Decisional responsibility for mechanical ventilation and weaning: an international survey

Introduction: Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement.

Methods: A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making.

Results: Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0)). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs.

Conclusions: Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.

Adsorption-controlled molecular-beam epitaxial growth of BiFeO3

BiFeO3 thin films have been deposited on (111) SrTiO3 single crystal substrates by reactive molecular-beam epitaxy in an adsorption-controlled growth regime. This is achieved by supplying a bismuth overpressure and utilizing the differential vapor pressures between bismuth oxides and BiFeO3 to control stoichiometry. Four-circle x-ray diffraction reveals phase-pure, untwinned, epitaxial, (0001)-oriented films with rocking curve full width at half maximum values as narrow as 25 arc sec (0.007 degrees). Second harmonic generation polar plots combined with diffraction establish the crystallographic point group of these untwinned epitaxial films to be 3m at room temperature. (C) 2007 American Institute of Physics.

Insulin receptor substrate-2 is expressed in kidney epithelium and up-regulated in diabetic nephropathy

Diabetic nephropathy (DN) is a progressive fibrotic condition that may lead to end-stage renal disease and kidney failure. Transforming growth factor-ß1 and bone morphogenetic protein-7 (BMP7) have been shown to induce DN-like changes in the kidney and protect the kidney from such changes, respectively. Recent data identified insulin action at the level of the nephron as a crucial factor in the development and progression of DN. Insulin requires a family of insulin receptor substrate (IRS) proteins for its physiological effects, and many reports have highlighted the role of insulin and IRS proteins in kidney physiology and disease. Here, we observed IRS2 expression predominantly in the developing and adult kidney epithelium in mouse and human. BMP7 treatment of human kidney proximal tubule epithelial cells (HK-2 cells) increases IRS2 transcription. In addition, BMP7 treatment of HK-2 cells induces an electrophoretic shift in IRS2 migration on SDS/PAGE, and increased association with phosphatidylinositol-3-kinase, probably due to increased tyrosine/serine phosphorylation. In a cohort of DN patients with a range of chronic kidney disease severity, IRS2 mRNA levels were elevated approximately ninefold, with the majority of IRS2 staining evident in the kidney tubules in DN patients. These data show that IRS2 is expressed in the kidney epithelium and may play a role in the downstream protective events triggered by BMP7 in the kidney. The specific up-regulation of IRS2 in the kidney tubules of DN patients also indicates a novel role for IRS2 as a marker and/or mediator of human DN progression.

Mathematics background of engineering students in Northern Ireland and Finland

The Organisation for Economic Co-operation and Development investigated numeracy proficiency among adults of working age in 23 countries across the world. Finland had the highest mean numeracy proficiency for people in the 16 – 24 age group while Northern Ireland’s score was below the mean for all the countries. An international collaboration has been undertaken to investigate the prevalence of mathematics within the secondary education systems in Northern Ireland and Finland, to highlight particular issues associated with transition into university and consider whether aspects of the Finnish experience are applicable elsewhere. In both Northern Ireland and Finland, at age 16, about half of school students continue into upper secondary level following their compulsory education. The upper secondary curriculum in Northern Ireland involves a focus on three subjects while Finnish students study a very wide range of subjects with about two-thirds of the courses being compulsory. The number of compulsory courses in maths is proportionally large; this means that all upper secondary pupils in Finland (about 55% of the population) follow a curriculum which has a formal maths content of 8%, at the very minimum. In contrast, recent data have indicated that only about 13% of Northern Ireland school leavers studied mathematics in upper secondary school. The compulsory courses of the advanced maths syllabus in Finland are largely composed of pure maths with a small amount of statistics but no mechanics. They lack some topics (for example, in advanced calculus and numerical methods for integration) which are core in Northern Ireland. This is not surprising given the much broader curriculum within upper secondary education in Finland. In both countries, there is a wide variation in the mathematical skills of school leavers. However, given the prevalence of maths within upper secondary education in Finland, it is to be expected that young adults in that country demonstrate high numeracy proficiency.

