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Sample records for maximal respiratory pressures

  1. Maximal respiratory pressures and pulmonary function in male runners.

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    Cordain, L; Glisan, B J; Latin, R W; Tucker, A; Stager, J M

    1987-01-01

    To determine the effects of long term exercise on respiratory muscle strength, maximal inspiratory (Pl max) and expiratory (PE max) pressures, pulmonary volumes and capacities and anthropometric parameters were measured in a group of 101 male runners aged 16 to 58 years. The runners exhibited significantly (p less than 0.05) lower PE max (202 +/- 41 cm H2O and significantly greater residual lung volumes (RV) (2.08 +/- 0.49 L) than predicted values for normal subjects of similar height and age...

  2. Comparison of three protocols for measuring the maximal respiratory pressures

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    Isabela Maria B. Sclauser Pessoa

    Full Text Available Introduction To avoid the selection of submaximal efforts during the assessment of maximal inspiratory and expiratory pressures (MIP and MEP, some reproducibility criteria have been suggested. Criteria that stand out are those proposed by the American Thoracic Society (ATS and European Respiratory Society (ERS and by the Brazilian Thoracic Association (BTA. However, no studies were found that compared these criteria or assessed the combination of both protocols. Objectives To assess the pressure values selected and the number of maneuvers required to achieve maximum performance using the reproducibility criteria proposed by the ATS/ERS, the BTA and the present study. Materials and method 113 healthy subjects (43.04 ± 16.94 years from both genders were assessed according to the criteria proposed by the ATS/ERS, BTA and the present study. Descriptive statistics were used for analysis, followed by ANOVA for repeated measures and post hoc LSD or by Friedman test and post hoc Wilcoxon, according to the data distribution. Results The criterion proposed by the present study resulted in a significantly higher number of maneuvers (MIP and MEP – median and 25%-75% interquartile range: 5[5-6], 4[3-5] and 3[3-4] for the present study criterion, BTA and ATS/ERS, respectively; p < 0.01 and higher pressure values (MIP – mean and 95% confidence interval: 103[91.43-103.72], 100[97.19-108.83] and 97.6[94.06-105.95]; MEP: median and 25%-75% interquartile range: 124.2[101.4-165.9], 123.3[95.4-153.8] and 118.4[95.5-152.7]; p < 0.05. Conclusion The proposed criterion resulted in the selection of pressure values closer to the individual’s maximal capacity. This new criterion should be considered in future studies concerning MIP and MEP measurements.

  3. Lung volumes and maximal respiratory pressures in collegiate swimmers and runners.

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    Cordain, L; Tucker, A; Moon, D; Stager, J M

    1990-03-01

    To determine whether respiratory muscle strength is related to pulmonary volume differences in athletes and nonathletes, 11 intercollegiate female swimmers, 11 female cross-country runners, and two nonathletic control groups, matched to the athletes in height and age, were evaluated for pulmonary parameters including maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax). Swimmers exhibited larger (p less than .05) vital capacities (VC), residual lung volumes (RV), inspiratory capacities (IC), and functional residual capacities (FRC) than both the runners or the controls but no difference (p greater than .05) in either PImax or inspiratory flow (FIV 25%-75%). Timed expiratory volumes (FEV 0.5 and FEV 1.0) were significantly (p less than .05) lower in the swimmers than in the controls. These data suggest that an adaptational growth may be responsible, in part, for the augmented static lung volumes demonstrated in swimmers.

  4. Face mask spirometry and respiratory pressures in normal subjects.

    NARCIS (Netherlands)

    Wohlgemuth, M.; Kooi, E.L. van der; Hendriks, J.C.M.; Padberg, G.W.A.M.; Folgering, H.T.M.

    2003-01-01

    Spirometry and maximal respiratory pressures are pulmonary function parameters commonly used to evaluate respiratory function. Prediction values are available for conventional lung function devices using a standard tube or flanged type of mouthpiece connection. This equipment is not suitable for

  5. Does treadmill running performance, heart rate and breathing rate response during maximal graded exercise improve after volitional respiratory muscle training?

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    Radhakrishnan, K; Sharma, V K; Subramanian, S K

    2017-05-10

    Maximal physical exertion in sports usually causes fatigue in the exercising muscles, but not in the respiratory muscles due to triggering of the Respiratory muscle metabo-reflex, a sympathetic vasoconstrictor response leading to preferential increment in blood flow to respiratory muscles. 1 We planned to investigate whether a six week yogic pranayama based Volitional Respiratory Muscle Training (VRMT) can improve maximal Graded Exercise Treadmill Test (GXTT) performance in healthy adult recreational sportspersons. Consecutive, consenting healthy adult recreational sportspersons aged 20.56±2.49 years (n=30), volunteered to 'baseline recording' of resting heart rate (HR), blood pressure (BP), respiratory rate (RR), and Bruce ramp protocol maximal GXTT until volitional exhaustion providing total test time (TTT), derived VO2max, Metabolic Equivalent of Task (METs), HR and BP response during maximal GXTT and drop in recovery HR data. After six weeks of observation, they underwent 'pre-intervention recording' followed by supervised VRMT intervention for 6 weeks (30 minutes a day; 5 days a week) and then 'post-intervention recording'. Repeated measures ANOVA with pairwise t statistical comparison was used to analyse the data. After supervised VRMT, we observed significant decrease in their resting supine RR (prespiratory muscle aerobic capacity, attenuation of respiratory muscle metabo-reflex, increase in cardiac stroke volume and autonomic resetting towards parasympatho-dominance. Yogic Pranayama based VRMT can be used in sports conditioning programme of athletes to further improve their maximal exercise performance, and as part of rehabilitation training during return from injury.

  6. OPTIMUM LEVEL OF POSITIVE END-EXPIRATORY PRESSURE IN ACUTE RESPIRATORY DISTRESS SYNDROME CAUSED BY INFLUENZA A(H1NI)PDM09: BALANCE BETWEEN MAXIMAL END-EXPIRATORY VOLUME AND MINIMAL ALVEOLAR OVERDISTENSION.

    Science.gov (United States)

    Yaroshetskiym A I; Protsenko, D N; Boytsov, P V; Chentsov, V B; Nistratov, S L; Kudlyakov, O N; Solov'ev, V V; Banova, Zh I; Shkuratova, N V; Rezenov, N A; Gel'fand, B R

    2016-11-01

    to determine optimum level ofpositive end-expiratory pressure (PEEP) according to balance between maxi- mal end-expiratory lung volume (EEL V)(more than predicted) and minimal decrease in exhaled carbon dioxide volume (VCO) and then to develop the algorithm of gas exchange correction based on prognostic values of EEL K; alveolar recruitability, PA/FiO2, static compliance (C,,,) and VCO2. 27 mechanically ventilatedpatients with acute respiratory distress syndrome (ARDS) caused by influenza A (HINJ)pdm09 in Moscow Municipal Clinics ICU's from January to March 2016 were included in the trial. At the beginning of the study patients had the following characteristic: duration offlu symptoms 5 (3-10) days, p.0/FiO2 120 (70-50) mmHg. SOFA 7 (5-9), body mass index 30.1 (26.4-33.8) kg/m², static compliance of respiratory system 35 (30-40) ml/mbar: Under sedation and paralysis we measured EELV, C VCO and end-tidal carbon dioxide concentration (EtCO) (for CO₂ measurements we fixed short-term values after 2 min after PEEP level change) at PEEP 8, 11,13,15,18, 20 mbar consequently, and incase of good recruitability, at 22 and 24 mbar. After analyses of obtained data we determined PEEP value in which increase in EELV was maximal (more than predicted) and depression of VCO₂ was less than 20%, change in mean blood pressure and heart rate were both less than 20% (measured at PEEP 8 mbar). After that we set thus determined level of PEEP and didn't change it for 5 days. Comparision of predicted and measured EELV revealed two typical points of alveloar recruiment: the first at PEEP 11-15 mbar, the second at PEEP 20-22 mbar. EELV measured at PEEP 18 mbar appeared to be higher than predicted at PEEP 8 mbar by 400 ml (approx.), which was the sign of alveolar recruitment-1536 (1020-1845) ml vs 1955 (1360-2320) ml, p=0,001, Friedman test). we didn't found significant changes of VCO₂ when increased PEEP in the range from 8 to 15 mbar (p>0.05, Friedman test). PEEP increase from 15 to

  7. Reference Values for Maximal Inspiratory Pressure: A Systematic Review

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    Isabela MB Sclauser Pessoa

    2014-01-01

    Full Text Available BACKGROUND: Maximal inspiratory pressure (MIP is the most commonly used measure to evaluate inspiratory muscle strength. Normative values for MIP vary significantly among studies, which may reflect differences in participant demographics and technique of MIP measurement.

  8. Arteriovenous extracorporeal lung assist allows for maximization of oscillatory frequencies: a large-animal model of respiratory distress

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    Kranke Peter

    2008-11-01

    Full Text Available Abstract Background Although the minimization of the applied tidal volume (VT during high-frequency oscillatory ventilation (HFOV reduces the risk of alveolar shear stress, it can also result in insufficient CO2-elimination with severe respiratory acidosis. We hypothesized that in a model of acute respiratory distress (ARDS the application of high oscillatory frequencies requires the combination of HFOV with arteriovenous extracorporeal lung assist (av-ECLA in order to maintain or reestablish normocapnia. Methods After induction of ARDS in eight female pigs (56.5 ± 4.4 kg, a recruitment manoeuvre was performed and intratracheal mean airway pressure (mPaw was adjusted 3 cmH2O above the lower inflection point (Plow of the pressure-volume curve. All animals were ventilated with oscillatory frequencies ranging from 3–15 Hz. The pressure amplitude was fixed at 60 cmH2O. At each frequency gas exchange and hemodynamic measurements were obtained with a clamped and de-clamped av-ECLA. Whenever the av-ECLA was de-clamped, the oxygen sweep gas flow through the membrane lung was adjusted aiming at normocapnia. Results Lung recruitment and adjustment of the mPaw above Plow resulted in a significant improvement of oxygenation (p Conclusion In this animal model of ARDS, maximization of oscillatory frequencies with subsequent minimization of VT leads to hypercapnia that can only be reversed by adding av-ECLA. When combined with a recruitment strategy, these high frequencies do not impair oxygenation

  9. Relation between lowered colloid osmotic pressure, respiratory failure, and death.

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    Tonnesen, A S; Gabel, J C; McLeavey, C A

    1977-01-01

    Plasma colloid osmotic pressure was measured each day in 84 intensive care unit patients. Probit analysis demonstrated a direct relationship between colloid osmotic pressure (COP) and survival. The COP associated with a 50% survival rate was 15.0 torr. COP was higher in survivors than in nonsurvivors without respiratory failure and in patients who recovered from respiratory failure. We conclude that lowered COP is associated with an elevated mortality rate. However, the relationship to death is not explained by the relationship to respiratory failure.

  10. Validation of a protocol to evaluate maximal expiratory pressure using a pressure transducer and a signal conditioner

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    Viviane Soares

    2011-09-01

    Full Text Available The respiratory muscles can present fatigue and even chronic inability to generate force. So, reliable devices are necessary to their evaluation. The aim of this study is to evaluate the MEP (Maximal Expiratory Pressure values of individuals between 20 and 25 years old and to validate a protocol using a pressure transducer and a signal conditioner comparing it with the digital manometer. We evaluated the MEP of 10 participants. They remained seated and made six respiratory maneuvers from Total Lung Capacity (TLC to Residual Volume (RV. The results in the study showed no statistically significant differences when compared to values reported in the literature, and that the pressure transducer provides reliable values for MEP.Os músculos respiratórios podem apresentar fadiga e até mesmo a incapacidade crônica na geração de força, sendo necessários dispositivos confiáveis para sua avaliação. O objetivo deste estudo foi avaliar a pressão expiratória máxima (PeMáx de indivíduos entre 20 e 25 anos e validar um protocolo que utiliza um transdutor de pressão e um condicionador de sinais comparando-o com a manovacuometria. Foram avaliadas a PeMáx de 10 participantes. Estes permaneceram sentados e realizaram seis manobras respiratórias a partir da capacidade pulmonar total (CPT até o volume residual (VR. Os resultados do estudo não apresentaram diferenças estatisticamente significativas quando comparados com os valores de normalidade descritos na literatura e mostraram que o transdutor de pressão fornece valores confiáveis para Pe máx.

  11. A comparative meta-analysis of maximal aerobic metabolism of vertebrates: implications for respiratory and cardiovascular limits to gas exchange.

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    Hillman, Stanley S; Hancock, Thomas V; Hedrick, Michael S

    2013-02-01

    Maximal aerobic metabolic rates (MMR) in vertebrates are supported by increased conductive and diffusive fluxes of O(2) from the environment to the mitochondria necessitating concomitant increases in CO(2) efflux. A question that has received much attention has been which step, respiratory or cardiovascular, provides the principal rate limitation to gas flux at MMR? Limitation analyses have principally focused on O(2) fluxes, though the excess capacity of the lung for O(2) ventilation and diffusion remains unexplained except as a safety factor. Analyses of MMR normally rely upon allometry and temperature to define these factors, but cannot account for much of the variation and often have narrow phylogenetic breadth. The unique aspect of our comparative approach was to use an interclass meta-analysis to examine cardio-respiratory variables during the increase from resting metabolic rate to MMR among vertebrates from fish to mammals, independent of allometry and phylogeny. Common patterns at MMR indicate universal principles governing O(2) and CO(2) transport in vertebrate cardiovascular and respiratory systems, despite the varied modes of activities (swimming, running, flying), different cardio-respiratory architecture, and vastly different rates of metabolism (endothermy vs. ectothermy). Our meta-analysis supports previous studies indicating a cardiovascular limit to maximal O(2) transport and also implicates a respiratory system limit to maximal CO(2) efflux, especially in ectotherms. Thus, natural selection would operate on the respiratory system to enhance maximal CO(2) excretion and the cardiovascular system to enhance maximal O(2) uptake. This provides a possible evolutionary explanation for the conundrum of why the respiratory system appears functionally over-designed from an O(2) perspective, a unique insight from previous work focused solely on O(2) fluxes. The results suggest a common gas transport blueprint, or Bauplan, in the vertebrate clade.

  12. Effects of Increased Respiratory Resistance on Maximal O2 Uptake and Anaerobic Threshold during Incremental Exercise Tests

    OpenAIRE

    ÖZÇELİK, Oğuz

    2014-01-01

    This study was undertaken to assess whether maximal O2 uptake (VO2max) can be used as an index of measuring aerobic capacity under the condition of increased respiratory resistance. Seven male subjects performed two incremental exercise tests on a cycle ergometer on different days: one control (C) and one breathing through an 8 mm bore diameter respiratory resistance (R). Ventilatory and gas exchange responses were measured with a turbine volume transducer and mass spectrometry, and processed...

  13. Maximal oxygen consumption, respiratory volume and some related factors in fire-fighting personnel

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    Touraj Khazraee

    2017-01-01

    Full Text Available Background: Firefighters for difficult activities and rescue of damaged people must be in appropriate physical ability. Maximal oxygen capacity is an indicator for diagnosis of physical ability of workers. This study aimed to assess the cardiorespiratory system and its related factors in firefighters. Methods: This study was conducted on 110 firefighters from various stations. An self-administered questionnaire (respiratory disorders questionnaire, Tuxworth-Shahnavaz step test, and pulmonary function test was used to collection of required data. Average of humidity and temperature was 52% and 17°C, respectively. Background average noise levels were between 55 and 65 dB. Data were analyzed using SPSS software (version 19. Results: The mean age of the study participants was 32 ± 6.2 years. The means of forced vital capacity (FVC, forced expiratory volume in 1 s (FEV1, and FEV1/FVC were 92% ±9.4%, 87% ±9.2%, and 80% ±6.1%, respectively. The participants' mean VO2-max was 2.79 ± 0.29 L/min or 37.34 ± 4.27 ml/kg body weight per minute. The results revealed that weight has a direct association with vital capacity (VC, FVC, and peak expiratory flow. In addition, height was directly associated with VC, FVC, and VO2-max (P < 0.05. However, there was an inverse and significant association between height and FEV1/FVC (r = −0.23,P< 0.05. Height, weight, body mass index, and waist circumference were directly associated with VO2-max. Conclusions: The findings of this study showed that the amount of maximum oxygen consumption is close with the proposed range of this parameter among firefighters in other studies. Furthermore, the results of the study revealed that individuals had normal amounts of lung volume index. This issue can be attributed to the appropriate usage of respiratory masks.

  14. The pressure gradient in the human respiratory tract

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    Chovancová Michaela

    2014-03-01

    Full Text Available Respiratory airways cause resistance to air flow during inhalation and exhalation. The pressure gradient is necessary to transport the air from the mount (or nose to pulmonary alveoli. The knowledge of pressure gradient (i.e. respiratory airways resistance is also needed to solve the question of aerosol deposition in the human respiratory tract. The obtained data will be used as boundary conditions for CFD simulations of aerosol transport. Understanding of aerosol transport in the human lungs can help us to determine the health hazard of harmful particles. On the other hand it can be used to set the conditions for transport of medication to the desirable place. This article deals with the description of the mathematical equations defining the pressure gradient and resistance in the bronchial three and describes the geometry used in the calculation.

  15. Hyperventilation-induced respiratory alkalosis falls short of countering fatigue during repeated maximal isokinetic contractions.

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    Sakamoto, Akihiro; Naito, Hisashi; Chow, Chin Moi

    2015-07-01

    Hyperventilation, implemented during recovery of repeated maximal sprints, has been shown to attenuate performance decrement. This study evaluated the effects of hyperventilation, using strength exercises, on muscle torque output and EMG amplitude. Fifteen power-trained athletes underwent maximal isokinetic knee extensions consisting of 12 repetitions × 8 sets at 60°/s and 25 repetitions × 8 sets at 300°/s. The inter-set interval was 40 s for both speeds. For the control condition, subjects breathed spontaneously during the interval period. For the hyperventilation condition, subjects hyperventilated for 30 s before each exercise set (50 breaths/min, PETCO2: 20-25 mmHg). EMG was recorded from the vastus medialis and lateralis muscles to calculate the mean amplitude for each contraction. Hyperventilation increased blood pH by 0.065-0.081 and lowered PCO2 by 8.3-10.3 mmHg from the control values (P < 0.001). Peak torque declined with repetition and set numbers for both speeds (P < 0.001), but the declining patterns were similar between conditions. A significant, but small enhancement in peak torque was observed with hyperventilation at 60°/s during the initial repetition phase of the first (P = 0.032) and fourth sets (P = 0.040). EMG amplitude also declined with set number (P < 0.001) for both speeds and muscles, which was, however, not attenuated by hyperventilation. Despite a minor ergogenic effect in peak torque at 60°/s, hyperventilation was not effective in attenuating the decrement in torque output at 300°/s and decrement in EMG amplitude at both speeds during repeated sets of maximal isokinetic knee extensions.

  16. Model-based setting of inspiratory pressure and respiratory rate in pressure-controlled ventilation

    International Nuclear Information System (INIS)

    Schranz, C; Möller, K; Becher, T; Schädler, D; Weiler, N

    2014-01-01

    Mechanical ventilation carries the risk of ventilator-induced-lung-injury (VILI). To minimize the risk of VILI, ventilator settings should be adapted to the individual patient properties. Mathematical models of respiratory mechanics are able to capture the individual physiological condition and can be used to derive personalized ventilator settings. This paper presents model-based calculations of inspiration pressure (p I ), inspiration and expiration time (t I , t E ) in pressure-controlled ventilation (PCV) and a retrospective evaluation of its results in a group of mechanically ventilated patients. Incorporating the identified first order model of respiratory mechanics in the basic equation of alveolar ventilation yielded a nonlinear relation between ventilation parameters during PCV. Given this patient-specific relation, optimized settings in terms of minimal p I and adequate t E can be obtained. We then retrospectively analyzed data from 16 ICU patients with mixed pathologies, whose ventilation had been previously optimized by ICU physicians with the goal of minimization of inspiration pressure, and compared the algorithm's ‘optimized’ settings to the settings that had been chosen by the physicians. The presented algorithm visualizes the patient-specific relations between inspiration pressure and inspiration time. The algorithm's calculated results highly correlate to the physician's ventilation settings with r = 0.975 for the inspiration pressure, and r = 0.902 for the inspiration time. The nonlinear patient-specific relations of ventilation parameters become transparent and support the determination of individualized ventilator settings according to therapeutic goals. Thus, the algorithm is feasible for a variety of ventilated ICU patients and has the potential of improving lung-protective ventilation by minimizing inspiratory pressures and by helping to avoid the build-up of clinically significant intrinsic positive end

  17. Model-based setting of inspiratory pressure and respiratory rate in pressure-controlled ventilation.

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    Schranz, C; Becher, T; Schädler, D; Weiler, N; Möller, K

    2014-03-01

    Mechanical ventilation carries the risk of ventilator-induced-lung-injury (VILI). To minimize the risk of VILI, ventilator settings should be adapted to the individual patient properties. Mathematical models of respiratory mechanics are able to capture the individual physiological condition and can be used to derive personalized ventilator settings. This paper presents model-based calculations of inspiration pressure (pI), inspiration and expiration time (tI, tE) in pressure-controlled ventilation (PCV) and a retrospective evaluation of its results in a group of mechanically ventilated patients. Incorporating the identified first order model of respiratory mechanics in the basic equation of alveolar ventilation yielded a nonlinear relation between ventilation parameters during PCV. Given this patient-specific relation, optimized settings in terms of minimal pI and adequate tE can be obtained. We then retrospectively analyzed data from 16 ICU patients with mixed pathologies, whose ventilation had been previously optimized by ICU physicians with the goal of minimization of inspiration pressure, and compared the algorithm's 'optimized' settings to the settings that had been chosen by the physicians. The presented algorithm visualizes the patient-specific relations between inspiration pressure and inspiration time. The algorithm's calculated results highly correlate to the physician's ventilation settings with r = 0.975 for the inspiration pressure, and r = 0.902 for the inspiration time. The nonlinear patient-specific relations of ventilation parameters become transparent and support the determination of individualized ventilator settings according to therapeutic goals. Thus, the algorithm is feasible for a variety of ventilated ICU patients and has the potential of improving lung-protective ventilation by minimizing inspiratory pressures and by helping to avoid the build-up of clinically significant intrinsic positive end-expiratory pressure.

  18. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome.

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    Zhou, Yongfang; Jin, Xiaodong; Lv, Yinxia; Wang, Peng; Yang, Yunqing; Liang, Guopeng; Wang, Bo; Kang, Yan

    2017-11-01

    Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV). A total of 138 patients with ARDS who received mechanical ventilation for mechanical ventilation from enrollment to day 28. The secondary endpoints included oxygenation, P plat , respiratory system compliance, and patient outcomes. Compared with the LTV group, patients in the APRV group had a higher median number of ventilator-free days {19 [interquartile range (IQR) 8-22] vs. 2 (IQR 0-15); P mechanical ventilation and ICU stay.

  19. Pressure overload-induced mild cardiac hypertrophy reduces leftventricular transmural differences in mitochondrial respiratory chainactivity and increases oxidative stress

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    Michel eKINDO

    2012-08-01

    Full Text Available Objective: Increased mechanical stress and contractility characterizes normal left ventricular subendocardium (Endo but whether Endo mitochondrial respiratory chain complex activities is reduced as compared to subepicardium (Epi and whether pressure overload-induced left ventricular hypertrophy (LVH might modulate transmural gradients through increased reactive oxygen species (ROS production is unknown. Methods: LVH was induced by 6 weeks abdominal aortic banding and cardiac structure and function were determined with echocardiography and catheterization in sham-operated and LVH rats (n=10 for each group. Mitochondrial respiration rates, coupling, content and ROS production were measured in LV Endo and Epi, using saponin-permeabilised fibres, Amplex Red fluorescence and citrate synthase activity.Results: In sham, a transmural respiratory gradient was observed with decreases in endo maximal oxidative capacity (-36.7%, P<0.01 and complex IV activity (-57.4%, P<0.05. Mitochondrial hydrogen peroxide (H2O2 production was similar in both LV layers.Aortic banding induced mild LVH (+31.7% LV mass, associated with normal LV fractional shortening and end diastolic pressure. LVH reduced maximal oxidative capacity (-23.6 and -33.3%, increased mitochondrial H2O2 production (+86.9 and +73.1%, free radical leak (+27.2% and +36.3% and citrate synthase activity (+27.2% and +36.3% in Endo and Epi, respectively.Transmural mitochondrial respiratory chain complex IV activity was reduced in LVH (-57.4 vs –12.2%; P=0.02. Conclusions: Endo mitochondrial respiratory chain complexes activities are reduced compared to LV Epi. Mild LVH impairs mitochondrial oxidative capacity, increases oxidative stress and reduces transmural complex IV activity. Further studies will be helpful to determine whether reduced LV transmural gradient in mitochondrial respiration might be a new marker of a transition from uncomplicated toward complicated LVH.

  20. A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure

    OpenAIRE

    Guldager, Henrik; Nielsen, Soeren L; Carl, Peder; Soerensen, Mogens B

    1997-01-01

    Background: The aim of this study was to test the hypothesis that a new mode of ventilation (pressure-regulated volume control; PRVC) is associated with improvements in respiratory mechanics and outcome when compared with conventional volume control (VC) ventilation in patients with acute respiratory failure. We conducted a randomised, prospective, open, cross over trial on 44 patients with acute respiratory failure in the general intensive care unit of a university hospital. After a stabiliz...

  1. Determination of respiratory system compliance during pressure support ventilation by small variations of pressure support.

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    Becher, Tobias; Schädler, Dirk; Rostalski, Philipp; Zick, Günther; Frerichs, Inéz; Weiler, Norbert

    2017-09-22

    In mechanically ventilated patients, measurement of respiratory system compliance (C rs ) is of high clinical interest. Spontaneous breathing activity during pressure support ventilation (PSV) can impede the correct assessment of C rs and also alter the true C rs by inducing lung recruitment. We describe a method for determination of C rs during PSV and assess its accuracy in a study on 20 mechanically ventilated patients. To assess C rs during pressure support ventilation (C rs,PSV ), we performed repeated changes in pressure support level by ± 2 cmH 2 O. C rs,PSV was calculated from the volume change induced by these changes in pressure support level, taking into account the inspiration time and the expiratory time constant. As reference methods, we used C rs , measured during volume controlled ventilation (C rs,VCV ). In a post-hoc analysis, we assessed C rs during the last 20% of the volume-controlled inflation (C rs,VCV20 ). Values were compared by linear regression and Bland-Altman methods comparison. Comparing C rs,PSV to the reference value C rs,VCV , we found a coefficient of determination (r 2 ) of 0.90, but a relatively high bias of - 7 ml/cm H 2 O (95% limits of agreement - 16.7 to + 2.7 ml/cmH 2 O). Comparison with C rs,VCV20 resulted in a negligible bias (- 1.3 ml/cmH 2 O, 95% limits of agreement - 13.9 to + 11.3) and r 2 of 0.81. We conclude that the novel method provides an estimate of end-inspiratory C rs during PSV. Despite its limited accuracy, it might be useful for non-invasive monitoring of C rs in patients undergoing pressure support ventilation.

  2. The effect of Sub-maximal exercise-rehabilitation program on cardio-respiratory endurance indexes and oxygen pulse in patients with spastic cerebral palsy

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    M Izadi

    2006-05-01

    Full Text Available Background: Physical or cardio-respiratory fitness are of the best important physiological variables in children with cerebral palsy (CP, but the researches on exercise response of individuals with CP are limited. Our aim was to determine the effect of sub-maximal rehabilitation program (aerobic exercise on maximal oxygen uptake, oxygen pulse and cardio- respiratory physiological variables of children with moderate to severe spastic cerebral palsy diplegia and compare with able-bodied children. Methods: In a controlled clinical trial study, 15 children with diplegia spastic cerebral palsy, were recruited on a voluntarily basis (experimental group and 18 subjects without neurological impairments selected as control group. In CP group, aerobic exercise program performed on the average of exercise intensity (144 beat per minute of heart rate, 3 times a week for 3 months. The time of each exercise session was 20-25 minutes. Dependent variables were measured in before (pretest and after (post test of rehabilitation program through Mac Master Protocol on Tantories cycle ergometer in CP group and compared with the control group. Results: The oxygen pulse (VO2/HR during ergometery protocol was significantly lower in CP group than normal group (P<0.05. No significant statistical difference in maximal oxygen uptake (VO2 max was found between groups. The rehabilitation program leads to little increase of this variable in CP group. After sub-maximal exercise in pretest and post test, the heart rate of patient group was greater than control group, and aerobic exercise leads to significant decrease in heart rate in CP patients(P<0.05. Conclusion: The patients with spastic cerebral palsy, because of high muscle tone, severe spasticity and involuntarily movements have higher energy cost and lower aerobic fitness than normal people. The rehabilitation exercise program can improve physiological function of muscle and cardio-respiratory endurance in these

  3. Respiratory

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    The words "respiratory" and "respiration" refer to the lungs and breathing. ... Boron WF. Organization of the respiratory system. In: Boron WF, Boulpaep EL, eds. Medical Physiology . 3rd ed. Philadelphia, PA: Elsevier; 2017:chap 26.

  4. Respiratory sinus arrhythmia stabilizes mean arterial blood pressure at high-frequency interval in healthy humans.

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    Elstad, Maja; Walløe, Lars; Holme, Nathalie L A; Maes, Elke; Thoresen, Marianne

    2015-03-01

    Arterial blood pressure variations are an independent risk factor for end organ failure. Respiratory sinus arrhythmia (RSA) is a sign of a healthy cardiovascular system. However, whether RSA counteracts arterial blood pressure variations during the respiratory cycle remains controversial. We restricted normal RSA with non-invasive intermittent positive pressure ventilation (IPPV) to test the hypothesis that RSA normally functions to stabilize mean arterial blood pressure. Ten young volunteers were investigated during metronome-paced breathing and IPPV. Heart rate (ECG), mean arterial blood pressure and left stroke volume (finger arterial pressure curve) and right stroke volume (pulsed ultrasound Doppler) were recorded, while systemic and pulmonary blood flow were calculated beat-by-beat. Respiratory variations (high-frequency power, 0.15-0.40 Hz) in cardiovascular variables were estimated by spectral analysis. Phase angles and correlation were calculated by cross-spectral analysis. The magnitude of RSA was reduced from 4.9 bpm(2) (95% CI 3.0, 6.2) during metronome breathing to 2.8 bpm(2) (95% CI 1.1, 5.0) during IPPV (p = 0.03). Variations in mean arterial blood pressure were greater (2.3 mmHg(2) (95% CI 1.4, 3.9) during IPPV than during metronome breathing (1.0 mmHg(2) [95% CI 0.7, 1.3]) (p = 0.014). Respiratory variations in right and left stroke volumes were inversely related in the respiratory cycle during both metronome breathing and IPPV. RSA magnitude is lower and mean arterial blood pressure variability is greater during IPPV than during metronome breathing. We conclude that in healthy humans, RSA stabilizes mean arterial blood pressure at respiratory frequency.

  5. Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway.

    Directory of Open Access Journals (Sweden)

    Samantha Torres Grams

    Full Text Available Maximal Inspiratory Pressure (MIP is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway.This study aimed to compare the MIP values assessed by standard method (MIPsta and by unidirectional expiratory valve method (MIPuni in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated.This was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B at two moments (Tests 1 and 2 to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1] was used to determine intraobserver and interobserver reproducibility.The mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O than the mean values for MIPsta (-102.5 ± 23.9 cmH2O (p<0.001. Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91, and high correlation for Test 2 (ICC[2,1] = 0.88. The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86 and evaluator B (ICC[2,1] = 0.77.MIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway.

  6. Early predictors of success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

    Science.gov (United States)

    Bhattacharyya, D; Prasad, Bnbm; Tampi, P S; Ramprasad, R

    2011-10-01

    Non-invasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute hypercapnic respiratory failure. Patients with hypercapnic respiratory failure requiring ventilation therapy (respiratory rate [RR] of > 30 breaths per minutes, PaCO2 > 55 mmHg and arterial pH success group and these parameters continued to improve even after four and 24 hours of NIPPV treatment. Out of 24 (24%) patients who failed to respond, 13 (54%) needed endotracheal intubation within one hour. The failure group had higher baseline HR than the success group. Improvement in HR, RR, pH, and PCO2 one hour after putting the patient on NIPPV predicts success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

  7. Maximum respiratory pressure measuring system : calibration and evaluation of uncertainty

    NARCIS (Netherlands)

    Ferreira, J.L.; Pereira, N.C.; Oliveira Júnior, M.; Vasconcelos, F.H.; Parreira, V.F.; Tierra-Criollo, C.J.

    2010-01-01

    The objective of this paper is to present a methodology for the evaluation of uncertainties in the measurements results obtained during the calibration of a digital manovacuometer prototype (DM) with a load cell sensor pressure device incorporated. Calibration curves were obtained for both pressure

  8. Effects of a short-term personalized Intermittent Work Exercise Program (IWEP) on maximal cardio-respiratory function and endurance parameters among healthy young and older seniors.

    Science.gov (United States)

    Vogel, T; Leprêtre, P-M; Brechat, P-H; Lonsdorfer, E; Benetos, A; Kaltenbach, G; Lonsdorfer, J

    2011-12-01

    The aim of this study was to evaluate the efficiency of a short-term Intermittent Work Exercise Program (IWEP) among healthy elderly subjects. This longitudinal prospective study took place at the Strasbourg University Hospital geriatric department. One hundred and fifty older volunteers, previously determined as being free from cardiac and pulmonary disease, were separated into two age groups: the "young senior" (60.2 ± 3.1 yr) and the "older senior" groups (70.8 ± 5.2 yr). These groups were then subdivided by gender into the "young female senior", "young male senior" "older female senior" and "older male senior" groups. Before and after the IWEP, all subjects were asked to perform an incremental cycle exercise to obtain their first ventilatory threshold (VT1), maximal tolerated power (MTP), peak oxygen uptake (VO2peak) and maximal minute ventilation (MMV). The IWEP consisted of a 30-min cycling exercise which took place twice a week, and was divided into six 5-min stages consisting of 4 min at VT1 intensity and 1 min at 90% MTP. An assessment was made of the effects of the IWEP on maximal cardio-respiratory function (MTP, VO2peak, MMV) and endurance parameters (VT1, heart rate [HR] measured at pretraining VT1 and lactate concentrations at pre-training MTP). This short-term training program resulted in a significant increase of MTP (from 13.2% to 20.6%), VO2peak (from 8.9% to 16.6%) and MMV (from 11.1% to 21.8%) in all groups (pseniors" were not significantly different (p>0.05) from the "young seniors" pre-training values for the same parameters. The most striking finding in this study is that after only 9 weeks, our short-term "individually-tailored" IWEP significantly improved both maximal cardio-respiratory function and endurance parameters in healthy, previously untrained seniors.

