Automated versus non-automated weaning for reducing the duration of mechanical ventilation in critically ill adults & children (Review)

Background Automated closed loop 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. This review was originally published in 2013 with an update published in 2014. Objectives The primary objective for this review was to compare the total duration of weaning from mechanical ventilation, defined as the time from study randomization to successful extubation (as defined by study authors), for critically ill ventilated patients managed with an automated weaning system versus no automated weaning system (usual care). Secondary objectives for this review were to determine differences in the duration of ventilation, intensive care unit (ICU) and hospital lengths of stay (LOS), mortality, and adverse events related to early or delayed extubation with the use of automated weaning systems compared to weaning in the absence of an automated weaning system. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8); MEDLINE (OvidSP) (1948 to September 2013); EMBASE (OvidSP) (1980 to September 2013); CINAHL (EBSCOhost) (1982 to September 2013); and the Latin American and Caribbean Health Sciences Literature (LILACS). Relevant published reviews were sought using the Database of Abstracts of Reviews of Effects (DARE) and the Health Technology Assessment Database (HTA Database). We also searched the Web of Science Proceedings; conference proceedings; trial registration websites; and reference lists of relevant articles. The original search was run in August 2011, with database auto-alerts up to August 2012. Selection criteria We included randomized controlled trials comparing automated closed loop ventilator applications to non-automated weaning strategies including non-protocolized usual care and protocolized weaning in patients over four weeks of age receiving invasive mechanical ventilation in an ICU. Data collection and analysis Two authors independently extracted study data and assessed risk of bias. We combined data in forest plots using random-effects modelling. Subgroup and sensitivity analyses were conducted according to a priori criteria. Main results We included 21 trials (19 adult, two paediatric) totaling 1676 participants (1628 adults, 48 children) in this updated review. Pooled data from 16 eligible trials reporting weaning duration indicated that automated closed loop systems reduced the geometric mean duration of weaning by 30% (95% confidence interval (CI) 13% to 45%), however heterogeneity was substantial (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 in surgical populations or using other systems. Automated closed loop systems reduced the duration of ventilation (10%, 95% CI 3% to 16%) and ICU LOS (8%, 95% CI 0% to 15%). There was no strong evidence of an effect on mortality rates, hospital LOS, reintubation rates, self-extubation and use of non-invasive ventilation following extubation. Prolonged mechanical ventilation > 21 days and tracheostomy were reduced in favour of automated systems (relative risk (RR) 0.51, 95% CI 0.27 to 0.95 and RR 0.67, 95% CI 0.50 to 0.90 respectively). Overall the quality of the evidence was high with the majority of trials rated as low risk. Authors' conclusions Automated closed loop systems may result in reduced duration of weaning, ventilation and ICU stay. Reductions are more likely to occur in mixed or medical ICU populations. Due to the lack of, or limited, evidence on automated systems other than Smartcare/PS™ and Adaptive Support Ventilation no conclusions can be drawn regarding their influence on these outcomes. Due to substantial heterogeneity in trials there is a need for an adequately powered, high quality, multi-centre randomized controlled trial in adults that excludes 'simple to wean' patients. There is a pressing need for further technological development and research in the paediatric population.

Of no fixed form: The Irish Pavilion at Venice 2014 and beyond

This paper explores the theme of exhibiting architectural research through a particular example, the development of the Irish pavilion for the 14th architectural biennale, Venice 2014. Responding to Rem Koolhaas’s call to investigate the international absorption of modernity, the Irish pavilion became a research project that engaged with the development of the architectures of infrastructure in Ireland in the twentieth and twenty-first centuries. Central to this proposition was that infrastructure is simultaneously a technological and cultural construct, one that for Ireland occupied a critical position in the building of a new, independent post-colonial nation state, after 1921.

