972 resultados para Pressure support ventilation


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We report new radio continuum and 21 cm HI observations using the Giant Metrewave Radio Telescope (GMRT) of the group Holmberg 124 ( Ho 124) comprising four late-type galaxies, namely NGC 2820, Mrk 108, NGC 2814 and NGC 2805. The three galaxies, NGC 2820, Mrk 108 and NGC 2814 which are closely located in the sky plane have clearly undergone tidal interactions as seen from the various morphological tidal signatures and debris. Moreover we note various features in the group members which we believe might be due to ram pressure. In this paper, we describe four interesting results emerging from our observations: a) detection of the tidal radio continuum bridge at 330 MHz connecting the galaxies NGC 2820+ Mrk 108 with NGC 2814. The radio bridge was discovered at 1465 MHz by van der Hulst & Hummel ( 1985, A& A, 150, 17). We find that the bridge has a fairly steep spectrum with a spectral index alpha(S proportional to nu(alpha)) of - 1.8(-0.2)(+0.3) which is much steeper than the - 0.8 quoted by van der Hulst & Hummel ( 1985); b) detection of other tidal features like the tilted HI and radio continuum disk of NGC 2814, a HI streamer and a radio continuum tail arising from the south of NGC 2814. We also report the detection of a possible tidal dwarf galaxy in HI; c) sharp truncation in the HI distribution in the south of NGC 2820 and in the HI and radio continuum distribution in the north of NGC 2814. The optical disks in both the cases look undisturbed. As pointed out by Davis et al. ( 1997, AJ, 114, 613), ram pressure affects different components of the interstellar medium to varying degrees. Simple estimates of pressure in different components of the interstellar medium ( radio continuum, Ha and HI) in NGC 2820 indicate that ram pressure will significantly influence HI; d) detection of a large one-sided HI loop to the north of NGC 2820. No radio continuum emission or Ha emission is associated with the HI loop. We discuss various scenarios for the origin of this loop including a central starburst, ram pressure stripping and tidal interaction. We do not support the central starburst scenario since the loop is not detected in ionized gas. Using the upper limit on X-ray luminosity of Ho 124 (Mulchaey et al. 2003, ApJS, 145, 39), we estimate an upper limit on the intragroup medium (IGrM) density of 8.8 x 10(-4) cm(-3). For half this electron density, we estimate the ram pressure force of the IGrM to be comparable to the gravitational pull of the disk of NGC 2820. Since tidal interaction has obviously influenced the group, we suggest that the loop could have formed by ram pressure stripping if tidal effects had reduced the surface density of HI in NGC 2820. From the complex observational picture of Ho 124 and the numerical estimates, we suggest that the evolution of the Ho 124 group may be governed by both tidal forces due to the interaction and the ram pressure due to motion of the member galaxies in the IGrM and that the IGrM densities should not be too low (i.e. >= 4 x 10(-4)). However this needs to be verified by further observations.

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The swelling pressure of soil depends upon various soil parameters such as mineralogy, clay content, Atterberg's limits, dry density, moisture content, initial degree of saturation, etc. along with structural and environmental factors. It is very difficult to model and analyze swelling pressure effectively taking all the above aspects into consideration. Various statistical/empirical methods have been attempted to predict the swelling pressure based on index properties of soil. In this paper, the computational intelligence techniques artificial neural network and support vector machine have been used to develop models based on the set of available experimental results to predict swelling pressure from the inputs; natural moisture content, dry density, liquid limit, plasticity index, and clay fraction. The generalization of the model to new set of data other than the training set of data is discussed which is required for successful application of a model. A detailed study of the relative performance of the computational intelligence techniques has been carried out based on different statistical performance criteria.