  9. Effect of mechanical pressure-controlled ventilation in patients with disturbed respiratory function during laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Šurbatović Maja

    2013-01-01

    Full Text Available Background/Aim: Laparoscopic cholecystectomy is considered to be the gold standard for laparoscopic surgical procedures. In ASA III patients with concomitant respiratory diseases, however, creation of pneumoperitoneum and the position of patients during surgery exert additional negative effect on intraoperative respiratory function, thus making a higher challenge for the anesthesiologist than for the surgeon. The aim of this study was to compare the effect of intermittent positive pressure ventilation (IPPV and pressure controlled ventilation (PCV during general anesthesia on respiratory function in ASA III patients submitted to laparoscopic cholecystectomy. Methods. The study included 60 patients randomized into two groups depending on the mode of ventilation: IPPV or PCV. Respiratory volume (VT, peak inspiratory pressure (PIP, compliance (C, end-tidal CO2 pressure (PETCO2, oxygen saturation (SpO2, partial pressures of O2, CO2 (PaO2 and PaCO2 and pH of arterial blood were recorded within four time intervals. Results. There were no statistically significant differences in VT, SpO2, PaO2, PaCO2 and pH values neither within nor between the two groups. In time interval t1 there were no statistically significant differences in PIP, C, PETCO2 values between the IPPV and the PCV group. But, in the next three time intervals there was a difference in PIP, C, and PETCO2 values between the two groups which ranged from statistically significant to highly significant; PIP was lower, C and PETCO2 were higher in the PCV group. Conclusion. Pressure controlled ventilation better maintains stability regarding intraoperative ventilatory parameters in ASA III patients with concomitant respiratory diseases during laparoscopic cholecystectomy.

  10. Effects of recruitment maneuver and positive end-expiratory pressure on respiratory mechanics and transpulmonary pressure during laparoscopic surgery.

    Science.gov (United States)

    Cinnella, Gilda; Grasso, Salvatore; Spadaro, Savino; Rauseo, Michela; Mirabella, Lucia; Salatto, Potito; De Capraris, Antonella; Nappi, Luigi; Greco, Pantaleo; Dambrosio, Michele

    2013-01-01

    The authors tested the hypothesis that during laparoscopic surgery, Trendelenburg position and pneumoperitoneum may worsen chest wall elastance, concomitantly decreasing transpulmonary pressure, and that a protective ventilator strategy applied after pneumoperitoneum induction, by increasing transpulmonary pressure, would result in alveolar recruitment and improvement in respiratory mechanics and gas exchange. In 29 consecutive patients, a recruiting maneuver followed by positive end-expiratory pressure 5 cm H(2)O maintained until the end of surgery was applied after pneumoperitoneum induction. Respiratory mechanics, gas exchange, blood pressure, and cardiac index were measured before (T(BSL)) and after pneumoperitoneum with zero positive end-expiratory pressure (T(preOLS)), after recruitment with positive end-expiratory pressure (T(postOLS)), and after peritoneum desufflation with positive end-expiratory pressure (T(end)). Esophageal pressure was used for partitioning respiratory mechanics between lung and chest wall (data are mean ± SD): on T(preOLS), chest wall elastance (E(cw)) and elastance of the lung (E(L)) increased (8.2 ± 0.9 vs. 6.2 ± 1.2 cm H(2)O/L, respectively, on T(BSL); P = 0.00016; and 11.69 ± 1.68 vs. 9.61 ± 1.52 cm H(2)O/L on T(BSL); P = 0.0007). On T(postOLS), both chest wall elastance and E(L) decreased (5.2 ± 1.2 and 8.62 ± 1.03 cm H(2)O/L, respectively; P = 0.00015 vs. T(preOLS)), and Pao(2)/inspiratory oxygen fraction improved (491 ± 107 vs. 425 ± 97 on T(preOLS); P = 0.008) remaining stable thereafter. Recruited volume (the difference in lung volume for the same static airway pressure) was 194 ± 80 ml. Pplat(RS) remained stable while inspiratory transpulmonary pressure increased (11.65 + 1.37 cm H(2)O vs. 9.21 + 2.03 on T(preOLS); P = 0.007). All respiratory mechanics parameters remained stable after abdominal desufflation. Hemodynamic parameters remained stable throughout the study. In patients submitted to laparoscopic surgery in

  11. Servo-controlled pneumatic pressure oscillator for respiratory impedance measurements and high-frequency ventilation.

    Science.gov (United States)

    Kaczka, David W; Lutchen, Kenneth R

    2004-04-01

    The ability to provide forced oscillatory excitation of the respiratory system can be useful in mechanical impedance measurements as well as high frequency ventilation (HFV). Experimental systems currently used for generating forced oscillations are limited in their ability to provide high amplitude flows or maintain the respiratory system at a constant mean pressure during excitation. This paper presents the design and implementation of a pneumatic pressure oscillator based on a proportional solenoid valve. The device is capable of providing forced oscillatory excitations to the respiratory system over a bandwidth suitable for mechanical impedance measurements and HVF. It delivers high amplitude flows (> 1.4 l/s) and utilizes a servo-control mechanism to maintain a load at a fixed mean pressure during simultaneous oscillation. Under open-loop conditions, the device exhibited a static hysteresis of approximately 7%, while its dynamic magnitude and phase responses were flat out to 10 Hz. Broad-band measurement of total harmonic distortion was approximately 19%. Under closed-loop conditions, the oscillator was able to maintain a mechanical test load at both positive and negative mean pressures during oscillatory excitations from 0.1 to 10.0 Hz. Impedance of the test load agreed closely with theoretical predictions. We conclude that this servo-controlled oscillator can be a useful tool for respiratory impedance measurements as well as HFV.

  12. [Treatment of acute respiratory distress syndrome using pressure and volume controlled ventilation with lung protective strategy].

    Science.gov (United States)

    Ge, Ying; Wan, Yong; Wang, Da-qing; Su, Xiao-lin; Li, Jun-ying; Chen, Jing

    2004-07-01

    To investigate the significance and effect of pressure controlled ventilation (PCV) as well as volume controlled ventilation (VCV) by lung protective strategy on respiratory mechanics, blood gas analysis and hemodynamics in patients with acute respiratory distress syndrome (ARDS). Fifty patients with ARDS were randomly divided into PCV and VCV groups with permissive hypercapnia and open lung strategy. Changes in respiratory mechanics, blood gas analysis and hemodynamics were compared between two groups. Peak inspiration pressure (PIP) in PCV group was significantly lower than that in VCV group, while mean pressure of airway (MPaw) was significantly higher than that in VCV after 24 hours mechanical ventilation. After 24 hours mechanical ventilation, there were higher central venous pressure (CVP) and slower heart rate (HR) in two groups, CVP was significantly higher in VCV compared with PCV, and PCV group had slower HR than VCV group, the two groups had no differences in mean blood pressure (MBP) at various intervals. All patients showed no ventilator-induced lung injury. Arterial blood oxygenations were obviously improved in two groups after 24 hours mechanical ventilation, PCV group had better partial pressure of oxygen in artery (PaO2) than VCV group. Both PCV and VCV can improve arterial blood oxygenations, prevent ventilator-induced lung injury, and have less disturbance in hemodynamic parameters. PCV with lung protective ventilatory strategy should be early use for patients with ARDS.

  13. Quantas medidas de pressões respiratórias são necessárias para se obterem medidas máximas em pacientes com tetraplegia? ¿Cuántas maniobras son necesarias para llegar a las presiones máximas en pacientes con tetraplejía? How many maneuvers of respiratory pressures are required to obtain maximal values in patients with quadriplegia?

    Directory of Open Access Journals (Sweden)

    Ada Clarice Gastaldi

    2010-06-01

    Full Text Available INTRODUÇÃO: pressões inspiratórias (PImax ou expiratórias (PEmax máximas constituem um método simples e não-invasivo para avaliação da força de músculos respiratórios e auxiliam na identificação de fraqueza dos músculos respiratórios, presente em diversas doenças e situações clínicas, como a tetraplegia. OBJETIVO: avaliar o número de manobras necessárias para atingir as pressões máximas em pacientes com tetraplegia. MÉTODOS: oito pacientes com tetraplegia (sete homens, média de idade de 37,8±11,96 anos, com diagnóstico de lesão raquimedular cervical completa realizaram 10 medidas de PImax e PEmax nas posições sentada e deitada, totalizando 320 medidas. Os dados foram comparados pelo teste de Wilcoxon (pINTRODUCCIÓN: las presiones inspiratorias (PImax y espiratorias (PEmax máximas constituyen un método simple y no invasivo para evaluar la fuerza de los músculos respiratorios, y ayudan a identificar la debilidad de los músculos respiratorios presente en diferentes enfermedades y situaciones clínicas, como la tetraplejía. OBJETIVO: evaluar el número de maniobras necesarias para llegar a las presiones máximas en pacientes con tetraplejía. MÉTODOS: fueron incluidos ocho pacientes con tetraplejía (siete hombres, con edad media de 37,8±11,96 años y diagnóstico de lesión cervical raquis medular completa, a lo que se le realizaron 10 mediciones de PImax y PEmax en posición sentado y acostado, totalizando 320 mediciones. Los datos fueron comparados por el test de Wilcoxon (pINTRODUCTION: maximum inspiratory (IPmax and expiratory (EPmax pressures constitute a simple noninvasive method for evaluation of respiratory muscle strength which helps in the identification of muscle weakness usually present in several diseases and clinical situations, such as quadriplegia. OBJECTIVE: to assess the number of maneuvers needed to achieve maximum pressures in patients with quadriplegia. METHODS: eight quadriplegic

  14. Regional respiratory inflation and deflation pressure-volume curves determined by electrical impedance tomography.

    Science.gov (United States)

    Frerichs, I; Dargaville, P A; Rimensberger, P C

    2013-06-01

    Measurement of regional lung volume changes during a quasi-static pressure-volume (PV) manoeuvre using electrical impedance tomography (EIT) could be used to assess regional respiratory system mechanics and to determine optimal ventilator settings in individual patients. Using this approach, we studied regional respiratory system mechanics in healthy and lung-injured animals, before and after surfactant administration during inflation and deflation PV manoeuvres. The comparison of the EIT-derived regional PV curves in ventral, middle and dorsal regions of the right and left lungs showed not only different amounts of hysteresis in these regions but also marked differences among different landmark pressures calculated on the inflation and deflation limbs of the curves. Regional pressures at maximum compliance as well as the lower and upper pressures of maximum compliance change differed between the inflation and deflation and increased from ventral to dorsal regions in all lung conditions. All these pressure values increased in the injured and decreased in the surfactant treated lungs. Examination of regional respiratory system mechanics using EIT enables the assessment of spatial and temporal heterogeneities in the ventilation distribution. Characteristic landmarks on the inflation and especially on the deflation limb of regional PV curves may become useful measures for guiding mechanical ventilation.

  15. A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure

    Science.gov (United States)

    Guldager, Henrik; Nielsen, Soeren L; Carl, Peder; Soerensen, Mogens B

    1997-01-01

    Background: The aim of this study was to test the hypothesis that a new mode of ventilation (pressure-regulated volume control; PRVC) is associated with improvements in respiratory mechanics and outcome when compared with conventional volume control (VC) ventilation in patients with acute respiratory failure. We conducted a randomised, prospective, open, cross over trial on 44 patients with acute respiratory failure in the general intensive care unit of a university hospital. After a stabilization period of 8 h, a cross over trial of 2 × 2 h was conducted. Apart from the PRVC/VC mode, ventilator settings were comparable. The following parameters were recorded for each patient: days on ventilator, failure in the assigned mode of ventilation (peak inspiratory pressure > 50 cmH2O) and survival. Results: In the crossover trial, peak inspiratory pressure was significantly lower using PRVC than with VC (20 cmH2O vs 24 cmH2O, P < 0.0001). No other statistically significant differences were found. Conclusions: Peak inspiratory pressure was significantly lower during PRVC ventilation than during VC ventilation, and thus PRVC may be superior to VC in certain patients. However, in this small group of patients, we could not demonstrate that PRVC improved outcome. PMID:11056699

  16. The Role of Continuous Positive Airway Pressure Therapy in the Management of Respiratory Distress in Extremely Premature Infants

    OpenAIRE

    Sekar, Kris

    2006-01-01

    The use of mechanical ventilation for the treatment of respiratory distress syndrome (RDS) in low birth weight infants may cause barotrauma, volutrauma, and chronic lung disease. Different continuous positive airway pressure (CPAP) delivery systems exist, each with its own practical and clinical advantages and disadvantages. CPAP can be used as either a primary or an adjunctive respiratory support for RDS. Research demonstrates that CPAP decreases the incidence of respiratory failure after ex...

  17. Understanding the use of continuous oscillating positive airway pressure (bubble CPAP) to treat neonatal respiratory disease: an engineering approach.

    Science.gov (United States)

    Manilal-Reddy, P I; Al-Jumaily, A M

    2009-01-01

    A continuous oscillatory positive airway pressure with pressure oscillations incidental to the mean airway pressure (bubble CPAP) is defined as a modified form of traditional continuous positive airway pressure (CPAP) delivery where pressure oscillations in addition to CPAP are administered to neonates with lung diseases. The mechanical effect of the pressure oscillations on lung performance is investigated by formulating mathematical models of a typical bubble CPAP device and a simple representation of a neonatal respiratory system. Preliminary results of the respiratory system's mechanical response suggest that bubble CPAP may improve lung performance by minimizing the respiratory system impedance and that the resonant frequency of the respiratory system may be a controlling factor. Additional steps in terms of clinical trials and a more complex respiratory system model are required to gain a deeper insight into the mechanical receptiveness of the respiratory system to pressure oscillations. However, the current results are promising in that they offer a deeper insight into the trends of variations that can be expected in future extended models as well as the model philosophies that need to be adopted to produce results that are compatible with experimental verification.

  18. [Management of patients receiving home respiratory care with tracheostomy and positive-pressure ventilation].

    Science.gov (United States)

    Aoki, Masashi

    2013-01-01

    On March 11, 2011, the Great East Japan Earthquake occurred and a massive tsunami hit the northeastern coast of Japan. In Miyagi prefecture in Tokoku district, 49 patients with amyotrophic lateral sclerosis were supported by home respiratory care with tracheostomy and positive-pressure ventilation at that time. Among them, two patients were died in the tsunami and 25 patients were forced to evacuate to hospitals. We should hurry to submit a guideline for medical transportation for patients with neuromuscular diseases requiring artificial ventilation. We also should research the disaster medicine in the field of neurology.

  19. Respiratory Pattern and Tidal Volumes Differ for Pressure Support and Volume-assured Pressure Support in Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Nicholson, Trevor T; Smith, Sean B; Siddique, Teepu; Sufit, Robert; Ajroud-Driss, Senda; Coleman, John M; Wolfe, Lisa F

    2017-07-01

    Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease resulting in respiratory failure and death. Use of noninvasive ventilation (NIV) improves survival. However, use of volume-assured pressure support (VAPS) has not been extensively studied in ALS. To explore the clinical usefulness of a detailed evaluation of device-recorded NIV data in the management of chronic respiratory failure in ALS, and to determine whether there are differences in efficacy between patients using VAPS or PS. We performed a retrospective chart review of 271 patients with ALS using either PS or VAPS, along with an evaluation of device-recorded data to explore differences in attainment of goal tidal volumes (Vt) and ratio of respiratory rate to tidal volume (f/Vt), in addition to triggering and cycling ability. Two hundred and fifteen patients were using PS, while 56 were using VAPS. There were no significant differences in demographic data, symptoms, pulmonary function, or patient compliance. Compared with VAPS, achieved Vt was significantly lower for PS while f/Vt was significantly higher. Percent spontaneous triggering was relatively preserved in both cohorts, whereas percent spontaneous cycling was considerably decreased in both. Furthermore, there was no association found between spontaneous triggering or cycling, and pulmonary function, indicating the presence of low spontaneous breath cycling or triggering ability is difficult to predict. Examination of device data for exhaled tidal volumes and f/Vt may be of use in evaluating efficacy of NIV in ALS. VAPS provides more reliable goal Vt than does PS, and is associated with decreased f/Vt. Spontaneous cycling is decreased in ALS despite preservation of triggering ability. Although a set backup rate may address decreased triggering, perhaps more importantly, setting a sufficient fixed inspiratory time would address the issue of decreased cycling.

  20. SU-E-J-190: Development of Abdominal Compression & Respiratory Guiding System Using Gas Pressure Sensor

    International Nuclear Information System (INIS)

    Kim, T; Kim, D; Kang, S; Cho, M; Kim, K; Shin, D; Suh, T; Kim, S

    2015-01-01

    Purpose: Abdominal compression is known to be effective but, often makes external-marker-based monitoring of breathing motion not feasible. In this study, we developed and evaluated a system that enables both abdominal compression and monitoring of residual abdominal motion simultaneously. The system can also provide visual-biofeedback capability. Methods: The system developed consists of a compression belt, an abdominal motion monitoring sensor (gas pressure sensor) and a visual biofeedback device. The compression belt was designed to be able to compress the frontal side of the abdomen. The pressure level of the belt is controlled by air volume and monitored in real time using the gas pressure sensor. The system displays not only the real-time monitoring curve but also a guiding respiration model (e.g., a breath hold or shallow breathing curve) simultaneously on the head mounted display to help patients keep their breathing pattern as consistent as possible. Three healthy volunteers were enrolled in this pilot study and respiratory signals (pressure variations) were obtained both with and without effective abdominal compression to investigate the feasibility of the developed system. Two guidance patterns, breath hold and shallow breathing, were tested. Results: All volunteers showed smaller abdominal motion with compression (about 40% amplitude reduction compared to without compression). However, the system was able to monitor residual abdominal motion for all volunteers. Even under abdominal compression, in addition, it was possible to make the subjects successfully follow the guide patterns using the visual biofeedback system. Conclusion: The developed abdominal compression & respiratory guiding system was feasible for residual abdominal motion management. It is considered that the system can be used for a respiratory motion involved radiation therapy while maintaining the merit of abdominal compression. This work was supported by the Radiation Technology R

  1. SU-E-J-190: Development of Abdominal Compression & Respiratory Guiding System Using Gas Pressure Sensor

    Energy Technology Data Exchange (ETDEWEB)

    Kim, T; Kim, D; Kang, S; Cho, M; Kim, K; Shin, D; Suh, T [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of); Kim, S [Virginia Commonwealth University, Richmond, VA (United States)

    2015-06-15

    Purpose: Abdominal compression is known to be effective but, often makes external-marker-based monitoring of breathing motion not feasible. In this study, we developed and evaluated a system that enables both abdominal compression and monitoring of residual abdominal motion simultaneously. The system can also provide visual-biofeedback capability. Methods: The system developed consists of a compression belt, an abdominal motion monitoring sensor (gas pressure sensor) and a visual biofeedback device. The compression belt was designed to be able to compress the frontal side of the abdomen. The pressure level of the belt is controlled by air volume and monitored in real time using the gas pressure sensor. The system displays not only the real-time monitoring curve but also a guiding respiration model (e.g., a breath hold or shallow breathing curve) simultaneously on the head mounted display to help patients keep their breathing pattern as consistent as possible. Three healthy volunteers were enrolled in this pilot study and respiratory signals (pressure variations) were obtained both with and without effective abdominal compression to investigate the feasibility of the developed system. Two guidance patterns, breath hold and shallow breathing, were tested. Results: All volunteers showed smaller abdominal motion with compression (about 40% amplitude reduction compared to without compression). However, the system was able to monitor residual abdominal motion for all volunteers. Even under abdominal compression, in addition, it was possible to make the subjects successfully follow the guide patterns using the visual biofeedback system. Conclusion: The developed abdominal compression & respiratory guiding system was feasible for residual abdominal motion management. It is considered that the system can be used for a respiratory motion involved radiation therapy while maintaining the merit of abdominal compression. This work was supported by the Radiation Technology R

  2. Technical and dosimetric aspects of respiratory gating using a pressure-sensor motion monitoring system

    International Nuclear Information System (INIS)

    Li, X. Allen; Stepaniak, Christopher; Gore, Elizabeth

    2006-01-01

    This work introduces a gating technique that uses 4DCT to determine gating parameters and to plan gated treatment, and employs a Siemens linear accelerator to deliver the gated treatment. Because of technology incompatibility, the 4DCT scanner (LightSpeed, GE) and the Siemens accelerator require two different motion-monitoring systems. The motion monitoring system (AZ-773V, Anzai Med.) used for the gated delivery utilizes a pressure sensor to detect the external respiratory motion (pressure change) in real time. Another system (RPM, Varian) used for the 4DCT scanner (LightSpeed, GE) is based on an infrared camera to detect motion of external markers. These two motion monitoring systems (RPM and Anzai systems) were found to correlate well with each other. The depth doses and profile measured for gated delivery (with a duty cycle of 25% or 50%) were found to agree within 1.0% with those measured for ungated delivery, indicating that gating did not significantly alter beam characteristics. The measurement verified also that the MU linearity and beam output remained unchanged (within 0.3%). A practical method of using 4DCT to plan a gated treatment was developed. The duty cycle for either phase or amplitude gating can be determined based on 4DCT with consideration of set-up error and delivery efficiency. The close-loop measurement involving the entire gating process (imaging, planning, and delivery) showed that the measured isodose distributions agreed with those intended, validating the accuracy and reliability of the gating technique. Based these observations, we conclude that the gating technique introduced in this work, integrating Siemens linear accelerator and Anzai pressure sensor device with GE/Varian RPM 4DCT, is reliable and effective, and it can be used clinically to account for respiratory motion during radiation therapy

  3. Maximum inspiratory pressure as a clinically meaningful trial endpoint for neuromuscular diseases: A comprehensive review of the literature

    NARCIS (Netherlands)

    B. Schoser; Fong, E. (Edward); Geberhiwot, T. (Tarekegn); Hughes, D. (Derralynn); Kissel, J.T. (John T.); Madathil, S.C. (Shyam C.); Orlikowski, D. (David); Polkey, M.I. (Michael I.); M. Roberts (Mark); H.A.W.M. Tiddens (Harm); Young, P. (Peter)

    2017-01-01

    textabstractRespiratory muscle strength is a proven predictor of long-term outcome of neuromuscular disease (NMD), including amyotrophic lateral sclerosis, Duchenne muscular dystrophy, and spinal muscular atrophy. Maximal inspiratory pressure (MIP), a sensitive measure of respiratory muscle

  4. Respiratory complications associated with ketamine anesthesia for ophthalmic procedures following intraocular pressure measurement in children

    Directory of Open Access Journals (Sweden)

    Lei Wu

    2014-01-01

    Full Text Available Background: We compared respiratory complications (RCs in children who received intramuscular (IM versus intravenous (IV or no ketamine for intraocular pressure (IOP measurement to test our observation that IM ketamine is associated with higher incidence of RCs. Materials and Methods: We analyzed 149 eye examinations under anesthesia with ketamine in 27 patients and 263 non-ketamine examinations under anesthesia in 81 patients using a mixed effects logistic regression model. Results: IM ketamine was strongly associated with increased odds of RCs compared to no ketamine (odds ratio (OR: 20.23, P < 0.0001 and to IV ketamine (OR: 6.78, P = 0.02, as were higher American Society of Anesthesiologists (ASA classification (OR: 2.60, P = 0.04, and the use of volatile agents (OR: 3.32, P = 0.02. Conclusion: Further studies should be conducted to confirm our observation of increased RCs with IM ketamine.

  5. Respiratory training during rehabilitation of acute organic fluorine-poisoned patients treated by non-invasive positive pressure ventilation.

    Science.gov (United States)

    Liu, L; Liu, D Z; Wang, Q P; Zhu, Z L; Li, H M; Lu, X Y

    2017-01-01

    This paper aimed to analyze the effects of respiratory training on pulmonary function during the rehabilitation period for acute organic fluorine-poisoned patients treated by non-invasive positive pressure ventilation (NIPPV). Sixty-two acute organic fluorine-poisoned patients admitted to the Xinxiang Central Hospital, Xinxiang City, China, from May 2012 to March 2016 were selected and randomly divided into an observation group and a control group, with 31 cases in each. Both groups received NIPPV. The patients in the control group exercised daily, while the patients in the observation group received contracting lips-abdominal breathing training. The therapeutic effects, pulmonary ventilation function, serum levels of α-antitrypsin1 (α-AT1), surfactant protein D (SP-D), neutrophil elastase (NE), transforming growth factor beta 1 (TGF-β1), and quality of life were analyzed and compared between the two groups both before and after the administration of treatment. The total effective rate of the observation group was 93.55%, which was significantly higher when compared with the control group (74.19%) (P less than 0.05). The levels of forced expiratory volume in one second (FEV1), FEV1/FVC ratio, vital capacity (VC), carbon monoxide diffusion capacity (DLco), and maximal voluntary ventilation (MVV) of the observation group were better when compared with the control group and had statistical significance (P less than 0.05). Before treatment, the serum levels of α-AT1, SP-D, NE, and TGF-β1, and quality of life had no statistical significance in either group (P>0.05); after treatment, these indexes and the quality of life for the observation group were significantly higher when compared with the control group, with statistical significance (P less than 0.05). The respiratory training in acute organic fluorine-poisoned patients treated by NIPPV can improve the serum indexes, dilute toxicity, and recover pulmonary function, which play key roles in improving the

  6. BreathSens: A Continuous On-Bed Respiratory Monitoring System With Torso Localization Using an Unobtrusive Pressure Sensing Array.

    Science.gov (United States)

    Liu, Jason J; Huang, Ming-Chun; Xu, Wenyao; Zhang, Xiaoyi; Stevens, Luke; Alshurafa, Nabil; Sarrafzadeh, Majid

    2015-09-01

    The ability to continuously monitor respiration rates of patients in homecare or in clinics is an important goal. Past research showed that monitoring patient breathing can lower the associated mortality rates for long-term bedridden patients. Nowadays, in-bed sensors consisting of pressure sensitive arrays are unobtrusive and are suitable for deployment in a wide range of settings. Such systems aim to extract respiratory signals from time-series pressure sequences. However, variance of movements, such as unpredictable extremities activities, affect the quality of the extracted respiratory signals. BreathSens, a high-density pressure sensing system made of e-Textile, profiles the underbody pressure distribution and localizes torso area based on the high-resolution pressure images. With a robust bodyparts localization algorithm, respiratory signals extracted from the localized torso area are insensitive to arbitrary extremities movements. In a study of 12 subjects, BreathSens demonstrated its respiratory monitoring capability with variations of sleep postures, locations, and commonly tilted clinical bed conditions.

  7. Extubation success in premature infants with respiratory distress syndrome treated with bi-level nasal continuous positive airway pressure versus nasal intermittent positive pressure ventilation.

    Science.gov (United States)

    Thomas, Patricia E; LeFlore, Judy

    2013-01-01

    Infants born prematurely with respiratory distress syndrome are at high risk for complications from mechanical ventilation. Strategies are needed to minimize their days on the ventilator. The purpose of this study was to compare extubation success rates in infants treated with 2 different types of continuous positive airway pressure devices. A retrospective cohort study design was used. Data were retrieved from electronic medical records for patients in a large, metropolitan, level III neonatal intensive care unit. A sample of 194 premature infants with respiratory distress syndrome was selected, 124 of whom were treated with nasal intermittent positive pressure ventilation and 70 with bi-level variable flow nasal continuous positive airway pressure (bi-level nasal continuous positive airway pressure). Infants in both groups had high extubation success rates (79% of nasal intermittent positive pressure ventilation group and 77% of bi-level nasal continuous positive airway pressure group). Although infants in the bi-level nasal continuous positive airway pressure group were extubated sooner, there was no difference in duration of oxygen therapy between the 2 groups. Promoting early extubation and extubation success is a vital strategy to reduce complications of mechanical ventilation that adversely affect premature infants with respiratory distress syndrome.

  8. Continuous positive airway pressure (CPAP) to treat respiratory distress in newborns in low- and middle-income countries.

    Science.gov (United States)

    Dewez, Juan Emmanuel; van den Broek, Nynke

    2017-01-01

    Severe respiratory distress is a serious complication common to the three major causes of neonatal mortality and morbidity (prematurity, intra-partum-related hypoxia and infections). In low- and middle-income countries (LMICs), 20% of babies presenting with severe respiratory distress die.Continuous positive airway pressure (CPAP), is an effective intervention for respiratory distress in newborns and widely used in high-income countries. Following the development of simple, safe and relatively inexpensive CPAP devices, there is potential for large-scale implementation in the developing world.In this article, we describe existing CPAP systems and present a review of the current literature examining the effectiveness of CPAP compared to standard care (oxygen) in newborns with respiratory distress. We also discuss the evidence gap which needs to be addressed prior to its integration into health systems in LMICs. © The Author(s) 2016.

  9. Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography.

    Science.gov (United States)

    Garcia-Montilla, Romel; Imam, Faryal; Miao, Mi; Stinson, Kathryn; Khan, Akram; Heitner, Stephen

    2017-06-01

    Right ventricular (RV) systolic dysfunction is common in acute respiratory distress syndrome (ARDS). While preload optimization is crucial in its management, dynamic fluid responsiveness indices lack reliability, and there is no consensus on target central venous pressure (CVP). We analyzed the utility of RV free wall longitudinal strain (RVFWS) in the estimation of optimal RV filling pressure in ARDS. A retrospective cross-sectional analysis of clinical data and echocardiograms of patients with ARDS was performed. Tricuspid annular plane systolic excursion (TAPSE), tricuspid peak systolic velocity (S'), RV fractional area change (RVFAC), RVFWS, CVP, systolic pulmonary artery pressure (SPAP), and left ventricular ejection fraction (LVEF) were measured. Fifty-one patients with moderate-severe ARDS were included. There were inverse correlations between CVP and TAPSE, S', RVFAC, RVFWS, and LVEF. The most significant was with RVFWS (r:.74, R 2 :.55, P:.00001). Direct correlations with creatinine and lactate were noted. Receiver operating characteristic analysis showed that RVFWS -21% (normal reference value) was associated with CVP: 13 mm Hg (AUC: 0.92, 95% CI: 0.83-1.00). Regression model analysis of CVP, and RVFWS interactions established an RVFWS range from -18% to -24%. RVFWS -24% corresponded to CVP: 11 mm Hg and RVFWS -18% to CVP: 15 mm Hg. Beyond a CVP of 15 mm Hg, biventricular systolic dysfunction rapidly ensues. Our data are the first to show that an RV filling pressure of 13±2 mm Hg-as by CVP-correlates with optimal RV mechanics as evaluated by strain echocardiography in patients with moderate-severe ARDS. © 2017, Wiley Periodicals, Inc.

  10. Update: Non-Invasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to COPD.

    Science.gov (United States)

    Altintas, Nejat

    2016-01-01

    Long-term non-invasive positive pressure ventilation (NPPV) has widely been accepted to treat chronic hypercapnic respiratory failure arising from different etiologies. Although the survival benefits provided by long-term NPPV in individuals with restrictive thoracic disorders or stable, slowly-progressing neuromuscular disorders are overwhelming, the benefits provided by long-term NPPV in patients with chronic obstructive pulmonary disease (COPD) remain under question, due to a lack of convincing evidence in the literature. In addition, long-term NPPV reportedly failed in the classic trials to improve important physiological parameters such as arterial blood gases, which might serve as an explanation as to why long-term NPPV has not been shown to substantially impact on survival. However, high intensity NPPV (HI-NPPV) using controlled NPPV with the highest possible inspiratory pressures tolerated by the patient has recently been described as a new and promising approach that is well-tolerated and is also capable of improving important physiological parameters such as arterial blood gases and lung function. This clearly contrasts with the conventional approach of low-intensity NPPV (LI-NPPV) that uses considerably lower inspiratory pressures with assisted forms of NPPV. Importantly, HI-NPPV was very recently shown to be superior to LI-NPPV in terms of improved overnight blood gases, and was also better tolerated than LI-NPPV. Furthermore, HI-NPPV, but not LI-NPPV, improved dyspnea, lung function and disease-specific aspects of health-related quality of life. A recent study showed that long-term treatment with NPPV with increased ventilatory pressures that reduced hypercapnia was associated with significant and sustained improvements in overall mortality. Thus, long-term NPPV seems to offer important benefits in this patient group, but the treatment success might be dependent on effective ventilatory strategies.

  11. Current issues in the respiratory care of patients with amyotrophic lateral sclerosis

    Directory of Open Access Journals (Sweden)

    Marco Orsini

    2015-10-01

    Full Text Available Amyotrophic lateral sclerosis is a progressive neuromuscular disease, resulting in respiratory muscle weakness, reduced pulmonary volumes, ineffective cough, secretion retention, and respiratory failure. Measures as vital capacity, maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressure, cough peak flow and pulse oximetry are recommended to monitor the respiratory function. The patients should be followed up by a multidisciplinary team, focused in improving the quality of life and deal with the respiratory symptoms. The respiratory care approach includes airway clearance techniques, mechanically assisted cough and noninvasive mechanical ventilation. Vaccination and respiratory pharmacological support are also recommended. To date, there is no enough evidence supporting the inspiratory muscle training and diaphragmatic pacing.

  12. Prevention of Medical Device-Related Pressure Injuries Associated With Respiratory Equipment Use in a Critical Care Unit: A Quality Improvement Project.