Dynamic identification of building structures: new strategies:Meccanica dei materiali e delle strutture

In this paper the evolution of a time domain dynamic identification technique based on a statistical moment approach is presented. This technique can be used in the case of structures under base random excitations in the linear state and in the non linear one. By applying Itoˆ stochastic calculus, special algebraic equations can be obtained depending on the statistical moments of the response of the system to be identified. Such equations can be used for the dynamic identification of the mechanical parameters and of the input. The above equations, differently from many techniques in the literature, show the possibility of obtaining the identification of the dissipation characteristics independently from the input. Through the paper the first formulation of this technique, applicable to non linear systems, based on the use of a restricted class of the potential models, is presented. Further a second formulation of the technique in object, applicable to each kind of linear systems and based on the use of a class of linear models, characterized by a mass proportional damping matrix, is described.

Sets of multiplicity and closable multipliers on group algebras

We undertake a detailed study of the sets of multiplicity in a second countable locally compact group G and their operator versions. We establish a symbolic calculus for normal completely bounded maps from the space B(L-2(G)) of bounded linear operators on L-2 (G) into the von Neumann algebra VN(G) of G and use it to show that a closed subset E subset of G is a set of multiplicity if and only if the set E* = {(s,t) is an element of G x G : ts(-1) is an element of E} is a set of operator multiplicity. Analogous results are established for M-1-sets and M-0-sets. We show that the property of being a set of multiplicity is preserved under various operations, including taking direct products, and establish an Inverse Image Theorem for such sets. We characterise the sets of finite width that are also sets of operator multiplicity, and show that every compact operator supported on a set of finite width can be approximated by sums of rank one operators supported on the same set. We show that, if G satisfies a mild approximation condition, pointwise multiplication by a given measurable function psi : G -> C defines a closable multiplier on the reduced C*-algebra G(r)*(G) of G if and only if Schur multiplication by the function N(psi): G x G -> C, given by N(psi)(s, t) = psi(ts(-1)), is a closable operator when viewed as a densely defined linear map on the space of compact operators on L-2(G). Similar results are obtained for multipliers on VN(C).

Capturing Goodwillie's Derivative

Recent work of Biedermann and Roendigs has translated Goodwillie's calculus of functors into the language of model categories. Their work focuses on symmetric multilinear functors and the derivative appears only briefly. In this paper we focus on understanding the derivative as a right Quillen functor to a new model category. This is directly analogous to the behaviour of Weiss's derivative in orthogonal calculus. The immediate advantage of this new category is that we obtain a streamlined and more informative proof that the n-homogeneous functors are classified by spectra with an action of the symmetric group on n objects. In a later paper we will use this new model category to give a formal comparison between the orthogonal calculus and Goodwillie's calculus of functors.

Handling Sequential Observations in Intelligent Surveillance

Demand for intelligent surveillance in public transport systems is growing due to the increased threats of terrorist attack, vandalism and litigation. The aim of intelligent surveillance is in-time reaction to information received from various monitoring devices, especially CCTV systems. However, video analytic algorithms can only provide static assertions, whilst in reality, many related events happen in sequence and hence should be modeled sequentially. Moreover, analytic algorithms are error-prone, hence how to correct the sequential analytic results based on new evidence (external information or later sensing discovery) becomes an interesting issue. In this paper, we introduce a high-level sequential observation modeling framework which can support revision and update on new evidence. This framework adapts the situation calculus to deal with uncertainty from analytic results. The output of the framework can serve as a foundation for event composition. We demonstrate the significance and usefulness of our framework with a case study of a bus surveillance project.

Existência de minimizantes relaxados e fenómeno de Lavrentiev

Neste trabalho prova-se a existência de minimizantes relaxados em problemas de controlo óptimo não convexos usando técnicas de compactificação. Faz-se a extensão do exemplo de Manià a dimensão dois, obtendo-se uma classe de problemas variacionais em 2D que apresentam Fenómeno de Lavrentiev. Prova-se que o fenómeno persiste a certas perturbações, obtendo- -se assim uma classe de funcionais cujos Lagrangianos são coercivos e convexos em relação ao gradiente. Adicionalmente, apresentam-se exemplos de problemas do cálculo das variações com diferentes condições de fronteira, e em diferentes tipos de domínios (incluindo domínios com fronteira fractal), que exibem Fenómeno de Lavrentiev.