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The swelling pressure of soil depends upon various soil parameters such as mineralogy, clay content, Atterberg's limits, dry density, moisture content, initial degree of saturation, etc. along with structural and environmental factors. It is very difficult to model and analyze swelling pressure effectively taking all the above aspects into consideration. Various statistical/empirical methods have been attempted to predict the swelling pressure based on index properties of soil. In this paper, the computational intelligence techniques artificial neural network and support vector machine have been used to develop models based on the set of available experimental results to predict swelling pressure from the inputs; natural moisture content, dry density, liquid limit, plasticity index, and clay fraction. The generalization of the model to new set of data other than the training set of data is discussed which is required for successful application of a model. A detailed study of the relative performance of the computational intelligence techniques has been carried out based on different statistical performance criteria.

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Te-rich Si15Te85-xGex (1 <= x <= 11) glasses are found to exhibit an anomalous phase separations with germanium composition. The structural transformation of o-GeTe crystalline phase from o-GeTe with a = 11.76 angstrom, b = 16.59 angstrom, c = 17.44 angstrom, to high pressure o-GeTe with a new reduced lattice parameters a = 10.95 angstrom, b = 4.03 angstrom, c = 4.45 angstrom, is observed at T-c3 in the composition range 6 <= x <= 11. Raman studies support the possible existence of high pressure o-GeTe phase which is observed in X-ray diffraction experiments. Copyright 2012 Author(s). This article is distributed under a Creative Commons Attribution 3.0 Unported License. http://dx.doi.org/10.1063/1.3696862]

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A molecular dynamics simulation study of aqueous solution of LiCl is reported as a function of pressure. Experimental measurements of conductivity of Li+ ion as a function of pressure shows an increase in conductivity with pressure. Our simulations are able to reproduce the observed trend in conductivity. A number of relevant properties have been computed in order to understand the reasons for the increase in conductivity with pressure. These include radial distribution function, void and neck distributions, hydration or coordination numbers, diffusivity, velocity autocorrelation functions, angles between ion-oxygen and dipole of water as well as OH vector, mean residence time for water in the hydration shell, etc. These show that the increase in pressure acts as a structure breaker. The decay of the self part of the intermediate scattering function at small wave number k shows a bi-exponential decay at 1 bar which changes to single exponential decay at higher pressures. The k dependence of the ratio of the self part of the full width at half maximum of the dynamic structure factor to 2Dk(2) exhibits trends which suggest that the void structure of water is playing a role. These support the view that the changes in void and neck distributions in water can account for changes in conductivity or diffusivity of Li+ with pressure. These results can be understood in terms of the levitation effect. (C) 2012 American Institute of Physics. http://dx.doi.org/10.1063/1.4756909]

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This thesis is an investigation into the nature of data analysis and computer software systems which support this activity.

The first chapter develops the notion of data analysis as an experimental science which has two major components: data-gathering and theory-building. The basic role of language in determining the meaningfulness of theory is stressed, and the informativeness of a language and data base pair is studied. The static and dynamic aspects of data analysis are then considered from this conceptual vantage point. The second chapter surveys the available types of computer systems which may be useful for data analysis. Particular attention is paid to the questions raised in the first chapter about the language restrictions imposed by the computer system and its dynamic properties.

The third chapter discusses the REL data analysis system, which was designed to satisfy the needs of the data analyzer in an operational relational data system. The major limitation on the use of such systems is the amount of access to data stored on a relatively slow secondary memory. This problem of the paging of data is investigated and two classes of data structure representations are found, each of which has desirable paging characteristics for certain types of queries. One representation is used by most of the generalized data base management systems in existence today, but the other is clearly preferred in the data analysis environment, as conceptualized in Chapter I.

This data representation has strong implications for a fundamental process of data analysis -- the quantification of variables. Since quantification is one of the few means of summarizing and abstracting, data analysis systems are under strong pressure to facilitate the process. Two implementations of quantification are studied: one analagous to the form of the lower predicate calculus and another more closely attuned to the data representation. A comparison of these indicates that the use of the "label class" method results in orders of magnitude improvement over the lower predicate calculus technique.