    Science.gov (United States)

    Padula, Cynthia A; Paradis, Heidi; Goodwin, Robert; Lynch, Judith; Hegerich-Bartula, Deborah

    Medical devices have been identified as an extrinsic risk factor for development of pressure injuries, with as many as 30% to 70% of medical device-related pressure injuries resulting from respiratory equipment. This article describes a quality improvement project undertaken to reduce the occurrence of respiratory device-related pressure injuries in a critically care unit. Multiple actions were implemented to achieve this goal. Respiratory therapists were trained to document occurrences on a daily basis, and apparent cause analyses were conducted on each occurrence. An interdisciplinary team conducted biweekly rounds on patients with respiratory devices and consulted other professionals as indicated. Nurses and respiratory therapists attended an evidence-based, collaborative, educational offering and completed a measure of team functioning before the program and at the end of the study period. The occurrence rates of respiratory device-related pressure injuries were reduced over the project period, and these changes were sustained over the subsequent 12 months.

  13. Negative-pressure in treatment of persistent post-traumatic subcutaneous emphysema with respiratory failure: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Jakov Mihanović

    2018-02-01

    Full Text Available Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Since the first report of negative pressure wound therapy for the treatment of severe subcutaneous emphysema in 2009, only few publications on use of commercially available sets were published. We report on patient injured in a motor vehicle accident who had serial rib fractures and bilateral pneumothorax managed initially in another hospital. Due to respiratory deterioration, haemodynamic instability and renal failure patient was transferred to our Intensive Care Unit. Massive and persistent subcutaneous emphysema despite adequate thoracic drainage with respiratory deterioration and potentially injurious mechanical ventilation with high airway pressures was the indication for active surgical treatment. Negative-pressure wound therapy dressing was applied on typical blowhole incisions which resulted in swift emphysema regression and respiratory improvement. Negative pressure wound therapy for decompression of severe subcutaneous emphysema represents simple, effective and relatively unknown technique that deserves wider attention.

  14. Classifying Acute Respiratory Distress Syndrome Severity: Correcting the Arterial Oxygen Partial Pressure to Fractional Inspired Oxygen at Altitude.

    Science.gov (United States)

    Pérez-Padilla, Rogelio; Hernández-Cárdenas, Carmen Margarita; Lugo-Goytia, Gustavo

    2016-01-01

    In the well-known Berlin definition of acute respiratory distress syndrome (ARDS), there is a recommended adjustment for arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FIO2) at altitude, but without a reference as to how it was derived.

  15. Time-courses of lung function and respiratory muscle pressure generating capacity after spinal cord injury : a prospective cohort study

    NARCIS (Netherlands)

    Mueller, Gabi; de Groot, Sonja; van der Woude, Lucas; Hopman, Maria T E

    OBJECTIVE: To investigate the time-courses of lung function and respiratory muscle pressure generating capacity after spinal cord injury. DESIGN: Multi-centre, prospective cohort study. SUBJECTS: One hundred and nine subjects with recent, motor complete spinal cord injury. METHODS: Lung function and

  16. Associations of maximal voluntary isometric hip extension torque with muscle size of hamstring and gluteus maximus and intra-abdominal pressure.

    Science.gov (United States)

    Tayashiki, Kota; Hirata, Kosuke; Ishida, Kiraku; Kanehisa, Hiroaki; Miyamoto, Naokazu

    2017-06-01

    Muscle size of the hamstring and gluteus maximus (GM) as well as intra-abdominal pressure (IAP) are considered as factors affecting the torque development during hip extension. This study examined the associations of torque development during maximal voluntary isometric hip extension with IAP and muscle size of the hamstring and GM. Anatomical cross-sectional area (ACSA) of the hamstring and thickness of GM were determined in 20 healthy young males using an ultrasonography apparatus (Experiment 1). Torque and IAP were simultaneously measured while subjects performed maximal voluntary isometric hip extension. The IAP was measured using a pressure transducer placed in the rectum and determined at the time at which the developed torque reached to the maximal. In Experiment 2, torque and IAP were measured during maximal voluntary isometric hip flexion in 18 healthy young males. The maximal hip extension torque was significantly correlated with the IAP (r = 0.504, P = 0.024), not with the ACSA of the hamstring (r = 0.307, P = 0.188) or the thickness of GM (r = 0.405, P = 0.076). The relationship was still significant even when the ACSA of the hamstring and the thickness of GM were adjusted statistically (r = 0.486, P = 0.041). The maximal hip flexion torque was not significantly correlated with the IAP (r = -0.118, P = 0.642). The current results suggest that IAP can contribute independently of the muscle size of the agonists to maximal voluntary hip extension torque.

  17. The influence of physiotherapy on blood pressure in children and adolescents with respiratory tract diseases

    Directory of Open Access Journals (Sweden)

    Iwona Pirogowicz

    2017-03-01

    Full Text Available Background. Arterial hypertension is an essential, often underestimated medical problem among school youth. Maintaining a low blood pressure (BP in children should be an important point of pediatric preventive healthcare. Objectives . In our study, we considered the influence of physiotherapy on the blood pressure level in a group of 233 children aged from 8 to 15 years taking part in a rehabilitation camp for children in the Szklarska Poreba mountain resort (95 children in 2014 and 138 children in 2015. Material and methods. The children selected for the study suffered from asthma or recurrent respiratory infections. Measurements were made before and after physiotherapy. During the camp, the children were examined two times in 2014 and three times in 2015. The database created contained 1,208 scores of systolic and diastolic BP. The control group consisted of 50 children whose BP was measured in the same hours, but during the weekend, which was free of physiotherapy. Moreover, the values of heart rate (HR during the first measurement were recorded, both in 2014 and 2015. Results. Systolic BP after physiotherapy was significantly lower than before. This result was achieved in every five measuring sessions. In the control group, BP measured in the afternoon was higher than in the morning. The values of HR were not significantly different. The values of BP before and after physiotherapy between children treated with inhaled glucocorticoids and treated without glucocorticoid were not statistically significant. Conclusions . Our studies showed that morning exercise can significantly reduce blood pressure in children throughout the day, even in those who were treated with inhaled glucocorticoids.

  18. In vivo measurements of maximal occlusal force and minimal pressure threshold on overdentures supported by implants or natural roots: a comparative study, Part 1.

    Science.gov (United States)

    Mericske-Stern, R; Hofmann, J; Wedig, A; Geering, A H

    1993-01-01

    Numerous investigations give evidence of improvement of masticatory performance when edentulous patients have had implants placed. A comparative study was carried out to investigate the oral function and tactile sensibility of patients restored with implant-supported overdentures. Twenty-six patients with ITI implants and 18 patients with natural-tooth roots were selected. The minimal pressure threshold perceived in vertical and horizontal directions was registered with dynamometers. Maximal occlusal force was recorded with a miniature bite recorder placed between each pair of antagonistic teeth on both jaw sides separately. All measurements were repeated three times and the average was calculated. The records of minimal perceived pressure revealed a significantly higher threshold (factor 100) for the implant group. In both test groups, values registered in the vertical direction were slightly increased. A tendency for test subjects with implants to reach higher maximal occlusal force was observed, but not at a statistically significant level. In both test groups, the average maximum was found on the second premolar. The minimal pressure threshold seems to depend on the presence of receptors in the periodontal ligament. The records of maximal occlusal force, which were similar in both test groups, lead to the assumption that the limitation in maximal occlusal capacity of overdenture wearers is multifactorial and does not depend on the presence of a periodontal ligament.

  19. Relationship between loss in parenchymal elastic recoil pressure and maximal airway narrowing in subjects with alpha1-antitrypsin deficiency

    NARCIS (Netherlands)

    Cheung, D.; Schot, R.; Zwinderman, A. H.; Zagers, H.; Dijkman, J. H.; Sterk, P. J.

    1997-01-01

    Airway hyperresponsiveness is characterized by an increase in sensitivity and excessive airway narrowing to inhaled bronchoconstrictor stimuli. There is experimental evidence that maximal airway narrowing is related to lung elasticity in normal and asthmatic subjects. We hypothesized that reduced

  20. Systematic review of non-invasive positive pressure ventilation for chronic respiratory failure.

    Science.gov (United States)

    Hannan, Liam M; Dominelli, Giulio S; Chen, Yi-Wen; Darlene Reid, W; Road, Jeremy

    2014-02-01

    This systematic review examined the effect of non-invasive positive pressure ventilation (NIPPV) on patient reported outcomes (PROs) and survival for individuals with or at risk of chronic respiratory failure (CRF). Randomised controlled trials (RCTs) and prospective non-randomised studies in those treated with NIPPV for CRF were identified from electronic databases, reference lists and grey literature. Diagnostic groups included in the review were amyotrophic lateral sclerosis/motor neuron disease (ALS/MND), Duchenne muscular dystrophy (DMD), restrictive thoracic disease (RTD) and obesity hypoventilation syndrome (OHS). Eighteen studies were included and overall study quality was weak. Those with ALS/MND had improved somnolence and fatigue as well as prolonged survival with NIPPV. For OHS, improvements in somnolence and fatigue, dyspnoea and sleep quality were demonstrated, while for RTD, measures of dyspnoea, sleep quality, physical function and health, mental and emotional health and social function improved. There was insufficient evidence to form conclusions regarding the effect of NIPPV for those with DMD. This review has demonstrated that NIPPV influences PROs differently depending on the underlying cause of CRF. These findings may provide assistance to patients and clinicians to determine the relative costs and benefits of NIPPV therapy and also highlight areas in need of further research. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD)

    Science.gov (United States)

    McCurdy, BR

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  2. Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure.

    Science.gov (United States)

    Thokala, Praveen; Goodacre, Steve; Ward, Matt; Penn-Ashman, Jerry; Perkins, Gavin D

    2015-05-01

    We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. We developed an economic model using a United Kingdom health care system perspective to compare the costs and health outcomes of out-of-hospital CPAP to standard care (inhospital noninvasive ventilation) when applied to a hypothetical cohort of patients with acute respiratory failure. The model assigned each patient a probability of intubation or death, depending on the patient's characteristics and whether he or she had out-of-hospital CPAP or standard care. The patients who survived accrued lifetime quality-adjusted life-years (QALYs) and health care costs according to their age and sex. Costs were accrued through intervention and hospital treatment costs, which depended on patient outcomes. All results were converted into US dollars, using the Organisation for Economic Co-operation and Development purchasing power parities rates. Out-of-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio of £20,514 per QALY ($29,720/QALY) and a 49.5% probability of being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold. The probability of out-of-hospital CPAP's being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold depended on the incidence of eligible patients and varied from 35.4% when a low estimate of incidence was used to 93.8% with a high estimate. Variation in the incidence of eligible patients also had a marked influence on the expected value of sample information for a future randomized trial. The cost-effectiveness of out-of-hospital CPAP is uncertain. The incidence of patients eligible for out-of-hospital CPAP appears to be the key determinant of cost-effectiveness. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All

  3. Hemodynamic mechanisms of the attenuated blood pressure response to mental stress after a single bout of maximal dynamic exercise in healthy subjects

    Directory of Open Access Journals (Sweden)

    F.J. Neves

    2012-07-01

    Full Text Available To determine the hemodynamic mechanisms responsible for the attenuated blood pressure response to mental stress after exercise, 26 healthy sedentary individuals (age 29 ± 8 years underwent the Stroop color-word test before and 60 min after a bout of maximal dynamic exercise on a treadmill. A subgroup (N = 11 underwent a time-control experiment without exercise. Blood pressure was continuously and noninvasively recorded by infrared finger photoplethysmography. Stroke volume was derived from pressure signals, and cardiac output and peripheral vascular resistance were calculated. Perceived mental stress scores were comparable between mental stress tests both in the exercise (P = 0.96 and control (P = 0.24 experiments. After exercise, the blood pressure response to mental stress was attenuated (pre: 10 ± 13 vs post: 6 ± 7 mmHg; P 0.05. In conclusion, a single bout of maximal dynamic exercise attenuates the blood pressure response to mental stress in healthy subjects, along with lower stroke volume and cardiac output, denoting an acute modulatory action of exercise on the central hemodynamic response to mental stress.

  4. Influences of Duration of Inspiratory Effort, Respiratory Mechanics, and Ventilator Type on Asynchrony With Pressure Support and Proportional Assist Ventilation.

    Science.gov (United States)

    Vasconcelos, Renata S; Sales, Raquel P; Melo, Luíz H de P; Marinho, Liégina S; Bastos, Vasco Pd; Nogueira, Andréa da Nc; Ferreira, Juliana C; Holanda, Marcelo A

    2017-05-01

    Pressure support ventilation (PSV) is often associated with patient-ventilator asynchrony. Proportional assist ventilation (PAV) offers inspiratory assistance proportional to patient effort, minimizing patient-ventilator asynchrony. The objective of this study was to evaluate the influence of respiratory mechanics and patient effort on patient-ventilator asynchrony during PSV and PAV plus (PAV+). We used a mechanical lung simulator and studied 3 respiratory mechanics profiles (normal, obstructive, and restrictive), with variations in the duration of inspiratory effort: 0.5, 1.0, 1.5, and 2.0 s. The Auto-Trak system was studied in ventilators when available. Outcome measures included inspiratory trigger delay, expiratory trigger asynchrony, and tidal volume (V T ). Inspiratory trigger delay was greater in the obstructive respiratory mechanics profile and greatest with a effort of 2.0 s (160 ms); cycling asynchrony, particularly delayed cycling, was common in the obstructive profile, whereas the restrictive profile was associated with premature cycling. In comparison with PSV, PAV+ improved patient-ventilator synchrony, with a shorter triggering delay (28 ms vs 116 ms) and no cycling asynchrony in the restrictive profile. V T was lower with PAV+ than with PSV (630 mL vs 837 mL), as it was with the single-limb circuit ventilator (570 mL vs 837 mL). PAV+ mode was associated with longer cycling delays than were the other ventilation modes, especially for the obstructive profile and higher effort values. Auto-Trak eliminated automatic triggering. Mechanical ventilation asynchrony was influenced by effort, respiratory mechanics, ventilator type, and ventilation mode. In PSV mode, delayed cycling was associated with shorter effort in obstructive respiratory mechanics profiles, whereas premature cycling was more common with longer effort and a restrictive profile. PAV+ prevented premature cycling but not delayed cycling, especially in obstructive respiratory mechanics

  5. Activation of respiratory muscles during respiratory muscle training.

    Science.gov (United States)

    Walterspacher, Stephan; Pietsch, Fabian; Walker, David Johannes; Röcker, Kai; Kabitz, Hans-Joachim

    2018-01-01

    It is unknown which respiratory muscles are mainly activated by respiratory muscle training. This study evaluated Inspiratory Pressure Threshold Loading (IPTL), Inspiratory Flow Resistive Loading (IFRL) and Voluntary Isocapnic Hyperpnea (VIH) with regard to electromyographic (EMG) activation of the sternocleidomastoid muscle (SCM), parasternal muscles (PARA) and the diaphragm (DIA) in randomized order. Surface EMG were analyzed at the end of each training session and normalized using the peak EMG recorded during maximum inspiratory maneuvers (Sniff nasal pressure: SnPna, maximal inspiratory mouth occlusion pressure: PImax). 41 healthy participants were included. Maximal activation was achieved for SCM by SnPna; the PImax activated predominantly PARA and DIA. Activations of SCM and PARA were higher in IPTL and VIH than for IFRL (p<0.05). DIA was higher applying IPTL compared to IFRL or VIH (p<0.05). IPTL, IFRL and VIH differ in activation of inspiratory respiratory muscles. Whereas all methods mainly stimulate accessory respiratory muscles, diaphragm activation was predominant in IPTL. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Respiratory Therapy for Acute Lung Lesion, by Using Biphasic Positive Pressure Ventilation

    Directory of Open Access Journals (Sweden)

    Yu. V. Marchenkov

    2005-01-01

    Full Text Available Objective. To comparatively study the efficiency of respiratory support in patients with acute lung lesion, by applying BIPAP, SIMV, and aIPPV.Subjects. Twenty-six patients with acute lung lesion whose pattern included acute respiratory distress syndrome (n=16, pneumonia (и=6, and pneumonitis (n=4 were examined. The severity of disease was 18 to 21 APACHE II scale score.Results. The use of BIPAP leads to a better adaptation of a patient to respiratory support, to a reduction in the number of used myorelaxants and sedatives, and to improvement of gas exchange in the lung and diminishes the negative impact of artificial ventilation on hemodynamics. As compared with other types of assisted ventilation, BIPAP accelerates transfer from total respiratory support to spontaneous breathing.

  7. Automatic determination of pressurized water reactor core loading patterns which maximize end-of-cycle reactivity within power peaking and burnup constraints

    International Nuclear Information System (INIS)

    Hobson, G.H.

    1985-01-01

    An automated procedure for determining the optimal core loading pattern for a pressurized water reactor which maximizes end-of-cycle k/sub eff/ while satisfying constraints on power peaking and discharge burnup has been developed. The optimization algorithm combines a two energy group, two-dimensional coarse-mesh finite difference diffusion theory neutronics model to simulate core conditions, a perturbation theory approach to determine reactivity, flux, power and burnup changes as a function of assembly shuffling, and Monte Carlo integer programming to select the optimal loading pattern solution. The core examined was a typical Cycle 2 reload with no burnable poisons. Results indicate that the core loading pattern that maximizes end-of-cycle k/sub eff/ results in a 5.4% decrease in fuel cycle costs compared with the core loading pattern that minimizes the maximum relative radial power peak

  8. Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy

    DEFF Research Database (Denmark)

    de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal

    2015-01-01

    OBJECTIVES: In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed......: Within the entire study population (major abdominal surgeries and craniotomies), we found an association between application of PEEP ≥5 cmH2O and a decreased risk of postoperative respiratory complications compared with PEEP 5 cmH2O was associated with a significant lower...... undergoing major abdominal surgery. Our data suggest that default mechanical ventilator settings should include PEEP of 5-10 cmH2O during major abdominal surgery....

  9. A comparison of maximal inspiratory pressure and forced vital capacity as potential criteria for initiating non-invasive ventilation in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Mendoza, Michelle; Gelinas, Deborah F; Moore, Dan H; Miller, Robert G

    2007-04-01

    Using a retrospective analysis of 161 patients with amyotrophic lateral sclerosis (ALS) from the Western ALS study group (WALS) database, the sensitivity of maximal inspiratory pressure (MIP)NIV) were compared. Sixty-five per cent of patients at enrollment met the MIP criterion, compared with only 8% of patients who met the FVC criterion. There were no cases in which FVCNIV, a MIP< -60 cm H(2)O allows US clinicians to obtain non-invasive ventilatory support for patients earlier than if using the FVC criterion alone.

  10. MRI of ventilated neonates and infants: respiratory pressure as trigger signal

    International Nuclear Information System (INIS)

    Lotz, J.; Reiffen, H.P.

    2004-01-01

    Introduction: motivated by the difficulties often encountered in the setup of respiratory trigger in MR imaging of mechanical ventilated pediatric patients, a simplified approach in terms of time and reliability was sought. Method: with the help of a male-to-male Luer-Lock adapter in combination with a 3-way adapter the tube of the respiratory compensation bellow was fixed to the output channel for capnography of the airway filter. Ten patients (age 4 months to 6 years) were tested with spin echo imaging and either respiration compensation (T1-weighted imaging) or respiratory triggered (T2-weighted imaging). Results: a clear trigger signal was achieved in all cases. No negative influence on the quality or security of the mechanical ventilation of the patients was observed. Summary: the proposed adapter is safe, efficient and fast to install in patients undergoing MR imaging in general anaesthesia. (orig.) [de

  11. Effects of respiratory rate, plateau pressure, and positive end-expiratory pressure on PaO2 oscillations after saline lavage.

    Science.gov (United States)

    Baumgardner, James E; Markstaller, Klaus; Pfeiffer, Birgit; Doebrich, Marcus; Otto, Cynthia M

    2002-12-15

    One of the proposed mechanisms of ventilator-associated lung injury is cyclic recruitment of atelectasis. Collapse of dependent lung regions with every breath should lead to large oscillations in PaO2 as shunt varies throughout the respiratory cycle. We placed a fluorescence-quenching PO2 probe in the brachiocephalic artery of six anesthetized rabbits after saline lavage. Using pressure-controlled ventilation with oxygen, ventilator settings were varied in random order over three levels of positive end-expiratory pressure (PEEP), respiratory rate (RR), and plateau pressure minus PEEP (Delta). Dependence of the amplitude of PaO2 oscillations on PEEP, RR, and Delta was modeled by multiple linear regression. Before lavage, arterial PO2 oscillations varied from 3 to 22 mm Hg. After lavage, arterial PO2 oscillations varied from 5 to 439 mm Hg. Response surfaces showed markedly nonlinear dependence of amplitude on PEEP, RR, and Delta. The large PaO2 oscillations observed provide evidence for cyclic recruitment in this model of lung injury. The important effect of RR on the magnitude of PaO2 oscillations suggests that the static behavior of atelectasis cannot be accurately extrapolated to predict dynamic behavior at realistic breathing frequencies.

  12. Automatic determination of pressurized water reactor core loading patterns that maximize beginning-of-cycle reactivity within power-peaking and burnup constraints

    International Nuclear Information System (INIS)

    Hobson, G.H.; Turinsky, P.J.

    1986-01-01

    Computational capability has been developed to automatically determine a good estimate of the core loading pattern, which minimizes fuel cycle costs for a pressurized water reactor (PWR). Equating fuel cycle cost minimization with core reactivity maximization, the objective is to determine the loading pattern that maximizes core reactivity while satisfying power peaking, discharge burnup, and other constraints. The method utilizes a two-dimensional, coarse-mesh, finite difference scheme to evaluate core reactivity and fluxes for an initial reference loading pattern. First-order perturbation theory is applied to determine the effects of assembly shuffling on reactivity, power distribution, end-of-cycle burnup. Monte Carlo integer programming is then used to determine a near-optimal loading pattern within a range of loading patterns near the reference pattern. The process then repeats with the new loading pattern as the reference loading pattern and terminates when no better loading pattern can be determined. The process was applied with both reactivity maximization and radial power-peaking minimization as objectives. Results on a typical large PWR indicate that the cost of obtaining an 8% improvement in radial power-peaking margin is ≅2% in fuel cycle costs, for the reload core loaded without burnable poisons that was studied

  13. Use of dynamic CT in acute respiratory distress syndrome (ARDS) with comparison of positive and negative pressure ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Helm, Emma; Babyn, Paul [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Talakoub, Omid; Alirezaie, Javad [Ryerson University, Department of Electrical and Computer Engineering, Toronto, ON (Canada); Grasso, Francesco; Engelberts, Doreen; Kavanagh, Brian P. [Hospital for Sick Children and the University of Toronto, Departments of Anesthesia and Critical Care Medicine and the Program in Pulmonary and Experimental Medicine, Toronto (Canada)

    2009-01-15

    Negative pressure ventilation via an external device ('iron lung') has the potential to provide better oxygenation with reduced barotrauma in patients with ARDS. This study was designed to see if oxygenation differences between positive and negative ventilation could be explained by CT. Six anaesthetized rabbits had ARDS induced by repeated saline lavage. Rabbits were ventilated with positive pressure ventilation (PPV) and negative pressure ventilation (NPV) in turn. Dynamic CT images were acquired over the respiratory cycle. A computer-aided method was used to segment the lung and calculate the range of CT densities within each slice. Volumes of ventilated lung and atelectatic lung were measured over the respiratory cycle. NPV was associated with an increased percentage of ventilated lung and decreased percentage of atelectatic lung. The most significant differences in ventilation and atelectasis were seen at mid-inspiration and mid-expiration (ventilated lung NPV=61%, ventilated lung PPV=47%, p<0.001; atelectatic lung NPV=10%, atelectatic lung PPV 19%, p<0.001). Aeration differences were not significant at end-inspiration. Dynamic CT can show differences in lung aeration between positive and negative ventilation in ARDS. These differences would not be appreciated if only static breath-hold CT was used. (orig.)

  14. Neuromuscular disease and respiratory physiology in children: putting lung function into perspective.

    Science.gov (United States)

    Fauroux, Brigitte; Khirani, Sonia

    2014-08-01

    Neuromuscular diseases represent a heterogeneous group of disorders of the muscle, nerve or neuromuscular junction. The respiratory muscles are rarely spared in neuromuscular diseases even if the type of muscle involvement, severity and time course greatly varies among the different diseases. Diagnosis of respiratory muscle weakness is crucial because of the importance of respiratory morbidity and mortality. Presently, routine respiratory evaluation is based on non-invasive volitional tests, such as the measurement of lung volumes, spirometry and the maximal static pressures, which may be difficult or impossible to obtain in some young children. Other tools or parameters are thus needed to assess the respiratory muscle weakness and its consequences in young children. The measurement of oesogastric pressures can be helpful as they allow the diagnosis and quantification of paradoxical breathing, as well as the assessment of the strength of the inspiratory and expiratory muscles by means of the oesophageal pressure during a maximal sniff and of the gastric pressure during a maximal cough. Sleep assessment should also be part of the respiratory evaluation of children with neuromuscular disease with at least the recording of nocturnal gas exchange if polysomnography is not possible or unavailable. This improvement in the assessment of respiratory muscle performance may increase our understanding of the respiratory pathophysiology of the different neuromuscular diseases, improve patient care, and guide research and innovative therapies by identifying and validating respiratory parameters. © 2014 Asian Pacific Society of Respirology.

  15. Respiratory Outcomes of the Surfactant Positive Pressure and Oximetry Randomized Trial

    Science.gov (United States)

    Stevens, Timothy P.; Finer, Neil N.; Carlo, Waldemar A.; Szilagyi, Peter G.; Phelps, Dale L.; Walsh, Michele C.; Gantz, Marie G.; Laptook, Abbot R.; Yoder, Bradley A.; Faix, Roger G.; Newman, Jamie E.; Das, Abhik; Do, Barbara T.; Schibler, Kurt; Rich, Wade; Newman, Nancy S.; Ehrenkranz, Richard A.; Peralta-Carcelen, Myriam; Vohr, Betty R.; Wilson-Costello, Deanne E.; Yolton, Kimberly; Heyne, Roy J.; Evans, Patricia W.; Vaucher, Yvonne E.; Adams-Chapman, Ira; McGowan, Elisabeth C.; Bodnar, Anna; Pappas, Athina; Hintz, Susan R.; Acarregui, Michael J.; Fuller, Janell; Goldstein, Ricki F.; Bauer, Charles R.; O’Shea, T. Michael; Myers, Gary J.; Higgins, Rosemary D.

    2014-01-01

    Objective To explore the early childhood pulmonary outcomes of infants who participated in the NICHD SUPPORT Trial, using a factorial design that randomized extremely preterm infants to lower vs. higher oxygen saturation targets and delivery room CPAP vs. intubation/surfactant, found no significant difference in the primary composite outcome of death or BPD. Study design The Breathing Outcomes Study, a prospective secondary to SUPPORT, assessed respiratory morbidity at 6 month intervals from hospital discharge to 18–22 months corrected age (CA). Two pre-specified primary outcomes, wheezing more than twice per week during the worst 2 week period and cough longer than 3 days without a cold were compared between each randomized intervention. Results One or more interviews were completed for 918 of 922 eligible infants. The incidence of wheezing and cough were 47.9% and 31.0%, respectively, and did not differ between study arms of either randomized intervention. Infants randomized to lower vs. higher oxygen saturation targets had similar risks of death or respiratory morbidities (except for croup, treatment with oxygen or diuretics at home). Infants randomized to CPAP vs. intubation/surfactant had fewer episodes of wheezing without a cold (28.9% vs. 36.5%, pCPAP rather than intubation/surfactant is associated with less respiratory morbidity by 18–22 months CA. Longitudinal assessment of pulmonary morbidity is necessary to fully evaluate the potential benefits of respiratory interventions for neonates. PMID:24725582

  16. The effect of vocal and instrumental music on cardio respiratory variables, energy expenditure and exertion levels during sub maximal treadmill exercise.

    Science.gov (United States)

    Savitha, D; Sejil, T V; Rao, Shwetha; Roshan, C J; Roshan, C J

    2013-01-01

    The purpose of the study was to investigate the effect of vocal and instrumental music on various physiological parameters during submaximal exercise. Each subject underwent three sessions of exercise protocol without music, with vocal music, and instrumental versions of same piece of music. The protocol consisted of 10 min treadmill exercise at 70% HR(max) and 20 min of recovery. Minute to minute heart rate and breath by breath recording of respiratory parameters, rate of energy expenditure and perceived exertion levels were measured. Music, irrespective of the presence or absence of lyrics, enabled the subjects to exercise at a significantly lower heart rate and oxygen consumption, reduced the metabolic cost and perceived exertion levels of exercise (P Music having a relaxant effect could have probably increased the parasympathetic activation leading to these effects.

  17. Entropy maximization

    Indian Academy of Sciences (India)

    Abstract. It is shown that (i) every probability density is the unique maximizer of relative entropy in an appropriate class and (ii) in the class of all pdf f that satisfy. ∫ fhi dμ = λi for i = 1, 2,...,...k the maximizer of entropy is an f0 that is pro- portional to exp(. ∑ ci hi ) for some choice of ci . An extension of this to a continuum of.

  18. Entropy Maximization

    Indian Academy of Sciences (India)

    It is shown that (i) every probability density is the unique maximizer of relative entropy in an appropriate class and (ii) in the class of all pdf that satisfy ∫ f h i d = i for i = 1 , 2 , … , … k the maximizer of entropy is an f 0 that is proportional to exp ⁡ ( ∑ c i h i ) for some choice of c i . An extension of this to a continuum of ...

  19. Respiratory system model for quasistatic pulmonary pressure-volume (P-V) curve: inflation-deflation loop analyses.

    Science.gov (United States)

    Amini, R; Narusawa, U

    2008-06-01

    A respiratory system model (RSM) is developed for the deflation process of a quasistatic pressure-volume (P-V) curve, following the model for the inflation process reported earlier. In the RSM of both the inflation and the deflation limb, a respiratory system consists of a large population of basic alveolar elements, each consisting of a piston-spring-cylinder subsystem. A normal distribution of the basic elements is derived from Boltzmann statistical model with the alveolar closing (opening) pressure as the distribution parameter for the deflation (inflation) process. An error minimization by the method of least squares applied to existing P-V loop data from two different data sources confirms that a simultaneous inflation-deflation analysis is required for an accurate determination of RSM parameters. Commonly used terms such as lower inflection point, upper inflection point, and compliance are examined based on the P-V equations, on the distribution function, as well as on the geometric and physical properties of the basic alveolar element.

  20. Model of pulmonary fluid traffic homeostasis based on respiratory cycle pressure, bidirectional bronchiolo-pulmonar shunting and water evaporation.

    Science.gov (United States)

    Kurbel, Sven; Kurbel, Beatrica; Gulam, Danijela; Spajić, Borislav

    2010-06-01

    The main puzzle of the pulmonary circulation is how the alveolar spaces remain dry over a wide range of pulmonary vascular pressures and blood flows. Although normal hydrostatic pressure in pulmonary capillaries is probably always below 10 mmHg, well bellow plasma colloid pressure of 25 mmHg, most textbooks state that some fluid filtration through capillary walls does occur, while the increased lymph drainage prevents alveolar fluid accumulation. The lack of a measurable pressure drop along pulmonary capillaries makes the classic description of Starling forces unsuitable to the low pressure, low resistance pulmonary circulation. Here presented model of pulmonary fluid traffic describes lungs as a matrix of small vascular units, each consisting of alveoli whose capillaries are anastomotically linked to the bronchiolar capillaries perfused by a single bronchiolar arteriole. It proposes that filtration and absorption in pulmonary and in bronchiolar capillaries happen as alternating periods of low and of increased perfusion pressures. The model is based on three levels of filtration control: short filtration phases due to respiratory cycle of the whole lung are modulated by bidirectional bronchiolo-pulmonar shunting independently in each small vascular unit, while fluid evaporation from alveolar groups further tunes local filtration. These mechanisms are used to describe a self-sustaining regulator that allows optimal fluid traffic in different settings. The proposed concept is used to describe development of pulmonary edema in several clinical entities (exercise in wet or dry climate, left heart failure, people who rapidly move to high altitudes, acute cyanide and carbon monoxide poisoning, large pulmonary embolisms). .

  1. Extravascular lung water and pulmonary arterial wedge pressure for fluid management in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Hu, Wei; Lin, Chang-Wen; Liu, Bing-Wei; Hu, Wei-Hang; Zhu, Ying

    2014-01-16

    Extravascular lung water (EVLW) is a sensitive prognostic indicator of pulmonary edema. Thus, EVLW may be an advantageous method of fluid management. This study aims to evaluate the outcomes of using EVLW and pulmonary artery wedge pressure (PAWP) as strategies for fluid management in patients with acute respiratory distress syndrome (ARDS). Twenty-nine patients were randomly divided into the EVLW and PAWP groups. The survival rate, ICU (Intensive Care Unit) length of stay, duration of mechanical ventilation, acute lung injury scores, and oxygenation index of the EVLW and PAWP groups were compared. No significant difference in the survival rates at 28 and 60 days (d) after treatment was found between the two groups (p = 0.542). The duration of mechanical ventilation and ICU length of stay were significantly lower (p management improved clinical results in patients with ARDS better than PAWP.

  2. [Predictive factors for failure of non-invasive positive pressure ventilation in immunosuppressed patients with acute respiratory failure].

    Science.gov (United States)

    Jia, Xiangli; Yan, Ci; Xu, Sicheng; Gu, Xingli; Wan, Qiufeng; Hu, Xinying; Li, Jingwen; Liu, Guangming; Caikai, Shareli; Guo, Zhijin

    2018-02-01

    To evaluate the predictive factors for failure of non-invasive positive pressure ventilation (NIPPV) in immunosuppressed patients with acute respiratory failure (ARF). The clinical data of 118 immuno-deficient patients treated with NIPPV in the respiratory and intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2012 to August 2017 were retrospectively analyzed. The patients were divided into a non-endotracheal intubation (ETI) group (n = 62) and ETI group (n = 56) according to whether ETI was performed during the hospitalization period or not. Each observed indicator was analyzed by univariate analysis, and factors leading to failure of NIPPV were further analyzed by Logistic regression. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of risk factors for failure of NIPPV in immunosuppressed patients with ARF. The non-intubation rate for NIPPV in immunosuppressed patients was 50.8% (60/118). Compared with the non-ETI group, the body temperature, pH value in the ETI group were significantly increased, the partial pressure of arterial carbon dioxide (PaCO 2 ) was significantly decreased, the ratio of oxygenation index (PaO 2 /FiO 2 ) failure of NIPPV. ROC curve analysis showed that the APACHE II score ≥ 20 and PaO 2 /FiO 2 failure of NIPPV, the area under ROC curve (AUC) of the APACHE II score ≥ 20 was 0.787, the sensitivity was 83.93%, the specificity was 69.35%, the positive predict value (PPV) was 71.21%, the negative predict value (NPV) was 82.69%, the positive likelihood ratio (PLR) was 2.74, the negative likelihood ratio (NLR) was 0.23, and Youden index was 0.53; the AUC of PaO 2 /FiO 2 failure of NIPPV in immunocompromised patients.

