana and C. vitifolium. The emission rates were determined with a dynamic plant enclosure system. In general, the emissions increased exponentially with increasing temperature and solar radiation. Therefore, the emission rates showed high variability. Consequently, the data were normalized to a standard temperature of 30°C, and standard emission rates thus determined allowed for interspecific and seasonal comparisons. The range of average daytime (10:00-16:00) emission rates of total VOCs measured from green (mature and young) grasses was between 510-960 ngC/g/h. Methanol was the primary emission (140-360 ngC/g/h), followed by acetaldehyde, butene and butanol and acetone with emission rates between 70-200 ngC/g/h. The emissions of propene and methyl ethyl ketone (MEK) were <80 ngC/g/h, and those of isoprene and C5-alcohols were between 10-130 ngC/g/h. The oxygenated species represented 70-75% of the total. The emission of VOCs was found to vary by up to a factor of three between plants of the same species, and by up to a factor of two between the different species. The annual source of methanol from savanna grasses worldwide estimated in this work was 3 to 4.4 TgC, which could represent up to 12% of the current estimated global emission from terrestrial vegetation. Two of the studied tree species, were isoprene emitters, and isoprene was also their primary emission (which accounted for 70-94% of the total carbon emitted) followed by methanol and butene + butanol. The daytime average emission rate of isoprene measured in the wet season was 27 mgC/g/h for B. crassifolia, and 123 mgC/g/h for C. vitifolium. The daytime emissions of methanol and butene + butanol were between 0.3 and 2 mgC/g/h. The total sum of VOCs emission measured during the day in the wet season was between 30 and 130 mgC/g/h. In the dry season, in contrast, the methanol emissions from C. vitifolium saplings –whose leaves were still developing– were an order of magnitude higher than in the wet season (15 mgC/g/h). The isoprene emission from B. crassifolia in the dry season was comparable to the emission in the wet season, whereas isoprene emission from C. vitifolium was about a factor of three lower (~43 mgC/g/h). Biogenic emission inventories show that isoprenoids are the most prominent and best-studied compounds. The standard emission rates of isoprene and monoterpenes of the measured savanna trees were in the lower end of the range found in the literature. The emission of other biogenic VOCs has been sparsely investigated, but in general, the standard emissions from trees studied here were within the range observed in previous investigations. The biomass burning study comprised the measurement of VOCs and other trace-gas emissions of 44 fires from 15 different fuel types, primarily from Africa and Indonesia, in a combustion laboratory. The average sum of emissions (excluding CO2, CO and NO) from African fuels was ~18 g(VOC)/kg. Six of the ten most important emissions were oxygenated VOCs. Acetic acid was the major emission, followed by methanol and formaldehyde. The emission of methane was of the same order as the methanol emission (~5 g/kg), and that of nitrogen-containing compounds was ~1 g/kg. An estimate of the VOC source from biomass burning of savannas and grasslands worldwide suggests that the sum of emissions is about 56 Tg/yr, of which 34 Tg correspond to oxygenated VOCs, 14 Tg to unsaturated and aromatic compounds, 5 Tg to methane and 3 Tg to N-compounds. The estimated emissions of CO, CO2 and NO are 216, 5117 and 9.4 Tg/yr, respectively. The emission factors reported here for Indonesian fuels are the first results of laboratory fires using Indonesian fuels. Acetic acid was the highest organic emission, followed by acetol, a compound not previously reported in smoke, methane, mass 97 (tentatively identified as furfural, dimethylfuran and ethylfuran), and methanol. The sum of total emissions of Indonesian fuels was 91 g/kg, which is 5 times higher than the emissions from African fuels. The results of this study reinforces the importance of oxygenated compounds. Due to the vast area covered by tropical savannas worldwide, the biogenic and biomass burning emission of methanol and other oxygenated compounds may be important for the regional and even global tropospheric chemistry.

