Neurally Adjusted Ventilatory Assist (NAVA) improves the matching of diaphragmatic electrical activity and tidal volume in comparison to pressure support (PS) under non invasive ventilation

INTRODUCTION. Patient-ventilator asynchrony is a frequent issue in non invasivemechanical ventilation (NIV) and leaks at the patient-mask interface play a major role in itspathogenesis. NIV algorithms alleviate the deleterious impact of leaks and improve patient-ventilator interaction. Neurally adusted ventilatory assist (NAVA), a neurally triggered modethat avoids interferences between leaks and the usual pneumatic trigger, could further improvepatient-ventilator interaction in NIV patients.OBJECTIVES. To evaluate the feasibility ofNAVAin patients receiving a prophylactic postextubationNIV and to compare the respective impact ofPSVandNAVAwith and withoutNIValgorithm on patient-ventilator interaction.METHODS. Prospective study conducted in 16 beds adult critical care unit (ICU) in a tertiaryuniversity hospital. Over a 2 months period, were included 17 adult medical ICU patientsextubated for less than 2 h and in whom a prophylactic post-extubation NIV was indicated.Patients were randomly mechanically ventilated for 10 min with: PSV without NIV algorithm(PSV-NIV-), PSV with NIV algorithm (PSV-NIV+),NAVAwithout NIV algorithm (NAVANIV-)and NAVA with NIV algorithm (NAVA-NIV+). Breathing pattern descriptors, diaphragmelectrical activity, leaks volume, inspiratory trigger delay (Tdinsp), inspiratory time inexcess (Tiexcess) and the five main asynchronies were quantified. Asynchrony index (AI) andasynchrony index influenced by leaks (AIleaks) were computed.RESULTS. Peak inspiratory pressure and diaphragm electrical activity were similar in thefour conditions. With both PSV and NAVA, NIV algorithm significantly reduced the level ofleak (p\0.01). Tdinsp was not affected by NIV algorithm but was shorter in NAVA than inPSV (p\0.01). Tiexcess was shorter in NAVA and PSV-NIV+ than in PSV-NIV- (p\0.05).The prevalence of double triggering was significantly lower in PSV-NIV+ than in NAVANIV+.As compared to PSV,NAVAsignificantly reduced the prevalence of premature cyclingand late cycling while NIV algorithm did not influenced premature cycling. AI was not affectedby NIV algorithm but was significantly lower in NAVA than in PSV (p\0.05). AIleaks wasquasi null with NAVA and significantly lower than in PSV (p\0.05).CONCLUSIONS. NAVA is feasible in patients receiving a post-extubation prophylacticNIV. NAVA and NIV improve patient-ventilator synchrony in different manners. NAVANIV+offers the best patient-ventilator interaction. Clinical studies are required to assess thepotential clinical benefit of NAVA in patients receiving NIV.

Poly-N-Acetyl Glucosamine Fibers Induce Angiogenesis in ADP Inhibitor-Treated Diabetic Mice

Background: It has been previously demonstrated that short-fiber poly-N-acetyl-glucosamine (sNAG) nanofibers specifically interact with platelets, are hemostatic, and stimulate diabetic wound healing by activating angiogenesis, cell proliferation, and reepithelialization. Platelets play a significant physiologic role in wound healing. The influence of altered platelet function by treatment with the ADP inhibitor Clopidogrel (CL) on wound healing and the ability of sNAG to repair wounds in diabetic mice treated with CL were studied.Methods: Dorsal 1 cm2 skin wounds were excised on genetically diabetic 8-week to 12-week-old, Lep/r-db/db male mice, and wound healing kinetics were determined. Microscopic analysis was performed for angiogenesis (PECAM-1) and cell proliferation (Ki67). Mice were either treated with CL (P2Y12 ADP receptor antagonist, CL) or saline solution (NT). CL wounds were also treated with either a single application of topical sNAG (CL-sNAG) or were left untreated (CL-NT).Results: CL treatment did not alter wound healing kinetics, while sNAG induced faster wound closure in CL-treated mice compared with controls. CL treatment of diabetic mice caused an augmentation of cell proliferation and reduced angiogenesis compared with nontreated wounds. However, sNAG reversed the effects of CL on angiogenesis and partially reversed the effect on cell proliferation in the wound beds. The sNAG-treated wounds in CL-treated mice showed higher levels of cell proliferation and not did inhibit angiogenesis.Conclusions: CL treatment of diabetic mice decreased angiogenesis and increased cell proliferation in wounds but did not influence macroscopic wound healing kinetics. sNAG treatment did not inhibit angiogenesis in CL-treated mice and induced faster wound closure; sNAG technology is a promising strategy to facilitate the healing of complex bleeding wounds in CL-treated diabetic patients.