  3. [Effects of noninvasive proportional assist vs pressure support ventilation on respiratory work in chronic obstructive pulmonary disease patients with hypercapnia].

    Science.gov (United States)

    Zhang, J H; Luo, Q; Zhang, H J; Chen, R C

    2017-06-12

    Objective: To investigate the effect of noninvasive proportional assist ventilation (PAV) on respiratory work in chronic obstructive pulmonary disease(COPD) patients, in comparison to noninvasive pressure support ventilation(PSV). Methods: Ten severe COPD patients with hypercapnia during acute exacerbation were examined. The baseline inspiratory pressure of PSV (PS) and the assistance level of PAV(PA) were titrated by patients' tolerance. In addition to the baseline PS and PA, an additional decrease by 25% (PS-=75% PS, PA-=75% PA) or increase by 25% (PS+ =125% PS, PA+ =125% PA) of the assist level were applied to the patients. After the assessment of unassisted spontaneous breathing (SB), the patient was placed on the 6 levels of noninvasive-PSV and noninvasive-PAV in random sequence. Each level lasted at least 20 minutes. Respiratory rate (RR), tidal volume (Vt), and respiratory work(Wex, Wip and Wv) were measured. Asynchrony index (AI) was calculated. Results: During ventilation, Vt was significantly higher with each assist level than with SB. The Vt was significant increased with PS+ than with PA+ . An increase in expiratory work(Wex) and decrease in inspiratory work(Wip) were observed respectively, with the increasing assist level. The inspiratory muscles assessed by Wip were more unloaded at PS compared with PA [PS: (1.59±1.27) J/min vs PA: (4.99±3.48) J/min P increased with the increasing assist level of PSV [PS-: (0.46±0.57)%, PS: (1.36±1.24)% PS+ : (5.26±4.77)]. No asynchrony events were observed at PA- and PA. "Runaway" (expiratory asynchrony) was observed during PA+ [AI: (2.62±2.72)%]. Conclusions: Noninvasive-PAV can increase the Vt and decrease the Wip of the COPD patients with hypercapnia and avoid the over-assistance. The "Runaway" will occur at assist level higher than that set by tolerance. Physiological data can monitor the patient's responses and the ventilator-patient interaction, which may provide objective criteria for ventilator setting.

  4. Determination of optimized oxygen partial pressure to maximize the liver regenerative potential of the secretome obtained from adipose-derived stem cells.

    Science.gov (United States)

    Lee, Sang Chul; Kim, Kee-Hwan; Kim, Ok-Hee; Lee, Sang Kuon; Hong, Ha-Eun; Won, Seong Su; Jeon, Sang-Jin; Choi, Byung Jo; Jeong, Wonjun; Kim, Say-June

    2017-08-03

    A hypoxic-preconditioned secretome from stem cells reportedly promotes the functional and regenerative capacity of the liver more effectively than a control secretome. However, the optimum oxygen partial pressure (pO 2 ) in the cell culture system that maximizes the therapeutic potential of the secretome has not yet been determined. We first determined the cellular alterations in adipose tissue-derived stem cells (ASCs) cultured under different pO 2 (21%, 10%, 5%, and 1%). Subsequently, partially hepatectomized mice were injected with the secretome of ASCs cultured under different pO 2 , and then sera and liver specimens were obtained for analyses. Of all AML12 cells cultured under different pO 2 , the AML12 cells cultured under 1% pO 2 showed the highest mRNA expression of proliferation-associated markers (IL-6, HGF, and VEGF). In the cell proliferation assay, the AML12 cells cultured with the secretome of 1% pO 2 showed the highest cell proliferation, followed by the cells cultured with the secretome of 21%, 10%, and 5% pO 2 , in that order. When injected into the partially hepatectomized mice, the 1% pO 2 secretome most significantly increased the number of Ki67-positive cells, reduced serum levels of proinflammatory mediators (IL-6 and TNF-α), and reduced serum levels of liver transaminases. In addition, analysis of the liver specimens indicated that injection with the 1% pO 2 secretome maximized the expression of the intermediate molecules of the PIP3/Akt and IL-6/STAT3 signaling pathways, all of which are known to promote liver regeneration. The data of this study suggest that the secretome of ASCs cultured under 1% pO 2 has the highest liver reparative and regenerative potential of all the secretomes tested here.

  5. A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

    Directory of Open Access Journals (Sweden)

    Chang SC

    2016-05-01

    Full Text Available Suchi Chang,1 Jindong Shi,2 Cuiping Fu,1 Xu Wu,1 Shanqun Li1 1Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 2Department of Respiratory Medicine, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, People’s Republic of China Background: COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. Objective: We evaluated pressure-regulated volume control (PRVC ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Patients and methods: Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation – volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2–4 hours and 48 hours. Results: Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2, and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2 levels. The pH and PaCO2 levels at 2–4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both; after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05. Vital signs during 2–4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05. The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2–4 hours and 48

  6. Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure.

    Science.gov (United States)

    Colombo, Davide; Cammarota, Gianmaria; Bergamaschi, Valentina; De Lucia, Marta; Corte, Francesco Della; Navalesi, Paolo

    2008-11-01

    Neurally adjusted ventilatory assist (NAVA) is a new mode wherein the assistance is provided in proportion to diaphragm electrical activity (EAdi). We assessed the physiologic response to varying levels of NAVA and pressure support ventilation (PSV). ICU of a University Hospital. Fourteen intubated and mechanically ventilated patients. DESIGN AND PROTOCOL: Cross-over, prospective, randomized controlled trial. PSV was set to obtain a VT/kg of 6-8 ml/kg with an active inspiration. NAVA was matched with a dedicated software. The assistance was decreased and increased by 50% with both modes. The six assist levels were randomly applied. Arterial blood gases (ABGs), tidal volume (VT/kg), peak EAdi, airway pressure (Paw), neural and flow-based timing. Asynchrony was calculated using the asynchrony index (AI). There was no difference in ABGs regardless of mode and assist level. The differences in breathing pattern, ventilator assistance, and respiratory drive and timing between PSV and NAVA were overall small at the two lower assist levels. At the highest assist level, however, we found greater VT/kg (9.1 +/- 2.2 vs. 7.1 +/- 2 ml/kg, P < 0.001), and lower breathing frequency (12 +/- 6 vs. 18 +/- 8.2, P < 0.001) and peak EAdi (8.6 +/- 10.5 vs. 12.3 +/- 9.0, P < 0.002) in PSV than in NAVA; we found mismatch between neural and flow-based timing in PSV, but not in NAVA. AI exceeded 10% in five (36%) and no (0%) patients with PSV and NAVA, respectively (P < 0.05). Compared to PSV, NAVA averted the risk of over-assistance, avoided patient-ventilator asynchrony, and improved patient-ventilator interaction.

  7. A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure.

    Science.gov (United States)

    Chang, Suchi; Shi, Jindong; Fu, Cuiping; Wu, Xu; Li, Shanqun

    2016-01-01

    COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation - volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2-4 hours and 48 hours. Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2-4 hours were lower and higher, respectively, in the test group than those in the control group (P0.05). Vital signs during 2-4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2-4 hours and 48 hours was significantly lower than that in the control group (P0.05). Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation - volume control.

  8. The use of continuous positive airway pressure in preterm babies with respiratory distress syndrome: a report from Baghdad, Iraq.

    Science.gov (United States)

    Hameed, Numan Nafie; Abdul Jaleel, Ra'id Khalil; Saugstad, Ola Didrik

    2014-04-01

    To study maternal and neonatal risk factors related to outcome of preterm babies with respiratory distress syndrome (RDS) on Continuous Positive Airway Pressure (CPAP) in a tertiary Iraqi NICU. A prospective case study carried out from January 5, 2011 to January 5, 2012, on 70 preterm neonates with RDS who were started on CPAP. Maternal and infant variables of preterm babies with successful or failed CPAP therapy were compared. Seventy neonates, 44 (63%) males and 26 (37%) females were included. Mean (SD) gestation was 32.8 (2.8) weeks and mean (SD) birth weight was 1860 (656) g. Thirty-seven (52.9%) babies failed CPAP, of them 29 (78.3%) were started on mechanical ventilation. The variables associated with failure of CPAP were: Birth weight ≤1500 g, gestational age ≤30 weeks, white out on the chest X-ray, FiO2 ≥50% at 20 min of CPAP, PEEP ≥5.5 cm H2O. Mortality rates were 94.6% in CPAP failures versus 5.4% in CPAP successes (p = 0.001). In infants surviving till discharge, duration of hospital stay was longer in babies who were CPAP successes (9.6 ± 3.7 versus 3.0 ± 2.7 days, p = 0.001). Gestational age, birth weight, whiteout chest X-ray, and FiO2 are important predictive values for success of CPAP therapy. A larger prospective multicenter controlled trial is needed to determine the benefits and risks of CPAP and predictors of its failure in our setting. Our results may be useful for others practicing in similar settings as us.

  9. Running on a lower-body positive pressure treadmill

    DEFF Research Database (Denmark)

    Raffalt, Peter C; Hovgaard-Hansen, Line; Jensen, Bente Rona

    2013-01-01

    This study investigated maximal oxygen consumption (VO2max) and time to exhaustion while running on a lower-body positive pressure treadmill (LBPPT) at normal body weight (BW) as well as how BW support affects respiratory responses, ground reaction forces, and stride characteristics.......This study investigated maximal oxygen consumption (VO2max) and time to exhaustion while running on a lower-body positive pressure treadmill (LBPPT) at normal body weight (BW) as well as how BW support affects respiratory responses, ground reaction forces, and stride characteristics....

  10. Short term evaluation of respiratory effort by premature infants supported with bubble nasal continuous airway pressure using Seattle-PAP and a standard bubble device

    Science.gov (United States)

    Welty, Stephen E.; Rusin, Craig G.; Stanberry, Larissa I.; Mandy, George T.; Gest, Alfred L.; Ford, Jeremy M.; Backes, Carl H.; Richardson, C. Peter; Howard, Christopher R.; Hansen, Thomas N.

    2018-01-01

    Background Almost one million prematurely born infants die annually from respiratory insufficiency, predominantly in countries with limited access to respiratory support for neonates. The primary hypothesis tested in the present study was that a modified device for bubble nasal continuous positive airway pressure (Bn-CPAP) would provide lower work of spontaneous breathing, estimated by esophageal pressure-rate products. Methods Infants born CPAP with FiO2 CPAP, then 2 h with Bn-CPAP using a modified bubble device presently termed Seattle-PAP, which produces a different pattern of pressure fluctuations and which provided greater respiratory support in preclinical studies, then 2 h on standard Bn-CPAP. Results All 40 infants enrolled completed the study and follow-up through 36 wks post menstrual age or hospital discharge, whichever came first. No infants were on supplemental oxygen at completion of follow-up. No infants developed pneumothoraces or nasal trauma, and no adverse events attributed to the study were observed. Pressure-rate products on the two devices were not different, but effort of breathing, assessed by areas under esophageal pressure-time curves, was lower with Seattle-PAP than with standard Bn-CPAP. Conclusion Use of Seattle-PAP to implement Bn-CPAP lowers the effort of breathing exerted even by relatively healthy spontaneously breathing premature neonates. Whether the lower effort of breathing observed with Seattle-PAP translates to improvements in neonatal mortality or morbidity will need to be determined by studies in appropriate patient populations. PMID:29590143

  11. Assisted Ventilation in Patients with Acute Respiratory Distress Syndrome: Lung-distending Pressure and Patient-Ventilator Interaction

    NARCIS (Netherlands)

    Doorduin, J.; Sinderby, C.A.; Beck, J.; Hoeven, J.G. van der; Heunks, L.M.

    2015-01-01

    BACKGROUND: In patients with acute respiratory distress syndrome (ARDS), the use of assisted mechanical ventilation is a subject of debate. Assisted ventilation has benefits over controlled ventilation, such as preserved diaphragm function and improved oxygenation. Therefore, higher level of

  12. Assessment of blood gas parameters and the degree of inflammation in noninvasive positive pressure ventilation combined with aminophylline treatment of COPD complicated with type II respiratory failure

    Directory of Open Access Journals (Sweden)

    Jin-Ru Zhang

    2016-10-01

    Full Text Available Objective: To analyze the effect of noninvasive positive pressure ventilation combined with aminophylline therapy on blood gas parameters and the degree of inflammation in patients with COPD and type II respiratory failure. Methods: A total of 80 patients with COPD and type Ⅱ respiratory failure were randomly divided into observation group and control group (n=40, control group received symptomatic treatment + aminophylline treatment, observation group received symptomatic treatment + aminophylline + noninvasive positive pressure ventilation treatment, and then differences in blood gas parameters, pulmonary function parameters, hemorheology parameters and inflammatory factor levels were compared between two groups of patients after treatment. Results: Radial artery pH and PO2 values of observation group after treatment were higher than those of control group while PCO2, Cl- and CO2CP values were lower than those of control group; pulmonary function parameters FVC, FEV1, FEF25-75, MMF, PEF and FRC values of observation group after treatment were higher than those of control group; whole blood viscosity (150 s- and 10 s-, plasma viscosity, fibrinogen, erythrocyte aggregation index and erythrocyte rigidity index values in peripheral venous blood of observation group after treatment were lower than those of control group; serum IL-17, IL-33, TREM-1, sICAM-1 and PGE2 levels of observation group after treatment were lower than those of control group. Conclusion: Noninvasive positive pressure ventilation combined with aminophylline can optimize the respiratory function of patients with COPD and type II respiratory failure and improve blood gas parameters and the degree of inflammation.

  13. [The clinical effect of airway pressure release ventilation for acute lung injury/acute respiratory distress syndrome].

    Science.gov (United States)

    Song, Shaohua; Tian, Huiyu; Yang, Xiufen; Hu, Zhenjie

    2016-01-01

    To evaluate the effect of airway pressure release ventilation (APRV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), to evaluate the extent of ventilator-induced lung injury (VILI), and to explore its possible mechanism. A prospective study was conducted in the Department of Critical Care Medicine of the First Hospital of Hebei Medical University from December 2010 to February 2012. The patients with ALI/ARDS were enrolled. They were randomly divided into two groups. The patients in APRV group were given APRV pattern, while those in control group were given lung protection ventilation, synchronized intermittent mandatory ventilation with positive end-expiratory pressure (SIMV+PEEP). All patients were treated with AVEA ventilator. The parameters such as airway peak pressure (Ppeak), mean airway pressure (Pmean), pulse oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial blood gas, urine output (UO), the usage of sedation and muscle relaxation drugs were recorded. AVEA ventilator "turning point (Pflex) operation" was used to describe the quasi-static pressure volume curve (P-V curve). High and low inflection point (UIP, LIP) and triangular Pflex volume (Vdelta) were automatically measured and calculated. The ventilation parameters were set, and the 24-hour P-V curve was recorded again in order to be compared with subsequent results. Venous blood was collected before treatment, 24 hours and 48 hours after ventilation to measure lung surfactant protein D (SP-D) and large molecular mucus in saliva (KL-6) by enzyme linked immunosorbent assay (ELISA), and the correlation between the above two parameters and prognosis on 28 days was analyzed by multinomial logistic regression. Twenty-six patients with ALI/ARDS were enrolled, and 22 of them completed the test with 10 in APRV group and 12 in control group. The basic parameters and P-V curves between two groups were similar before

  14. Respiratory muscle training for cystic fibrosis.

    Science.gov (United States)

    Hilton, Nathan; Solis-Moya, Arturo

    2018-05-24

    muscle training interventions varied dramatically, with frequency, intensity and duration ranging from thrice weekly to twice daily, 20% to 80% of maximal effort, and 10 to 30 minutes, respectively. Participant numbers ranged from 11 to 39 participants in the included studies; five studies were in adults only and four in a combination of children and adults.No significant improvement was reported in the primary outcome of pulmonary function (forced expiratory volume in one second and forced vital capacity) (very low-quality evidence). Although no change was reported in exercise capacity as assessed by the maximum rate of oxygen use, a 10% improvement in exercise duration was found when working at 60% of maximal effort in one study (n = 20) (very low-quality evidence). In a further study (n = 18), when working at 80% of maximal effort, health-related quality of life improved in the mastery and emotion domains (very low-quality evidence). With regards to the review's secondary outcomes, one study (n = 11) found a significant change in intramural pressure, functional residual capacity and maximal inspiratory pressure following training (low-quality evidence). A further study (n = 22) reported that respiratory muscle endurance was significantly longer in the training group (P < 0.01). No studies reported on any other secondary outcomes. Meta-analyses could not be performed due to a lack of consistency and insufficient detail in reported outcome measures. There is insufficient evidence to suggest whether this intervention is beneficial or not. Healthcare practitioners should consider the use of respiratory muscle training on a case-by-case basis. Further research of reputable methodological quality is needed to determine the effectiveness of respiratory muscle training in people with cystic fibrosis. Researchers should consider the following clinical outcomes in future studies; respiratory muscle function, pulmonary function, exercise capacity, hospital admissions, and health

  15. Physiologic Evaluation of Ventilation Perfusion Mismatch and Respiratory Mechanics at Different Positive End-expiratory Pressure in Patients Undergoing Protective One-lung Ventilation.

    Science.gov (United States)

    Spadaro, Savino; Grasso, Salvatore; Karbing, Dan Stieper; Fogagnolo, Alberto; Contoli, Marco; Bollini, Giacomo; Ragazzi, Riccardo; Cinnella, Gilda; Verri, Marco; Cavallesco, Narciso Giorgio; Rees, Stephen Edward; Volta, Carlo Alberto

    2018-03-01

    Arterial oxygenation is often impaired during one-lung ventilation, due to both pulmonary shunt and atelectasis. The use of low tidal volume (VT) (5 ml/kg predicted body weight) in the context of a lung-protective approach exacerbates atelectasis. This study sought to determine the combined physiologic effects of positive end-expiratory pressure and low VT during one-lung ventilation. Data from 41 patients studied during general anesthesia for thoracic surgery were collected and analyzed. Shunt fraction, high V/Q and respiratory mechanics were measured at positive end-expiratory pressure 0 cm H2O during bilateral lung ventilation and one-lung ventilation and, subsequently, during one-lung ventilation at 5 or 10 cm H2O of positive end-expiratory pressure. Shunt fraction and high V/Q were measured using variation of inspired oxygen fraction and measurement of respiratory gas concentration and arterial blood gas. The level of positive end-expiratory pressure was applied in random order and maintained for 15 min before measurements. During one-lung ventilation, increasing positive end-expiratory pressure from 0 cm H2O to 5 cm H2O and 10 cm H2O resulted in a shunt fraction decrease of 5% (0 to 11) and 11% (5 to 16), respectively (P ventilation, high positive end-expiratory pressure levels improve pulmonary function without increasing high V/Q and reduce driving pressure.

  16. Respiratory acidosis

    Science.gov (United States)

    Ventilatory failure; Respiratory failure; Acidosis - respiratory ... Causes of respiratory acidosis include: Diseases of the airways (such as asthma and COPD ) Diseases of the lung tissue (such as ...

  17. Respiratory mechanics to understand ARDS and guide mechanical ventilation.

    Science.gov (United States)

    Mauri, Tommaso; Lazzeri, Marta; Bellani, Giacomo; Zanella, Alberto; Grasselli, Giacomo

    2017-11-30

    As precision medicine is becoming a standard of care in selecting tailored rather than average treatments, physiological measurements might represent the first step in applying personalized therapy in the intensive care unit (ICU). A systematic assessment of respiratory mechanics in patients with the acute respiratory distress syndrome (ARDS) could represent a step in this direction, for two main reasons. Approach and Main results: On the one hand, respiratory mechanics are a powerful physiological method to understand the severity of this syndrome in each single patient. Decreased respiratory system compliance, for example, is associated with low end expiratory lung volume and more severe lung injury. On the other hand, respiratory mechanics might guide protective mechanical ventilation settings. Improved gravitationally dependent regional lung compliance could support the selection of positive end-expiratory pressure and maximize alveolar recruitment. Moreover, the association between driving airway pressure and mortality in ARDS patients potentially underlines the importance of sizing tidal volume on respiratory system compliance rather than on predicted body weight. The present review article aims to describe the main alterations of respiratory mechanics in ARDS as a potent bedside tool to understand severity and guide mechanical ventilation settings, thus representing a readily available clinical resource for ICU physicians.

  18. Association between polymorphic markers of IL-10 gene and chronic diseases of the upper respiratory tract in children living under technogenic pressure

    Directory of Open Access Journals (Sweden)

    Lyudmila Borisovna Masnavieva

    2015-03-01

    Full Text Available Respiratory diseases are among the leading causes of infant morbidity. Disturbances of functioning of the immune system play an important role in their development. Interleukin-10 (IL-10 is a key regulator of the immune response. Mononucleotide substitutions at positions (-1082, (-819 and (-592 of IL-10 gene results in low level of the protein production. Our purpose was to study the associations between polymorphic markers of IL-10 gene and chronic respiratory diseases in children living under conditions of anthropogenic pressure. 189 adolescents living in a city with high levels of air pollution and 82 from a city with a moderate level of contamination were examined. Children with chronic upper airway pathology in remission were identified. Blood samples from all children were tested for allelic variants -1082G / A, -592C / A, -819C / T of IL-10 gene in. Analysis of associations between polymorphic variants and the presence of chronic respiratory diseases was conducted. The -592C allele of IL-10 gene was less common among children with chronic diseases of the respiratory tract living in conditions of moderate air pollution than in the healthy comparison group. Similar association has not been established in thr group of children living in conditions of high air pollution. Thus, the C allele of the polymorphic -592C/A locus marks resistance to the development of a chronic disease of the upper respiratory tract in children living in conditions of moderate air pollution, while in conditions of high level of pollution contribution of genetic factors in its development is leveled.

  19. Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure: a retrospective cohort study.

    Science.gov (United States)

    Caironi, Pietro; Carlesso, Eleonora; Cressoni, Massimo; Chiumello, Davide; Moerer, Onner; Chiurazzi, Chiara; Brioni, Matteo; Bottino, Nicola; Lazzerini, Marco; Bugedo, Guillermo; Quintel, Michael; Ranieri, V Marco; Gattinoni, Luciano

    2015-04-01

    The Berlin definition of acute respiratory distress syndrome has introduced three classes of severity according to PaO2/FIO2 thresholds. The level of positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking acute respiratory distress syndrome severity, which should reflect the underlying lung injury (lung edema and recruitability). We hypothesized that the assessment of acute respiratory distress syndrome severity at standardized low positive end-expiratory pressure may improve the association between the underlying lung injury, as detected by CT, and PaO2/FIO2-derived severity. Retrospective analysis. Four university hospitals (Italy, Germany, and Chile). One hundred forty-eight patients with acute lung injury or acute respiratory distress syndrome according to the American-European Consensus Conference criteria. Patients underwent a three-step ventilator protocol (at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure). Whole-lung CT scans were obtained at 5 and 45 cm H2O airway pressure. Nine patients did not fulfill acute respiratory distress syndrome criteria of the novel Berlin definition. Patients were then classified according to PaO2/FIO2 assessed at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure. At clinical positive end-expiratory pressure (11±3 cm H2O), patients with severe acute respiratory distress syndrome had a greater lung tissue weight and recruitability than patients with mild or moderate acute respiratory distress syndrome (pBerlin definition of acute respiratory distress syndrome assessed at 5 cm H2O allows a better evaluation of lung recruitability and edema than at higher positive end-expiratory pressure clinically set.

  20. Effects of a high-intensity interval training program versus a moderate-intensity continuous training program on maximal oxygen uptake and blood pressure in healthy adults: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Arboleda Serna, Víctor Hugo; Arango Vélez, Elkin Fernando; Gómez Arias, Rubén Darío; Feito, Yuri

    2016-08-18

    Participation in aerobic exercise generates increased cardiorespiratory fitness, which results in a protective factor for cardiovascular disease and all-cause mortality. High-intensity interval training might cause higher increases in cardiorespiratory fitness in comparison with moderate-intensity continuous training; nevertheless, current evidence is not conclusive. To our knowledge, this is the first study to test the effect of high-intensity interval training with total load duration of 7.5 min per session. A randomized controlled trial will be performed on two groups of healthy, sedentary male volunteers (n = 44). The study protocol will include 24 exercise sessions, three times a week, including aerobic training on a treadmill and strength training exercises. The intervention group will perform 15 bouts of 30 s, each at an intensity between 90 % and 95 % of maximal heart rate. The control group will complete 40 min of continuous exercise, ranging between 65 % and 75 % of maximal heart rate. The primary outcome measure to be evaluated will be maximal oxygen uptake (VO2max), and systolic and diastolic blood pressure will be evaluated as secondary outcome measures. Waist circumference, body mass index, and body composition will also be evaluated. Epidemiological evidence shows the link between VO2max and its association with chronic conditions that trigger CVD. Therefore, finding ways to improve VO2max and reduce blood pressure it is of vital importance to public health. NCT02288403 . Registered on 4 November 2014.

  1. Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Wagner da Silva Naue

    2014-01-01

    Full Text Available OBJECTIVE: To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation. METHODS: This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group. We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected. RESULTS: We included 34 patients. The mean age was 64.2 ± 14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004, a greater increase in mean expiratory tidal volume (16 ± 69 mL vs. 56 ± 69 mL; p = 0.018, and a greater increase in mean dynamic compliance (0.1 ± 4.9 cmH2O vs. 2.8 ± 4.5 cmH2O; p = 0.005. CONCLUSIONS: In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/

  2. Differential Effects of Endotracheal Suctioning on Gas Exchanges in Patients with Acute Respiratory Failure under Pressure-Controlled and Volume-Controlled Ventilation

    Directory of Open Access Journals (Sweden)

    Xiao-Wei Liu

    2015-01-01

    Full Text Available This study was conducted to evaluate the effects of open endotracheal suctioning on gas exchange and respiratory mechanics in ARF patients under the modes of PCV or VCV. Ninety-six ARF patients were treated with open endotracheal suctioning and their variations in respiratory mechanics and gas exchange after the suctions were compared. Under PCV mode, compared with the initial level of tidal volume (VT, ARF patients showed 30.0% and 27.8% decrease at 1 min and 10 min, respectively. Furthermore, the initial respiratory system compliance (Crs decreased by 29.6% and 28.5% at 1 min and 10 min, respectively. Under VCV mode, compared with the initial level, 38.6% and 37.5% increase in peak airway pressure (PAP were found at 1 min and 10 min, respectively. Under PCV mode, the initial PaO2 increased by 6.4% and 10.2 % at 3 min and 10 min, respectively, while 18.9% and 30.6% increase of the initial PaO2 were observed under VCV mode. Summarily, endotracheal suctioning may impair gas exchange and decrease lung compliance in ARF patients receiving mechanical ventilation under both PCV and VCV modes, but endotracheal suctioning effects on gas exchange were more severe and longer-lasting under PCV mode than VCV.

  3. Energetic Interrelationship between Spontaneous Low-Frequency Fluctuations in Regional Cerebral Blood Volume, Arterial Blood Pressure, Heart Rate, and Respiratory Rhythm

    Science.gov (United States)

    Katura, Takusige; Yagyu, Akihiko; Obata, Akiko; Yamazaki, Kyoko; Maki, Atsushi; Abe, Masanori; Tanaka, Naoki

    2007-07-01

    Strong spontaneous fluctuations around 0.1 and 0.3 Hz have been observed in blood-related brain-function measurements such as functional magnetic resonance imaging and optical topography (or functional near-infrared spectroscopy). These fluctuations seem to reflect the interaction between the cerebral circulation system and the systemic circulation system. We took an energetic viewpoint in our analysis of the interrelationships between fluctuations in cerebral blood volume (CBV), mean arterial blood pressure (MAP), heart rate (HR), and respiratory rhythm based on multivariate autoregressive modeling. This approach involves evaluating the contribution of each fluctuation or rhythm to specific ones by performing multivariate spectral analysis. The results we obtained show MAP and HR can account slightly for the fluctuation around 0.1 Hz in CBV, while the fluctuation around 0.3 Hz is derived mainly from the respiratory rhythm. During our presentation, we will report on the effects of posture on the interrelationship between the fluctuations and the respiratory rhythm.

  4. Respiratory exercise in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Pinto, Susana; Swash, Michael; de Carvalho, Mamede

    2012-01-01

    We have evaluated the potential role of respiratory exercise by implementing specific inspiratory muscle training in a selected population of early-affected amyotrophic lateral sclerosis (ALS) patients. We studied 26 patients with ALS with normal respiratory function using two groups of patients in a parallel, control-group, randomized, delayed-start design. Patients in the first group (G1) started the active inspiratory exercise programme at entry and were followed for eight months, while the second group (G2) of patients followed a placebo exercise programme for the first four months and then active exercise for the second four-month period. The primary outcome measure was the ALSFRS. Respiratory tests, neurophysiological measurements, fatigue and quality of life scales were secondary outcomes. Analysis of covariance was used to compare changes between and within groups. Results showed that there was no significant difference between the two patient groups. Within-group analysis suggested that inspiratory exercise promotes a transient improvement in the respiratory subscore and in the maximal voluntary ventilation, peak expiratory flow, and sniff inspiratory pressure. In conclusion, there was no clear positive or negative outcome of the respiratory exercise protocol we have proposed, but we cannot rule out a minor positive effect. Exercise regimes merit more detailed clinical evaluation in ALS.

  5. Profit maximization mitigates competition

    DEFF Research Database (Denmark)

    Dierker, Egbert; Grodal, Birgit

    1996-01-01

    We consider oligopolistic markets in which the notion of shareholders' utility is well-defined and compare the Bertrand-Nash equilibria in case of utility maximization with those under the usual profit maximization hypothesis. Our main result states that profit maximization leads to less price...... competition than utility maximization. Since profit maximization tends to raise prices, it may be regarded as beneficial for the owners as a whole. Moreover, if profit maximization is a good proxy for utility maximization, then there is no need for a general equilibrium analysis that takes the distribution...... of profits among consumers fully into account and partial equilibrium analysis suffices...

  6. Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial.

    Science.gov (United States)

    D'Antini, Davide; Huhle, Robert; Herrmann, Jacob; Sulemanji, Demet S; Oto, Jun; Raimondo, Pasquale; Mirabella, Lucia; Hemmes, Sabrine N T; Schultz, Marcus J; Pelosi, Paolo; Kaczka, David W; Vidal Melo, Marcos Francisco; Gama de Abreu, Marcelo; Cinnella, Gilda

    2018-01-01

    In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D). To test our hypothesis, we used the volume-dependent elastance index %E2, a respiratory parameter that allows for noninvasive and radiation-free assessment of dominant overdistension and intratidal R/D. We compared the incidence of intratidal R/D, linear expansion, and overdistension by means of %E2 in a subset of the PROVHILO cohort. In 36 patients from 2 participating centers of the PROVHILO trial, we calculated respiratory system elastance (E), resistance (R), and %E2, a surrogate parameter for intratidal overdistension (%E2 > 30%) and R/D (%E2 mechanical ventilation with protective tidal volumes in patients undergoing open abdominal surgery, lung recruitment followed by PEEP of 12 cm H2O decreased the incidence of intratidal R/D and did not worsen overdistension, when compared to PEEP ≤2 cm H2O.

  7. Comparison of Comfort and Effectiveness of Total Face Mask and Oronasal Mask in Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure: A Clinical Trial.

    Science.gov (United States)

    Sadeghi, Somayeh; Fakharian, Atefeh; Nasri, Peiman; Kiani, Arda

    2017-01-01

    Background . There is a growing controversy about the use of oronasal masks (ONM) or total facemask (TFM) in noninvasive positive pressure ventilation (NPPV), so we designed a trial to compare the uses of these two masks in terms of effectiveness and comfort. Methods . Between February and November 2014, a total of 48 patients with respiratory failure were studied. Patients were randomized to receive NPPV via ONM or TFM. Data were recorded at 60 minutes and six and 24 hours after intervention. Patient comfort was assessed using a questionnaire. Data were analyzed using t -test and chi-square test. Repeated measures ANOVA and Mann-Whitney U test were used to compare clinical and laboratory data. Results . There were no differences in venous blood gas (VBG) values between the two groups ( P > 0.05). However, at six hours, TFM was much more effective in reducing the partial pressure of carbon dioxide (PCO2) ( P = 0.04). Patient comfort and acceptance were statistically similar in both groups ( P > 0.05). Total time of NPPV was also similar in the two groups ( P > 0.05). Conclusions . TFM was superior to ONM in acute phase of respiratory failure but not once the patients were out of acute phase.

  8. Comparison of Comfort and Effectiveness of Total Face Mask and Oronasal Mask in Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    Somayeh Sadeghi

    2017-01-01

    Full Text Available Background. There is a growing controversy about the use of oronasal masks (ONM or total facemask (TFM in noninvasive positive pressure ventilation (NPPV, so we designed a trial to compare the uses of these two masks in terms of effectiveness and comfort. Methods. Between February and November 2014, a total of 48 patients with respiratory failure were studied. Patients were randomized to receive NPPV via ONM or TFM. Data were recorded at 60 minutes and six and 24 hours after intervention. Patient comfort was assessed using a questionnaire. Data were analyzed using t-test and chi-square test. Repeated measures ANOVA and Mann–Whitney U test were used to compare clinical and laboratory data. Results. There were no differences in venous blood gas (VBG values between the two groups (P>0.05. However, at six hours, TFM was much more effective in reducing the partial pressure of carbon dioxide (PCO2 (P=0.04. Patient comfort and acceptance were statistically similar in both groups (P>0.05. Total time of NPPV was also similar in the two groups (P>0.05. Conclusions. TFM was superior to ONM in acute phase of respiratory failure but not once the patients were out of acute phase.