Presupposing infrastructure as consisting of both visible and invisible networks, the idea of a matrix become a central conceptual and visual tool in the curatorial and design process for the exhibition and pavilion. To begin with this was a two-dimensional grid used to identify and order what became described as a series of ten ‘infrastructural episodes’. These were determined chronologically across the decades between 1914 and 2014 and their spatial manifestations articulated in terms of scale: micro, meso and macro. At this point ten academics were approached as researchers. Their purpose was twofold, to establish the broader narratives around which the infrastructures developed and to scrutinise relevant archives for compelling visual material. Defining the meso scale as that of the building, the media unearthed was further filtered and edited according to a range of categories – filmic/image, territory, building detail, and model – which sought to communicate the relationship between the pieces of architecture and the larger systems to which they connect. New drawings realised by the design team further iterated these relationships, filling in gaps in the narrative by providing composite, strategic or detailed drawings.

Conceived as an open-ended and extendable matrix, the pavilion was influenced by a series of academic writings, curatorial practices, artworks and other installations including: Frederick Kiesler’s City of Space (1925), Eduardo Persico and Marcello Nizzoli’s Medaglio d’Oro room (1934), Sol Le Witt’s Incomplete Open Cubes (1974) and Rosalind Krauss’s seminal text ‘Grids’ (1979). A modular frame whose structural bays would each hold and present an ‘episode’, the pavilion became both a visual analogue of the unseen networks embodying infrastructural systems and a reflection on the predominance of framed structures within the buildings exhibited. Sharing the aspiration of adaptability of many of these schemes, its white-painted timber components are connected by easily-dismantled steel fixings. These and its modularity allow the structure to be both taken down and re-erected subsequently in different iterations. The pavilion itself is, therefore, imagined as essentially provisional and – as with infrastructure – as having no fixed form. Presenting archives and other material over time, the transparent nature of the space allowed these to overlap visually conveying the nested nature of infrastructural production. Pursuing a means to evoke the qualities of infrastructural space while conveying a historical narrative, the exhibition’s termination in the present is designed to provoke in the visitor, a perceptual extension of the matrix to engage with the future.

Atmospheric cold plasma process for vegetable leaf decontamination: A feasibility study on radicchio (red chicory, Cichorium intybus L.)

Cold plasma is an emerging non-thermal processing technology that could be used for large scale leaf decontamination as an alternative to chlorine washing. In this study the effect of an atmospheric cold plasma apparatus (air DBD, 15 kV) on the safety, antioxidant activity and quality of radicchio (red chicory, Cichorium intybus L.) was investigated after 15 and 30 min of treatment (in afterglow at 70 mm from the discharge, at 22 °C and 60% of RH) and during storage. Escherichia coli O157:H7 inoculated on radicchio leaves was significantly reduced after 15 min cold plasma treatment (-1.35 log MPN/cm²). However, a 30 min plasma treatment was necessary to achieve a significant reduction of Listeria monocytogenes counts (-2.2 log CFU/cm²). Immediately after cold plasma treatment, no significant effects emerged in terms of antioxidant activity assessed by the ABTS and ORAC assay and external appearance of the radicchio leaves. Significant changes between treated and untreated radicchio leaves are quality defects based on the cold plasma treatment. Atmospheric cold plasma appears to be a promising processing technology for the decontamination of leafy vegetables although some criticalities, that emerged during storage, need to be considered in future studies.

Exploring the Findings from Three Randomised Controlled Trials of Bookgifting Programmes

Aims: This paper explores the effects from three similar bookgifting programmes on improving reading outcomes of early years’ children, their parents and teachers.
Methods: The paper draws on research data produced by the Centre for Effective Education during three randomised controlled trial (RCT) evaluations of bookgifting programmes (N=1694 participant families in total). The three studies used pre and post test measures to identify effects across a total of 15 social, cognitive and behavioural reading outcomes.
Results: The overall average effect across the 15 outcomes from data provided by 1694 participant families, was d=0.07. This is a relatively small overall effect and there was an overall pattern of small positive effects of this scale across the wide range of the reading outcomes assessed. However, only one significant effect was identified in the 15 outcomes assessed across all three studies.
Conclusions: The review of these three studies suggests that the RCTs struggle to identify significant effects in these low exposure and low cost bookgifting interventions. Furthermore, it is recommended that future RCT studies of this type of programme require very large sample sizes in the scale of 1000’s rather than 100’s to generate enough study power. Or alternatively, these programmes could be evaluated as a component part of more intensive reading interventions.