Report of the Governor's Task Force on the Overepresentation of African-Americans in Prison, 2001

In 1999, 24 percent of Iowa prison beds were occupied by African-American inmates, despite the fact that African-Americans comprised just over 2 percent of the state’s total population. That year the median incarceration rate for African-Americans in Iowa was 2,950 per every 100,000 people (or approximately 3.0 percent of the state’s African-American population). The median incarceration rate for Caucasians in Iowa was 188 per every 100,000 people (or approximately 0.2 percent of the state’s Caucasian population). Seven percent of all African-Americans in this state were under some form of criminal justice supervision in 1999. 1999 statistics also reveal that there were nearly twice as many African-Americans under criminal justice supervision in Iowa than atte nded one of the state’s post-secondary institutions.

Gene-flow in a mosaic hybrid zone: is local introgression adaptive?

Genome-wide scans of genetic differentiation between hybridizing taxa can identify genome regions with unusual rates of introgression. Regions of high differentiation might represent barriers to gene flow, while regions of low differentiation might indicate adaptive introgression-the spread of selectively beneficial alleles between reproductively isolated genetic backgrounds. Here we conduct a scan for unusual patterns of differentiation in a mosaic hybrid zone between two mussel species, Mytilus edulis and M. galloprovincialis. One outlying locus, mac-1, showed a characteristic footprint of local introgression, with abnormally high frequency of edulis-derived alleles in a patch of M. galloprovincialis enclosed within the mosaic zone, but low frequencies outside of the zone. Further analysis of DNA sequences showed that almost all of the edulis allelic diversity had introgressed into the M. galloprovincialis background in this patch. We then used a variety of approaches to test the hypothesis that there had been adaptive introgression at mac-1. Simulations and model fitting with maximum-likelihood and approximate Bayesian computation approaches suggested that adaptive introgression could generate a "soft sweep," which was qualitatively consistent with our data. Although the migration rate required was high, it was compatible with the functioning of an effective barrier to gene flow as revealed by demographic inferences. As such, adaptive introgression could explain both the reduced intraspecific differentiation around mac-1 and the high diversity of introgressed alleles, although a localized change in barrier strength may also be invoked. Together, our results emphasize the need to account for the complex history of secondary contacts in interpreting outlier loci.

Distribution of hospital admissions in a middle-income country of the African region