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The finite element method (FEM) is growing in popularity over the pressure diagram/hand calculation method for analysis of excavation systems in general and deep soil mixing excavations in particular. In this paper, a finite element analysis is used to study the behavior of a deep mixed excavation. Through the use of Plaxis (a FEM software program), the construction sequence is simulated by following the various construction phases allowing for deflections due to strut or anchor installation to be predicted. The numerical model used in this study simulates the soil cement columns as a continuous wall matching the bending stiffness of the actual wall. Input parameters based on laboratory tests and modeling assumptions are discussed. An example of the approach is illustrated using the Islais Creek Transport/Storage Project in San Francisco, California. Copyright ASCE 2006.

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A novel temperature and pressure sensor based on a single film bulk acoustic resonator (FBAR) is designed. This FBAR support two resonant modes, which response opposite to the change of temperature. By sealed the back cavity of a back-trench membrane type FBAR with silicon wafer, an on-chip single FBAR sensor suitable for measuring temperature and pressure simultaneously is proposed. For unsealed device, the experimental results show that the first resonant mode has a temperature coefficient of frequency (TCF) of 69.5ppm/K, and the TCF of the second mode is -8.1ppm/K. After sealed the back trench, it can be used as a pressure sensor, the pressure coefficient of frequency (PCF) for the two resonant mode is -17.4ppm/kPa and -6.1 ppm/kPa respectively, both of them being more sensitive than other existing pressure sensors. © 2013 Trans Tech Publications Ltd, Switzerland.

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ZnTe epilayers were grown on GaAs(0 0 1) substrates by molecular beam epitaxy (MBE) at different VI/II beam equivalent pressure (BEP) ratios (R-VI/II) in a wide range of 0.96-11 with constant Zn flux. Based on in situ reflection high-energy electron diffraction (RHEED) observation, two-dimensional (2D) growth mode can be formed by increasing the R-VI/II to 2.8. The Te/Zn pressure ratios lower than 4.0 correspond to Zn-rich growth state, while the ratios over 6.4 correspond to Te-rich one. The Zn sticking coefficient at various VI/II ratios are derived by the growth rate measurement. The ZnTe epilayer grown at a R-VI/II of 6.4 displays the narrowest full-width at half-maximum (FWHM) of double-crystal X-ray rocking curve (DCXRC) for (0 0 4) reflection. Atomic force microscopy (AFM) characterization shows that the grain size enlarges drastically with the R-VI/II. The surface root-mean-square (RMS) roughness decreases firstly, attains a minimum of 1.14 nm at a R-VI/II of 4.0 and then increases at higher ratios. It is suggested that the most suitable R-VI/II be controlled between 4.0 and 6.4 in order to grow high-quality ZnTe epitaxial thin films.

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Background Good blood pressure (BP) control reduces the risk of recurrence of stroke/transient ischaemic attack (TIA). Although there is strong evidence that BP telemonitoring helps achieve good control, none of the major trials have considered the effectiveness in stroke/TIA survivors. We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/ TIA survivors with uncontrolled BP in primary care. Method Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA randomised 3:1 to BP telemonitoring for 6 months or usual care. Phase 2 was a qualitative evaluation and comprised semi-structured interviews with 16 trial participants who received telemonitoring and 3 focus groups with 23 members of stroke support groups and 7 carers. Results Overall, 125 patients (60 stroke patients, 65 TIA patients) were approached and 55 (44%) patients were randomised including 27 stroke patients and 28 TIA patients. Fifty-two participants (95%) attended the 6-month follow-up appointment, but one declined the second daytime ambulatory blood pressure monitoring (ABPM) measurement resulting in a 93% completion rate for ABPM − the proposed primary outcome measure for a full trial. Adherence to telemonitoring was good; of the 40 participants who were telemonitoring, 38 continued to provide readings throughout the 6 months. There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group, which suggested the potential for a substantial effect from telemonitoring. Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement, was easy, convenient and reassuring Conclusions A full-scale trial is feasible, likely to recruit well and have good rates of compliance and follow-up.