  9. Effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure

    Directory of Open Access Journals (Sweden)

    You-Ming Zhu1

    2017-03-01

    Full Text Available Objective: T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD and type II respiratory failure. Methods: 90 patients with COPD and type II respiratory failure were randomly divided into observation group and control group (n=45. Control group received conventional therapy, observation group received conventional therapy + adjuvant noninvasive positive pressure ventilation, and differences in blood gas parameters, cardiac function, inflammatory state, etc., were compared between two groups of patients 2 weeks after treatment. Results: Arterial blood gas parameters pH and alveolar-arterial partial pressure of oxygen [P(A-aO2] levels of observation group were higher than those of control group while, potassium ion (K+, chloride ion (Cl﹣ and carbon dioxide combining power (CO2CP levels were lower than those of control group 2 weeks after treatment; echocardiography parameters Doppler-derived tricuspid lateral annular systolic velocity (DTIS and pulmonary arterial velocity (PAV levels were lower than those of control group (P<0.05 while pulmonary artery accelerating time (PAACT, left ventricular enddiastolic dimension (LVDd and right atrioventricular tricuspid annular plane systolic excursion (TAPSE levels were higher than those of control group (P<0.05; serum cardiac function indexes adiponectin (APN, Copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP, cystatin C (CysC, growth differentiation factor-15 (GDF-15 and heart type fatty acid binding protein (H-FABP content were lower than those of control group (P<0.05; serum inflammatory factors hypersensitive C-reactive protein (hs-CRP, tumor necrosis factor-α (TNF-α, interleukin-1β (IL-1β, IL-8, IL-10, and transforming growth factor-β1 (TGF-β1 content were lower than those of control group (P<0.05. Conclusions: Adjuvant

  10. Initial treatment of respiratory distress syndrome with nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Amir-Mohammad Armanian

    2014-01-01

    Full Text Available Background: Neonatal respiratory distress syndrome (RDS in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation (MV nowadays researchers in interested minimizing MV. To determine, in very low birth weight (BW preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation (early NIMV compared with early nasal continuous positive airway pressure (early NCPAP obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. Methods: In this single-center randomized control trial study, infants (BW ≤ 1500 g and/or gestational age ≤ 34 weeks with respiratory distress were considered eligible. Forty-four infants were randomly assigned to receive early-NIMV and 54 comparable infants to early-NCPAP. Surfactants were given, when FIO 2 requirement was of >30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. Results: 98 infants were enrolled (44 in the NIMV and 54 in the NCPAP group. The Preventive power of MV of NIMV usage (95.5% was not lower than the NCPAP (98.1% strength (hazard ratio: 0.21 (95% confidence interval: 0.02-2.66; P: 0.23. The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP (the median (range was 24 (18.00-48.00 h versus 48.00 (22.00-120.00 h in NIMV versus NCPAP groups; P < 0.001. Similarly, the duration of dependency on oxygen was less, for NIMV (the median (range was 96.00 (41.00-504.00 h versus144.00 (70.00-1130.00 h in NIMV versus NCPAP groups; P: 0.009. Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group. Conclusions: Initial treatment of RDS with NIMV was safe, and well tolerated. Furthermore, NIMV had excellent

  11. Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model.

    Science.gov (United States)

    Park, Marcelo; Mendes, Pedro Vitale; Costa, Eduardo Leite Vieira; Barbosa, Edzangela Vasconcelos Santos; Hirota, Adriana Sayuri; Azevedo, Luciano Cesar Pontes

    2016-01-01

    The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure. The factors associated with oxygen - and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested. Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.036mmHg/mL/min), cardiac output (beta coefficient = -11.970mmHg/L/min) and pulmonary shunting (beta coefficient = -0.232mmHg/%). Furthermore, the initial oxygen partial pressure and carbon dioxide partial pressure measurements were also associated with oxygenation, with beta coefficients of 0.160 and 0.442mmHg/mmHg, respectively. Carbon dioxide partial pressure was associated with cardiac output (beta coefficient = 3.578mmHg/L/min), sweep gas flow (beta coefficient = -2.635mmHg/L/min), temperature (beta coefficient = 4.514mmHg/ºC), initial pH (beta coefficient = -66.065mmHg/0.01 unit) and hemoglobin (beta coefficient = 6.635mmHg/g/dL). In conclusion, elevations in blood and sweep gas flows in an apneic veno-venous extracorporeal membrane oxygenation model resulted in an increase in oxygen partial pressure and a reduction in carbon dioxide partial pressure 2, respectively. Furthermore, without the possibility of causal inference, oxygen partial pressure was negatively associated with pulmonary shunting and cardiac output, and carbon dioxide partial pressure was positively associated with cardiac output, core temperature and initial hemoglobin.

  12. Maximally Rotating Supermassive Stars at the Onset of Collapse: The Perturbative Effects of Gas Pressure, Magnetic Fields, Dark Matter and Dark Energy

    Science.gov (United States)

    Butler, Satya P.; Lima, Alicia R.; Baumgarte, Thomas W.; Shapiro, Stuart L.

    2018-04-01

    The discovery of quasars at increasingly large cosmological redshifts may favor "direct collapse" as the most promising evolutionary route to the formation of supermassive black holes. In this scenario, supermassive black holes form when their progenitors - supermassive stars - become unstable to gravitational collapse. For uniformly rotating stars supported by pure radiation pressure and spinning at the mass-shedding limit, the critical configuration at the onset of collapse is characterized by universal values of the dimensionless spin and radius parameters J/M2 and R/M, independent of mass M. We consider perturbative effects of gas pressure, magnetic fields, dark matter and dark energy on these parameters, and thereby determine the domain of validity of this universality. We obtain leading-order corrections for the critical parameters and establish their scaling with the relevant physical parameters. We compare two different approaches to approximate the effects of gas pressure, which plays the most important role, find identical results for the above dimensionless parameters, and also find good agreement with recent numerical results.

  13. Respiratory alkalosis

    Science.gov (United States)

    Alkalosis - respiratory ... leads to shortness of breath can also cause respiratory alkalosis (such as pulmonary embolism and asthma). ... Treatment is aimed at the condition that causes respiratory alkalosis. Breathing into a paper bag -- or using ...

  14. Respiratory effects of low versus high tidal volume with or without positive end-expiratory pressure in anesthetized dogs with healthy lungs.

    Science.gov (United States)

    De Monte, Valentina; Bufalari, Antonello; Grasso, Salvatore; Ferrulli, Fabienne; Crovace, Alberto Maria; Lacitignola, Luca; Staffieri, Francesco

    2018-05-01

    OBJECTIVE To evaluate the impact of 2 tidal volumes (T V s) with or without positive end-expiratory pressure (PEEP) on lung mechanics, aeration, and gas exchange in healthy anesthetized dogs. ANIMALS 40 mixed-breed dogs with healthy lungs. PROCEDURES Anesthetized dogs were randomly assigned to 4 groups (n = 10/group) with different ventilatory settings: T V of 8 mL/kg and PEEP of 0 cm H 2 O (low T V group), T V of 8 mL/kg and PEEP of 5 cm H 2 O (low T V plus PEEP group), T V of 15 mL/kg and PEEP of 0 cm H 2 O (high T V group), or T V of 15 mL/kg and PEEP of 5 cm H 2 O (high T V plus PEEP group). Expired CO 2 and respiratory rate were titrated on the basis of a predetermined stepwise protocol. Gas exchange, respiratory mechanics, and pulmonary aeration were evaluated by means of CT 30 minutes after starting mechanical ventilation at the assigned setting. RESULTS Partial pressures of arterial and expired CO 2 were higher in the low T V and low T V plus PEEP groups than in the high T V and high T V plus PEEP groups. Peak and plateau airway pressures were higher in the PEEP group than in the other groups. Static lung compliance was higher in the high T V plus PEEP group than in the low T V group. Relative percentages of atelectatic and poorly aerated lung were lower in the high T V plus PEEP group than in the other groups. Oxygenation was similar among groups. CONCLUSIONS AND CLINICAL RELEVANCE Differences in T V and PEEP application during mechanical ventilation may affect respiratory function in anesthetized dogs with healthy lungs. Ventilation with a T V of 15 mL/kg and PEEP of 5 cm H 2 O significantly improved lung compliance and reduced the amount of atelectatic and poorly aerated lung.

  15. Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity: A Randomized Clinical Noninferiority Trial.

    Science.gov (United States)

    Lavizzari, Anna; Colnaghi, Mariarosa; Ciuffini, Francesca; Veneroni, Chiara; Musumeci, Stefano; Cortinovis, Ivan; Mosca, Fabio

    2016-08-08

    Heated, humidified high-flow nasal cannula (HHHFNC) has gained increasing popularity as respiratory support for newborn infants thanks to ease of use and improved patient comfort. However, its role as primary therapy for respiratory distress syndrome (RDS) of prematurity needs to be further elucidated by large, randomized clinical trials. To determine whether HHHFNC provides respiratory support noninferior to nasal continuous positive airway pressure (nCPAP) or bilevel nCPAP (BiPAP) as a primary approach to RDS in infants older than 28 weeks' gestational age (GA). An unblinded, monocentric, randomized clinical noninferiority trial at a tertiary neonatal intensive care unit. Inborn infants at 29 weeks 0 days to 36 weeks 6 days of GA were eligible if presenting with mild to moderate RDS requiring noninvasive respiratory support. Criteria for starting noninvasive respiratory support were a Silverman score of 5 or higher or a fraction of inspired oxygen higher than 0.3 for a target saturation of peripheral oxygen of 88% to 93%. Infants were ineligible if they had major congenital anomalies or severe RDS requiring early intubation. Infants were enrolled between January 5, 2012, and June 28, 2014. Randomization to either HHHFNC at 4 to 6 L/min or nCPAP/BiPAP at 4 to 6 cm H2O. Need for mechanical ventilation within 72 hours from the beginning of respiratory support. The absolute risk difference in the primary outcome and its 95% confidence interval were calculated to determine noninferiority (noninferiority margin, 10%). An intention-to-treat analysis was performed. A total of 316 infants were enrolled in the study: 158 in the HHHFNC group (mean [SD] GA, 33.1 [1.9] weeks; 52.5% female) and 158 in the nCPAP/BiPAP group (mean [SD] GA, 33.0 [2.1] weeks; 47.5% female). The use of HHHFNC was noninferior to nCPAP with regard to the primary outcome: failure occurred in 10.8% vs 9.5% of infants, respectively (95% CI of risk difference, -6.0% to 8.6% [within the noninferiority

  16. Maximally incompatible quantum observables

    Energy Technology Data Exchange (ETDEWEB)

    Heinosaari, Teiko, E-mail: teiko.heinosaari@utu.fi [Turku Centre for Quantum Physics, Department of Physics and Astronomy, University of Turku, FI-20014 Turku (Finland); Schultz, Jussi, E-mail: jussi.schultz@gmail.com [Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milano (Italy); Toigo, Alessandro, E-mail: alessandro.toigo@polimi.it [Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milano (Italy); Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Celoria 16, I-20133 Milano (Italy); Ziman, Mario, E-mail: ziman@savba.sk [RCQI, Institute of Physics, Slovak Academy of Sciences, Dúbravská cesta 9, 84511 Bratislava (Slovakia); Faculty of Informatics, Masaryk University, Botanická 68a, 60200 Brno (Czech Republic)

    2014-05-01

    The existence of maximally incompatible quantum observables in the sense of a minimal joint measurability region is investigated. Employing the universal quantum cloning device it is argued that only infinite dimensional quantum systems can accommodate maximal incompatibility. It is then shown that two of the most common pairs of complementary observables (position and momentum; number and phase) are maximally incompatible.

  17. Maximally incompatible quantum observables

    International Nuclear Information System (INIS)

    Heinosaari, Teiko; Schultz, Jussi; Toigo, Alessandro; Ziman, Mario

    2014-01-01

    The existence of maximally incompatible quantum observables in the sense of a minimal joint measurability region is investigated. Employing the universal quantum cloning device it is argued that only infinite dimensional quantum systems can accommodate maximal incompatibility. It is then shown that two of the most common pairs of complementary observables (position and momentum; number and phase) are maximally incompatible.

  18. Achieving quasi-adiabatic thermal environment to maximize resolution power in very high-pressure liquid chromatography: Theory, models, and experiments.

    Science.gov (United States)

    Gritti, Fabrice; Gilar, Martin; Jarrell, Joseph A

    2016-04-29

    A cylindrical vacuum chamber (inner diameter 5 cm) housing a narrow-bore 2.1 mm×100 mm column packed with 1.8 μm HSS-T3 fully porous particles was built in order to isolate thermally the chromatographic column from the external air environment. Consistent with statistical physics and the mean free path of air molecules, the experimental results show that natural air convection and conduction are fully eliminated for housing air pressures smaller than 10(-4) Torr. Heat radiation is minimized by wrapping up the column with low-emissivity aluminum-tape (emissivity coefficient ϵ=0.03 vs. 0.28 for polished stainless steel 316). Overall, the heat flux at the column wall is reduced by 96% with respect to standard still-air ovens. From a practical viewpoint, the efficiency of the column run at a flow rate of 0.6 mL/min at a constant 13,000 psi pressure drop (the viscous heat power is around 9 W/m) is improved by up to 35% irrespective of the analyte retention. Models of heat and mass transfer reveal that (1) the amplitude of the radial temperature gradient is significantly reduced from 0.30 to 0.01 K and (2) the observed improvement in resolution power stems from a more uniform distribution of the flow velocity across the column diameter. The eddy dispersion term in the van Deemter equation is reduced by 0.8±0.1 reduced plate height unit, a significant gain in column performance. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Wunder Christian

    2006-06-01

    Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

  20. Muscle mitochondrial capacity exceeds maximal oxygen delivery in humans

    DEFF Research Database (Denmark)

    Boushel, Robert Christopher; Gnaiger, Erich; Calbet, Jose A L

    2011-01-01

    Across a wide range of species and body mass a close matching exists between maximal conductive oxygen delivery and mitochondrial respiratory rate. In this study we investigated in humans how closely in-vivo maximal oxygen consumption (VO(2) max) is matched to state 3 muscle mitochondrial respira...

  1. Flow-Synchronized Nasal Intermittent Positive Pressure Ventilation for Infants <32 Weeks' Gestation with Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    C. Gizzi

    2012-01-01

    Full Text Available Aim. To evaluate whether synchronized-NIPPV (SNIPPV used after the INSURE procedure can reduce mechanical ventilation (MV need in preterm infants with RDS more effectively than NCPAP and to compare the clinical course and the incidence of short-term outcomes of infants managed with SNIPPV or NCPAP. Methods. Chart data of inborn infants 0.4, respiratory acidosis, or intractable apnoea that occurred within 72 hours of surfactant administration. Results. Eleven out of 31 (35.5% infants in the NCPAP group and 2 out of 33 (6.1% infants in the SNIPPV group failed the INSURE approach and underwent MV (. Fewer infants in the INSURE/SNIPPV group needed a second dose of surfactant, a high caffeine maintenance dose, and pharmacological treatment for PDA. Differences in O2 dependency at 28 days and 36 weeks of postmenstrual age were at the limit of significance in favor of SNIPPV treated infants. Conclusions. SNIPPV use after INSURE technique in our NICU reduced MV need and favorably affected short-term morbidities of our premature infants.

  2. Effects of wheelchair sports on respiratory muscle strength and thoracic mobility of individuals with spinal cord injury.

    Science.gov (United States)

    Moreno, Marlene Aparecida; Zamunér, Antonio Roberto; Paris, Juliana Viana; Teodori, Rosana Macher; Barros, Ricardo M L

    2012-06-01

    The aim of this study was to evaluate the effects of wheelchair sports on respiratory muscle strength and the thoracic mobility of individuals with spinal cord injury. Thirty male subjects with chronic spinal cord injury (American Spinal Injury Association Impairment Scale grade A) took part in the study and were divided into four groups: sedentary subjects with quadriplegia (S-QUAD, n = 7), wheelchair rugby athletes with quadriplegia (A-QUAD, n = 8), sedentary subjects with paraplegia (S-PARA, n = 6), and wheelchair basketball athletes with paraplegia (A-PARA, n = 9). The main outcome measures were maximal inspiratory and expiratory pressure and the respiratory coefficients at the axillary and xiphoid levels. A-QUAD group presented values significantly higher for all respiratory variables studied compared with the S-QUAD group. No significant differences in any of the respiratory variables were observed between S-PARA and A-PARA groups. There was a negative correlation between spinal cord injury level and respiratory variables for the S-QUAD and S-PARA groups. There were positive correlations in the A-QUAD group between time of training and maximal inspiratory pressure (adjusted R = 0.84; P = 0.001) and respiratory coefficients at the axillary level (adjusted R = 0.80; P = 0.002). Physical training seems to have a positive influence on respiratory muscle strength and thoracic mobility, especially in subjects with quadriplegia.

  3. Maximizers versus satisficers

    OpenAIRE

    Andrew M. Parker; Wandi Bruine de Bruin; Baruch Fischhoff

    2007-01-01

    Our previous research suggests that people reporting a stronger desire to maximize obtain worse life outcomes (Bruine de Bruin et al., 2007). Here, we examine whether this finding may be explained by the decision-making styles of self-reported maximizers. Expanding on Schwartz et al. (2002), we find that self-reported maximizers are more likely to show problematic decision-making styles, as evidenced by self-reports of less behavioral coping, greater dependence on others when making decisions...

  4. Maximal combustion temperature estimation

    International Nuclear Information System (INIS)

    Golodova, E; Shchepakina, E

    2006-01-01

    This work is concerned with the phenomenon of delayed loss of stability and the estimation of the maximal temperature of safe combustion. Using the qualitative theory of singular perturbations and canard techniques we determine the maximal temperature on the trajectories located in the transition region between the slow combustion regime and the explosive one. This approach is used to estimate the maximal temperature of safe combustion in multi-phase combustion models

  5. Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Dat, Vu Quoc; Geskus, Ronald B; Wolbers, Marcel; Loan, Huynh Thi; Yen, Lam Minh; Binh, Nguyen Thien; Chien, Le Thanh; Mai, Nguyen Thi Hoang; Phu, Nguyen Hoan; Lan, Nguyen Phu Huong; Hao, Nguyen Van; Long, Hoang Bao; Thuy, Tran Phuong; Kinh, Nguyen Van; Trung, Nguyen Vu; Phu, Vu Dinh; Cap, Nguyen Trung; Trinh, Dao Tuyet; Campbell, James; Kestelyn, Evelyne; Wertheim, Heiman F L; Wyncoll, Duncan; Thwaites, Guy Edward; van Doorn, H Rogier; Thwaites, C Louise; Nadjm, Behzad

    2018-04-04

    Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in intensive care units (ICUs) worldwide, responsible for a large proportion of antibiotic use within ICUs. Evidence-based strategies for the prevention of VARI in resource-limited settings are lacking. Preventing the leakage of oropharyngeal secretions into the lung using continuous endotracheal cuff pressure control is a promising strategy. The aim of this study is to investigate the efficacy of automated, continuous endotracheal cuff pressure control in preventing the development of VARI and reducing antibiotic use in ICUs in Vietnam. This is an open-label randomised controlled multicentre trial. We will enrol 600 adult patients intubated for ≤ 24 h at the time of enrolment. Eligible patients will be stratified according to admission diagnosis (180 tetanus, 420 non-tetanus) and site and will be randomised in a 1:1 ratio to receive either (1) automated, continuous control of endotracheal cuff pressure or (2) intermittent measurement and control of endotracheal cuff pressure using a manual cuff pressure meter. The primary outcome is the occurrence of VARI, defined as either VAP or VAT during the ICU admission up to a maximum of 90 days after randomisation. Patients in both groups who are at risk for VARI will receive a standardised battery of investigations if their treating physician feels a new infection has occurred, the results of which will be used by an endpoint review committee, blinded to the allocated arm and independent of patient care, to determine the primary outcome. All enrolled patients will be followed for mortality and endotracheal tube cuff-related complications at 28 days and 90 days after randomisation. Other secondary outcomes include antibiotic use; days ventilated, in ICU and in hospital

  6. A randomised controlled trial on the effect of mask choice on residual respiratory events with continuous positive airway pressure treatment.

    Science.gov (United States)

    Ebben, Matthew R; Narizhnaya, Mariya; Segal, Alan Z; Barone, Daniel; Krieger, Ana C

    2014-06-01

    It has been found that mask style can affect the amount of continuous positive airway pressure (CPAP) required to reduce an apnoea/hyponoea index (AHI) to mask style to another post titration could affect the residual AHI with CPAP. The purpose of this study was to investigate the differences in residual AHI with CPAP treatment between oronasal and nasal masks. Twenty-one subjects (age mean (M)=62.9, body mass index (BMI) M=29.6 kg/m2) were randomised (14 subjects completed the protocol) to undergo an in-laboratory CPAP titration with either a nasal mask or an oronasal mask. Subjects were then assigned this mask for 3weeks of at-home CPAP use with the optimal treatment pressure determined on the laboratory study (CPAP M=8.4 cm of H2O). At the end of this 3-week period, data were collected from the CPAP machine and the subject was given the other mask to use with the same CPAP settings for the next 3weeks at home (if the nasal mask was given initially, the oronasal one was given later and vice versa). On completion of the second 3-week period, data on residual AHI were again collected and compared with the first 3-week period on CPAP. A Wilcoxon Signed-Rank Test (two-tailed) revealed that residual AHI with CPAP treatment was significantly higher with the oronasal compared with the nasal mask (z = -3.296, pmask, and 50% of the subjects had a residual AHI >10/h in the oronasal mask condition, even though all of these subjects were titrated to an AHI of mask compared with a nasal mask. Switching to an oronasal mask post titration results in an increase in residual AHI with CPAP treatment, and pressure adjustment may be warranted. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. The Effects of Massage with Coconut and Sunflower Oils on Oxygen Saturation of Premature Infants with Respiratory Distress Syndrome Treated With Nasal Continuous Positive Airway Pressure

    Directory of Open Access Journals (Sweden)

    Sousan Valizadeh

    2012-11-01

    Full Text Available Introduction: Nowadays particular emphasis is placed on the developmental aspects of premature infants care. Massage therapy is one of the best-known methods of caring. Due to the minimal touch policy in neonatal intensive care units (NICUs, massaging is not usually performed on premature infants. However, there is not sufficient evidence to support the claim that newborn infants with complex medical conditions should not be massaged. This study aimed to determine the effects of massage with coconut and sunflower oils on oxygen saturation of infants with respiratory distress syndrome (RDS treated with nasal continuous positive airway pressure (NCPAP. Methods: This was a randomized controlled trial on 90 newborns who were admitted to Alzahra Hospital (Tabriz, Iran. The infants were divided into control and massage therapy groups (massage with coconut and sunflower oils. Data was collected using a hospital documentation form. A 15-minute daily massage was performed for 3 days. Respiratory rate (RR, fraction of inspired oxygen (FiO2 and oxygen saturation were measured 5 minutes before the massage, 3 times during the massage, and 5 minutes after the massage. The collected data was analyzed using a mixed model. Results: In comparison to coconut oil and control groups, mean oxygen saturation of sunflower oil group was improved. In addition, the coconut massage group showed lower oxygen saturation than the control group but was all values were within the normal range. Although massage decreased oxygen saturation, there was no need to increase FiO2. Conclusion: Massage therapy can provide developmental care for infants treated with NCPAP.

  8. Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index

    Directory of Open Access Journals (Sweden)

    M.T.M. Araújo

    2003-12-01

    Full Text Available A transitory increase in blood pressure (BP is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10 were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05 increase in nighttime but not daytime systolic BP (119 ± 5 vs 107 ± 3 mmHg, diastolic BP (72 ± 4 vs 67 ± 2 mmHg, HR (67 ± 4 vs 57 ± 2 bpm, respiratory disturbance index (RDI characterized by apnea-hypopnea (30 ± 10 vs 13 ± 4 events/h of sleep and norepinephrine levels (22.0 ± 4.7 vs 11.0 ± 1.3 µg l-1 12 h-1 after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01 but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 ± 0.8 vs 5.0 ± 0.9 cm, respectively. These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI.

  9. Predicting mortality among older adults hospitalized for community-acquired pneumonia: an enhanced confusion, urea, respiratory rate and blood pressure score compared with pneumonia severity index.

    Science.gov (United States)

    Abisheganaden, John; Ding, Yew Yoong; Chong, Wai-Fung; Heng, Bee-Hoon; Lim, Tow Keang

    2012-08-01

    Pneumonia Severity Index (PSI) predicts mortality better than Confusion, Urea >7 mmol/L, Respiratory rate >30/min, low Blood pressure: diastolic blood pressure blood pressure 65 years (CURB-65) for community-acquired pneumonia (CAP) but is more cumbersome. The objective was to determine whether CURB enhanced with a small number of additional variables can predict mortality with at least the same accuracy as PSI. Retrospective review of medical records and administrative data of adults aged 55 years or older hospitalized for CAP over 1 year from three hospitals. For 1052 hospital admissions of unique patients, 30-day mortality was 17.2%. PSI class and CURB-65 predicted 30-day mortality with area under curve (AUC) of 0.77 (95% confidence interval (CI): 0.73-0.80) and 0.70 (95% CI: 0.66-0.74) respectively. When age and three co-morbid conditions (metastatic cancer, solid tumours without metastases and stroke) were added to CURB, the AUC improved to 0.80 (95% CI: 0.77-0.83). Bootstrap validation obtained an AUC estimate of 0.78, indicating negligible overfitting of the model. Based on this model, a clinical score (enhanced CURB score) was developed that had possible values from 5 to 25. Its AUC was 0.79 (95% CI: 0.76-0.83) and remained similar to that of PSI class. An enhanced CURB score predicted 30-day mortality with at least the same accuracy as PSI class did among older adults hospitalized for CAP. External validation of this score in other populations is the next step to determine whether it can be used more widely. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

  10. Maximally multipartite entangled states

    Science.gov (United States)

    Facchi, Paolo; Florio, Giuseppe; Parisi, Giorgio; Pascazio, Saverio

    2008-06-01

    We introduce the notion of maximally multipartite entangled states of n qubits as a generalization of the bipartite case. These pure states have a bipartite entanglement that does not depend on the bipartition and is maximal for all possible bipartitions. They are solutions of a minimization problem. Examples for small n are investigated, both analytically and numerically.

  11. Maximizers versus satisficers

    Directory of Open Access Journals (Sweden)

    Andrew M. Parker

    2007-12-01

    Full Text Available Our previous research suggests that people reporting a stronger desire to maximize obtain worse life outcomes (Bruine de Bruin et al., 2007. Here, we examine whether this finding may be explained by the decision-making styles of self-reported maximizers. Expanding on Schwartz et al. (2002, we find that self-reported maximizers are more likely to show problematic decision-making styles, as evidenced by self-reports of less behavioral coping, greater dependence on others when making decisions, more avoidance of decision making, and greater tendency to experience regret. Contrary to predictions, self-reported maximizers were more likely to report spontaneous decision making. However, the relationship between self-reported maximizing and worse life outcomes is largely unaffected by controls for measures of other decision-making styles, decision-making competence, and demographic variables.

  12. [The influence of positive end-expiratory pressure on cerebral blood flow and cerebrovascular autoregulation in patients with acute respiratory distress syndrome].

    Science.gov (United States)

    Yang, Chunli; Chen, Zhi; Lu, Yuanhua; He, Huiwei; Zeng, Weihua

    2014-05-01

    To explore the influence of different positive end-expiratory pressure (PEEP) levels on cerebral blood flow (CBF) and cerebrovascular autoregulation in patients with acute respiratory distress syndrome(ARDS). A prospective study was conducted. Moderate or severe ARDS patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st, 2013 to October 1st, 2013 were enrolled. The changes in hemodynamics, respiratory mechanics and gas exchange under different levels of PEEP were observed. CBF velocity of middle cerebral artery (MCA) was measured using transcranial Doppler (TCD), and breath-holding index (BHI) was also calculated. 35 patients with ARDS were included. The oxygenation index (OI), peak inspiratory pressure (PIP), plat pressure (Pplat) and central venous pressure (CVP) were markedly elevated (OI: 324.7±117.2 mmHg vs. 173.4±95.8 mmHg, t=5.913, P=0.000; PIP: 34.7±9.1 cmH2O vs. 26.1±7.9 cmH2O,t=4.222, P=0.000; Pplat: 30.5±8.4 cmH2O vs. 22.2±7.1 cmH2O, t=4.465, P=0.000; CVP: 12.1±3.5 mmHg vs. 8.8±2.2 mmHg, t=4.723, P=0.000) when PEEP was increased from (6.4±1.0) cmH2O to (14.5±2.0) cmH2O (1 cmH2O=0.098 kPa). But no significant difference in the heart rate (85.5±19.1 beats/min vs. 82.7±17.3 beats/min, t=0.643, P=0.523), mean arterial pressure (73.5±12.4 mmHg vs. 76.4±15.1 mmHg, t=0.878, P=0.383) and CBF velocity of MCA [peak systolic flow velocity (Vmax): 91.26±17.57 cm/s vs. 96.64±18.71 cm/s, t=1.240, P=0.219; diastolic flow velocity (Vmin): 31.54±7.71 cm/s vs. 33.87±8.53 cm/s, t=1.199, P=0.235; mean velocity (Vmean): 51.19±12.05 cm/s vs. 54.27±13.36 cm/s, t=1.013, P=0.315] was found. 18 patients with BHI<0.1 at baseline demonstrated that cerebral vasomotor reactivity was poor. BHI was slightly decreased with increase in PEEP (0.78±0.16 vs. 0.86±0.19, t=1.905, P=0.061). Some of moderate or severe ARDS patients without central nervous system disease have independent of preexisting cerebral

  13. Respiratory Failure

    Science.gov (United States)

    Respiratory failure happens when not enough oxygen passes from your lungs into your blood. Your body's organs, ... brain, need oxygen-rich blood to work well. Respiratory failure also can happen if your lungs can' ...

  14. Respiratory system

    Science.gov (United States)

    Bartlett, R. G., Jr.

    1973-01-01

    The general anatomy and function of the human respiratory system is summarized. Breathing movements, control of breathing, lung volumes and capacities, mechanical relations, and factors relevant to respiratory support and equipment design are discussed.

  15. Effects of respiratory rate and tidal volume on gas exchange in total liquid ventilation.

    Science.gov (United States)

    Bull, Joseph L; Tredici, Stefano; Fujioka, Hideki; Komori, Eisaku; Grotberg, James B; Hirschl, Ronald B

    2009-01-01

    Using a rabbit model of total liquid ventilation (TLV), and in a corresponding theoretical model, we compared nine tidal volume-respiratory rate combinations to identify a ventilator strategy to maximize gas exchange, while avoiding choked flow, during TLV. Nine different ventilation strategies were tested in each animal (n = 12): low [LR = 2.5 breath/min (bpm)], medium (MR = 5 bpm), or high (HR = 7.5 bpm) respiratory rates were combined with a low (LV = 10 ml/kg), medium (MV = 15 ml/kg), or high (HV = 20 ml/kg) tidal volumes. Blood gases and partial pressures, perfluorocarbon gas content, and airway pressures were measured for each combination. Choked flow occurred in all high respiratory rate-high volume animals, 71% of high respiratory rate-medium volume (HRMV) animals, and 50% of medium respiratory rate-high volume (MRHV) animals but in no other combinations. Medium respiratory rate-medium volume (MRMV) resulted in the highest gas exchange of the combinations that did not induce choke. The HRMV and MRHV animals that did not choke had similar or higher gas exchange than MRMV. The theory predicted this behavior, along with spatial and temporal variations in alveolar gas partial pressures. Of the combinations that did not induce choked flow, MRMV provided the highest gas exchange. Alveolar gas transport is diffusion dominated and rapid during gas ventilation but is convection dominated and slow during TLV. Consequently, the usual alveolar gas equation is not applicable for TLV.

  16. Is CP violation maximal

    International Nuclear Information System (INIS)

    Gronau, M.

    1984-01-01

    Two ambiguities are noted in the definition of the concept of maximal CP violation. The phase convention ambiguity is overcome by introducing a CP violating phase in the quark mixing matrix U which is invariant under rephasing transformations. The second ambiguity, related to the parametrization of U, is resolved by finding a single empirically viable definition of maximal CP violation when assuming that U does not single out one generation. Considerable improvement in the calculation of nonleptonic weak amplitudes is required to test the conjecture of maximal CP violation. 21 references

  17. Aerobic exercise and respiratory muscle strength in patients with cystic fibrosis.

    Science.gov (United States)

    Dassios, Theodore; Katelari, Anna; Doudounakis, Stavros; Dimitriou, Gabriel

    2013-05-01

    The beneficial role of exercise in maintaining health in patients with cystic fibrosis (CF) is well described. Few data exist on the effect of exercise on respiratory muscle function in patients with CF. Our objective was to compare respiratory muscle function indices in CF patients that regularly exercise with those CF patients that do not. This cross-sectional study assessed nutrition, pulmonary function and respiratory muscle function in 37 CF patients that undertook regular aerobic exercise and in a control group matched for age and gender which consisted of 44 CF patients that did not undertake regular exercise. Respiratory muscle function in CF was assessed by maximal inspiratory pressure (Pimax), maximal expiratory pressure (Pemax) and pressure-time index of the respiratory muscles (PTImus). Median Pimax and Pemax were significantly higher in the exercise group compared to the control group (92 vs. 63 cm H2O and 94 vs. 64 cm H2O respectively). PTImus was significantly lower in the exercise group compared to the control group (0.089 vs. 0.121). Upper arm muscle area (UAMA) and mid-arm muscle circumference were significantly increased in the exercise group compared to the control group (2608 vs. 2178 mm2 and 23 vs. 21 cm respectively). UAMA was significantly related to Pimax in the exercising group. These results suggest that CF patients that undertake regular aerobic exercise maintain higher indices of respiratory muscle strength and lower PTImus values, while increased UAMA values in exercising patients highlight the importance of muscular competence in respiratory muscle function in this population. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Alterations in the rate of limb movement using a lower body positive pressure treadmill do not influence respiratory rate or phase III ventilation.