Introduction: Few studies have reported the distribution of all hospital admissions at the entire country level in low and middle-income countries (LMICs). We examined this question in Seychelles, a rapidly developing small island state in the Africa region, in which access to health care is provided free of charge to all inhabitants through a national health system and all hospital admissions are routinely registered. Methods: Based on all admissions to all hospitals in Seychelles in 2005-2008, we calculated the distribution of hospital admissions, age at admission, length of stay and bed occupancy (i.e. cumulated number of patients * number of days spent in all hospitals) according to both hospital departments and broad causes of diseases (using codes of the ICD-10 classification of diseases). Results: Bed occupancy was largest in the surgical wards (36.7% of all days spent in all hospitals), followed by the medical wards (24.3%), gynecology/obstetrics wards (18.4%), pediatric wards (11.2%), and psychiatric wards (7.2%). According to broad causes of diseases/conditions, bed occupancy was highest for obstetrics/gynecology conditions (19.9% of all days spent at hospital), mental diseases (8.6%), cardiovascular diseases (8.1%), upper aerodigestive/pulmonary diseases (8%), infectious/parasitic diseases (8%), gastrointestinal diseases (7.2%), and urogenital diseases (6.7%). Adjusted to 100'000 population, 153 hospital beds are needed every day, including 31 for obstetrics/gynecologic conditions, 13 for mental diseases, 12 for cardiovascular diseases, 12 for upper aerodigestive diseases, 12 for infectious/parasitic diseases, and 11 for gastrointestinal diseases. Conclusion: Our findings give a good indication of the overall distribution of admissions according to both hospital departments and broad causes of diseases in a middle-income country. These findings provide important information for health care planning at the national level

The oceanic base of slope record of the Permian-Triassic crisis: view from Tethys (Oman)

The Oman Mountains provide some of the best sections of Permian and Triassic sediments from ocean sea floor to base-of-slope environments related to the distal South Tethyan margin. The central part of the range exposes the Buday'ah section of oceanic sediments in the so-called "Hawasina allochtons". The locality of Wadi Maqam in the north-western part of the Oman Mountains is among places where the thick Permian-Triassic base-of-slope sediments is exposed (Baud et al., 2001). Overlying 400 m of middle Permian limestones and dolomites, the upper Permian sediments consist of 50 m of ≈ 10 cm thick beds of cherts and dolomites rich in sponge spicules. The top of the Permian units is well bioturbated lime mudstone-wackestone, devoid of cherts and dated as late Changhsingian (Krystyn in Richoz et al., 2005). The boundary yellow shales are overlain by very thinly bedded, laminated microbial platy lime mudstone with H. parvus. The dramatic loss of the burrowing infauna indicates the appearance of oxygen-poor water. These Induan sediments are about 25 m thick and show at the top the first calcirudites, commonly clast-supported (edge-wise conglomerates), and are characterized by tabular clasts representing the sub- in situ reworking of the laminated, platy calcilutite. The very thick Smithian overlying litho-unit (up to 900 m) marks the onset on the base-of-slope of a deep-marine basin in which carbonate submarine fan deposits developed This very thick unit consists essentially of platy limestones, calcarenites and calcirudites. It comprises mainly grey-beige calcilutite, laminated and flaggy, interbedded with sparse beds of fine-grained calcarenite in cm beds. Channelized beds of intraformational calcirudite are also part of this succession which constitutes the greater part of the outcrop available. During the Spathian to Anisian, the sedimentation changes to terrigenous mudstone and siltstone that ended with Ladinian radiolarites.

Office of the State Long-Term Care Ombudsman Annual Report 2005, January 2006.

The State Long-Term Care Ombudsman program operates as a unit within the Office of Elder Rights at Iowa Department of Elder Affairs. Duties of all long-term care ombudsmen are mandated by the Older Americans Act. This office serves people living in nursing facilities, residential care facilities, elder group homes and assisted living programs. Cases and complaints remain to be this office’s top priority. Facility closures take a tremendous amount of time, and with 1 Long-Term Care Ombudsman per 10,500 beds this office struggles to meet all of the mandates of the Older Americans Act.

Direct Care Entities in Iowa, 2008

A directory of Direct Care Entities in Iowa, by type of service, number of facilities and number of beds available.

