Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial

INTRODUCTION: It is unclear to which level mean arterial blood pressure (MAP) should be increased during septic shock in order to improve outcome. In this study we investigated the association between MAP values of 70 mmHg or higher, vasopressor load, 28-day mortality and disease-related events in septic shock. METHODS: This is a post hoc analysis of data of the control group of a multicenter trial and includes 290 septic shock patients in whom a mean MAP > or = 70 mmHg could be maintained during shock. Demographic and clinical data, MAP, vasopressor requirements during the shock period, disease-related events and 28-day mortality were documented. Logistic regression models adjusted for the geographic region of the study center, age, presence of chronic arterial hypertension, simplified acute physiology score (SAPS) II and the mean vasopressor load during the shock period was calculated to investigate the association between MAP or MAP quartiles > or = 70 mmHg and mortality or the frequency and occurrence of disease-related events. RESULTS: There was no association between MAP or MAP quartiles and mortality or the occurrence of disease-related events. These associations were not influenced by age or pre-existent arterial hypertension (all P > 0.05). The mean vasopressor load was associated with mortality (relative risk (RR), 1.83; confidence interval (CI) 95%, 1.4-2.38; P < 0.001), the number of disease-related events (P < 0.001) and the occurrence of acute circulatory failure (RR, 1.64; CI 95%, 1.28-2.11; P < 0.001), metabolic acidosis (RR, 1.79; CI 95%, 1.38-2.32; P < 0.001), renal failure (RR, 1.49; CI 95%, 1.17-1.89; P = 0.001) and thrombocytopenia (RR, 1.33; CI 95%, 1.06-1.68; P = 0.01). CONCLUSIONS: MAP levels of 70 mmHg or higher do not appear to be associated with improved survival in septic shock. Elevating MAP >70 mmHg by augmenting vasopressor dosages may increase mortality. Future trials are needed to identify the lowest acceptable MAP level to ensure tissue perfusion and avoid unnecessary high catecholamine infusions.

Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA)

This study evaluated the response to increasing levels of neurally adjusted ventilatory assist (NAVA), a mode converting electrical activity of the diaphragm (EAdi) into pressure, regulated by a proportionality constant called the NAVA level. Fourteen rabbits were studied during baseline, resistive loading and ramp increases of the NAVA level. EAdi, airway (Paw) and esophageal pressure (Pes), Pes pressure time product (PTPes), breathing pattern, and blood gases were measured. Resistive loading increased PTPes and EAdi. P(a)(CO)(2) increased with high load but not during low load. Increasing NAVA levels increased Paw until a breakpoint where the Paw increase was reduced despite increasing NAVA level. At this breakpoint, Pes, PTPes, EAdi, and P(a)(CO)(2) were similar to baseline. Further increase of the NAVA level reduced Pes, PTPes and EAdi without changes in ventilation. In conclusion, observing the trend in Paw during a ramp increase of the NAVA level allows determination of a level where the inspiratory effort matches unloaded conditions.

Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia.

BACKGROUND Few data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa. METHODS We enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression. RESULTS Seventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1-9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3-13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192-8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir. CONCLUSION One half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.

Host-parasite dynamics and outgrowth of virus containing a single K70R amino acid change in reverse transcriptase are responsible for the loss of human immunodeficiency virus type 1 RNA load suppression by zidovudine.

The association between human immunodeficiency virus type I (HIV-1) RNA load changes and the emergence of resistant virus variants was investigated in 24 HIV-1-infected asymptomatic persons during 2 years of treatment with zidovudine by sequentially measuring serum HIV-1 RNA load and the relative amounts of HIV-1 RNA containing mutations at reverse transcriptase (RT) codons 70 (K-->R), 41 (M-->L), and 215 (T-->Y/F). A mean maximum decline in RNA load occurred during the first month, followed by a resurgence between 1 and 3 months, which appeared independent of drug-resistance. Mathematical modeling suggests that this resurgence is caused by host-parasite dynamics, and thus reflects infection of the transiently increased numbers of CD4+ lymphocytes. Between 3 and 6 months of treatment, the RNA load returned to baseline values, which was associated with the emergence of virus containing a single lysine to arginine amino acid change at RT codon 70, only conferring an 8-fold reduction in susceptibility. Despite the relative loss of RNA load suppression, selection toward mutations at RT codons 215 and 41 continued. Identical patterns were observed in the mathematical model. While host-parasite dynamics and outgrowth of low-level resistant virus thus appear responsible for the loss of HIV-1 RNA load suppression, zidovudine continues to select for alternative mutations, conferring increasing levels of resistance.

