Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study.

OBJECTIVE : To determine the prevalence of patient-ventilator asynchrony in patients receiving non-invasive ventilation (NIV) for acute respiratory failure. DESIGN : Prospective multicenter observation study. SETTING : Intensive care units in three university hospitals. METHODS: Patients consecutively admitted to ICU were included. NIV, performed with an ICU ventilator, was set by the clinician. Airway pressure, flow, and surface diaphragmatic electromyography were recorded continuously for 30 min. Asynchrony events and the asynchrony index (AI) were determined from visual inspection of the recordings and clinical observation. RESULTS: A total of 60 patients were included, 55% of whom were hypercapnic. Auto-triggering was present in 8 (13%) patients, double triggering in 9 (15%), ineffective breaths in 8 (13%), premature cycling 7 (12%) and late cycling in 14 (23%). An AI > 10%, indicating severe asynchrony, was present in 26 patients (43%), whose median (25-75 IQR) AI was 26 (15-54%). A significant correlation was found between the magnitude of leaks and the number of ineffective breaths and severity of delayed cycling. Multivariate analysis indicated that the level of pressure support and the magnitude of leaks were weakly, albeit significantly, associated with an AI > 10%. Patient comfort scale was higher in pts with an AI < 10%. CONCLUSION: Patient-ventilator asynchrony is common in patients receiving NIV for acute respiratory failure. Our results suggest that leaks play a major role in generating patient-ventilator asynchrony and discomfort, and point the way to further research to determine if ventilator functions designed to cope with leaks can reduce asynchrony in the clinical setting.

Secure Care (PDF 301KB)

An Inspection of Secure Accommodation at Shamrock House and Linden House

Adopting Best Care (PDF 185KB)

Inspection of Statutory Adoption Services in NI

National Standards for Children's Residential Centres

The Department of Health and Children and the Social Services Inspectorate in conjunction with representatives of the Health Boards have developed these National Standards for the inspection of childrenâ?Ts residential centres, both statutory and nonstatutory Download the Report here

Fish pedicures: Information for the Public

Although the risk of catching an infection as a result of a fish spa pedicure is likely to be very low, it cannot be completely excluded. However, there are certain things you can do to further reduce your risk of catching or spreading an infection when having one of these treatments.Choosing a salonUse your personal judgment: as with all beauty salons, if it looks unsanitary, do not go there for your treatment. If you are very concerned about the cleanliness of a salon you visit, you can report this to your local Environmental Health department, who will be able to perform an inspection of the premises.When having a treatment, a trained member of staff should perform an inspection of your feet both beforehand, to check for any broken skin / infections, and afterwards, to check for signs of bleeding. They should also ask you to wash your feet with soap and water before putting them in the tank, to make sure that any products you have used that could be harmful to the fish are washed away, and to reduce the risk of spreading any infection.Ask your therapist what other procedures the salon has in place to minimise the risk of infection. The Health Protection Agency, England has produced a set of guidelines for salons which, if followed, will ensure any potential risk of infection is kept to an absolute minimum.Before having the treatment The HPA has identified a number of health conditions or prior treatments which may mean that you should not have a fish pedicure. These are:Leg waxing or shaving in last 24 hoursAny open cuts/wounds/abrasions/broken skin on the feet or lower legsInfection on the feet (including athlete's foot, verruca)Psoriasis, eczema or dermatitis affecting the feet or lower legsDiabetes (increased risk of infection)Infection with a blood borne virus such as Hepatitis B or Hepatitis C or HIVAny immune deficiency due to illness or medicationBleeding disorders or on anticoagulant medication (e.g. heparin or warfarinMore information and advice on fish spa pedicures and the full set of guidance can be found on the Health Protection website www.hpa.org.uk

Diseño de una herramienta para la visualización de moleculas

L'objectiu d'aquest TFC consisteix a desenvolupar i implementar l'eina de visualització molecular opengl: HVM. Aquesta aplicació, que permet la visualització i la inspecció de molècules, és de gran utilitat en àrees com la química, la farmàcia, la docència, etc., i admet definicions de molècules mitjançant un fitxer d'entrada (una variació simplificada del format XMOL XYZ), construint-ne el model, cosa que afavoreix que s'hi pugui navegar, com també la selecció i la identificació dels seus elements i el càlcul de distàncies i angles de torsió entre ells. A més, permet la definició d'un eix sobre el qual es pot generar una rotació del model i gravar una seqüència de sortida.

Línia : Desenvolupament de projectes de programari lliure

Aquest projecte s'emmarca dins l'activitat docent dels centres de la Comunitat Valenciana que imparteixen cicles formatius de Formació Professional. En concret, totes les titulacions han d¿incloure pràctiques formatives en empreses o altres entitats com a part del seu currículum. El projecte intenta facilitar el màxim possible tot el procés de gestió d'aquestes pràctiques.