Generating vegetation-spectra as a basis for global monitoring of annual vegetation cycles using DOAS satellite observations

Vegetation-cycles are of general interest for many applications. Be it for harvest-predictions, global monitoring of climate-change or as input to atmospheric models.rnrnCommon Vegetation Indices use the fact that for vegetation the difference between Red and Near Infrared reflection is higher than in any other material on Earth’s surface. This gives a very high degree of confidence for vegetation-detection.rnrnThe spectrally resolving data from the GOME and SCIAMACHY satellite-instrumentsrnprovide the chance to analyse finer spectral features throughout the Red and Near Infrared spectrum using Differential Optical Absorption Spectroscopy (DOAS). Although originally developed to retrieve information on atmospheric trace gases, we use it to gain information on vegetation. Another advantage is that this method automatically corrects for changes in the atmosphere. This renders the vegetation-information easily comparable over long time-spans.rnThe first results using previously available reference spectra were encouraging, but also indicated substantial limitations of the available reflectance spectra of vegetation. This was the motivation to create new and more suitable vegetation reference spectra within this thesis.rnThe set of reference spectra obtained is unique in its extent and also with respect to its spectral resolution and the quality of the spectral calibration. For the first time, this allowed a comprehensive investigation of the high-frequency spectral structures of vegetation reflectance and of their dependence on the viewing geometry.rnrnThe results indicate that high-frequency reflectance from vegetation is very complex and highly variable. While this is an interesting finding in itself, it also complicates the application of the obtained reference spectra to the spectral analysis of satellite observations.rnrnThe new set of vegetation reference spectra created in this thesis opens new perspectives for research. Besides refined satellite analyses, these spectra might also be used for applications on other platforms such as aircraft. First promising studies have been presented in this thesis, but the full potential for the remote sensing of vegetation from satellite (or aircraft) could bernfurther exploited in future studies.

Corpus callosum index and long-term disability in multiple sclerosis patients

Prediction of long-term disability in patients with multiple sclerosis (MS) is essential. Magnetic resonance imaging (MRI) measurement of brain volume may be of predictive value but sophisticated MRI techniques are often inaccessible in clinical practice. The corpus callosum index (CCI) is a normalized measurement that reflects changes of brain volume. We investigated medical records and 533 MRI scans at diagnosis and during clinical follow-up of 169 MS patients (mean age 42 +/- 11 years, 86% relapsing-remitting MS, time since first relapse 11 +/- 9 years). CCI at diagnosis was 0.345 +/- 0.04 and correlated with duration of disease (p = 0.002; r = -0.234) and expanded disability status scale (EDSS) score at diagnosis (r = -0.428; p < 0.001). Linear regression analyses identified age, duration of disease, relapse rate and EDSS at diagnosis as independent predictors for disability after mean of 7.1 years (Nagelkerkes' R:0.56). Annual CCI decrease was 0.01 +/- 0.02 (annual tissue loss: 1.3%). In secondary progressive MS patients, CCI decrease was double compared to that in relapsing-remitting MS patients (p = 0.04). There was a trend of greater CCI decrease in untreated patients compared to those who received disease modifying drugs (p = 0.2). CCI is an easy to use MRI marker for estimating brain atrophy in patients with MS. Brain atrophy as measured with CCI was associated with disability progression but it was not an independent predictor of long-term disability.

Impact of body mass index on the five-year outcome of patients having percutaneous coronary interventions with drug-eluting stents

The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome of patients treated by percutaneous coronary intervention (PCI) using drug-eluting stents. Patients were stratified according to BMI as normal (<25 kg/m(2)), overweight (25 to 30 kg/m(2)), or obese (>30 kg/m(2)). At 5-year follow-up all-cause death, myocardial infarction, clinically justified target vessel revascularization (TVR), and definite stent thrombosis were assessed. A complete dataset was available in 7,427 patients, of which 45%, 22%, and 33% were classified according to BMI as overweight, obese, and normal, respectively. Mean age of patients was significantly older in those with a normal BMI (p <0.05). Incidence of diabetes mellitus, hypertension, and dyslipidemia increased as BMI increased (p <0.05). Significantly higher rates of TVR (15.3% vs 12.8%, p = 0.02) and early stent thrombosis (1.5% vs 0.9%, p = 0.04) were observed in the obese compared to the normal BMI group. No significant difference among the 3 BMI groups was observed for the composite of death/myocardial infarction/TVR or for definite stent thrombosis at 5 years, whereas the normal BMI group was at higher risk for all-cause death at 5 years (obese vs normal BMI, hazard ratio 0.74, confidence interval 0.53 to 0.99, p = 0.05; overweight vs normal BMI, hazard ratio 0.73, confidence interval 0.59 to 0.94, p = 0.01) in the multivariate Cox proportional hazard model. Age resulted in a linearly dependent covariate with BMI in the all-cause 5-year mortality multivariate model (p = 0.001). In conclusion, the "obesity paradox" observed in 5-year all-cause mortality could be explained by the higher rate of elderly patients in the normal BMI group and the existence of colinearity between BMI and age. However, obese patients had a higher rate of TVR and early stent thrombosis and a higher rate of other risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia.