Nutrient Load Reduction: Challenges facing the Chesapeake 2000 Agreement

The Chesapeake Bay is the largest estuary in the United States supporting a complex ecosystem that sustains many habitats and the organisms that depend on them. The bay also supports economic, recreational, and cultural activities to over 16 million people residing in the watershed. Changes within the watershed have caused excessive levels of nutrients, mainly nitrogen and phosphorous, to pollute the bay. The Chesapeake Bay Program, guided by a complex agreement, was created to address these and other issues and oversee the restoration of the bay. The most recent version of this agreement, the Chesapeake 2000, declares its continued commitment to restore the bay with over 100 goals to be met by the year 2010. Reports show that although intensive efforts have been made to promote nutrient reduction, very little reduction has actually resulted. This project described these efforts. The final results reveal obstacles affecting progress, shortcomings to current approaches and possible solutions for future implementation.

Real-time reverse transcriptase PCR for the endogenous koala retrovirus reveals an association between plasma viral load and neoplastic disease in koalas

Koala retrovirus (KoRV) is a newly described endogenous retrovirus and is unusual in that inserts comprise a full-length replication competent genome. As koalas are known to suffer from an extremely high incidence of leukaemia/lymphoma, the association between this retrovirus and disease in koalas was examined. Using quantitative real-time reverse transcriptase PCR it was demonstrated that KoRV RNA levels in plasma are significantly increased in animals suffering from leukaemia or lymphoma when compared with healthy animals. Increased levels of KoRV were also seen for animals with clinical chlamydiosis. A significant positive association between viral RNA levels and age was also demonstrated. Real-time PCR demonstrated as much as 5 log variation in KoRV proviral DNA levels in genomic DNA extracted from whole blood from different animals. Taken together these data indicate that KoRV is an active endogenous retrovirus and suggests that it may be causally linked to neoplastic disease in koalas.

Client fish ectoparasite loads and cleaner shrimp Urocaridella sp c hunger levels affect cleaning behaviour

Cleaning is a classic example of mutualism and determining the factors that maintain the balance between the costs and benefits for mutualist partners can assist our understanding of how cleaning relationships are maintained. Optimal foraging theory suggests two factors that might help to maintain the relationship between cleaners and their clients: client ectoparasite load and cleaner hunger levels. The ecological relevance and importance of foraging by cleaner fish in marine systems has been demonstrated repeatedly, yet there is little information available on this behaviour in cleaner shrimp. To determine whether cleaner shrimp base their choice of client fish on food patch quality (i.e. client fish ectoparasite load) we offered the yellow-beaked cleaner shrimp Urocaridella sp. c a choice of parasitized and unparasitized rock cods, Cephalopholis cyanostigma. To determine whether cleaner shrimp hunger levels influence cleaning time, we manipulated hunger levels in Urocaridella sp. c and examined their behaviour towards parasitized client fish. Cleaner shrimp preferred parasitized to unparasitized client fish and food-deprived cleaner shrimp cleaned parasitized rock cods more frequently than satiated cleaner shrimp did. Therefore, variations in client fish ectoparasite load and cleaner shrimp hunger level are two factors that affect the balance in this mutualism. Finally, our results meet some of the assumptions of biological market theory, a framework used to understand cooperative interactions, and thus this framework is suggested for future studies on this cleaning system.

Stability of Ampelometric Characteristics of Vitis vinifera L. cv. 'Syrah' and 'Sauvignon blanc' Leaves: Impact of Within-vineyard Variability and Pruning Method/Bud Load

Historically, grapevine (Vitis vinifera L.) leaf characterisation has been a driving force in the identification of cultivars. In this study, ampelometric (foliometric) analysis was done on leaf samples collected from hand-pruned, mechanically pruned and minimally pruned ‘Sauvignon blanc’ and ‘Syrah’ vines to estimate the impact of within-vineyard variability and a change in bud load on the stability of leaf properties. The results showed that within-vineyard variability of ampelometric characteristics was high within a cultivar, irrespective of bud load. In terms of the O.I.V. coding system, zero to four class differences were observed between minimum and maximum values of each characteristic. The value of variability of each characteristic was different between the three levels of bud load and the two cultivars. With respect to bud load, the number of shoots per vine had a significant effect on the characteristics of the leaf laminae. Single leaf area and lengths of veins changed significantly for both cultivars, irrespective of treatment, while angle between veins proved to be a stable characteristic. A large number of biometric data can be recorded on a single leaf; the data measured on several leaves, however, are not necessarily unique for a specific cultivar. The leaf characteristics analysed in this study can be divided into two groups according to the response to a change in bud load, i.e. stable (angles between the veins, depths of sinuses) and variable (length of the veins, length of the petiole, single leaf area). The variable characteristics are not recommended to be used in cultivar identification, unless the pruning method/bud load is known.