Cálculo das variações fraccional generalizado

Nesta tese de doutoramento apresentamos um cálculo das variações fraccional generalizado. Consideramos problemas variacionais com derivadas e integrais fraccionais generalizados e estudamo-los usando métodos directos e indirectos. Em particular, obtemos condições necessárias de optimalidade de Euler-Lagrange para o problema fundamental e isoperimétrico, condições de transversalidade e teoremas de Noether. Demonstramos a existência de soluções, num espaço de funções apropriado, sob condições do tipo de Tonelli. Terminamos mostrando a existência de valores próprios, e correspondentes funções próprias ortogonais, para problemas de Sturm- Liouville.

Aprendizagem matemática no ensino superior: a influência da plataforma M@T-educar com sucesso

Novas abordagens educacionais têm vindo a surgir como resultado de mudanças económicas, sociais e políticas, que levaram, a nível europeu ao desenvolvimento do Processo de Bolonha. As instituições de ensino superior enfrentam, assim, novos desafios e oportunidades, nomeadamente, o desenvolvimento de contextos educativos mais centrados nas aprendizagens dos alunos, promotores de cidadãos mais autónomos, mais ativos e mais provocadores, capazes de responderem às exigências da Sociedade do Conhecimento global. Diversos estudos apontam a importância de ambientes online na persecução desses objetivos, designadamente na área da Matemática. Neste contexto, desenvolveu-se a plataforma online – M@t-educar com Sucesso – que, a partir da informação teórica, permite a resolução de tarefas interativas, algumas delas contendo animações, das quais se fornece um feedback imediato, a qual carece de avaliação. Assim, este estudo tem como objetivo principal avaliar a influência da exploração prévia às aulas da referida plataforma no desenvolvimento de conhecimentos e capacidades matemáticas, da autonomia e do interesse por essa área em estudantes do ensino superior. O estudo ocorreu na unidade curricular de Cálculo Infinitesimal do Curso Superior de Gestão de uma instituição do ensino superior. Metodologicamente, optou-se por uma abordagem mista de investigação e pelo design de estudo de caso, tendo-se partido de uma análise macro, envolvendo todos os alunos de Cálculo Infinitesimal, seguida de uma análise meso, considerando os alunos da turma da professora/investigadora, que foi evoluindo para uma análise micro, estudando cinco casos da turma. Para tal, utilizaram-se diversas técnicas de recolha de dados – inquirição, observação e análise documental, suportadas por variados instrumentos. A análise estatística e de conteúdo a que os dados foram submetidos permite concluir que a exploração prévia dos conteúdos através desta plataforma contribui para o desenvolvimento, principalmente, de autonomia e da capacidade de aplicação de conhecimento produzido à resolução de tarefas de diversa natureza.

A matemática e o comércio em Portugal através das obras de aritméticos do século XVI: Gaspar Nicolas, Ruy Mendes e Bento Fernandes

Esta dissertação tem como objetivo a divulgação de temas e de algoritmos presentes nos tratados de aritmética prática do século XVI. Pretendemos delinear a atuação dos seus autores face aos desafios do mundo mercantil envolvente. Sendo o nosso «ator principal» Ruy Mendes, esta escolha deve-se a dois motivos: entre os três autores é aquele que tem sido menos mencionado e estudado; os interesses de Mendes parecem-nos mais distantes do mundo mercantil. Assim, no desenrolar deste estudo apresentaremos a Prática do ponto de vista da estrutura e organização, contemplando os seguintes pontos: uma Matemática básica; a Matemática pour elle Même; uma Matemática para o comércio. Neste último ponto incluiremos as regras locais do comércio português: a regra de quarto e vintena e a regra da conta de Flandres. Para cada assunto é realizado um estudo comparativo com os dois tratados da mesma época: o Tratado da Pratica d'Arismetica de Gaspar Nicolas e o Tratado da Arte d'Arismetica de Bento Fernandes. Apesar de se tratar de autores já referidos por alguns historiadores, consideramos que não foram ainda estudados do ponto de vista do interesse intrínseco presente no conhecimento histórico da Matemática, bem como na sua atuação relativamente à divulgação do cálculo aritmético e do seu contributo para o desenvolvimento da Matemática através de problemas práticos.

Olhares para a matemática depois de um processo de RVCC

Trabalho de projecto de mestrado, Ciências da Educação (Formação de Adultos), Universidade de Lisboa, Instituto de Educação, 2011