A realistic validation study of a new nitrogen multiple-breath washout system

Background For reliable assessment of ventilation inhomogeneity, multiple-breath washout (MBW) systems should be realistically validated. We describe a new lung model for in vitro validation under physiological conditions and the assessment of a new nitrogen (N2)MBW system. Methods The N2MBW setup indirectly measures the N2 fraction (FN2) from main-stream carbon dioxide (CO2) and side-stream oxygen (O2) signals: FN2 = 1−FO2−FCO2−FArgon. For in vitro N2MBW, a double chamber plastic lung model was filled with water, heated to 37°C, and ventilated at various lung volumes, respiratory rates, and FCO2. In vivo N2MBW was undertaken in triplets on two occasions in 30 healthy adults. Primary N2MBW outcome was functional residual capacity (FRC). We assessed in vitro error (√[difference]2) between measured and model FRC (100–4174 mL), and error between tests of in vivo FRC, lung clearance index (LCI), and normalized phase III slope indices (Sacin and Scond). Results The model generated 145 FRCs under BTPS conditions and various breathing patterns. Mean (SD) error was 2.3 (1.7)%. In 500 to 4174 mL FRCs, 121 (98%) of FRCs were within 5%. In 100 to 400 mL FRCs, the error was better than 7%. In vivo FRC error between tests was 10.1 (8.2)%. LCI was the most reproducible ventilation inhomogeneity index. Conclusion The lung model generates lung volumes under the conditions encountered during clinical MBW testing and enables realistic validation of MBW systems. The new N2MBW system reliably measures lung volumes and delivers reproducible LCI values.

Differences in Soil Fungal Communities between European Beech (Fagus sylvatica L.) Dominated Forests Are Related to Soil and Understory Vegetation

Fungi are important members of soil microbial communities with a crucial role in biogeochemical processes. Although soil fungi are known to be highly diverse, little is known about factors influencing variations in their diversity and community structure among forests dominated by the same tree species but spread over different regions and under different managements. We analyzed the soil fungal diversity and community composition of managed and unmanaged European beech dominated forests located in three German regions, the Schwäbische Alb in Southwestern, the Hainich-Dün in Central and the Schorfheide Chorin in the Northeastern Germany, using internal transcribed spacer (ITS) rDNA pyrotag sequencing. Multiple sequence quality filtering followed by sequence data normalization revealed 1655 fungal operational taxonomic units. Further analysis based on 722 abundant fungal OTUs revealed the phylum Basidiomycota to be dominant (54%) and its community to comprise 71.4% of ectomycorrhizal taxa. Fungal community structure differed significantly (p≤0.001) among the three regions and was characterized by non-random fungal OTUs co-occurrence. Soil parameters, herbaceous understory vegetation, and litter cover affected fungal community structure. However, within each study region we found no difference in fungal community structure between management types. Our results also showed region specific significant correlation patterns between the dominant ectomycorrhizal fungal genera. This suggests that soil fungal communities are region-specific but nevertheless composed of functionally diverse and complementary taxa.

A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease

BACKGROUND: Ankle-brachial pressure index (ABI) is a simple, inexpensive, and useful tool in the detection of peripheral arterial occlusive disease (PAD). The current guidelines published by the American Heart Association define ABI as the quotient of the higher of the systolic blood pressures (SBPs) of the two ankle arteries of that limb (either the anterior tibial artery or the posterior tibial artery) and the higher of the two brachial SBPs of the upper limbs. We hypothesized that considering the lower of the two ankle arterial SBPs of a side as the numerator and the higher of the brachial SBPs as the denominator would increase its diagnostic yield. METHODS: The former method of eliciting ABI was termed as high ankle pressure (HAP) and the latter low ankle pressure (LAP). ABI was assessed in 216 subjects and calculated according to the HAP and the LAP method. ABI findings were confirmed by arterial duplex ultrasonography. A significant arterial stenosis was assumed if ABI was <0.9. RESULTS: LAP had a sensitivity of 0.89 and a specificity of 0.93. The HAP method had a sensitivity of 0.68 and a specificity of 0.99. McNemar's test to compare the results of both methods demonstrated a two-tailed P < .0001, indicating a highly significant difference between both measurement methods. CONCLUSIONS: LAP is the superior method of calculating ABI to identify PAD. This result is of great interest for epidemiologic studies applying ABI measurements to detect PAD and assessing patients' cardiovascular risk.