2008 Annual Report of the Iowa Railway Finance Authority

The Iowa Railway Finance Authority (IRFA) was created in 1980 by the 68th General Assembly to provide for the financing of rail facilities and to enhance and continue the operation of essential rail facilities. IRFA was authorized to offer financial assistance for the acquisition, rehabilitation, construction, refinancing, extension, replacement, maintenance, repair, or leasing of any rail facility. Rail Revolving Loan and Grant Program The 2005 legislative session amended Iowa Code 327H.20 by assigning all repayments of IRFA and other Iowa Department of Transportation (Iowa DOT) rail assistance loans to the Rail Revolving Loan and Grant Program (RRLGP). In addition, the following annual appropriations were allocated to the fund: • FY 2007: $235,000 • FY 2008: $2 million • FY 2009: $2 million Since the creation of the RRLGP in 2005, IRFA has awarded funding to 23 projects totaling over $7.2 million in grants and loans in its three rounds of competitive funding. These projects have pledged to create 1,672 jobs within two years of project completion and 1,361 jobs have been retained. Funded projects are associated with over $2 billion in total private capital investment. In 2008, the IRFA Board directed all available funds be used to help repair railroads devastated by summer flooding. On July 31, $3.9 million in deferred payment loans were offered to seven Iowa based railroads to allow for immediate repair of rail beds, including the cost of materials, labor and equipment.

Investigation of Restraint Device use in Iowa's County Jail

Executive Summary The use of full-body restraint devices is a widespread practice in Iowa’s county jails. Full-body restraints come in the form of restraint chairs, boards, and beds, including two such devices manufactured in Iowa. Iowa law, which refers to these as four- and fivepoint restraints, states they are only to be used when an inmate is a threat to self, others, or jail security. However, the Ombudsman found they were also used on inmates who caused minor disruptions or in response to an inmate’s verbal abuse. In some cases, the restraints were used on inmates with known mental illness who were acting out, though no attempts were made to seek medical or mental health reviews for those inmates while restrained, leading to extended use of the restraint device.

Significado sedimentológico de los niveles con Assilinas de la Formación Armancies (Eoceno medio) y sus equivalentes laterales

In this paper we show some sedimentological characteristics of Assilina beds from Armancies Fm. (middle Eocene) and their lateral equivalents that let us to remark some aspects of their genesis. We arrive to the conclusion that, in occidental sector (Bagá-Campdevanol), ‘las barras de Assilinas’ from the Armancies Fm. are grain flow channels, first sedimented at W of Terrades and after slided, from E to W in a turbidite basin, without any coarse clastic

Extracção de areia na praia de Calhetona (Ilha de Santiago, Cabo Verde): causas, processos e consequências

A extracção clandestina de areia, nas faixas costeiras e nos leitos das ribeiras, tem sido prática de muitos agregados familiares cabo-verdianos. Nas últimas décadas, a praia de Calhetona (Ilha de Santiago) foi um dos muitos locais que sofreram degradação ambiental significativa, devido à realização desta actividade sem quaisquer planos de extracção e de posterior recuperação das áreas degradadas. Este trabalho, através da conjugação de recolha de dados por inquérito, observação directa e pesquisa documental e bibliográfica, teve como objectivos a caracterização da comunidade (que habita no bairro de Ponta Calhetona) que se dedica à extracção de areia na praia de Calhetona, a descrição da dinâmica da actividade extractiva, a avaliação da percepção que a comunidade tem relativamente às consequências da sua actividade e a descrição do impacte ambiental resultante da extracção de areia. Da análise dos inquéritos, efectuados em Fevereiro de 2012, a 25 chefes de agregados familiares que efectuam a extracção de areia na praia de Calhetona, constata-se que estes são maioritariamente mulheres, predominantemente com idade compreendida entre os 40 e os 59 anos, domésticas, com baixa escolaridade, com famílias numerosas e/ou alargadas a seu cargo e dedicando-se à extração de areia à mais de 10 anos. Os inquiridos, face à situação de vulnerabilidade económica, à falta de emprego e à grande procura de areia para a construção civil, vêem nesta actividade uma fonte de rendimento. Contudo, o proveito obtido desta actividade difícil e potencialmente perigosa é reduzido. Quem efectivamente beneficia são os camionistas que compram a areia a quem procede à extracção e a vendem ao consumidor final pelo dobro do preço. Os inquiridos demonstram uma consciência generalizada dos diversos impactes ambientais negativos resultantes da sua actividade, mas alegam que a extracção de areia é uma das poucas alternativas existentes para providenciar o sustento dos seus agregados familiares. Com base na comparação do estado actual da praia de Calhetona com relatos de habitantes locais, relativos às características da mesma no passado, verifica-se que nos últimos 40-50 anos, desde que se iniciou a intensa extracção de areia nesta praia, o seu aspecto físico se degradou claramente. Essa degradação caracteriza-se principalmente pelo recuo da linha de costa, pela quase ausência de areia e pela salinização dos solos localizados nas proximidades da praia, para além dos consequentes impactes negativos sobre a desova das tartarugas e o turismo balnear.

