201 resultados para CCM


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Cyanobacteria possess a delicate system known as the carbon concentrating mechanism (CCM), which can efficiently elevate the intracellular inorganic carbon (Ci) concentration via active transportation. The system requires energy supplied by photosystems; therefore, the activity of the Ci transporter is closely related to light intensity. However, the relationship between CCM and light intensity has rarely been evaluated. Here, we present an improved quantitative model of CCM in which light is incorporated, and developed a CCM model that modified after Fridlyand et al. in 1996. Some equations used in this model were inducted to describe the relationship between transport capacity and light intensity, by which the response of the CCM to light change is simulated. Our results indicate that the efficiency of the carbon concentrating system is sensitive to light intensity. When the external Ci concentration was low, CO2 uptake dominated the total Ci uptake with increasing light intensity, while under high external Ci concentrations HCO3- uptake primarily contributed to the total Ci uptake. Variations in the ratio of energy allocated between the transport systems could markedly affect the operation of CCM. Indeed, our simulations suggest that various combinations of Ci fluxes can provide a possible approach to detect the way by which the cell distributes energy produced by the photosystems to the two active Ci transport processes. The proportion of the energy consumed on CCM to the total energy expenditure for the fixation of one CO2 molecule was determined at 18%-40%.

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A five-layer catalyst coated membrane (CCM) based upon Nation 115 membrane for direct methanol fuel cell (DMFC) was designed and fabricated by introducing a modified Nafion layer between the membrane and the catalyst layer. The properties of the CCM were determined by SEM, cyclic voltammetry, impedance spectroscopy, ruinous test and I-V curves. The characterizations show that the modified Nation layers provide increased interface contact area and enhanced interaction between the membrane and the catalyst layer. As a result, higher Pt utilization, lower contact resistance and superior durability of membrane electrode assembly was achieved. A 75% Pt utilization efficiency was obtained by using the novel CCM structure, whereas the conventional structure gave 60% efficiency. All these features greatly contribute to the increase in DMFC performance. The DMFC with new CCM structure presented a maximum power density of 260 MW cm(-2), but the DMFC with conventional structure gave only 200 mW cm(-2) under the same operation condition. (c) 2005 Elsevier B.V. All rights reserved.

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Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time

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Este artículo hace parte del trabajo “Criterios y Prácticas de Evaluación en torno a la Multiplicación”, tesis de maestría en proceso, la cual intenta contribuir al desarrollo del proyecto de investigación “Modelos y Prácticas Evaluativas de las Matemáticas en la Educación Básica. El caso del Campo Multiplicativo”, proyecto financiado por Colciencias y la Universidad Pedagógica Nacional (C´odigo1108-11-11328). Se realiza en este escrito un análisis del proceso de aprendizaje en torno al concepto de multiplicación desde la perspectiva sociocultural. Es pertinente señalar que la multiplicación es un concepto que se encuentra estrechamente relacionado con otros como: división, fracción, razón, proporción, función lineal,. . . y que conforman lo que Vergnaud (1994) ha denominado el Campo Conceptual Multiplicativo (CCM), por lo que su aprendizaje integra la necesidad de conectar estos conceptos con un campo de problemas y situaciones de tipo multiplicativo. En este sentido cobra importancia la cita de Sfard, en tanto, por ejemplo el aprendizaje de este concepto requiere un largo periodo de tiempo. En la primera parte del artículo se plantean algunos presupuestos teóricos que se comparten y ayudan a fundamentarlo, posteriormente se explicita qué es lo que se entiende por aproximación sociocultural del aprendizaje de la multiplicación, integrando la noción de competencia multiplicativa y finalmente se presenta los análisis de dos ejemplos en los cuales se muestra la complejidad de la multiplicación, en tanto se videncia el desarrollo de competencias cada vez más complejas.

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Objectives: Acute lung injury and the acute respiratory distress syndrome are characterized by noncardiogenic pulmonary edema, which can be assessed by measurement of extravascular lung water. Traditionally, extravascular lung water has been indexed to actual body weight (mL/kg). Because lung size is dependent on height rather than weight, we hypothesized indexing to predicted body weight may be a better predictor of mortality in acute lung injury/acute respiratory distress syndrome.