Warming alters photosynthetic rates of sub-boreal peatland vegetation

Boreal peatlands are important in the global carbon cycle. Despite covering only 3% of the global land area, peatlands store approximately one third of all soil carbon. Temperature is one of the major drivers in peatland carbon cycling as it affects both plant production and CO2 fluxes from soils. However, it is relatively unknown how boreal peatland plant photosynthesis is affected by higher temperatures. Therefore, we measured plant photosynthetic rates under two different warming treatments in a poor fen in Northern Michigan. Eighteen plots were established that were divided into three treatments: control, open-top chamber (OTC) warming and infrared (IR) lamp warming. Previous work at this site has shown that there was a significant increase in canopy and peat temperature with IR warming (5°C and 1.4°C respectively), while the OTC’s had mixed overall warming. Plots were divided equally into lawns and hummocks. We measured mid-day carbon dioxide (CO2) uptake on sedges (Carex utriculata), shrubs (Chamaedaphne calyculata) and Sphagnum mosses. Sphagnum moss net primary production (NPP) was also measured with cranked wires and compared with CO2 uptake. Our results indicate that there was no significant difference in sedge CO2 uptake, while shrub CO2 uptake significantly decreased with warming. A significant increase occurred in Sphagnum moss gross ecosystem production (GEP), ecosystem respiration (ER) and net ecosystem exchange (NEE). Contrary to the positive CO2 exchange of Sphagnum, overall NPP decreased significantly in hummocks with both warming treatments. The results of the study indicate that temperature partly limits the photosynthetic capacity of plants in sub-boreal peatlands, but not all species respond similarly to higher temperatures.

Entropy and bispectral index for assessment of sedation, analgesia and the effects of unpleasant stimuli in critically ill patients: an observational study

INTRODUCTION: Sedative and analgesic drugs are frequently used in critically ill patients. Their overuse may prolong mechanical ventilation and length of stay in the intensive care unit. Guidelines recommend use of sedation protocols that include sedation scores and trials of sedation cessation to minimize drug use. We evaluated processed electroencephalography (response and state entropy and bispectral index) as an adjunct to monitoring effects of commonly used sedative and analgesic drugs and intratracheal suctioning. METHODS: Electrodes for monitoring bispectral index and entropy were placed on the foreheads of 44 critically ill patients requiring mechanical ventilation and who previously had no brain dysfunction. Sedation was targeted individually using the Ramsay Sedation Scale, recorded every 2 hours or more frequently. Use of and indications for sedative and analgesic drugs and intratracheal suctioning were recorded manually and using a camera. At the end of the study, processed electroencephalographical and haemodynamic variables collected before and after each drug application and tracheal suctioning were analyzed. Ramsay score was used for comparison with processed electroencephalography when assessed within 15 minutes of an intervention. RESULTS: The indications for boli of sedative drugs exhibited statistically significant, albeit clinically irrelevant, differences in terms of their association with processed electroencephalographical parameters. Electroencephalographical variables decreased significantly after bolus, but a specific pattern in electroencephalographical variables before drug administration was not identified. The same was true for opiate administration. At both 30 minutes and 2 minutes before intratracheal suctioning, there was no difference in electroencephalographical or clinical signs in patients who had or had not received drugs 10 minutes before suctioning. Among patients who received drugs, electroencephalographical parameters returned to baseline more rapidly. In those cases in which Ramsay score was assessed before the event, processed electroencephalography exhibited high variation. CONCLUSIONS: Unpleasant or painful stimuli and sedative and analgesic drugs are associated with significant changes in processed electroencephalographical parameters. However, clinical indications for drug administration were not reflected by these electroencephalographical parameters, and barely by sedation level before drug administration or tracheal suction. This precludes incorporation of entropy and bispectral index as target variables for sedation and analgesia protocols in critically ill patients.