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Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation

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BACKGROUND: Web-based decision aids are increasingly important in medical research and clinical care. However, few have been studied in an intensive care unit setting. The objectives of this study were to develop a Web-based decision aid for family members of patients receiving prolonged mechanical ventilation and to evaluate its usability and acceptability. METHODS: Using an iterative process involving 48 critical illness survivors, family surrogate decision makers, and intensivists, we developed a Web-based decision aid addressing goals of care preferences for surrogate decision makers of patients with prolonged mechanical ventilation that could be either administered by study staff or completed independently by family members (Development Phase). After piloting the decision aid among 13 surrogate decision makers and seven intensivists, we assessed the decision aid's usability in the Evaluation Phase among a cohort of 30 surrogate decision makers using the Systems Usability Scale (SUS). Acceptability was assessed using measures of satisfaction and preference for electronic Collaborative Decision Support (eCODES) versus the original printed decision aid. RESULTS: The final decision aid, termed 'electronic Collaborative Decision Support', provides a framework for shared decision making, elicits relevant values and preferences, incorporates clinical data to personalize prognostic estimates generated from the ProVent prediction model, generates a printable document summarizing the user's interaction with the decision aid, and can digitally archive each user session. Usability was excellent (mean SUS, 80 ± 10) overall, but lower among those 56 years and older (73 ± 7) versus those who were younger (84 ± 9); p = 0.03. A total of 93% of users reported a preference for electronic versus printed versions. CONCLUSIONS: The Web-based decision aid for ICU surrogate decision makers can facilitate highly individualized information sharing with excellent usability and acceptability. Decision aids that employ an electronic format such as eCODES represent a strategy that could enhance patient-clinician collaboration and decision making quality in intensive care.

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The blood pressure waveform is modified on distal propagation by phenomena such as dispersion, reflection and the state of the arterial compliance. The consequent effects are amplification and narrowing of the wave, with an increased systolic, reduced diastolic and essentially unaltered mean blood pressure. The Finapres measures the peripheral pressure using the volume clamp principle; it has not been validated under altered physiological conditions and during pharmacodynamic interventions. We studied simultaneous Finapres and brachial blood pressures (using a conventional oscillometric sphygmomanometer—Vitalmap) in ten normal volunteers at rest, and during dynamic exercise and a cold pressor test. The effects of pharmacodynamic intervention were examined following beta-adrenoceptor blockade with propranolol (160 mg) or beta-adrenoceptor modulation with the beta-adrenoceptor partial agonist celiprolol (400 mg). The Finapres systolic pressure was significantly higher than the brachial value during all three test states. The difference between the systolic pressures measured by the two devices was shown to increase significantly during the cold pressor test, but not during dynamic (supine bicycle) exercise. The Finapres diastolic pressure was significantly higher than the Vitalmap value during exercise and the cold pressor test. The differences between the two methods increased significantly over time. Beta-adrenergic blockade with propranolol or modulation with celiprolol had no significant interaction with the pressure differences between the Finapres and Vitalmap techniques. The results would support the view that the Finapres can provide blood pressure information which is robust under most circumstances. Although this pharmacodynamic intervention did not alter the relationship between the peripheral and central blood pressure, it is important to note that this dynamic relationship is sensitive to circulatory loading conditions and wave transmission characteristics; it is possible that the Finapres could be less reliable in clinical settings where potent vasoactive agents were being administered.