    Science.gov (United States)

    Buono, Michael J; Burnsed-Torres, Marissa; Hess, Bethany; Lopez, Kristine; Ortiz, Catherine; Girodo, Ariel; Lolli, Karen; Bloom, Brett; Bailey, David; Kolkhorst, Fred W

    2015-01-01

    The purpose of this study was to determine the effect of alterations in rate of limb movement on Phase III ventilation during exercise, independent of metabolic rate, gait style, and treadmill incline. Subjects completed five submaximal exercise bouts on a lower body positive pressure treadmill (AlterG P 200). The percent body weight for the five exercise bouts was 100, 87, 75, 63, and 50% and each was matched for carbon dioxide production (V CO2 ). Naturally, to match the V CO2 while reducing the body weight up to 50% of normal required a significant increase in the treadmill speed from 3.0 ± 0.1 to 4.1 ± 0.2 mph, which resulted in a significant (P body weight) to 133 ± 6 at 4.1 mph (i.e., 50% of body weight). The most important finding was that significant increases in step frequency did not significantly alter minute ventilation or respiratory rate. Such results do not support an important role for the rate of limb movement in Phase III ventilation during submaximal exercise, when metabolic rate, gait style, and treadmill incline are controlled.

  19. Alterations in the Rate of Limb Movement Using a Lower Body Positive Pressure Treadmill Do Not Influence Respiratory Rate or Phase III Ventilation

    Directory of Open Access Journals (Sweden)

    Michael J. Buono

    2015-01-01

    Full Text Available The purpose of this study was to determine the effect of alterations in rate of limb movement on Phase III ventilation during exercise, independent of metabolic rate, gait style, and treadmill incline. Subjects completed five submaximal exercise bouts on a lower body positive pressure treadmill (AlterG P 200. The percent body weight for the five exercise bouts was 100, 87, 75, 63, and 50% and each was matched for carbon dioxide production (VCO2. Naturally, to match the VCO2 while reducing the body weight up to 50% of normal required a significant increase in the treadmill speed from 3.0±0.1 to 4.1±0.2 mph, which resulted in a significant (P<0.05 increase in the mean step frequency (steps per minute from 118±10 at 3 mph (i.e., 100% of body weight to 133±6 at 4.1 mph (i.e., 50% of body weight. The most important finding was that significant increases in step frequency did not significantly alter minute ventilation or respiratory rate. Such results do not support an important role for the rate of limb movement in Phase III ventilation during submaximal exercise, when metabolic rate, gait style, and treadmill incline are controlled.

  20. On Better Estimating and Normalizing the Relationship between Clinical Parameters: Comparing Respiratory Modulations in the Photoplethysmogram and Blood Pressure Signal (DPOP versus PPV

    Directory of Open Access Journals (Sweden)

    Paul S. Addison

    2015-01-01

    Full Text Available DPOP (ΔPOP or Delta-POP is a noninvasive parameter which measures the strength of respiratory modulations present in the pulse oximeter waveform. It has been proposed as a noninvasive alternative to pulse pressure variation (PPV used in the prediction of the response to volume expansion in hypovolemic patients. We considered a number of simple techniques for better determining the underlying relationship between the two parameters. It was shown numerically that baseline-induced signal errors were asymmetric in nature, which corresponded to observation, and we proposed a method which combines a least-median-of-squares estimator with the requirement that the relationship passes through the origin (the LMSO method. We further developed a method of normalization of the parameters through rescaling DPOP using the inverse gradient of the linear fitted relationship. We propose that this normalization method (LMSO-N is applicable to the matching of a wide range of clinical parameters. It is also generally applicable to the self-normalizing of parameters whose behaviour may change slightly due to algorithmic improvements.

  1. On better estimating and normalizing the relationship between clinical parameters: comparing respiratory modulations in the photoplethysmogram and blood pressure signal (DPOP versus PPV).

    Science.gov (United States)

    Addison, Paul S; Wang, Rui; Uribe, Alberto A; Bergese, Sergio D

    2015-01-01

    DPOP (ΔPOP or Delta-POP) is a noninvasive parameter which measures the strength of respiratory modulations present in the pulse oximeter waveform. It has been proposed as a noninvasive alternative to pulse pressure variation (PPV) used in the prediction of the response to volume expansion in hypovolemic patients. We considered a number of simple techniques for better determining the underlying relationship between the two parameters. It was shown numerically that baseline-induced signal errors were asymmetric in nature, which corresponded to observation, and we proposed a method which combines a least-median-of-squares estimator with the requirement that the relationship passes through the origin (the LMSO method). We further developed a method of normalization of the parameters through rescaling DPOP using the inverse gradient of the linear fitted relationship. We propose that this normalization method (LMSO-N) is applicable to the matching of a wide range of clinical parameters. It is also generally applicable to the self-normalizing of parameters whose behaviour may change slightly due to algorithmic improvements.

  2. Utilization of the lower inflection point of the pressure-volume curve results in protective conventional ventilation comparable to high frequency oscillatory ventilation in an animal model of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Felipe S. Rossi

    2008-01-01

    Full Text Available INTRODUCTION: Studies comparing high frequency oscillatory and conventional ventilation in acute respiratory distress syndrome have used low values of positive end-expiratory pressure and identified a need for better recruitment and pulmonary stability with high frequency. OBJECTIVE: To compare conventional and high frequency ventilation using the lower inflection point of the pressure-volume curve as the determinant of positive end-expiratory pressure to obtain similar levels of recruitment and alveolar stability. METHODS: After lung lavage of adult rabbits and lower inflection point determination, two groups were randomized: conventional (positive end-expiratory pressure = lower inflection point; tidal volume=6 ml/kg and high frequency ventilation (mean airway pressures= lower inflection point +4 cmH2O. Blood gas and hemodynamic data were recorded over 4 h. After sacrifice, protein analysis from lung lavage and histologic evaluation were performed. RESULTS: The oxygenation parameters, protein and histological data were similar, except for the fact that significantly more normal alveoli were observed upon protective ventilation. High frequency ventilation led to lower PaCO2 levels. DISCUSSION: Determination of the lower inflection point of the pressure-volume curve is important for setting the minimum end expiratory pressure needed to keep the airways opened. This is useful when comparing different strategies to treat severe respiratory insufficiency, optimizing conventional ventilation, improving oxygenation and reducing lung injury. CONCLUSIONS: Utilization of the lower inflection point of the pressure-volume curve in the ventilation strategies considered in this study resulted in comparable efficacy with regards to oxygenation and hemodynamics, a high PaCO2 level and a lower pH. In addition, a greater number of normal alveoli were found after protective conventional ventilation in an animal model of acute respiratory distress syndrome.

  3. A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

    OpenAIRE

    Chang, Suchi; Shi, Jindong; Fu, Cuiping; Wu, Xu; Li, Shanqun

    2016-01-01

    Suchi Chang,1 Jindong Shi,2 Cuiping Fu,1 Xu Wu,1 Shanqun Li1 1Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 2Department of Respiratory Medicine, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, People’s Republic of China Background: COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Inten...

  4. Factors related to respiration influencing survival and respiratory function in patients with amyotrophic lateral sclerosis: a retrospective study.

    Science.gov (United States)

    Leonardis, L; Dolenc Grošelj, L; Vidmar, G

    2012-12-01

    Various breathing abnormalities (Neurology 2009; 73: 1218) have been proposed as indicators for the introduction of non-invasive positive-pressure ventilation (NIV) in patients with amyotrophic lateral sclerosis (ALS). We were interested in the usefulness of symptoms of respiratory insufficiency and abnormal results of daytime arterial gas analyses (AGA) as predictors of survival and the effect of NIV on respiratory volumes and pressures. Reported symptoms, respiratory subscore of the ALS Functional Rating Scale (ALSFRS-r), Norris scale (Norris-r), and AGA were retrospectively analyzed in 189 ALS patients. Longitudinal follow-up of forced vital capacity (FVC), maximal inspiratory and expiratory pressure (MIP, MEP), and sniff nasal pressure (SNP) were analyzed with regard to the introduction of NIV. Respiratory symptoms were a bad prognostic sign (P = 0.007). Abnormalities in Norris-r, ALSFRS-r, pO(2), pCO(2), and oxygen saturation tended to be associated with a shorter survival, although they were not statistically significant. NIV prolonged survival and reduced the decline in FVC (P = 0.007), MIP, MEP, and SNP (the last three were not statistically significant). Symptoms, abnormal FVC, and AGA do not always coincide, and they can appear in a different sequence. Any respiratory abnormality should prompt the clinician to start discussing NIV with the patient. NIV prolongs survival and improves respiratory function. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  5. Effects of respiratory muscle training (RMT) in children with infantile-onset Pompe disease and respiratory muscle weakness.

    Science.gov (United States)

    Jones, Harrison N; Crisp, Kelly D; Moss, Tronda; Strollo, Katherine; Robey, Randy; Sank, Jeffrey; Canfield, Michelle; Case, Laura E; Mahler, Leslie; Kravitz, Richard M; Kishnani, Priya S

    2014-01-01

    Respiratory muscle weakness is a primary therapeutic challenge for patients with infantile Pompe disease. We previously described the clinical implementation of a respiratory muscle training (RMT) regimen in two adults with late-onset Pompe disease; both demonstrated marked increases in inspiratory and expiratory muscle strength in response to RMT. However, the use of RMT in pediatric survivors of infantile Pompe disease has not been previously reported. We report the effects of an intensive RMT program on maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) using A-B-A (baseline-treatment-posttest) single subject experimental design in two pediatric survivors of infantile Pompe disease. Both subjects had persistent respiratory muscle weakness despite long-term treatment with alglucosidase alfa. Subject 1 demonstrated negligible to modest increases in MIP/MEP (6% increase in MIP, d=0.25; 19% increase in MEP, d=0.87), while Subject 2 demonstrated very large increases in MIP/MEP (45% increase in MIP, d=2.38; 81% increase in MEP, d=4.31). Following three-month RMT withdrawal, both subjects maintained these strength increases and demonstrated maximal MIP and MEP values at follow-up. Intensive RMT may be a beneficial treatment for respiratory muscle weakness in pediatric survivors of infantile Pompe disease.

  6. Intrinsic positive end-expiratory pressure during one-lung ventilation of patients with pulmonary hyperinflation. Influence of low respiratory rate with unchanged minute volume.

    Science.gov (United States)

    Szegedi, L L; Barvais, L; Sokolow, Y; Yernault, J C; d'Hollander, A A

    2002-01-01

    We measured lung mechanics and gas exchange during one-lung ventilation (OLV) of patients with chronic obstructive pulmonary disease, using three respiratory rates (RR) and unchanged minute volume. We studied 15 patients about to undergo lung surgery, during anaesthesia, and placed in the lateral position. Ventilation was with constant minute volume, inspiratory flow and FIO2. For periods of 15 min, RR of 5, 10, and 15 bpm were applied in a random sequence and recordings were made of lung mechanics and an arterial blood gas sample was taken. Data were analysed with the repeated measures ANOVA and paired t-test with Bonferroni correction. PaO2 changes were not significant. At the lowest RR, PaCO2 decreased (from 42 (SD 4) mm Hg at RR 15-41 (4) mm Hg at RR 10 and 39 (4) mm Hg at RR 5, P<0.01), and end-tidal carbon dioxide increased (from 33 (5) mm Hg at RR 15 to 35 (5) mm Hg at RR 10 and 36 (6) mm Hg at RR 5, P<0.01). Intrinsic positive end-expiratory pressure (PEEPi) was reduced even with larger tidal volumes (from 6 (4) cm H2O at RR 15-5 (4) cm H2O at RR 10, and 3 (3) cm H2O at RR 5, P<0.01), most probably caused by increased expiratory time at the lowest RR. A reduction in RR reduces PEEPi and hypercapnia during OLV in anaesthetized patients with chronic obstructive lung disease.

  7. Respiratory muscle strength in children with mild bronchial asthma disease

    Directory of Open Access Journals (Sweden)

    Kateřina Neumannová

    2017-12-01

    Full Text Available Background: Respiratory muscle strength can be decreased in patients with asthma; however, it is not well-documented whether a mild bronchial asthma disease can affect respiratory muscle strength in children and can be associated with higher presence of breathing difficulties. Objective: The main aim of the present study was to compare respiratory muscle strength between children with asthma and age-matched healthy children. The next aim of this study was to assess the incidence of decreased respiratory muscle strength in children with asthma and healthy children and assess the effect of decreased respiratory muscle strength on the incidence of breathing difficulties. Methods: Children with mild bronchial asthma (n = 167 and age-matched, healthy children (n = 100 were recruited into this study. Pulmonary function tests, maximal inspiratory (PImax and expiratory (PEmax mouth pressures and the incidence of breathing difficulty were evaluated in children with asthma and healthy controls. Results: The inspiratory muscle strength was similar between children with asthma and healthy children. Conversely, the expiratory muscle strength was lower in asthmatic children. There was a statistically significant difference between girls with asthma and healthy girls (PEmax = 81.7 ± 29.8% vs. 100.1 ± 23.7% of predicted, p < .001. PEmax was significantly higher in boys with asthma than in girls with asthma (PEmax = 92.9 ± 26.4 % vs. 81.7 ± 29.8% of predicted, p = .03. A higher incidence of breathing difficulties during physical activity (uphill walking, running, swimming was confirmed in children with asthma with lower respiratory muscle strength. Conclusions: There was a higher prevalence of decreased expiratory muscle strength in children with asthma; therefore, respiratory muscle strength should be tested in these children, especially in those who are symptomatic.

  8. Vzájemný vztah mezi mobilitou a maximálním uzávěrovým tlakem uretry či Valsalva Leak-Point Pressure u žen se stresovým typem inkontince moči

    Czech Academy of Sciences Publication Activity Database

    Martan, A.; Mašata, J.; Švabík, K.; Drahorádová, P.; Hlásenská, Jana; Pavlíková, Markéta

    2005-01-01

    Roč. 70, č. 4 (2005), s. 123-128 ISSN 1210-7832 R&D Projects: GA MZd NH7378 Keywords : inkontinence moči u žen * hypermobilita uretry * maximální uzávěrový tlak uretry * Valsalva leak -point pressure Subject RIV: FK - Gynaecology, Childbirth

  9. Vzájemný vztah maximálního uzávěrového tlaku uretry a Valsalva Leak-Point Pressure u žen se stresovým typem inkontince moči

    Czech Academy of Sciences Publication Activity Database

    Martan, A.; Mašata, J.; Švabík, K.; Drahorádová, P.; Halaška, M.; Voigt, R.; Pavlíková, Markéta

    2004-01-01

    Roč. 69, č. 4 (2004), s. 267-272 ISSN 1210-7832 R&D Projects: GA MZd NH7378 Keywords : inkontinence moči u žen * maximální uzávěrový tlak uretry * Valsalva leak -point pressure Subject RIV: FK - Gynaecology, Childbirth

  10. Respiratory muscle function in infants with spinal muscular atrophy type I.

    Science.gov (United States)

    Finkel, Richard S; Weiner, Daniel J; Mayer, Oscar H; McDonough, Joseph M; Panitch, Howard B

    2014-12-01

    To determine the feasibility and safety of respiratory muscle function testing in weak infants with a progressive neuromuscular disorder. Respiratory insufficiency is the major cause of morbidity and mortality in infants with spinal muscular atrophy type I (SMA-I). Tests of respiratory muscle strength, endurance, and breathing patterns can be performed safely in SMA-I infants. Useful data can be collected which parallels the clinical course of pulmonary function in SMA-I. An exploratory study of respiratory muscle function testing and breathing patterns in seven infants with SMA-I seen in our neuromuscular clinic. Measurements were made at initial study visit and, where possible, longitudinally over time. We measured maximal inspiratory (MIP) and transdiaphragmatic pressures, mean transdiaphragmatic pressure, airway occlusion pressure at 100 msec of inspiration, inspiratory and total respiratory cycle time, and aspects of relative thoracoabdominal motion using respiratory inductive plethysmography (RIP). The tension time index of the diaphragm and of the respiratory muscles, phase angle (Φ), phase relation during the total breath, and labored breathing index were calculated. Age at baseline study was 54-237 (median 131) days. Reliable data were obtained safely for MIP, phase angle, labored breathing index, and the invasive and non-invasive tension time indices, even in very weak infants. Data obtained corresponded to the clinical estimate of severity and predicted the need for respiratory support. The testing employed was both safe and feasible. Measurements of MIP and RIP are easily performed tests that are well tolerated and provide clinically useful information for infants with SMA-I. © 2014 Wiley Periodicals, Inc.

  11. Guinea pig maximization test

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner

    1985-01-01

    Guinea pig maximization tests (GPMT) with chlorocresol were performed to ascertain whether the sensitization rate was affected by minor changes in the Freund's complete adjuvant (FCA) emulsion used. Three types of emulsion were evaluated: the oil phase was mixed with propylene glycol, saline...

  12. Respiratory muscle endurance training reduces chronic neck pain: A pilot study.

    Science.gov (United States)

    Wirth, B; Ferreira, T Duarte; Mittelholzer, M; Humphreys, B K; Boutellier, U

    2016-11-21

    Patients with chronic neck pain show also respiratory dysfunctions. To investigate the effects of respiratory muscle endurance training (RMET) on chronic neck pain. In this pilot study (single-subject design: 3 baseline measurements, 4 measurements during RMET), 15 neck patients (49.3 ± 13.7 years; 13 females) conducted 20 sessions of home-based RMET using a SpiroTiger® (normocapnic hyperpnoea). Maximal voluntary ventilation (MVV), maximal inspiratory (Pimax) and expiratory (Pemax) pressure were measured before and after RMET. Neck flexor endurance, cervical and thoracic mobility, forward head posture, chest wall expansion and self-assessed neck disability [Neck Disability Index (NDI), Bournemouth questionnaire] were weekly assessed. Repeated measure ANOVA (Bonferroni correction) compared the first and last baseline and the last measurement after RMET. RMET significantly increased MVV (p= 0.025), Pimax (p= 0.001) and Pemax (pneck pain. The underlying mechanisms, including blood gas analyses, need further investigation in a randomized controlled study.

  13. Respiratory mechanics

    CERN Document Server

    Wilson, Theodore A

    2016-01-01

    This book thoroughly covers each subfield of respiratory mechanics: pulmonary mechanics, the respiratory pump, and flow. It presents the current understanding of the field and serves as a guide to the scientific literature from the golden age of respiratory mechanics, 1960 - 2010. Specific topics covered include the contributions of surface tension and tissue forces to lung recoil, the gravitational deformation of the lung, and the interdependence forces that act on pulmonary airways and blood vessels. The geometry and kinematics of the ribs is also covered in detail, as well as the respiratory action of the external and internal intercostal muscles, the mechanics of the diaphragm, and the quantitative compartmental models of the chest wall is also described. Additionally, flow in the airways is covered thoroughly, including the wave-speed and viscous expiratory flow-limiting mechanisms; convection, diffusion and the stationary front; and the distribution of ventilation. This is an ideal book for respiratory ...

  14. Surfactant nebulisation prevents the adverse effects of surfactant therapy on blood pressure and cerebral blood flow in rabbits with severe respiratory failure

    NARCIS (Netherlands)

    Dijk, Peter H.; Heikamp, A; Bambang Oetomo, Sidarto

    1997-01-01

    Objective: Surfactant replacement therapy for the neonatal respiratory distress syndrome has shown beneficial effects on lung function and survival. Recently, rapid fluctuations of haemodynamics and cerebral perfusion following surfactant instillation have beer, described and an association with the

  15. Tri-maximal vs. bi-maximal neutrino mixing

    International Nuclear Information System (INIS)

    Scott, W.G

    2000-01-01

    It is argued that data from atmospheric and solar neutrino experiments point strongly to tri-maximal or bi-maximal lepton mixing. While ('optimised') bi-maximal mixing gives an excellent a posteriori fit to the data, tri-maximal mixing is an a priori hypothesis, which is not excluded, taking account of terrestrial matter effects

  16. Partnering for optimal respiratory home care: physicians working with respiratory therapists to optimally meet respiratory home care needs.

    Science.gov (United States)

    Spratt, G; Petty, T L

    2001-05-01

    The need for respiratory care services continues to increase, reimbursement for those services has decreased, and cost-containment measures have increased the frequency of home health care. Respiratory therapists are well qualified to provide home respiratory care, reduce misallocation of respiratory services, assess patient respiratory status, identify problems and needs, evaluate the effect of the home setting, educate the patient on proper equipment use, monitor patient response to and complications of therapy, monitor equipment functioning, monitor for appropriate infection control procedures, make recommendations for changes to therapy regimen, and adjust therapy under the direction of the physician. Teamwork benefits all parties and offers cost and time savings, improved data collection and communication, higher job satisfaction, and better patient monitoring, education, and quality of life. Respiratory therapists are positioned to optimize treatment efficacy, maximize patient compliance, and minimize hospitalizations among patients receiving respiratory home care.

  17. Improvised bubble continuous positive airway pressure (BCPAP ...

    African Journals Online (AJOL)

    Improvised bubble continuous positive airway pressure (BCPAP) device at the National Hospital Abuja gives immediate improvement in respiratory rate and oxygenation in neonates with respiratory distress.

  18. Prevention of Respiratory Distress After Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    O. A. Dolina

    2005-01-01

    Full Text Available The paper presents the results of a comparative study of different methods for preventing respiratory distress after laparoscopic cholecystectomy. It shows the advantages of use of noninvasive assisted ventilation that ensures excessive positive pressure in the respiratory contour, its impact on external respiratory function, arterial blood gases, oxygen transport and uptake. A scheme for the prevention of respiratory diseases applying noninvasive assisted ventilation is given.

  19. The Ratio of Partial Pressure Arterial Oxygen and Fraction of Inspired Oxygen 1 Day After Acute Respiratory Distress Syndrome Onset Can Predict the Outcomes of Involving Patients.

    Science.gov (United States)

    Lai, Chih-Cheng; Sung, Mei-I; Liu, Hsiao-Hua; Chen, Chin-Ming; Chiang, Shyh-Ren; Liu, Wei-Lun; Chao, Chien-Ming; Ho, Chung-Han; Weng, Shih-Feng; Hsing, Shu-Chen; Cheng, Kuo-Chen

    2016-04-01

    The initial hypoxemic level of acute respiratory distress syndrome (ARDS) defined according to Berlin definition might not be the optimal predictor for prognosis. We aimed to determine the predictive validity of the stabilized ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio) following standard ventilator setting in the prognosis of patients with ARDS.This prospective observational study was conducted in a single tertiary medical center in Taiwan and compared the stabilized PaO2/FiO2 ratio (Day 1) following standard ventilator settings and the PaO2/FiO2 ratio on the day patients met ARDS Berlin criteria (Day 0). Patients admitted to intensive care units and in accordance with the Berlin criteria for ARDS were collected between December 1, 2012 and May 31, 2015. Main outcome was 28-day mortality. Arterial blood gas and ventilator setting on Days 0 and 1 were obtained.A total of 238 patients met the Berlin criteria for ARDS were enrolled, and they were classified as mild (n = 50), moderate (n = 125), and severe (n = 63) ARDS, respectively. Twelve (5%) patients who originally were classified as ARDS did not continually meet the Berlin definition, and a total of 134 (56%) patients had the changes regarding the severity of ARDS from Day 0 to Day 1. The 28-day mortality rate was 49.1%, and multivariate analysis identified age, PaO2/FiO2 on Day 1, number of organ failures, and positive fluid balance within 5 days as significant risk factors of death. Moreover, the area under receiver-operating curve for mortality prediction using PaO2/FiO2 on Day 1 was significant higher than that on Day 0 (P = 0.016).PaO2/FiO2 ratio on Day 1 after applying mechanical ventilator is a better predictor of outcomes in patients with ARDS than those on Day 0.

  20. Rehabilitation of patients admitted to a respiratory intensive care unit.

    Science.gov (United States)

    Nava, S

    1998-07-01

    Pulmonary rehabilitation has been shown to be of benefit to clinically stable patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of pulmonary rehabilitation on some physiologic variables in COPD patients recovering from an episode of acute respiratory failure. A prospective, randomized study. A respiratory intensive care unit (RICU). Eighty COPD patients recovering from an episode of acute respiratory failure were randomized in a 3:1 fashion to receive stepwise pulmonary rehabilitation (group A, n=60 patients) or standard medical therapy (group B, n=20 patients). Improvements in exercise tolerance, sense of breathlessness, respiratory muscle function, and pulmonary function test values were measured, respectively, by exercise capacity (6-minute walking distance [6MWD]), dyspnea score (Visual Analog Scale [VAS]), maximal inspiratory pressure (MIP), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Group A received pulmonary rehabilitation that consisted of passive mobilization (step I), early deambulation (step II), respiratory and lower skeletal muscle training (step III), and if the patients were able, complete lower extremity training on a treadmill (step IV). Group B received standard medical therapy plus a basic deambulation program. Sixty-one of 80 patients were mechanically ventilated at admission to the unit and most of them were bedridden. Twelve of the 60 group A patients and 4 of the 20 group B patients died during their RICU stay, and 9 patients required invasive mechanical ventilation at home after their discharge. The total length of RICU stay was 38+/-14 days for patients in group A versus 33.2+/-11 days for those in group B. Most patients from both groups regained the ability to walk, either unaided or aided. At discharge, 6 MWD results were significantly improved (p respiratory failure and who, in most cases, required mechanical ventilation benefited from comprehensive early

  1. MAXIM: The Blackhole Imager

    Science.gov (United States)

    Gendreau, Keith; Cash, Webster; Gorenstein, Paul; Windt, David; Kaaret, Phil; Reynolds, Chris

    2004-01-01

    The Beyond Einstein Program in NASA's Office of Space Science Structure and Evolution of the Universe theme spells out the top level scientific requirements for a Black Hole Imager in its strategic plan. The MAXIM mission will provide better than one tenth of a microarcsecond imaging in the X-ray band in order to satisfy these requirements. We will overview the driving requirements to achieve these goals and ultimately resolve the event horizon of a supermassive black hole. We will present the current status of this effort that includes a study of a baseline design as well as two alternative approaches.

  2. Social group utility maximization

    CERN Document Server

    Gong, Xiaowen; Yang, Lei; Zhang, Junshan

    2014-01-01

    This SpringerBrief explains how to leverage mobile users' social relationships to improve the interactions of mobile devices in mobile networks. It develops a social group utility maximization (SGUM) framework that captures diverse social ties of mobile users and diverse physical coupling of mobile devices. Key topics include random access control, power control, spectrum access, and location privacy.This brief also investigates SGUM-based power control game and random access control game, for which it establishes the socially-aware Nash equilibrium (SNE). It then examines the critical SGUM-b

  3. Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness

    Directory of Open Access Journals (Sweden)

    Yannick Molgat-Seon

    2017-03-01

    Full Text Available The aim of the present study was to determine whether lung volume recruitment (LVR acutely increases respiratory system compliance (Crs in individuals with severe respiratory muscle weakness (RMW. Individuals with RMW resulting from neuromuscular disease or quadriplegia (n=12 and healthy controls (n=12 underwent pulmonary function testing and the measurement of Crs at baseline, immediately after, 1 h after and 2 h after a single standardised session of LVR. The LVR session involved 10 consecutive supramaximal lung inflations with a manual resuscitation bag to the highest tolerable mouth pressure or a maximum of 50 cmH2O. Each LVR inflation was followed by brief breath-hold and a maximal expiration to residual volume. At baseline, individuals with RMW had lower Crs than controls (37±5 cmH2O versus 109±10 mL·cmH2O−1, p0.05. LVR had no significant effect on measures of pulmonary function at any time point in either group (all p>0.05. During inflations, mean arterial pressure decreased significantly relative to baseline by 10.4±2.8 mmHg and 17.3±3.0 mmHg in individuals with RMW and controls, respectively (both p<0.05. LVR acutely increases Crs in individuals with RMW. However, the high airway pressures during inflations cause reductions in mean arterial pressure that should be considered when applying this technique.

  4. Titration of High Frequency Percussive Ventilation by means of real-time monitoring of the viscoelastic respiratory system properties and endotracheal tubes pressure drop.

    OpenAIRE

    Lucangelo, Umberto

    2014-01-01

    2012/2013 The use of High Frequency Percussive Ventilation (HFPV) is still debated although this type of non-conventional ventilation has proven effective and safe in patients with acute respiratory failure. In the clinical practice, HFPV is not an intuitive ventilatory modality and the absence of real-time delivered volume monitoring produces disaffection among the physicians. Avoiding the "volutrauma" is the cornerstone of the "protective ventilation strategy", which assumes a cons...

  5. Respiratory effort from the photoplethysmogram.

    Science.gov (United States)

    Addison, Paul S

    2017-03-01

    The potential for a simple, non-invasive measure of respiratory effort based on the pulse oximeter signal - the photoplethysmogram or 'pleth' - was investigated in a pilot study. Several parameters were developed based on a variety of manifestations of respiratory effort in the signal, including modulation changes in amplitude, baseline, frequency and pulse transit times, as well as distinct baseline signal shifts. Thirteen candidate parameters were investigated using data from healthy volunteers. Each volunteer underwent a series of controlled respiratory effort maneuvers at various set flow resistances and respiratory rates. Six oximeter probes were tested at various body sites. In all, over three thousand pleth-based effort-airway pressure (EP) curves were generated across the various airway constrictions, respiratory efforts, respiratory rates, subjects, probe sites, and the candidate parameters considered. Regression analysis was performed to determine the existence of positive monotonic relationships between the respiratory effort parameters and resulting airway pressures. Six of the candidate parameters investigated exhibited a distinct positive relationship (poximeter probe and an ECG (P2E-Effort) and the other using two pulse oximeter probes placed at different peripheral body sites (P2-Effort); and baseline shifts in heart rate, (BL-HR-Effort). In conclusion, a clear monotonic relationship was found between several pleth-based parameters and imposed respiratory loadings at the mouth across a range of respiratory rates and flow constrictions. The results suggest that the pleth may provide a measure of changing upper airway dynamics indicative of the effort to breathe. Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.

  6. Maximal Bell's inequality violation for non-maximal entanglement

    International Nuclear Information System (INIS)

    Kobayashi, M.; Khanna, F.; Mann, A.; Revzen, M.; Santana, A.

    2004-01-01

    Bell's inequality violation (BIQV) for correlations of polarization is studied for a product state of two two-mode squeezed vacuum (TMSV) states. The violation allowed is shown to attain its maximal limit for all values of the squeezing parameter, ζ. We show via an explicit example that a state whose entanglement is not maximal allow maximal BIQV. The Wigner function of the state is non-negative and the average value of either polarization is nil

  7. Effect of Aerobic Exercise Training on Ventilatory Efficiency and Respiratory Drive in Obese Subjects.

    Science.gov (United States)

    Chlif, Mehdi; Chaouachi, Anis; Ahmaidi, Said

    2017-07-01

    Obese patients show a decline in exercise capacity and diverse degrees of dyspnea in association with mechanical abnormalities, increased ventilatory requirements secondary to the increased metabolic load, and a greater work of breathing. Consequently, obese patients may be particularly predisposed to the development of respiratory muscle fatigue during exercise. The aim of this study was to assess inspiratory muscle performance during incremental exercise in 19 obese male subjects (body mass index 41 ± 6 kg/m 2 ) after aerobic exercise training using the noninvasive, inspiratory muscle tension-time index (T T0.1 ). Measurements performed included anthropometric parameters, lung function assessed by spirometry, rate of perceived breathlessness with the modified Borg dyspnea scale (0-10), breathing pattern, maximal exercise capacity, and inspiratory muscle performance with a breath-by-breath automated exercise metabolic system during an incremental exercise test. T T0.1 was calculated using the equation, T T0.1 = P 0.1 /P Imax × T I /T tot (where P 0.1 represents mouth occlusion pressure, P Imax is maximal inspiratory pressure, and T I /T tot is the duty cycle). At rest, there was no statistically significant difference for spirometric parameters and cardiorespiratory parameters between pre- and post-training. At maximal exercise, the minute ventilation, the rate of exchange ratio, the rate of perceived breathlessness, and the respiratory muscle performance parameters were not significantly different pre- and post-training; in contrast, tidal volume ( P = .037, effect size = 1.51), breathing frequency ( P = .049, effect size = 0.97), power output ( P = .048, effect size = 0.79), peak oxygen uptake ( P = .02, effect size = 0.92) were significantly higher after training. At comparable work load, training induces lower minute ventilation, mouth occlusion pressure, ratio of occlusion pressure to maximal inspiratory pressure, T T0.1 , and rate of perceived

  8. Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48hours or more: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Sandoval Moreno, L M; Casas Quiroga, I C; Wilches Luna, E C; García, A F

    2018-02-02

    To evaluate the efficacy of respiratory muscular training in the weaning of mechanical ventilation and respiratory muscle strength in patients on mechanical ventilation of 48hours or more. Randomized controlled trial of parallel groups, double-blind. Ambit: Intensive Care Unit of a IV level clinic in the city of Cali. 126 patients in mechanical ventilation for 48hours or more. The experimental group received daily a respiratory muscle training program with treshold, adjusted to 50% of maximal inspiratory pressure, additional to standard care, conventional received standard care of respiratory physiotherapy. MAIN INTEREST VARIABLES: weaning of mechanical ventilation. Other variables evaluated: respiratory muscle strength, requirement of non-invasive mechanical ventilation and frequency of reintubation. intention-to-treat analysis was performed with all variables evaluated and analysis stratified by sepsis condition. There were no statistically significant differences in the median weaning time of the MV between the groups or in the probability of extubation between groups (HR: 0.82 95% CI: 0.55-1.20 P=.29). The maximum inspiratory pressure was increased in the experimental group on average 9.43 (17.48) cmsH20 and in the conventional 5.92 (11.90) cmsH20 (P=.48). The difference between the means of change in maximal inspiratory pressure was 0.46 (P=.83 95%CI -3.85 to -4.78). respiratory muscle training did not demonstrate efficacy in the reduction of the weaning period of mechanical ventilation nor in the increase of respiratory muscle strength in the study population. Registered study at ClinicalTrials.gov (NCT02469064). Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  9. Respiratory Home Health Care

    Science.gov (United States)

    ... Us Home > Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources ... Teenagers Living With Lung Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at ...