Effects of worked examples and algebra problem -solving skill on error and cognitive load

This study determined the levels of algebra problem solving skill at which worked examples promoted learning of further problem solving skill and reduction of cognitive load in college developmental algebra students. Problem solving skill was objectively measured as error production; cognitive load was subjectively measured as perceived mental effort. ^ Sixty-three Ss were pretested, received homework of worked examples or mass problem solving, and posttested. Univarate ANCOVA (covariate = previous grade) were performed on the practice and posttest data. The factors used in the analysis were practice strategy (worked examples vs. mass problem solving) and algebra problem solving skill (low vs. moderate vs. high). Students in the practice phase who studied worked examples exhibited (a) fewer errors and reduced cognitive load, at moderate skill; (b) neither fewer errors nor reduced cognitive load, at low skill; and (c) only reduced cognitive load, at high skill. In the posttest, only cognitive load was reduced. ^ The results suggested that worked examples be emphasized for developmental students with moderate problem solving skill. Areas for further research were discussed. ^

Vocabulary learning through use of the picture-word inductive model for young English learners in China: A mixed methods examination using Cognitive Load Theory

English has been taught as a core and compulsory subject in China for decades. Recently, the demand for English in China has increased dramatically. China now has the world's largest English-learning population. The traditional English-teaching method cannot continue to be the only approach because it merely focuses on reading, grammar and translation, which cannot meet English learners and users' needs (i.e., communicative competence and skills in speaking and writing). ^ This study was conducted to investigate if the Picture-Word Inductive Model (PWIM), a new pedagogical method using pictures and inductive thinking, would benefit English learners in China in terms of potential higher output in speaking and writing. With the gauge of Cognitive Load Theory (CLT), specifically, its redundancy effect, I investigated whether processing words and a picture concurrently would present a cognitive overload for English learners in China. ^ I conducted a mixed methods research study. A quasi-experiment (pretest, intervention for seven weeks, and posttest) was conducted using 234 students in four groups in Lianyungang, China (58 fourth graders and 57 seventh graders as an experimental group with PWIM and 59 fourth graders and 60 seventh graders as a control group with the traditional method). No significant difference in the effects of PWIM was found on vocabulary acquisition based on grade levels. Observations, questionnaires with open-ended questions, and interviews were deployed to answer the three remaining research questions. A few students felt cognitively overloaded when they encountered too many writing samples, too many new words at one time, repeated words, mismatches between words and pictures, and so on. Many students listed and exemplified numerous strengths of PWIM, but a few mentioned weaknesses of PWIM. The students expressed the idea that PWIM had a positive effect on their English teaching. ^ As integrated inferences, qualitative findings were used to explain the quantitative results that there were no significant differences of the effects of the PWIM between the experimental and control groups in both grade levels, from four contextual aspects: time constraints on PWIM implementation, teachers' resistance, how to use PWIM and PWIM implemented in a classroom over 55 students.^

Vocabulary Learning through Use of the Picture-Word Inductive Model for Young English Learners in China: A Mixed Methods Examination Using Cognitive Load Theory