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Background:Mechanical ventilation is a critical component of paediatric intensive care therapy. It is indicated when the patient’s spontaneous ventilation is inadequate to sustain life. Weaning is the gradual reduction of ventilatory support and the transfer of respiratory control back to the patient. Weaning may represent a large proportion of the ventilatory period. Prolonged ventilation is associated with significant morbidity, hospital cost, psychosocial and physical risks to the child and even death. Timely and effective weaning may reduce the duration of mechanical ventilation and may reduce the morbidity and mortality associated with prolonged ventilation. However, no consensus has been reached on criteria that can be used to identify when patients are ready to wean or the best way to achieve it.Objectives:To assess the effects of weaning by protocol on invasively ventilated critically ill children. To compare the total duration of invasive mechanical ventilation of critically ill children who are weaned using protocols versus those weaned through usual (non-protocolized) practice. To ascertain any differences between protocolized weaning and usual care in terms of mortality, adverse events, intensive care unit length of stay and quality of life.Search methods:We searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 10, 2012), MEDLINE (1966 to October 2012), EMBASE (1988 to October 2012), CINAHL (1982 to October 2012), ISI Web of Science and LILACS. We identified unpublished data in the Web of Science (1990 to October 2012), ISI Conference Proceedings (1990 to October 2012) and Cambridge Scientific Abstracts (earliest to October 2012). We contacted first authors of studies included in the review to obtain further information on unpublished studies or work in progress. We searched reference lists of all identified studies and review papers for further relevant studies. We applied no language or publication restrictions.Selection criteriaWe included randomized controlled trials comparing protocolized weaning (professional-led or computer-driven) versus non-protocolized weaning practice conducted in children older than 28 days and younger than 18 years.Data collection and analysis:Two review authors independently scanned titles and abstracts identified by electronic searching. Three review authors retrieved and evaluated full-text versions of potentially relevant studies, independently extracted data and assessed risk of bias.Main results:We included three trials at low risk of bias with 321 children in the analysis. Protocolized weaning significantly reduced total ventilation time in the largest trial (260 children) by a mean of 32 hours (95% confidence interval (CI) 8 to 56; P = 0.01). Two other trials (30 and 31 children, respectively) reported non-significant reductions with a mean difference of -88 hours (95% CI -228 to 52; P = 0.2) and -24 hours (95% CI -10 to 58; P = 0.06). Protocolized weaning significantly reduced weaning time in these two smaller trials for a mean reduction of 106 hours (95% CI 28 to 184; P = 0.007) and 21 hours (95% CI 9 to 32; P < 0.001). These studies reported no significant effects for duration of mechanical ventilation before weaning, paediatric intensive care unit (PICU) and hospital length of stay, PICU mortality or adverse events.Authors' conclusions:Limited evidence suggests that weaning protocols reduce the duration of mechanical ventilation, but evidence is inadequate to show whether the achievement of shorter ventilation by protocolized weaning causes children benefit or harm.

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IntroductionAutomated weaning systems may improve adaptation of mechanical support for a patient’s ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation. Our objective was to compare mechanical ventilator weaning duration for critically ill adults and children when managed with automated systems versus non-automated strategies. Secondary objectives were to determine differences in duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), mortality, and adverse events.MethodsElectronic databases were searched to 30 September 2013 without language restrictions. We also searched conference proceedings; trial registration websites; and article reference lists. Two authors independently extracted data and assessed risk of bias. We combined data using random-effects modelling.ResultsWe identified 21 eligible trials totalling 1,676 participants. Pooled data from 16 trials indicated that automated systems reduced the geometric mean weaning duration by 30% (95% confidence interval (CI) 13% to 45%), with substantial heterogeneity (I2 = 87%, P <0.00001). Reduced weaning duration was found with mixed or medical ICU populations (42%, 95% CI 10% to 63%) and Smartcare/PS™ (28%, 95% CI 7% to 49%) but not with surgical populations or using other systems. Automated systems reduced ventilation duration with no heterogeneity (10%, 95% CI 3% to 16%) and ICU LOS (8%, 95% CI 0% to 15%). There was no strong evidence of effect on mortality, hospital LOS, reintubation, self-extubation and non-invasive ventilation following extubation. Automated systems reduced prolonged mechanical ventilation and tracheostomy. Overall quality of evidence was high.ConclusionsAutomated systems may reduce weaning and ventilation duration and ICU stay. Due to substantial trial heterogeneity an adequately powered, high quality, multi-centre randomized controlled trial is needed.