  10. Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial

    NARCIS (Netherlands)

    D'Antini, Davide; Huhle, Robert; Herrmann, Jacob; Sulemanji, Demet S.; Oto, Jun; Raimondo, Pasquale; Mirabella, Lucia; Hemmes, Sabrine N. T.; Schultz, Marcus J.; Pelosi, Paolo; Kaczka, David W.; Vidal Melo, Marcos Francisco; Gama de Abreu, Marcelo; Cinnella, Gilda

    2018-01-01

    In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications

  11. Respiratory muscle strength of patients with esophagus and stomach neoplasms

    Directory of Open Access Journals (Sweden)

    Evelyn Aline Boscolo Ruivo

    Full Text Available Abstract Introduction: In cancer patients, the reduced food intake causes weight loss and promotes protein-calorie malnutrition. This results in loss of lean body mass, which affects both skeletal muscles and respiratory muscles. Objective: Evaluate and compare the respiratory muscle strength of patients with esophageal and stomach neoplasia during the preoperative period. Methods: This is a cross-sectional study carried out with 24 patients of both genders hospitalized in a teaching hospital. They underwent a physical therapy evaluation composed of anthropometric data and measurement of respiratory muscle strength through manovacuometry. Paired and unpaired t-tests were used to compare the values obtained with the predicted equations. Results: Regarding the disease prevalence, 66.66%(16 of the individuals had stomach neoplasm and 33.33%(8 esophageal neoplasm. Of the patients with esophageal neoplasm, 100% were men with a mean age of 63 ± 9.16 years. Of those with stomach neoplasm, 68.75% were men with a mean age of 69.36 ± 10.92 years. Female patients with stomach neoplasm had significantly higher BMI (p = 0.01 than male patients, and they were classified as overweight. Both neoplasms had significantly lower real values (p ≤ 0.05 than predicted values at the maximal expiratory pressure. Conclusion: Patients with esophageal and stomach neoplasms in the preoperative period present reduction in the expiratory muscle strength. There were no statistically significant differences, when we compared the maximum respiratory pressures between the two types of neoplasms investigated.

  12. Do current sports brassiere designs impede respiratory function?

    Science.gov (United States)

    Bowles, Kelly-Ann; Steele, Julie R; Chaunchaiyakul, Rungchai

    2005-09-01

    Although sports brassieres are more effective in limiting breast motion and related breast pain when compared with standard fashion brassieres, some females do not wear sports brassieres during physical activity, as they perceive them to be too tight around the torso, possibly impeding their performance during physical activity. The purpose of this study was to determine whether breast hypertrophy, breast momentum, and/or wearing a sports brassiere impeded respiratory function at rest and during physical activity. Twenty-two active women completed standard resting spirometry maneuvers while not wearing a brassiere. All subjects then completed maximal cycle ergometer testing in two breast support conditions (sports brassiere and no brassiere (NB)), followed by submaximal treadmill exercise tests under three breast support conditions (sports brassiere, no brassiere and fashion brassiere) while standard spirometry, brassiere pressure and comfort were measured. The sports brassiere imparted significantly more pressure on smaller breasted females' torsos when compared with the fashion brassiere (0.861 +/- 0.247 and 0.672 +/- 0.254 N.cm(-2), respectively), although this increased pressure did not appear to significantly affect measured lung volumes or brassiere comfort scores. Brassiere size affected maximal exercise ability (relative VO(2peak): smaller breasted NB: 49.84 +/- 6.15 mL.kg(-1).min(-1); larger breasted NB: 40.76 +/- 4.47 mL.kg(-1).min(-1)) as well as some temporal measures of resting and submaximal respiration. However, no significant difference was found between the no brassiere and brassiere conditions in regards to measured lung volumes. As no significant restriction to exercise performance or respiratory mechanics was found when subjects wore sports brassieres, it was concluded that active females should wear a sports brassiere during physical activity to reduce breast motion and related breast pain.

  13. Maximally Symmetric Composite Higgs Models.

    Science.gov (United States)

    Csáki, Csaba; Ma, Teng; Shu, Jing

    2017-09-29

    Maximal symmetry is a novel tool for composite pseudo Goldstone boson Higgs models: it is a remnant of an enhanced global symmetry of the composite fermion sector involving a twisting with the Higgs field. Maximal symmetry has far-reaching consequences: it ensures that the Higgs potential is finite and fully calculable, and also minimizes the tuning. We present a detailed analysis of the maximally symmetric SO(5)/SO(4) model and comment on its observational consequences.

  14. Genetic variability in G2 and F2 region between biological clones of human respiratory syncytial virus with or without host immune selection pressure

    Directory of Open Access Journals (Sweden)

    Claudia Trigo Pedroso Moraes

    2015-02-01

    Full Text Available Human respiratory syncytial virus (HRSV is an important respiratory pathogens among children between zero-five years old. Host immunity and viral genetic variability are important factors that can make vaccine production difficult. In this work, differences between biological clones of HRSV were detected in clinical samples in the absence and presence of serum collected from children in the convalescent phase of the illness and from their biological mothers. Viral clones were selected by plaque assay in the absence and presence of serum and nucleotide sequences of the G2 and F2 genes of HRSV biological clones were compared. One non-synonymous mutation was found in the F gene (Ile5Asn in one clone of an HRSV-B sample and one non-synonymous mutation was found in the G gene (Ser291Pro in four clones of the same HRSV-B sample. Only one of these clones was obtained after treatment with the child's serum. In addition, some synonymous mutations were determined in two clones of the HRSV-A samples. In conclusion, it is possible that minor sequences could be selected by host antibodies contributing to the HRSV evolutionary process, hampering the development of an effective vaccine, since we verify the same codon alteration in absence and presence of human sera in individual clones of BR-85 sample.

  15. Genetic variability in G2 and F2 region between biological clones of human respiratory syncytial virus with or without host immune selection pressure.

    Science.gov (United States)

    Moraes, Claudia Trigo Pedroso; Oliveira, Danielle Bruna Leal; Campos, Angelica Cristine Almeida; Bosso, Patricia Alves; Lima, Hildener Nogueira; Stewien, Klaus Eberhard; Gilio, Alfredo Elias; Vieira, Sandra Elisabete; Botosso, Viviane Fongaro; Durigon, Edison Luiz

    2015-02-01

    Human respiratory syncytial virus (HRSV) is an important respiratory pathogens among children between zero-five years old. Host immunity and viral genetic variability are important factors that can make vaccine production difficult. In this work, differences between biological clones of HRSV were detected in clinical samples in the absence and presence of serum collected from children in the convalescent phase of the illness and from their biological mothers. Viral clones were selected by plaque assay in the absence and presence of serum and nucleotide sequences of the G2 and F2 genes of HRSV biological clones were compared. One non-synonymous mutation was found in the F gene (Ile5Asn) in one clone of an HRSV-B sample and one non-synonymous mutation was found in the G gene (Ser291Pro) in four clones of the same HRSV-B sample. Only one of these clones was obtained after treatment with the child's serum. In addition, some synonymous mutations were determined in two clones of the HRSV-A samples. In conclusion, it is possible that minor sequences could be selected by host antibodies contributing to the HRSV evolutionary process, hampering the development of an effective vaccine, since we verify the same codon alteration in absence and presence of human sera in individual clones of BR-85 sample.

  16. Principles of maximally classical and maximally realistic quantum ...

    Indian Academy of Sciences (India)

    Principles of maximally classical and maximally realistic quantum mechanics. S M ROY. Tata Institute of Fundamental Research, Homi Bhabha Road, Mumbai 400 005, India. Abstract. Recently Auberson, Mahoux, Roy and Singh have proved a long standing conjecture of Roy and Singh: In 2N-dimensional phase space, ...

  17. Assessment of dynamic mechanical properties of the respiratory system during high-frequency oscillatory ventilation*.

    Science.gov (United States)

    Dellacà, Raffaele L; Zannin, Emanuela; Ventura, Maria L; Sancini, Giulio; Pedotti, Antonio; Tagliabue, Paolo; Miserocchi, Giuseppe

    2013-11-01

    1) To investigate the possibility of estimating respiratory system impedance (Zrs, forced oscillation technique) by using high-amplitude pressure oscillations delivered during high-frequency oscillatory ventilation; 2) to characterize the relationship between Zrs and continuous distending pressure during an increasing/decreasing continuous distending pressure trial; 3) to evaluate how the optimal continuous distending pressure identified by Zrs relates to the point of maximal curvature of the deflation limb of the quasi-static pressure-volume curve. Prospective laboratory animal investigation. Experimental medicine laboratory. Eight New Zealand rabbits. The rabbits were ventilated with high-frequency oscillatory ventilation. Zrs was measured while continuous distending pressure was increased and decreased between 2 and 26 cm H2O in 1-minute steps of 4 cm H2O. At each step, a low-amplitude (6 cm H2O) sinusoidal signal was alternated with a high-amplitude (18 cm H2O) asymmetric high-frequency oscillatory ventilation square pressure waveform. Pressure-volume curves were determined at the end of the continuous distending pressure trial. All measurements were repeated after bronchoalveolar lavage. Zrs was estimated from flow and pressure measured at the inlet of the tracheal tube and expressed as resistance (Rrs) and reactance (Xrs). Linear correlation between the values, measured by applying the small-amplitude sinusoidal signal and the ventilator waveform, was good for Xrs (r = 0.95 ± 0.04) but not for Rrs (r = 0.60 ± 0.34). Following lavage, the Xrs-continuous distending pressure curves presented a maximum on the deflation limb, identifying an optimal continuous distending pressure that was, on average, 1.1 ± 1.7 cm H2O below the point of maximal curvature of the deflation limb of the pressure-volume curves. Xrs can be accurately measured during high-frequency oscillatory ventilation without interrupting ventilation and/or connecting additional devices. An optimal

  18. Refined reservoir description to maximize oil recovery

    International Nuclear Information System (INIS)

    Flewitt, W.E.

    1975-01-01

    To assure maximized oil recovery from older pools, reservoir description has been advanced by fully integrating original open-hole logs and the recently introduced interpretive techniques made available through cased-hole wireline saturation logs. A refined reservoir description utilizing normalized original wireline porosity logs has been completed in the Judy Creek Beaverhill Lake ''A'' Pool, a reefal carbonate pool with current potential productivity of 100,000 BOPD and 188 active wells. Continuous porosity was documented within a reef rim and cap while discontinuous porous lenses characterized an interior lagoon. With the use of pulsed neutron logs and production data a separate water front and pressure response was recognized within discrete environmental units. The refined reservoir description aided in reservoir simulation model studies and quantifying pool performance. A pattern water flood has now replaced the original peripheral bottom water drive to maximize oil recovery

  19. Maximizing and customer loyalty: Are maximizers less loyal?

    Directory of Open Access Journals (Sweden)

    Linda Lai

    2011-06-01

    Full Text Available Despite their efforts to choose the best of all available solutions, maximizers seem to be more inclined than satisficers to regret their choices and to experience post-decisional dissonance. Maximizers may therefore be expected to change their decisions more frequently and hence exhibit lower customer loyalty to providers of products and services compared to satisficers. Findings from the study reported here (N = 1978 support this prediction. Maximizers reported significantly higher intentions to switch to another service provider (television provider than satisficers. Maximizers' intentions to switch appear to be intensified and mediated by higher proneness to regret, increased desire to discuss relevant choices with others, higher levels of perceived knowledge of alternatives, and higher ego involvement in the end product, compared to satisficers. Opportunities for future research are suggested.

  20. Implications of maximal Jarlskog invariant and maximal CP violation

    International Nuclear Information System (INIS)

    Rodriguez-Jauregui, E.; Universidad Nacional Autonoma de Mexico

    2001-04-01

    We argue here why CP violating phase Φ in the quark mixing matrix is maximal, that is, Φ=90 . In the Standard Model CP violation is related to the Jarlskog invariant J, which can be obtained from non commuting Hermitian mass matrices. In this article we derive the conditions to have Hermitian mass matrices which give maximal Jarlskog invariant J and maximal CP violating phase Φ. We find that all squared moduli of the quark mixing elements have a singular point when the CP violation phase Φ takes the value Φ=90 . This special feature of the Jarlskog invariant J and the quark mixing matrix is a clear and precise indication that CP violating Phase Φ is maximal in order to let nature treat democratically all of the quark mixing matrix moduli. (orig.)

  1. Effects of Inhaled Fenoterol and Positive End-Expiratory Pressure on the Respiratory Mechanics of Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Claude Guerin

    2005-01-01

    Full Text Available BACKGROUND: During acute ventilatory failure in patients with chronic obstructive pulmonary disease (COPD, applying external positive end-expiratory pressure (PEEPe will reopen small airways and, thus, may enhance peripheral deposition as well as the physiological effects of inhaled beta-2 agonists.

  2. Phenomenology of maximal and near-maximal lepton mixing

    International Nuclear Information System (INIS)

    Gonzalez-Garcia, M. C.; Pena-Garay, Carlos; Nir, Yosef; Smirnov, Alexei Yu.

    2001-01-01

    The possible existence of maximal or near-maximal lepton mixing constitutes an intriguing challenge for fundamental theories of flavor. We study the phenomenological consequences of maximal and near-maximal mixing of the electron neutrino with other (x=tau and/or muon) neutrinos. We describe the deviations from maximal mixing in terms of a parameter ε(equivalent to)1-2sin 2 θ ex and quantify the present experimental status for |ε| e mixing comes from solar neutrino experiments. We find that the global analysis of solar neutrino data allows maximal mixing with confidence level better than 99% for 10 -8 eV 2 ∼ 2 ∼ -7 eV 2 . In the mass ranges Δm 2 ∼>1.5x10 -5 eV 2 and 4x10 -10 eV 2 ∼ 2 ∼ -7 eV 2 the full interval |ε| e mixing in atmospheric neutrinos, supernova neutrinos, and neutrinoless double beta decay

  3. Maximal quantum Fisher information matrix

    International Nuclear Information System (INIS)

    Chen, Yu; Yuan, Haidong

    2017-01-01

    We study the existence of the maximal quantum Fisher information matrix in the multi-parameter quantum estimation, which bounds the ultimate precision limit. We show that when the maximal quantum Fisher information matrix exists, it can be directly obtained from the underlying dynamics. Examples are then provided to demonstrate the usefulness of the maximal quantum Fisher information matrix by deriving various trade-off relations in multi-parameter quantum estimation and obtaining the bounds for the scalings of the precision limit. (paper)

  4. Work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome: a comparison between volume and pressure-regulated breathing modes.

    Science.gov (United States)

    Kallet, Richard H; Campbell, Andre R; Dicker, Rochelle A; Katz, Jeffrey A; Mackersie, Robert C

    2005-12-01

    Pressure-control ventilation (PCV) and pressure-regulated volume-control (PRVC) ventilation are used during lung-protective ventilation because the high, variable, peak inspiratory flow rate (V (I)) may reduce patient work of breathing (WOB) more than the fixed V (I) of volume-control ventilation (VCV). Patient-triggered breaths during PCV and PRVC may result in excessive tidal volume (V(T)) delivery unless the inspiratory pressure is reduced, which in turn may decrease the peak V (I). We tested whether PCV and PRVC reduce WOB better than VCV with a high, fixed peak V (I) (75 L/min) while also maintaining a low V(T) target. Fourteen nonconsecutive patients with acute lung injury or acute respiratory distress syndrome were studied prospectively, using a random presentation of ventilator modes in a crossover, repeated-measures design. A target V(T) of 6.4 + 0.5 mL/kg was set during VCV and PRVC. During PCV the inspiratory pressure was set to achieve the same V(T). WOB and other variables were measured with a pulmonary mechanics monitor (Bicore CP-100). There was a nonsignificant trend toward higher WOB (in J/L) during PCV (1.27 + 0.58 J/L) and PRVC (1.35 + 0.60 J/L), compared to VCV (1.09 + 0.59 J/L). While mean V(T) was not statistically different between modes, in 40% of patients, V(T) markedly exceeded the lung-protective ventilation target during PRVC and PCV. During lung-protective ventilation, PCV and PRVC offer no advantage in reducing WOB, compared to VCV with a high flow rate, and in some patients did not allow control of V(T) to be as precise.

  5. Maximize x(a - x)

    Science.gov (United States)

    Lange, L. H.

    1974-01-01

    Five different methods for determining the maximizing condition for x(a - x) are presented. Included is the ancient Greek version and a method attributed to Fermat. None of the proofs use calculus. (LS)

  6. Finding Maximal Quasiperiodicities in Strings

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting; Pedersen, Christian N. S.

    2000-01-01

    of length n in time O(n log n) and space O(n). Our algorithm uses the suffix tree as the fundamental data structure combined with efficient methods for merging and performing multiple searches in search trees. Besides finding all maximal quasiperiodic substrings, our algorithm also marks the nodes......Apostolico and Ehrenfeucht defined the notion of a maximal quasiperiodic substring and gave an algorithm that finds all maximal quasiperiodic substrings in a string of length n in time O(n log2 n). In this paper we give an algorithm that finds all maximal quasiperiodic substrings in a string...... in the suffix tree that have a superprimitive path-label....

  7. On the maximal diphoton width

    CERN Document Server

    Salvio, Alberto; Strumia, Alessandro; Urbano, Alfredo

    2016-01-01

    Motivated by the 750 GeV diphoton excess found at LHC, we compute the maximal width into $\\gamma\\gamma$ that a neutral scalar can acquire through a loop of charged fermions or scalars as function of the maximal scale at which the theory holds, taking into account vacuum (meta)stability bounds. We show how an extra gauge symmetry can qualitatively weaken such bounds, and explore collider probes and connections with Dark Matter.

  8. Lungs and Respiratory System

    Science.gov (United States)

    ... Videos for Educators Search English Español Lungs and Respiratory System KidsHealth / For Parents / Lungs and Respiratory System ... ll have taken at least 600 million breaths. Respiratory System Basics All of this breathing couldn't ...

  9. Neonatal respiratory distress syndrome

    Science.gov (United States)

    Hyaline membrane disease (HMD); Infant respiratory distress syndrome; Respiratory distress syndrome in infants; RDS - infants ... improves slowly after that. Some infants with severe respiratory distress syndrome will die. This most often occurs ...

  10. Short-term effects of combination of several physiotherapy methods on the respiratory function - a case report of adolescent idiopathic scoliosis.

    Science.gov (United States)

    Wnuk, Bartosz; Frackiewicz, Joanna; Durmala, Jacek; Czernicki, Krzysztof; Wadolowski, Karol

    2012-01-01

    The aim of the study was to evaluate the positive effects of combination of several physiotherapy methods on the respiratory function on example of a case report. 14 years old girl with an adolescent idiopathic scoliosis (AIS), right thoracic (primary curve, Cobb angle = 40°, AVR = 12°) and left lumbar (secondary curve, Cobb angle = 33°, AVR = 24°) participated in the study. She was 2 years after menarche. She underwent stationary (in-patient) treatment for 3 weeks with use of standard medical care (DoboMed). Treatment also included manual therapy (OMT Kaltenborn-Evjenth) and Dynamic Brace System (DBC) device, produced by Meditrack. Then she continued exercises at home. Respiratory system function was analyzed with use of SpiroPro electronic spirometer (Jaeger) and the strength of respiratory muscles with use of portable digital pressure meter equipped with the Omega PX 25 ± 35 kPa pressure transducer. Range of movement of the spine was examined with Rippstein V plurimeter, angle of apical trunk rotation (ATR) with the Bunnell scoliometer. Measurement was performed 4 times: before treatment, after one week and 3 weeks after the beginning of the treatment and 3 months after finalization of the treatment period. Examination showed that DoboMed medical care treatment, manual therapy and use of DBC device in period of 3 weeks caused improvement of respiratory parameters (MIP - maximal inspiration pressure by 6.7%; MEP - maximal expiratory pressure by 12.6%, PEF - peak expiratory flow by 16.1%). Spinal range of lateral movement and angle of apical trunk rotation has also improved. In short term treatment, the manual therapy aided with DBC system has improved the respiratory parameters and trunk morphology values. Such a composition of various physiotherapy methods can help to conduct further specialized exercises of DoboMed method.

  11. Alterations in the Rate of Limb Movement Using a Lower Body Positive Pressure Treadmill Do Not Influence Respiratory Rate or Phase III Ventilation

    OpenAIRE

    Michael J. Buono; Marissa Burnsed-Torres; Bethany Hess; Kristine Lopez; Catherine Ortiz; Ariel Girodo; Karen Lolli; Brett Bloom; David Bailey; Fred W. Kolkhorst

    2015-01-01

    The purpose of this study was to determine the effect of alterations in rate of limb movement on Phase III ventilation during exercise, independent of metabolic rate, gait style, and treadmill incline. Subjects completed five submaximal exercise bouts on a lower body positive pressure treadmill (AlterG P 200). The percent body weight for the five exercise bouts was 100, 87, 75, 63, and 50% and each was matched for carbon dioxide production (V CO2 ). Naturally, to match the V CO2 while reducin...

  12. Cardiorespiratory Coordination in Repeated Maximal Exercise

    Directory of Open Access Journals (Sweden)

    Sergi Garcia-Retortillo

    2017-06-01

    Full Text Available Increases in cardiorespiratory coordination (CRC after training with no differences in performance and physiological variables have recently been reported using a principal component analysis approach. However, no research has yet evaluated the short-term effects of exercise on CRC. The aim of this study was to delineate the behavior of CRC under different physiological initial conditions produced by repeated maximal exercises. Fifteen participants performed 2 consecutive graded and maximal cycling tests. Test 1 was performed without any previous exercise, and Test 2 6 min after Test 1. Both tests started at 0 W and the workload was increased by 25 W/min in males and 20 W/min in females, until they were not able to maintain the prescribed cycling frequency of 70 rpm for more than 5 consecutive seconds. A principal component (PC analysis of selected cardiovascular and cardiorespiratory variables (expired fraction of O2, expired fraction of CO2, ventilation, systolic blood pressure, diastolic blood pressure, and heart rate was performed to evaluate the CRC defined by the number of PCs in both tests. In order to quantify the degree of coordination, the information entropy was calculated and the eigenvalues of the first PC (PC1 were compared between tests. Although no significant differences were found between the tests with respect to the performed maximal workload (Wmax, maximal oxygen consumption (VO2 max, or ventilatory threshold (VT, an increase in the number of PCs and/or a decrease of eigenvalues of PC1 (t = 2.95; p = 0.01; d = 1.08 was found in Test 2 compared to Test 1. Moreover, entropy was significantly higher (Z = 2.33; p = 0.02; d = 1.43 in the last test. In conclusion, despite the fact that no significant differences were observed in the conventionally explored maximal performance and physiological variables (Wmax, VO2 max, and VT between tests, a reduction of CRC was observed in Test 2. These results emphasize the interest of CRC

  13. Maximizing Lumen Gain With Directional Atherectomy.

    Science.gov (United States)

    Stanley, Gregory A; Winscott, John G

    2016-08-01

    To describe the use of a low-pressure balloon inflation (LPBI) technique to delineate intraluminal plaque and guide directional atherectomy in order to maximize lumen gain and achieve procedure success. The technique is illustrated in a 77-year-old man with claudication who underwent superficial femoral artery revascularization using a HawkOne directional atherectomy catheter. A standard angioplasty balloon was inflated to 1 to 2 atm during live fluoroscopy to create a 3-dimensional "lumenogram" of the target lesion. Directional atherectomy was performed only where plaque impinged on the balloon at a specific fluoroscopic orientation. The results of the LPBI technique were corroborated with multimodality diagnostic imaging, including digital subtraction angiography, intravascular ultrasound, and intra-arterial pressure measurements. With the LPBI technique, directional atherectomy can routinely achieve <10% residual stenosis, as illustrated in this case, thereby broadly supporting a no-stent approach to lower extremity endovascular revascularization. © The Author(s) 2016.

  14. Elevated Extravascular Lung Water Index (ELWI) as a Predictor of Failure of Continuous Positive Airway Pressure Via Helmet (Helmet-CPAP) in Patients With Acute Respiratory Failure After Major Surgery.

    Science.gov (United States)

    Redondo Calvo, Francisco Javier; Bejarano Ramirez, Natalia; Uña Orejon, Rafael; Villazala Garcia, Ruben; Yuste Peña, Ana Sofia; Belda, Francisco Javier

    2015-11-01

    NIV is increasingly used for prevention and treatment of respiratory complications and failure. Some of them are admitted to the PACU with advanced hemodynamic monitors which allow quantification of Extravascular Lung Water (EVLW) by transpulmonary thermodilution technique (TPTD) and Pulmonary Vascular Permeability (PVP) providing information on lung edema. The objective of this study was to ascertain if EVLW Index and PVP Index may predict failure (intubation) or success (non-intubation) in patients developing acute respiratory failure (ARF) in the postoperative period following major abdominal surgery, where the first line of treatment was non-invasive continuous positive airway pressure via a helmet. Hemodynamic variables, EVLWI and PVPI were monitored with a transpulmonary thermodilution hemodynamic monitor device (PiCCO™) before and after the application of CPAP. Avoidance of intubation was observed in 66% of patients with Helmet-CPAP. In these patients after the first hour of application of CPAP, PaO2/FiO2 ratio significantly increased (303.33±65.2 vs. 141.6±14.6, P<.01). Before starting Helmet-CPAP values of EVLWI and PVPI were significantly lower in non-intubated patients (EVLWI 8.6±1.08 vs. 11.8±0.99ml/kg IBW, P<.01 and PVPI 1.7±0.56 vs. 3.0±0.88, P<.01). An optimal cut-off value for EVLWI was established at 9.5, and at 2.45 for PVPI (sensitivity of 0.7; specificity of 0.9, P<.01). In this type of patient the physiological parameters that predict the failure of Helmet-CPAP with the greatest accuracy were the value of the EVLWI and PVPI before Helmet-CPAP institution and the PaO2/FiO2 ratio and the respiratory rate after one hour of CPAP. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  15. Maximization

    Directory of Open Access Journals (Sweden)

    A. Garmroodi Asil

    2017-09-01

    To further reduce the sulfur dioxide emission of the entire refining process, two scenarios of acid gas or air preheats are investigated when either of them is used simultaneously with the third enrichment scheme. The maximum overall sulfur recovery efficiency and highest combustion chamber temperature is slightly higher for acid gas preheats but air preheat is more favorable because it is more benign. To the best of our knowledge, optimization of the entire GTU + enrichment section and SRU processes has not been addressed previously.

  16. Maximizing Entropy over Markov Processes

    DEFF Research Database (Denmark)

    Biondi, Fabrizio; Legay, Axel; Nielsen, Bo Friis

    2013-01-01

    The channel capacity of a deterministic system with confidential data is an upper bound on the amount of bits of data an attacker can learn from the system. We encode all possible attacks to a system using a probabilistic specification, an Interval Markov Chain. Then the channel capacity...... as a reward function, a polynomial algorithm to verify the existence of an system maximizing entropy among those respecting a specification, a procedure for the maximization of reward functions over Interval Markov Chains and its application to synthesize an implementation maximizing entropy. We show how...... to use Interval Markov Chains to model abstractions of deterministic systems with confidential data, and use the above results to compute their channel capacity. These results are a foundation for ongoing work on computing channel capacity for abstractions of programs derived from code....

  17. Maximizing entropy over Markov processes

    DEFF Research Database (Denmark)

    Biondi, Fabrizio; Legay, Axel; Nielsen, Bo Friis

    2014-01-01

    The channel capacity of a deterministic system with confidential data is an upper bound on the amount of bits of data an attacker can learn from the system. We encode all possible attacks to a system using a probabilistic specification, an Interval Markov Chain. Then the channel capacity...... as a reward function, a polynomial algorithm to verify the existence of a system maximizing entropy among those respecting a specification, a procedure for the maximization of reward functions over Interval Markov Chains and its application to synthesize an implementation maximizing entropy. We show how...... to use Interval Markov Chains to model abstractions of deterministic systems with confidential data, and use the above results to compute their channel capacity. These results are a foundation for ongoing work on computing channel capacity for abstractions of programs derived from code. © 2014 Elsevier...

  18. Effect of upper extremity proprioceptive neuromuscular facilitation combined with elastic resistance bands on respiratory muscle strength: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Guilherme P. T. Areas

    2013-12-01

    Full Text Available BACKGROUND: Elastic resistance bands (ERB combined with proprioceptive neuromuscular facilitation (PNF are often used in resistance muscle training programs, which have potential effects on peripheral muscle strength. However, the effects of the combination of ERB and PNF on respiratory muscle strength warrant further investigation. OBJECTIVES: The assessment of the effects of PNF combined with ERB on respiratory muscle strength. METHOD: Twenty healthy, right-handed females were included. Subjects were randomized to either the resistance training program group (TG, n=10 or the control group (CG, n=10. Maximal expiratory pressure (MEP and inspiratory pressure (MIP were measured before and after four weeks of an upper extremity resistance training program. The training protocol consisted of upper extremity PNF combined with ERB, with resistance selected from 1 repetition maximum protocol. RESULTS: PNF combined with ERB showed significant increases in MIP and MEP (p<0.05. In addition, there were significant differences between the TG and CG regarding ∆MIP (p=0.01 and ∆MEP (p=0.04. CONCLUSIONS: PNF combined with ERB can have a positive impact on respiratory muscle strength. These results may be useful with respect to cardiopulmonary chronic diseases that are associated with reduced respiratory muscle strength.

  19. Effect of thoracic mobilization on respiratory parameters in chronic non-specific low back pain: A randomized controlled trial.

    Science.gov (United States)

    Babina, R; Mohanty, P P; Pattnaik, M

    2016-02-19

    Altered respiratory function has been found to be associated with back pain. Limited chest excursion in subjects with chronic low back pain (CLBP) may be due to co-contraction or bracing of erector spinae and abdominal muscles; their flexed spinal posture; and/or their compromised spinal stability resulting from dysfunctional transversus abdominis. To check for the effects of thoracic mobilization on respiratory parameters in subjects with chronic non-specific low back pain. Sixty-two subjects (excluding 11 dropouts) with CLBP of age group 30-60 were randomly allocated to two groups. Both groups received individualized treatment for low back pain (LBP) and HEP (home exercise program) regime of breathing exercises. In addition, group 1 received Maitland's Central postero-anterior vertebral pressure for thoracic spine (T1-T8). Total treatment duration was 10 sessions in 2 weeks (5 sessions/week). Results showed significant improvement in respiratory parameters viz. Forced Vital Capacity (FVC), Sustained Maximal Inspiratory Pressure (SMIP) and Chest Wall Expansion (CWE) and Oswestry Disability Index (ODI) in both groups (pchronic low back pain with or without radiation to lower limbs when treated with thoracic central PA mobilization, in addition to LBP specific treatment and breathing exercises, show an improvement in respiratory parameters and reduction in disability.

  20. [Management and treatment of respiratory failure associated with amyotrophic lateral sclerosis].

    Science.gov (United States)

    Danel-Brunaud, V; Perez, T; Just, N; Destée, A

    2005-04-01

    In amyotrophic lateral sclerosis (ALS), respiratory muscle involvement is highly predictive of survival and quality of life (QOL). There is compelling evidence that non invasive ventilation (NIV) prolongs survival by several months and improves QOL more than any other currently available treatment. Frequent testing of pulmonary function and regular evaluations are recommended since 1999 by the American Academy of Neurology in order to take appropriate treatment decisions. There are numerous tests available to evaluate respiratory status in ALS and it is important to know their sensitivity and specificity to recognize clinical risk situations. Some recent data suggest that sniff nasal pressure and maximal inspiratory pressure (MIP) can be performed reliably by most ALS patients and are more sensitive to decrements in inspiratory muscle strength than spirometry or arterial blood gasometry. Airway obstruction caused by ineffective coughing is the principal cause of intolerance to NIV. Several factors other than respiratory muscle strength may affect pulmonary function: postural changes, nutritional status, infectious disease, drugs. The neurologist has to coordinate multidisciplinary care, with attention to individual patient preferences, and with a frank and compassionate discussion between the patient, the family, the physicians and the caregivers.

  1. Middle East Respiratory Syndrome

    Centers for Disease Control (CDC) Podcasts

    2014-07-07

    This podcast discusses Middle East Respiratory Syndrome, or MERS, a viral respiratory illness caused by Middle East Respiratory Syndrome Coronavirus—MERS-CoV.  Created: 7/7/2014 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 7/7/2014.

  2. Validation of the CORB75 (confusion, oxygen saturation, respiratory rate, blood pressure, and age ≥ 75 years) as a simpler pneumonia severity rule.

    Science.gov (United States)

    Ochoa-Gondar, O; Vila-Corcoles, A; Rodriguez-Blanco, T; Hospital, I; Salsench, E; Ansa, X; Saun, N

    2014-04-01

    This study compares the ability of two simpler severity rules (classical CRB65 vs. proposed CORB75) in predicting short-term mortality in elderly patients with community-acquired pneumonia (CAP). A population-based study was undertaken involving 610 patients ≥ 65 years old with radiographically confirmed CAP diagnosed between 2008 and 2011 in Tarragona, Spain (350 cases in the derivation cohort, 260 cases in the validation cohort). Severity rules were calculated at the time of diagnosis, and 30-day mortality was considered as the dependent variable. The area under the receiver operating characteristic curves (AUC) was used to compare the discriminative power of the severity rules. Eighty deaths (46 in the derivation and 34 in the validation cohorts) were observed, which gives a mortality rate of 13.1 % (15.6 % for hospitalized and 3.3 % for outpatient cases). After multivariable analyses, besides CRB (confusion, respiration rate ≥ 30/min, systolic blood pressure AUC statistics for predicting mortality in the derivation and validation cohorts were 0.79 and 0.82, respectively. In the derivation cohort, a CORB75 score ≥ 2 showed 78.3 % sensitivity and 65.5 % specificity for mortality (in the validation cohort, these were 82.4 and 71.7 %, respectively). The proposed CORB75 scoring system has good discriminative power in predicting short-term mortality among elderly people with CAP, which supports its use for severity assessment of these patients in primary care.