Compositional and structural variabilities of Mg-rich iron oxide spinels from tuffite

Maghemite (γFe2O3) from tuffite is exceptionally rich in Mg, relatively to most of those reportedly found in other mafic lithosystems. To investigate in detail the compositional and structural variabilities of this natural magnetic iron oxide, sets of crystals were isolated from samples collected at different positions in a tuffite weathering mantle. These sets of crystal were individually powdered and studied by X-ray diffractometry, Mössbauer spectroscopy, magnetization measurements and chemical analysis. Lattice parameter of the cubic cell (a0) was found to vary from 0.834(1) to 0.8412(1) nm. Lower a0-values are characteristic of maghemite whereas higher ones are related to a magnetite precursor. FeO content ranges up to 17 mass % and spontaneous magnetization ranges from 8 to 32 J T-1 kg-1. Zero-field room temperature Mössbauer spectra are rather complex, indicating that the hyperfine field distributions due to Fe3+ and mixed valence Fe3+/2+ overlap. The structural variabilities of the (Mg, Ti)-rich iron oxide spinels is essentially related to the range of chemical composition of its precursor (Mg, Ti)-rich magnetite, and probably to the extent to which it has been oxidized during transformation in soil.

The prelude of the end-Permian mass extinction predates a postulated bolide impact

The mass extinction at the Permian-Triassic Boundary (PTB) is said to have been abrupt and probably caused by an extraterrestrial impact. However, evidence from the Global Stratotype Section and Point (GSSP) of the base of the Induan at Meishan, China, shows that the biotic crisis began prior to the level, in beds 25 and 26 at which the postulated impact event occurred. Evidence of such an earlier biotic crisis occurs in other sections in South China, and in central and western Tethyan regions. This event is characterized by the extinction of a range of faunas, including corals, deep-water radiolarians, most fusulinids and pseudotirolitidammonoids, and many Permian brachiopods. In all sections, this extinction level is usually a few decimeters to meters below that of the main mass extinction in the event beds (25 and 26) at Meishan, and their correlatives elsewhere. This earlier extinction event happened before the postulated bolide impact at the level of beds 25 and 26, and constrains interpretation of the mechanisms that brought about this greatest mass extinction.

Low-grade metamorphism of the Gets nappe (Western Alps)

The Gets nappe, a decollement cover nappe located at the top of the Prealps, is characterized by the occurrence of ophiolitic rocks. The metamorphic grade in the Gets nappe was determined using illite crystallinity and clay mineral assemblages. Samples from the same locality were analyzed to estimate variations in illite crystallinity values and in the parageneses of clay minerals, both in sedimentary elements of a breccia and in the embedding shaly flysch. For samples from one and the same locality, the range in illite crystallinity data between breccia elements and the shaly flysch is comparable to the variation between different shaly beds. Two S-N transects along the Gets nappe reveal the same metamorphic gradient, with the internal parts of the nappe being characterized by middle anchizonal metamorphism and the external parts showing diagenetic conditions. The metamorphic grade is higher within the Gets nappe than in its hangingwall (i.e. the Breche and Simme nappes), suggesting that the metamorphism in the Gets unit is transported. The timing and conditions of thrusting of the Gets Nappe onto the Br che and the Simme nappes is constrained by stratigraphic and metamorphic data.