L’elecció del centre en famílies d’origen immigrat a la ciutat de Barcelona

El projecte ha assolit la majoria d’objectius, ajustats a la reducció d'una quarta part de l'import concedit: 1) caracteritzar la transformació del paisatge agro-forestal i urbà a dos municipis de la vall del Congost, La Garriga i Figaró-Montmany, reconstruint amb SIG els mapes d'ús del sòl de 1854, 1949, 1956 i 2005, obtenint per intersecció de cobertes les matrius dels canvis d'ús; i 2) avaluar amb l’índex de connectivitat ecològica l'impacte ambiental d'aquells canvis des del punt de vista de la biodiversitat i la resiliència del paisatges, amb un especial èmfasi en la reforestació induïda per l'abandonament rural i la pèrdua de paisatges en mosaic, en un àmbit més gran pel període 1956-1993-2005. Aquests resultats han permès preparar varis articles per publicar en co-autoría a revistes com Landscape History, Environment and History o Landscape and Urban Planning. Ja és a punt de poder-se lliurar el primer amb el títol de "Looking backwards into a Mediterranean edge environment: Landscape changes and ecological connectivity in El Congost Valley (province of Barcelona, Catalonia) 1850-2005", incloent dos objectius esmentats a la memòria: identificar les principals forces motores d'aquells canvis en el paisatge relacionant els usos del sòl amb les formes d'ordenació del territori, caracteritzar-ne les forces rectores econòmico-socials i el paper jugat per la protecció del Parc Natural del Montseny i els Cingles de Bertí. Els resultats també permetran abordar en el futur altres aspectes, com per exemple estimar el potencial energètic de la biomassa local tot cercant que el seu aprofitament generi sinèrgies territorials positives per a l'ecologia del paisatge amb la recuperació d’una ramaderia extensiva i una agricultura ecològica que facin possible la restauració dels paisatges en mosaic. L'estudi ha pogut incorporar un aspecte inicialment no previst, el cens d'orquídies mediterrànies a Figaró-Montmany elaborat pel naturalista Paul Wilcox.

Dealing with Errors in QCA

This paper discusses five strategies to deal with five types of errors in Qualitative Comparative Analysis (QCA): condition errors, systematic errors, random errors, calibration errors, and deviant case errors. These strategies are the comparative inspection of complex, intermediary, and parsimonious solutions; the use of an adjustment factor, the use of probabilistic criteria, the test of the robustness of calibration parameters, and the use of a frequency threshold for observed combinations of conditions. The strategies are systematically reviewed, assessed, and evaluated as regards their applicability, advantages, limitations, and complementarities.

Feature Extraction from Whole-Sky Ground-Based Images for Cloud-Type Recognition

Several features that can be extracted from digital images of the sky and that can be useful for cloud-type classification of such images are presented. Some features are statistical measurements of image texture, some are based on the Fourier transform of the image and, finally, others are computed from the image where cloudy pixels are distinguished from clear-sky pixels. The use of the most suitable features in an automatic classification algorithm is also shown and discussed. Both the features and the classifier are developed over images taken by two different camera devices, namely, a total sky imager (TSI) and a whole sky imager (WSC), which are placed in two different areas of the world (Toowoomba, Australia; and Girona, Spain, respectively). The performance of the classifier is assessed by comparing its image classification with an a priori classification carried out by visual inspection of more than 200 images from each camera. The index of agreement is 76% when five different sky conditions are considered: clear, low cumuliform clouds, stratiform clouds (overcast), cirriform clouds, and mottled clouds (altocumulus, cirrocumulus). Discussion on the future directions of this research is also presented, regarding both the use of other features and the use of other classification techniques

A reusable smart interface for gas sensor resistance measurement

The advances of the semiconductor industry enable microelectromechanical systems sensors, signal conditioning logic and network access to be integrated into a smart sensor node. In this framework, a mixed-mode interface circuit for monolithically integrated gas sensor arrays was developed with high-level design techniques. This interface system includes analog electronics for inspection of up to four sensor arrays and digital logic for smart control and data communication. Although different design methodologies were used in the conception of the complete circuit, high-level synthesis tools and methodologies were crucial in speeding up the whole design cycle, enhancing reusability for future applications and producing a flexible and robust component.

Maintenance Asset Management Project -- Phase II, July 31, 2013

Expanded abstract: Iowa Department of Transportation (IA DOT) is finalizing research to streamline field inventory/inspection of culverts by Maintenance and Construction staff while maximizing the use of tablet technologies. The project began in 2011 to develop some new best practices for field staff to assist in the inventory, inspection and maintenance of assets along the roadway. The team has spent the past year working through the complexities of identifying the most appropriate tablet hardware for field data collection. A small scale deployment of tablets occurred in spring of 2013 to collect several safety related assets (culverts, signs, guardrail, and incidents). Data can be collected in disconnected or connected modes and there is an associated desktop environment where data can be viewed and queried after being synced into the master database. The development of a deployment plan and related workflow processes are underway; which will eventually feed information into IA DOTs larger asset management system and make the information available for decision making. The team is also working with the IA DOT Design Office on Computer Aided Drafting (CAD) data processing and the IA DOT Construction office with a new digital As-Built plan process to leverage the complete data life-cycle so information can be developed once and leveraged by the Maintenance staff farther along in the process.