English has been taught as a core and compulsory subject in China for decades. Recently, the demand for English in China has increased dramatically. China now has the world’s largest English-learning population. The traditional English-teaching method cannot continue to be the only approach because it merely focuses on reading, grammar and translation, which cannot meet English learners and users’ needs (i.e., communicative competence and skills in speaking and writing). This study was conducted to investigate if the Picture-Word Inductive Model (PWIM), a new pedagogical method using pictures and inductive thinking, would benefit English learners in China in terms of potential higher output in speaking and writing. With the gauge of Cognitive Load Theory (CLT), specifically, its redundancy effect, I investigated whether processing words and a picture concurrently would present a cognitive overload for English learners in China. I conducted a mixed methods research study. A quasi-experiment (pretest, intervention for seven weeks, and posttest) was conducted using 234 students in four groups in Lianyungang, China (58 fourth graders and 57 seventh graders as an experimental group with PWIM and 59 fourth graders and 60 seventh graders as a control group with the traditional method). No significant difference in the effects of PWIM was found on vocabulary acquisition based on grade levels. Observations, questionnaires with open-ended questions, and interviews were deployed to answer the three remaining research questions. A few students felt cognitively overloaded when they encountered too many writing samples, too many new words at one time, repeated words, mismatches between words and pictures, and so on. Many students listed and exemplified numerous strengths of PWIM, but a few mentioned weaknesses of PWIM. The students expressed the idea that PWIM had a positive effect on their English teaching. As integrated inferences, qualitative findings were used to explain the quantitative results that there were no significant differences of the effects of the PWIM between the experimental and control groups in both grade levels, from four contextual aspects: time constraints on PWIM implementation, teachers’ resistance, how to use PWIM and PWIM implemented in a classroom over 55 students.

Table 1: Densities and snow loads for individual levels in 1967 and 1978

The deformation of a 20 m deep firn pit in the accumulation area of Kesselwandferner was surveyed over aperiod of 11 years. Six or seven surveying markers had been installed at each of 14 levels. The survey shows tImt the shear strain rate is independent of depth and the originally circular pit cross section was changed into an ellipse. In the direction of the glacier flow, the diameter was increased, the strain rate being approximately independent of depth. Transverse to the flow, however, the diameter decreased, the strain rate becoming higher as the depth increased. The vertical strain rates responsible for thinning of firn layers decrease with depth.

Low- vs. high-glycemic load diets: effects on postprandial plasma free fatty acids

Thesis (Master's)--University of Washington, 2016-06

A generic strategy for dynamic load balancing of distributed memory parallel computational mechanics using unstructured meshes

A large class of computational problems are characterised by frequent synchronisation, and computational requirements which change as a function of time. When such a problem is solved on a message passing multiprocessor machine [5], the combination of these characteristics leads to system performance which deteriorate in time. As the communication performance of parallel hardware steadily improves so load balance becomes a dominant factor in obtaining high parallel efficiency. Performance can be improved with periodic redistribution of computational load; however, redistribution can sometimes be very costly. We study the issue of deciding when to invoke a global load re-balancing mechanism. Such a decision policy must actively weigh the costs of remapping against the performance benefits, and should be general enough to apply automatically to a wide range of computations. This paper discusses a generic strategy for Dynamic Load Balancing (DLB) in unstructured mesh computational mechanics applications. The strategy is intended to handle varying levels of load changes throughout the run. The major issues involved in a generic dynamic load balancing scheme will be investigated together with techniques to automate the implementation of a dynamic load balancing mechanism within the Computer Aided Parallelisation Tools (CAPTools) environment, which is a semi-automatic tool for parallelisation of mesh based FORTRAN codes.

Development of error correction techniques for nitrate-N load estimation models

Excess nutrient loads carried by streams and rivers are a great concern for environmental resource managers. In agricultural regions, excess loads are transported downstream to receiving water bodies, potentially causing algal blooms, which could lead to numerous ecological problems. To better understand nutrient load transport, and to develop appropriate water management plans, it is important to have accurate estimates of annual nutrient loads. This study used a Monte Carlo sub-sampling method and error-corrected statistical models to estimate annual nitrate-N loads from two watersheds in central Illinois. The performance of three load estimation methods (the seven-parameter log-linear model, the ratio estimator, and the flow-weighted averaging estimator) applied at one-, two-, four-, six-, and eight-week sampling frequencies were compared. Five error correction techniques; the existing composite method, and four new error correction techniques developed in this study; were applied to each combination of sampling frequency and load estimation method. On average, the most accurate error reduction technique, (proportional rectangular) resulted in 15% and 30% more accurate load estimates when compared to the most accurate uncorrected load estimation method (ratio estimator) for the two watersheds. Using error correction methods, it is possible to design more cost-effective monitoring plans by achieving the same load estimation accuracy with fewer observations. Finally, the optimum combinations of monitoring threshold and sampling frequency that minimizes the number of samples required to achieve specified levels of accuracy in load estimation were determined. For one- to three-weeks sampling frequencies, combined threshold/fixed-interval monitoring approaches produced the best outcomes, while fixed-interval-only approaches produced the most accurate results for four- to eight-weeks sampling frequencies.