A tradução da Peregrinaçam de Fernão Mendes Pinto em Espanha, França, Inglaterra e Alemanha no século XVII

Este trabalho de investigação comparativista insere-se no âmbito das relações entretecidas pelos Estudos de Tradução e a Literatura Comparada, nomeadamente no que respeita ao conceito de tradução literária na Europa Ocidental do século XVII. Trata-se de um estudo intercultural, atendendo a que a tradução promove a mudança cultural decorrente de um processo de transferência intercultural com implicações literárias e ideológicas. Os textos que constituíram o nosso objeto de trabalho são a Peregrinaçam de Fernão Mendes Pinto (1614) e as primeiras traduções completas ou parciais para espanhol (1620), da autoria de Francisco de Herrera Maldonado, para francês (1628), de Bernard Figuier, para inglês (1653), de Henry Cogan, e para alemão (1671), dos editores Henrich e Dietrich Boom. No decorrer da análise comparativa, procurámos demonstrar o grau de (in)fidelidade de cada tradução, estabelecendo paralelismos e realçando os procedimentos tradutológicos adotados em cada versão, os quais revelam, claramente, contactos entre si e/ou condicionalismos culturais e ideológicos implícitos. Estudámos o modo como cada tradução adaptou a obra original ao gosto e aos códigos linguísticos e literários do seu público-alvo. No desenvolvimento do nosso trabalho, tivemos em mente os códigos tradutológicos do século XVII em Espanha, França, Inglaterra e Alemanha, em virtude de o nosso corpus ser constituído por textos publicados no decorrer desse período. Como metodologia de trabalho, delimitámos cinco momentos narrativos, no interior dos quais foram encontradas e analisadas comparativamente passagens consideradas exemplificativas das principais técnicas tradutivas características de cada texto e das inter-relações estabelecidas entre eles. Por fim, um outro objetivo nosso consistiu na avaliação do significado e da relevância da receção da tradução- -adaptação desta obra portuguesa naqueles contextos de chegada (no momento imediato e para além dele).

A Dinâmica comunicativa dos sítios Web de instituições de ensino superior militar

Neste artigo procuramos refletir sobre a forma como as instituições de ensino superior policial e militar comunicam com os seus públicos através dos respetivos sítios web. Para esse efeito, recorrer-se-á sobretudo ao enfoque epistemológico do Interacionismo Sociodiscursivo, no âmbito da Linguística do Texto e do Discurso.

Shared resources and precedence constraints with capacity sharing and stealing

This paper proposes a new strategy to integrate shared resources and precedence constraints among real-time tasks, assuming no precise information on critical sections and computation times is available. The concept of bandwidth inheritance is combined with a greedy capacity sharing and stealing policy to efficiently exchange bandwidth among tasks, minimising the degree of deviation from the ideal system's behaviour caused by inter-application blocking. The proposed capacity exchange protocol (CXP) focus on exchanging extra capacities as early, and not necessarily as fairly, as possible. This loss of optimality is worth the reduced complexity as the protocol's behaviour nevertheless tends to be fair in the long run and outperforms other solutions in highly dynamic scenarios, as demonstrated by extensive simulations.

Cidade lis-boa : a project for the renewal of the Museu da Cidade of Lisbon

The project of this thesis proceeds from the study of the relationship between town, people, and design and translates into a proposal for the renovation of the Museum of the Town of Lisbon. It was performed in cooperation with the Museum and with the Faculty of Fine Arts of the University of Lisbon.

A Junta Nacional de Emigração e a Política de Emigração no Estado Novo

Tese apresentada para cumprimento dos requisitos necessários à obtenção do grau de Doutor em História Contemporânea

Suite de la Clef, ou Journal historique sur les matieres du tems

1761/01 (T89)-1761/06.

Suite de la Clef, ou Journal historique sur les matieres du tems

1764/01 (T95)-1764/06.

Suite de la Clef, ou Journal historique sur les matieres du tems

1757/01 (T81)-1757/06.

Suite de la Clef, ou Journal historique sur les matieres du tems

1723/01 (T13)-1723/06.