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Objectives: Acute respiratory distress syndrome (ARDS) is characterized by alveolar-capillary barrier damage. Matrix metalloproteinases (MMPs) are implicated in the pathogenesis of ARDS. In the Beta Agonists in Acute Lung Injury Trial, intravenous salbutamol reduced extravascular lung water (EVLW) in patients with ARDS at day 4 but not inflammatory cytokines or neutrophil recruitment. We hypothesized that salbutamol reduces MMP activity in ARDS.

Methods: MMP-1/-2/-3/-7/-8/-9/-12/-13 was measured in supernatants of distal lung epithelial cells, type II alveolar cells, and bronchoalveolar lavage (BAL) fluid from patients in the Beta Agonists in Acute Lung Injury study by multiplex bead array and tissue inhibitors of metalloproteinases (TIMPs)-1/-2 by enzyme-linked immunosorbent assay. MMP-9 protein and activity levels were further measured by gelatin zymography and fluorokine assay.

Measurements and Main Results: BAL fluid MMP-1/-2/-3 declined by day 4, whereas total MMP-9 tended to increase. Unexpectedly, salbutamol augmented MMP-9 activity. Salbutamol induced 33.7- and 13.2-fold upregulation in total and lipocalin-associated MMP-9, respectively at day 4, compared with 2.0- and 1.3-fold increase in the placebo group, p < 0.03. Salbutamol did not affect BAL fluid TIMP-1/-2. Net active MMP-9 was higher in the salbutamol group (4222 pg/mL, interquartile range: 513-7551) at day 4 compared with placebo (151 pg/mL, 124-2108), p = 0.012. Subjects with an increase in BAL fluid MMP-9 during the 4-day period had lower EVLW measurements than those in whom MMP-9 fell (10 vs. 17 mL/kg, p = 0.004): change in lung water correlated inversely with change in MMP-9, r = -.54, p = 0.0296. Salbutamol up-regulated MMP-9 and down-regulated TIMP-1/-2 secretion in vitro by distal lung epithelial cells. Inhibition of MMP-9 activity in cultures of type II alveolar epithelial cells reduced wound healing.

Conclusions: Salbutamol specifically up-regulates MMP-9 in vitro and in vivo in patients with ARDS. Up-regulated MMP-9 is associated with a reduction in EVLW. MMP-9 activity is required for alveolar epithelial wound healing in vitro. Data suggest MMP-9 may have a previously unrecognized beneficial role in reducing pulmonary edema in ARDS by improving alveolar epithelial healing.

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Objective: Endothelial function may be impaired in critical illness. We hypothesized that impaired endothelium-dependent vasodilatation is a predictor of mortality in critically ill patients.
Design: Prospective observational cohort study.
Setting: Seventeen-bed adult intensive care unit in a tertiary referral university teaching hospital. Patients: Patients were recruited within 24 hrs of admission to the intensive care unit.
Interventions: The SphygmoCor Mx system was used to derive the aortic augmentation index from radial artery pulse pressure waveforms. Endothelium-dependent vasodilatation was calculated as the change in augmentation index in response to an endothelium-dependent vasodilator (salbutamol).
Measurements and Main Results: Demographics, severity of illness scores, and physiological parameters were collected. Statistically significant predictors of mortality identified using single regressor analysis were entered into a multiple logistic regression model. Receiver operator characteristic curves were generated. Ninety-four patients completed the study. There were 80 survivors and 14 nonsurvivors. The Simplified Acute Physiology Score II, the Sequential Organ Failure Assessment score, leukocyte count, and endothelium-dependent vasodilatation conferred an increased risk of mortality. In logistic regression analysis, endothelium-dependent vasodilatation was the only predictor of mortality with an adjusted odds ratio of 26.1 (95% confidence interval [CI], 4.3-159.5). An endothelium-dependent vasodilatation value of 0.5% or less predicted intensive care unit mortality with a sensitivity of 79% (CI, 59-88%) and specificity of 98% (CI, 94-99%).
Conclusions: In vivo bedside assessment of endothelium-dependent vasodilatation is an independent predictor of mortality in the critically ill. We have shown it to be superior to other validated severity of illness scores with high sensitivity and specificity.