Load Ratings for Standard Bridges, HR-239, 1982

The load ratings for these Standard bridges were calculated in compliance with the 1978 AASHTO Manual for Maintenance Inspection of Bridges, using the appropriate allowable stresses for the materials specified by the Standard plans. Distribution of loads is in compliance with the Manual unless otherwise noted. Except for truss spans, all bridges with roadway widths of 18 ft. or less were rated for one lane of traffic. All 18 ft. roadway truss bridges were rated for both one and two lanes of traffic. All bridges with roadway widths exceeding 18 ft. were rated for two lanes of traffic. If the posting rating for two lane bridges was less than legal, then the bridges were rated for traffic restricted to one lane, or to one lane centered in the roadway, as noted on the summary sheet. The ratings are applicable to bridges built in accordance with the standard plans and which exhibit no significant deterioration or damage to the structural members, and which have no added wearing surface material in excess of that noted on the summary sheets and used in the calculations. The inventory and operating ratings were based upon the standard AASHTO HS20-44 loading. The legal load ratings were based upon the three typical Iowa legal vehicles shown on page 5. The legal load ratings were based upon the maximum allowable Operating Rating stresses specified in the Manual. Refer to notations on the summary sheets for additional qualifications on the load ratings for specific standard bridge series. Load ratings for standard bridges with wood floors must be based upon existing conditions of attachment of the wood flooring to the top flanges of longitudinal steel stringers. The ratings must be reevaluated if the existing lateral support conditions are not in accordance with conditions used for the rating and noted on the summary sheets. Details of most of the standard bridges are included in the three books of "Iowa State Highway Commission, Bridge Standards," issued in June, 1972. Copies of plans for those standard bridges that were rated, and that are not included in the original books of standard plans, are being furnished under separate cover with these rating summaries.

Do protein–protein interaction databases identify moonlighting proteins?

One of the most striking results of the human (and mammalian) genomes is the low number of protein-coding genes. To-date, the main molecular mechanism to increase the number of different protein isoforms and functions is alternative splicing. However, a less-known way to increase the number of protein functions is the existence of multifunctional, multitask, or ‘‘moonlighting’’, proteins. By and large, moonlighting proteins are experimentally disclosed by serendipity. Proteomics is becoming one of the very active areas of biomedical research, which permits researchers to identify previously unseen connections among proteins and pathways. In principle, protein–protein interaction (PPI) databases should contain information on moonlighting proteins and could provide suggestions to further analysis in order to prove the multifunctionality. As far as we know, nobody has verified whether PPI databases actually disclose moonlighting proteins. In the present work we check whether well-established moonlighting proteins present in PPI databases connect with their known partners and, therefore, a careful inspection of these databases could help to suggest their different functions. The results of our research suggest that PPI databases could be a valuable tool to suggest multifunctionality.

Aulas inclusivas y aprendizaje cooperativo

Educación inclusiva y aprendizaje cooperativo son dos conceptos distintos pero estrechamente relacionados: las aulas inclusivas requieren una estructura cooperativa de la actividad, y educar los valores relacionados con la cooperación exige que las aulas sean inclusivas. Pasar de una estructura de la actividad individualista y/o competitiva a una estructura de la actividad cooperativa es un elemento trascendental para hacer posible la inclusión de todo el alumnado en un aula común. Resultado del Proyecto PAC –desarrollado por el Grupo de Investigación sobre Atención a la Diversidad (GRAD) de la Universidad de Vic-, el Programa CA/AC (“Cooperar para Aprender / Aprender a Cooperar”) ofrece al profesorado de educación infantil, primaria y secundaria herramientas para enseñar al alumnado a aprender en equipo. Y a partir del mismo proyecto se ha desarrollado asimismo un proceso de formación/asesoramiento para introducir en las aulas nuevas prácticas docentes basadas en el aprendizaje cooperativo. Un número considerable de centros de distintas zonas de España están siguiendo este proceso y se han recogido una gran cantidad de datos que, debidamente analizados, nos sirvan para confirmar una de las hipótesis del proyecto de investigación que nos ocupa en estos momentos: que el cambio de una estructura individualista o competitiva por otra de tipo cooperativo contribuye a que puedan aprender juntos, en un aula inclusiva, todos los alumnos y las alumnas, sean cuales sean sus necesidades educativas y sus culturas de origen.