  3. Uma análise entre índices pressóricos, obesidade e capacidade cardiorrespiratória em escolares Comparison analysis of blood pressure, obesity, and cardio-respiratory fitness in schoolchildren

    Directory of Open Access Journals (Sweden)

    Miria Suzana Burgos

    2010-06-01

    diseases, especially obesity, hypertension, and diabetes mellitus. Early intervention can prevent the development of these complications. OBJECTIVE: To determine the presence of cardiovascular risk (obesity and hypertension in schoolchildren and its potential interactions with cardio-respiratory fitness. METHODS: This was a cross-sectional study conducted in a stratified cluster sample of 1,666 schoolchildren, aged between 7 and 17 years, 873 (52.4% of them male and 793 (47.6% of them female. The following variables were evaluated: systolic blood pressure (SBP, diastolic blood pressure (DBP, body mass index (BMI, body fat percentage (BF %, and cardio-respiratory fitness. SBP and DBP were correlated with waist circumference (WC, waist-hip ratio (WHR, sum of skin folds (ΣSF, and cardio-respiratory fitness. RESULTS: A BMI assessment of the students showed that 26.7% of them were overweight or obese, and 35.9% had body fat percentage over moderately high. As to blood pressure, we found that 13.9% and 12.1% of the students were borderline or hypertensive, for SBP and DBP, respectively. There was an association among hypertension, obesity, and cardio-respiratory fitness. There was a significant correlation of SBP and DBP with all variables, and also a weak to moderate correlation with age, weight, height, BMI, and waist circumference. CONCLUSION: The presence of hypertension associated with obesity and its effects on cardio-respiratory fitness stress the importance of recommending, since childhood, a more active and healthy lifestyle.

  4. Chamaebatiaria millefolium (Torr.) Maxim.: fernbush

    Science.gov (United States)

    Nancy L. Shaw; Emerenciana G. Hurd

    2008-01-01

    Fernbush - Chamaebatiaria millefolium (Torr.) Maxim. - the only species in its genus, is endemic to the Great Basin, Colorado Plateau, and adjacent areas of the western United States. It is an upright, generally multistemmed, sweetly aromatic shrub 0.3 to 2 m tall. Bark of young branches is brown and becomes smooth and gray with age. Leaves are leathery, alternate,...

  5. Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Carmen Sílvia Valente Barbas

    2012-01-01

    Full Text Available This paper, based on relevant literature articles and the authors' clinical experience, presents a goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome (ARDS that can help improve clinicians' ability to care for these patients. Early recognition of ARDS modified risk factors and avoidance of aggravating factors during hospital stay such as nonprotective mechanical ventilation, multiple blood products transfusions, positive fluid balance, ventilator-associated pneumonia, and gastric aspiration can help decrease its incidence. An early extensive clinical, laboratory, and imaging evaluation of “at risk patients” allows a correct diagnosis of ARDS, assessment of comorbidities, and calculation of prognostic indices, so that a careful treatment can be planned. Rapid administration of antibiotics and resuscitative measures in case of sepsis and septic shock associated with protective ventilatory strategies and early short-term paralysis associated with differential ventilatory techniques (recruitment maneuvers with adequate positive end-expiratory pressure titration, prone position, and new extracorporeal membrane oxygenation techniques in severe ARDS can help improve its prognosis. Revaluation of ARDS patients on the third day of evolution (Sequential Organ Failure Assessment (SOFA, biomarkers and response to infection therapy allows changes in the initial treatment plans and can help decrease ARDS mortality.

  6. Magnetic resonance elastography of the lung parenchyma in an in situ porcine model with a noninvasive mechanical driver: correlation of shear stiffness with trans-respiratory system pressures.

    Science.gov (United States)

    Mariappan, Yogesh K; Kolipaka, Arunark; Manduca, Armando; Hubmayr, Rolf D; Ehman, Richard L; Araoz, Philip; McGee, Kiaran P

    2012-01-01

    Quantification of the mechanical properties of lung parenchyma is an active field of research due to the association of this metric with normal function, disease initiation and progression. A phase contrast MRI-based elasticity imaging technique known as magnetic resonance elastography is being investigated as a method for measuring the shear stiffness of lung parenchyma. Previous experiments performed with small animals using invasive drivers in direct contact with the lungs have indicated that the quantification of lung shear modulus with (1) H based magnetic resonance elastography is feasible. This technique has been extended to an in situ porcine model with a noninvasive mechanical driver placed on the chest wall. This approach was tested to measure the change in parenchymal stiffness as a function of airway opening pressure (P(ao) ) in 10 adult pigs. In all animals, shear stiffness was successfully quantified at four different P(ao) values. Mean (±STD error of mean) pulmonary parenchyma density corrected stiffness values were calculated to be 1.48 (±0.09), 1.68 (±0.10), 2.05 (±0.13), and 2.23 (±0.17) kPa for P(ao) values of 5, 10, 15, and 20 cm H2O, respectively. Shear stiffness increased with increasing P(ao) , in agreement with the literature. It is concluded that in an in situ porcine lung shear stiffness can be quantitated with (1) H magnetic resonance elastography using a noninvasive mechanical driver and that it is feasible to measure the change in shear stiffness due to change in P(ao) . Copyright © 2011 Wiley-Liss, Inc.

  7. Respiratory muscle weakness and respiratory muscle training in severely disabled multiple sclerosis patients.

    Science.gov (United States)

    Gosselink, R; Kovacs, L; Ketelaer, P; Carton, H; Decramer, M

    2000-06-01

    To evaluate the contribution of respiratory muscle weakness (part 1) and respiratory muscle training (part 2) to pulmonary function, cough efficacy, and functional status in patients with advanced multiple sclerosis (MS). Survey (part 1) and randomized controlled trial (part 2). Rehabilitation center for MS. Twenty-eight bedridden or wheelchair-bound MS patients (part 1); 18 patients were randomly assigned to a training group (n = 9) or a control group (n = 9) (part 2). The training group (part 2) performed three series of 15 contractions against an expiratory resistance (60% maximum expiratory pressure [PEmax]) two times a day, whereas the control group performed breathing exercises to enhance maximal inspirations. Forced vital capacity (FVC), inspiratory, and expiratory muscle strength (PImax and PEmax), neck flexion force (NFF), cough efficacy by means of the Pulmonary Index (PI), and functional status by means of the Extended Disability Status Scale (EDSS). Part 1 revealed a significantly reduced FVC (43% +/- 26% predicted), PEmax (18% +/- 8% predicted), and PImax (27% +/- 11% predicted), whereas NFF was only mildly reduced (93% +/- 26% predicted). The PI (median score, 10) and EDSS (median score, 8.5) were severely reduced. PEmax was significantly correlated to FVC, EDSS, and PI (r = .77, -.79, and -.47, respectively). In stepwise multiple regression analysis. PEmax was the only factor contributing to the explained variance in FVC (R2 = .60), whereas body weight (R2 = .41) was the only factor for the PI. In part 2, changes in PImax and PEmax tended to be higher in the training group (p = .06 and p = .07, respectively). The PI was significantly improved after 3 months of training compared with the control group (p functional status. Expiratory muscle training tended to enhance inspiratory and expiratory muscle strength. In addition, subjectively and objectively rated cough efficacy improved significantly and lasted for 3 months after training cessation.

  8. Immediate effect of manual therapy on respiratory functions and inspiratory muscle strength in patients with COPD

    Directory of Open Access Journals (Sweden)

    Yilmaz Yelvar GD

    2016-06-01

    Full Text Available Gul Deniz Yilmaz Yelvar,1 Yasemin Çirak,2 Yasemin Parlak Demir,3 Murat Dalkilinç,1 Bülent Bozkurt4 1Department of Musculoskeletal Physiotherapy, 2Department of Cardiopulmonary Physiotherapy, 3Department of Neurological Rehabilitation, School of Physiotherapy and Rehabilitation, 4Department of Respiratory Medicine, Faculty of Medicine, Turgut Özal University, Ankara, Turkey Objective: The objective of this study was to investigate the immediate effect of manual therapy (MT on respiratory functions and inspiratory muscle strength in patients with COPD.Participants and methods: Thirty patients with severe COPD (eight females and 22 males; mean age 62.4±6.8 years referred to pulmonary physiotherapy were included in this study. The patients participated in a single session of MT to measure the short-term effects. The lung function was measured using a portable spirometer. An electronic pressure transducer was used to measure respiratory muscle strength. Heart rate, breathing frequency, and oxygen saturation were measured with a pulse oximeter. For fatigue and dyspnea perception, the modified Borg rating of perceived exertion scale was used. All measurements were taken before and immediately after the first MT session. The ease-of-breathing visual analog scale was used for rating patients’ symptoms subjectively during the MT session.Results: There was a significant improvement in the forced expiratory volume in the first second, forced vital capacity, and vital capacity values (P<0.05. The maximal inspiratory pressure and maximal expiratory pressure values increased significantly after MT, compared to the pre-MT session (P<0.05. There was a significant decrease in heart rate, respiratory rate (P<0.05, and dyspnea and fatigue perception (P<0.05.Conclusion: A single MT session immediately improved pulmonary function, inspiratory muscle strength, and oxygen saturation and reduced dyspnea, fatigue, and heart and respiratory rates in patients with

  9. IMNN: Information Maximizing Neural Networks

    Science.gov (United States)

    Charnock, Tom; Lavaux, Guilhem; Wandelt, Benjamin D.

    2018-04-01

    This software trains artificial neural networks to find non-linear functionals of data that maximize Fisher information: information maximizing neural networks (IMNNs). As compressing large data sets vastly simplifies both frequentist and Bayesian inference, important information may be inadvertently missed. Likelihood-free inference based on automatically derived IMNN summaries produces summaries that are good approximations to sufficient statistics. IMNNs are robustly capable of automatically finding optimal, non-linear summaries of the data even in cases where linear compression fails: inferring the variance of Gaussian signal in the presence of noise, inferring cosmological parameters from mock simulations of the Lyman-α forest in quasar spectra, and inferring frequency-domain parameters from LISA-like detections of gravitational waveforms. In this final case, the IMNN summary outperforms linear data compression by avoiding the introduction of spurious likelihood maxima.

  10. Is the β phase maximal?

    International Nuclear Information System (INIS)

    Ferrandis, Javier

    2005-01-01

    The current experimental determination of the absolute values of the CKM elements indicates that 2 vertical bar V ub /V cb V us vertical bar =(1-z), with z given by z=0.19+/-0.14. This fact implies that irrespective of the form of the quark Yukawa matrices, the measured value of the SM CP phase β is approximately the maximum allowed by the measured absolute values of the CKM elements. This is β=(π/6-z/3) for γ=(π/3+z/3), which implies α=π/2. Alternatively, assuming that β is exactly maximal and using the experimental measurement sin(2β)=0.726+/-0.037, the phase γ is predicted to be γ=(π/2-β)=66.3 o +/-1.7 o . The maximality of β, if confirmed by near-future experiments, may give us some clues as to the origin of CP violation

  11. Randomized controlled trial of two methods of nasal continuous positive airway pressure (N-CPAP) in preterm infants with respiratory distress syndrome: underwater bubbly CPAP vs. Medijet system device.

    Science.gov (United States)

    Hosseini, Mohammad Bagher; Heidarzadeh, Mohammad; Balila, Masumeh; Ghojazadeh, Morteza; Janani, Raheleh; Safavi-nia, Sima; Naghavi-Behzad, Mohammad; Alikhah, Hossein

    2012-01-01

    There has been an increasing interest in the application of non-invasive respiratory support in preterm infants, and different types of nasal continuous positive airway pressure (N-CPAP) devices are being used in Neonatal Intensive Care Units (NICUs). The objective of the present study was to compare the duration of CPAP need and possible complications of two methods of (N-CPAP) delivery: Bubble CPAP (B-CPAP) and Medijet (MJ) system device in preterm infants with respiratory distress syndrome (RDS). This prospective randomized clinical trial was performed on 161 preterm infants (28-37 weeks of gestational age) with RDS and eligible for CPAP therapy. The infants were inborn and admitted in a level III NICU of Al-Zahra Teaching Hospital (Tabriz, Iran) from April 2010 to September 2011. All infants were randomized in the first hour of life to B-CPAP or MJ system. Short binasal prongs were used in both groups and CPAP was set at the level of 5-6 cm H2O. The primary outcome of this study was duration of CPAP need (hour). Other outcomes, such as complications of the two methods of N-CPAP, were evaluated using a checklist. Ninety infants were randomized to the MJ system, and 71 were randomized to B-CPAP. The mean gestational age and birth weight were similar in the two groups, as was the duration of CPAP need (44.3 ± 20.64 vs. 49.2 ± 21.2 hours, respectively; p=0.66). Moreover, the probability of complications, such as CPAP failure rate, pulmonary hemorrhage, pneumothorax, intraventricular hemorrhage, abdominal distention, necrotizing enterocolitis, and bronchopulmonary dysplasia, was the same between the two study groups (p>0.05). There was a trend of more hyperemia of the nose in the B-CPAP group in comparison to the MJ system group (10% versus 3.3%, respectively), but the difference was not significant (p=0.08). In conclusion, the MJ system is as effective as B-CPAP in the management of infants with RDS.

  12. Strategy to maximize maintenance operation

    OpenAIRE

    Espinoza, Michael

    2005-01-01

    This project presents a strategic analysis to maximize maintenance operations in Alcan Kitimat Works in British Columbia. The project studies the role of maintenance in improving its overall maintenance performance. It provides strategic alternatives and specific recommendations addressing Kitimat Works key strategic issues and problems. A comprehensive industry and competitive analysis identifies the industry structure and its competitive forces. In the mature aluminium industry, the bargain...

  13. Scalable Nonlinear AUC Maximization Methods

    OpenAIRE

    Khalid, Majdi; Ray, Indrakshi; Chitsaz, Hamidreza

    2017-01-01

    The area under the ROC curve (AUC) is a measure of interest in various machine learning and data mining applications. It has been widely used to evaluate classification performance on heavily imbalanced data. The kernelized AUC maximization machines have established a superior generalization ability compared to linear AUC machines because of their capability in modeling the complex nonlinear structure underlying most real world-data. However, the high training complexity renders the kernelize...

  14. FLOUTING MAXIMS IN INDONESIA LAWAK KLUB CONVERSATION

    Directory of Open Access Journals (Sweden)

    Rahmawati Sukmaningrum

    2017-04-01

    Full Text Available This study aims to identify the types of maxims flouted in the conversation in famous comedy show, Indonesia Lawak Club. Likewise, it also tries to reveal the speakers‘ intention of flouting the maxim in the conversation during the show. The writers use descriptive qualitative method in conducting this research. The data is taken from the dialogue of Indonesia Lawak club and then analyzed based on Grice‘s cooperative principles. The researchers read the dialogue‘s transcripts, identify the maxims, and interpret the data to find the speakers‘ intention for flouting the maxims in the communication. The results show that there are four types of maxims flouted in the dialogue. Those are maxim of quality (23%, maxim of quantity (11%, maxim of manner (31%, and maxim of relevance (35. Flouting the maxims in the conversations is intended to make the speakers feel uncomfortable with the conversation, show arrogances, show disagreement or agreement, and ridicule other speakers.

  15. Are there benefits or harm from pressure targeting during lung-protective ventilation?

    Science.gov (United States)

    MacIntyre, Neil R; Sessler, Curtis N

    2010-02-01

    Mechanically, breath design is usually either flow/volume-targeted or pressure-targeted. Both approaches can effectively provide lung-protective ventilation, but they prioritize different ventilation parameters, so their responses to changing respiratory-system mechanics and patient effort are different. These different response behaviors have advantages and disadvantages that can be important in specific circumstances. Flow/volume targeting guarantees a set minute ventilation but sometimes may be difficult to synchronize with patient effort, and it will not limit inspiratory pressure. In contrast, pressure targeting, with its variable flow, may be easier to synchronize and will limit inspiratory pressure, but it provides no control over delivered volume. Skilled clinicians can maximize benefits and minimize problems with either flow/volume targeting or pressure targeting. Indeed, as is often the case in managing complex life-support devices, it is operator expertise rather than the device design features that most impacts patient outcomes.

  16. The respiratory microbiome and respiratory infections

    NARCIS (Netherlands)

    Unger, Stefan A.; Bogaert, Debby

    2017-01-01

    Despite advances over the past ten years lower respiratory tract infections still comprise around a fifth of all deaths worldwide in children under five years of age with the majority in low- and middle-income countries. Known risk factors for severe respiratory infections and poor chronic

  17. Effects of inspiratory muscle training on pulmonary function, respiratory muscle strength and functional capacity in patients with atrial fibrillation: a randomized controlled trial.

    Science.gov (United States)

    Zeren, Melih; Demir, Rengin; Yigit, Zerrin; Gurses, Hulya N

    2016-12-01

    To investigate the effects of inspiratory muscle training on pulmonary function, respiratory muscle strength and functional capacity in patients with atrial fibrillation. Prospective randomized controlled single-blind study. Cardiology department of a university hospital. A total of 38 patients with permanent atrial fibrillation were randomly allocated to either a treatment group (n = 19; age 66.2 years (8.8)) or a control group (n = 19; age 67.1 years (6.4)). The training group received inspiratory muscle training at 30% of maximal inspiratory pressure for 15 minutes twice a day, 7 days a week, for 12 weeks alongside the standard medical treatment. The control group received standard medical treatment only. Spirometry, maximal inspiratory and expiratory pressures and 6-minute walking distance was measured at the beginning and end of the study. There was a significant increase in maximal inspiratory pressure (27.94 cmH 2 O (8.90)), maximal expiratory pressure (24.53 cmH 2 O (10.34)), forced vital capacity (10.29% (8.18) predicted), forced expiratory volume in one second (13.88% (13.42) predicted), forced expiratory flow 25%-75% (14.82% (12.44) predicted), peak expiratory flow (19.82% (15.62) predicted) and 6-minute walking distance (55.53 m (14.13)) in the training group (p  0.05). Inspiratory muscle training can improve pulmonary function, respiratory muscle strength and functional capacity in patients with atrial fibrillation. © The Author(s) 2016.

  18. Respiratory Syncytial Virus

    Science.gov (United States)

    ... with facebook share with twitter share with linkedin Respiratory Syncytial Virus (RSV) Credit: CDC This is the ... the United States. Why Is the Study of Respiratory Syncytial Virus (RSV) a Priority for NIAID? In ...

  19. Respiratory syncytial virus (RSV)

    Science.gov (United States)

    RSV; Palivizumab; Respiratory syncytial virus immune globulin; Bronchiolitis - RSV ... Crowe JE. Respiratory syncytial virus. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ...

  20. Respiratory Issues in OI

    Science.gov (United States)

    Respiratory Issues in Osteogenesis Imperfecta \\ Introduction The respiratory system’s job is to bring oxygen into the body and remove carbon dioxide, the waste product of breathing. Because oxygen is the fuel ...

  1. Acute respiratory distress syndrome

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000103.htm Acute respiratory distress syndrome To use the sharing features on this page, please enable JavaScript. Acute respiratory distress syndrome (ARDS) is a life-threatening lung ...

  2. Upper respiratory tract (image)

    Science.gov (United States)

    The major passages and structures of the upper respiratory tract include the nose or nostrils, nasal cavity, mouth, throat (pharynx), and voice box (larynx). The respiratory system is lined with a mucous membrane that ...

  3. Avian respiratory system disorders

    Science.gov (United States)

    Olsen, Glenn H.

    1989-01-01

    Diagnosing and treating respiratory diseases in avian species requires a basic knowledge about the anatomy and physiology of this system in birds. Differences between mammalian and avian respiratory system function, diagnosis, and treatment are highlighted.

  4. Seven-day mortality can be predicted in medical patients by blood pressure, age, respiratory rate, loss of independence, and peripheral oxygen saturation (the PARIS score: a prospective cohort study with external validation.

    Directory of Open Access Journals (Sweden)

    Mikkel Brabrand

    Full Text Available Most existing risk stratification systems predicting mortality in emergency departments or admission units are complex in clinical use or have not been validated to a level where use is considered appropriate. We aimed to develop and validate a simple system that predicts seven-day mortality of acutely admitted medical patients using routinely collected variables obtained within the first minutes after arrival.This observational prospective cohort study used three independent cohorts at the medical admission units at a regional teaching hospital and a tertiary university hospital and included all adult (≥ 15 years patients. Multivariable logistic regression analysis was used to identify the clinical variables that best predicted the endpoint. From this, we developed a simplified model that can be calculated without specialized tools or loss of predictive ability. The outcome was defined as seven-day all-cause mortality. 76 patients (2.5% met the endpoint in the development cohort, 57 (2.0% in the first validation cohort, and 111 (4.3% in the second. Systolic blood Pressure, Age, Respiratory rate, loss of Independence, and peripheral oxygen Saturation were associated with the endpoint (full model. Based on this, we developed a simple score (range 0-5, ie, the PARIS score, by dichotomizing the variables. The ability to identify patients at increased risk (discriminatory power and calibration was excellent for all three cohorts using both models. For patients with a PARIS score ≥ 3, sensitivity was 62.5-74.0%, specificity 85.9-91.1%, positive predictive value 11.2-17.5%, and negative predictive value 98.3-99.3%. Patients with a score ≤ 1 had a low mortality (≤ 1%; with 2, intermediate mortality (2-5%; and ≥ 3, high mortality (≥ 10%.Seven-day mortality can be predicted upon admission with high sensitivity and specificity and excellent negative predictive values.

  5. Sex differences in autonomic function following maximal exercise.

    Science.gov (United States)

    Kappus, Rebecca M; Ranadive, Sushant M; Yan, Huimin; Lane-Cordova, Abbi D; Cook, Marc D; Sun, Peng; Harvey, I Shevon; Wilund, Kenneth R; Woods, Jeffrey A; Fernhall, Bo

    2015-01-01

    Heart rate variability (HRV), blood pressure variability, (BPV) and heart rate recovery (HRR) are measures that provide insight regarding autonomic function. Maximal exercise can affect autonomic function, and it is unknown if there are sex differences in autonomic recovery following exercise. Therefore, the purpose of this study was to determine sex differences in several measures of autonomic function and the response following maximal exercise. Seventy-one (31 males and 40 females) healthy, nonsmoking, sedentary normotensive subjects between the ages of 18 and 35 underwent measurements of HRV and BPV at rest and following a maximal exercise bout. HRR was measured at minute one and two following maximal exercise. Males have significantly greater HRR following maximal exercise at both minute one and two; however, the significance between sexes was eliminated when controlling for VO2 peak. Males had significantly higher resting BPV-low-frequency (LF) values compared to females and did not significantly change following exercise, whereas females had significantly increased BPV-LF values following acute maximal exercise. Although males and females exhibited a significant decrease in both HRV-LF and HRV-high frequency (HF) with exercise, females had significantly higher HRV-HF values following exercise. Males had a significantly higher HRV-LF/HF ratio at rest; however, both males and females significantly increased their HRV-LF/HF ratio following exercise. Pre-menopausal females exhibit a cardioprotective autonomic profile compared to age-matched males due to lower resting sympathetic activity and faster vagal reactivation following maximal exercise. Acute maximal exercise is a sufficient autonomic stressor to demonstrate sex differences in the critical post-exercise recovery period.

  6. What Is Respiratory Distress Syndrome?

    Science.gov (United States)

    ... Home / Respiratory Distress Syndrome Respiratory Distress Syndrome Also known as What Is Respiratory ... This condition is called apnea (AP-ne-ah). Respiratory Distress Syndrome Complications Depending on the severity of ...

  7. Severe acute respiratory syndrome (SARS)

    Science.gov (United States)

    SARS; Respiratory failure - SARS ... Complications may include: Respiratory failure Liver failure Heart failure ... 366. McIntosh K, Perlman S. Coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). ...

  8. Respiratory muscle strength and pulmonary function in children with rhinitis and asthma after a six-minute walk test.

    Science.gov (United States)

    Soares, Ana Alice de Almeida; Barros, Camila Moraes; Santos, Cássia Giulliane Costa; Dos Santos, Maria Renata Aragão; Silva, José Rodrigo Santos; Silva Junior, Walderi Monteiro da; Simões, Silvia de Magalhães

    2018-03-01

    Rhinitis and asthma decrease quality of life. Few studies have assessed the performance of children with asthma or rhinitis under submaximal exercise. We evaluated maximal respiratory pressures, spirometric parameters, and ability to sustain submaximal exercise in these children before and after the 6-minute walk test (6MWT), compared to healthy children. This cross-sectional, analytical study included 89 children aged 6-12 years in outpatient follow-up: 27 healthy (H), 31 with rhinitis (R), and 31 with mild asthma under control (A). Pulmonary function parameters and maximal respiratory pressures were measured before and 5, 10, and 30 minutes after the 6MWT. Wilcoxon test was used to compare numerical numerical variables between two groups and analysis of variance or Kruskal-Wallis test for comparison among three groups. Total distance traveled in the 6MWT was similar among the three groups. Compared to pre-test values, VEF1 (Forced Expiratory Volume in 1 second), VEF0.75 (Forced Expiratory Volume in 0.75 second), and FEF25-75 (Forced Expiratory Flow 25-75% of the Forced Vital Capacity - CVF - curve) decreased significantly after the 6MWT in group A, and VEF0.75, FEF25-75, and VEF1/CVF decreased significantly in group R. Groups A and R had lower Maximum Inspiratory Pressure values than group H before and after the 6MWT at all time points assessed. The findings suggest that children with rhinitis and mild asthma present with alterations in respiratory muscle strength and pulmonary function not associated with clinical complaints, reinforcing the concept of the united airways.

  9. Maximal Abelian sets of roots

    CERN Document Server

    Lawther, R

    2018-01-01

    In this work the author lets \\Phi be an irreducible root system, with Coxeter group W. He considers subsets of \\Phi which are abelian, meaning that no two roots in the set have sum in \\Phi \\cup \\{ 0 \\}. He classifies all maximal abelian sets (i.e., abelian sets properly contained in no other) up to the action of W: for each W-orbit of maximal abelian sets we provide an explicit representative X, identify the (setwise) stabilizer W_X of X in W, and decompose X into W_X-orbits. Abelian sets of roots are closely related to abelian unipotent subgroups of simple algebraic groups, and thus to abelian p-subgroups of finite groups of Lie type over fields of characteristic p. Parts of the work presented here have been used to confirm the p-rank of E_8(p^n), and (somewhat unexpectedly) to obtain for the first time the 2-ranks of the Monster and Baby Monster sporadic groups, together with the double cover of the latter. Root systems of classical type are dealt with quickly here; the vast majority of the present work con...

  10. Hypnosis in paediatric respiratory medicine.

    Science.gov (United States)

    McBride, Joshua J; Vlieger, Arine M; Anbar, Ran D

    2014-03-01

    Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Effects of intravenous hyperosmotic sodium bicarbonate on arterial and cerebrospinal fluid acid-base status and cardiovascular function in calves with experimentally induced respiratory and strong ion acidosis.

    Science.gov (United States)

    Berchtold, Joachim F; Constable, Peter D; Smith, Geoffrey W; Mathur, Sheerin M; Morin, Dawn E; Tranquilli, William J

    2005-01-01

    The objectives of this study were to determine the effects of hyperosmotic sodium bicarbonate (HSB) administration on arterial and cerebrospinal fluid (CSF) acid-base balance and cardiovascular function in calves with experimentally induced respiratory and strong ion (metabolic) acidosis. Ten healthy male Holstein calves (30-47 kg body weight) were instrumented under halothane anesthesia to permit cardiovascular monitoring and collection of blood samples and CSE Respiratory acidosis was induced by allowing the calves to spontaneously ventilate, and strong ion acidosis was subsequently induced by i.v. administration of L-lactic acid. Calves were then randomly assigned to receive either HSB (8.4% NaHCO3; 5 ml/kg over 5 minutes, i.v.; n=5) or no treatment (controls, n=5) and monitored for 1 hour. Mixed respiratory and strong ion acidosis was accompanied by increased heart rate, cardiac index, mean arterial pressure, cardiac contractility (maximal rate of change of left ventricular pressure), and mean pulmonary artery pressure. Rapid administration of HSB immediately corrected the strong ion acidosis, transiently increased arterial partial pressure of carbon dioxide (P(CO2)), and expanded the plasma volume. The transient increase in arterial P(CO2) did not alter CSF P(CO2) or induce paradoxical CSF acidosis. Compared to untreated control calves, HSB-treated calves had higher cardiac index and contractility and a faster rate of left ventricular relaxation for 1 hour after treatment, indicating that HSB administration improved myocardial systolic function. We conclude that rapid i.v. administration of HSB provided an effective and safe method for treating strong ion acidosis in normovolemic halothane-anesthetized calves with experimentally induced respiratory and strong ion acidosis. Fear of inducing paradoxical CSF acidosis is not a valid reason for withholding HSB administration in calves with mixed respiratory and strong ion acidosis.

  12. Respiratory physiology during early life.

    Science.gov (United States)

    Stocks, J

    1999-08-01

    Despite the rapid adaptation to extrauterine life, the respiratory system of an infant is not simply a miniaturized version of that of an adult, since the rapid somatic growth that occurs during the first year of life is accompanied by major developmental changes in respiratory physiology. The highly compliant chest wall of the infant results in relatively low transpulmonary pressures at end expiration with increased tendency of the small peripheral airways to close during tidal breathing. This not only impairs gas exchange and ventilation-perfusion balance, particularly in dependent parts of the lung, but, together with the small absolute size of the airways, renders the infant and young child particularly susceptible to airway obstruction. Premature airways are highly compliant structures compared with those of mature newborns or adults. This increased compliance can cause airway collapse, resulting in increased airways resistance, flow limitation, poor gas exchange and increased work of breathing. Although there is clear evidence that airway reactivity is present from birth, its role in wheezing lower respiratory tract illnesses in young infants may be overshadowed by pre-existing abnormalities of airway geometry and lung mechanics, or by pathological changes such as airway oedema and mucus hypersecretion. Attempts to assess age-related changes in airway reactivity or response to aerosol therapy in the very young is confounded by changes in breathing patterns and the fact that infants are preferential nose breathers. There is increasing evidence that pre-existing abnormalities of respiratory function, associated with adverse events during foetal life (including maternal smoking during pregnancy), and familial predisposition to wheezing are important determinants of wheezing illnesses during the first years of life. This emphasizes the need to identify and minimize any factors that threaten the normal development of the lung during this critical period if

  13. Cycle length maximization in PWRs using empirical core models

    International Nuclear Information System (INIS)

    Okafor, K.C.; Aldemir, T.

    1987-01-01

    The problem of maximizing cycle length in nuclear reactors through optimal fuel and poison management has been addressed by many investigators. An often-used neutronic modeling technique is to find correlations between the state and control variables to describe the response of the core to changes in the control variables. In this study, a set of linear correlations, generated by two-dimensional diffusion-depletion calculations, is used to find the enrichment distribution that maximizes cycle length for the initial core of a pressurized water reactor (PWR). These correlations (a) incorporate the effect of composition changes in all the control zones on a given fuel assembly and (b) are valid for a given range of control variables. The advantage of using such correlations is that the cycle length maximization problem can be reduced to a linear programming problem

  14. Maximizing benefits from resource development

    International Nuclear Information System (INIS)

    Skjelbred, B.

    2002-01-01

    The main objectives of Norwegian petroleum policy are to maximize the value creation for the country, develop a national oil and gas industry, and to be at the environmental forefront of long term resource management and coexistence with other industries. The paper presents a graph depicting production and net export of crude oil for countries around the world for 2002. Norway produced 3.41 mill b/d and exported 3.22 mill b/d. Norwegian petroleum policy measures include effective regulation and government ownership, research and technology development, and internationalisation. Research and development has been in five priority areas, including enhanced recovery, environmental protection, deep water recovery, small fields, and the gas value chain. The benefits of internationalisation includes capitalizing on Norwegian competency, exploiting emerging markets and the assurance of long-term value creation and employment. 5 figs

  15. Maximizing synchronizability of duplex networks

    Science.gov (United States)

    Wei, Xiang; Emenheiser, Jeffrey; Wu, Xiaoqun; Lu, Jun-an; D'Souza, Raissa M.

    2018-01-01

    We study the synchronizability of duplex networks formed by two randomly generated network layers with different patterns of interlayer node connections. According to the master stability function, we use the smallest nonzero eigenvalue and the eigenratio between the largest and the second smallest eigenvalues of supra-Laplacian matrices to characterize synchronizability on various duplexes. We find that the interlayer linking weight and linking fraction have a profound impact on synchronizability of duplex networks. The increasingly large inter-layer coupling weight is found to cause either decreasing or constant synchronizability for different classes of network dynamics. In addition, negative node degree correlation across interlayer links outperforms positive degree correlation when most interlayer links are present. The reverse is true when a few interlayer links are present. The numerical results and understanding based on these representative duplex networks are illustrative and instructive for building insights into maximizing synchronizability of more realistic multiplex networks.

  16. Effect of respiratory function training on respiratory function of patients with severe cerebrovascular disease

    Directory of Open Access Journals (Sweden)

    Ming GUO

    2017-07-01

    Full Text Available Objective To investigate the effect of respiratory function training on respiratory function and conscious state of patients with severe cerebrovascular disease (SCVD.  Methods A total of 27 patients with SCVD were divided into control group (N = 17 and observation group (N = 10. Control group received routine drug and rehabilitation treatment, and observation group was added respiratory function training based on routine treatment. The respiratory rate, tidal volume (TV, heart rate, blood pressure and artery oxygen saturation (SaO2 of patients were monitored by breathing machine before and after 4-week treatment. Meanwhile, arterial blood gas analysis was used to detect arterial partial pressure of oxygen (PaO2, oxygenation index, partial pressure of carbon dioxide (PaCO2 and pH value. At the same time, Glasgow Coma Scale (GCS was used to evaluate the conscious state of patients.  Results All patients successfully completed 4-week rehabilitation training, without asphyxia, arrhythmia or other adverse events. Compared with before training, the respiratory rate (P = 0.006 and pH value (P = 0.010 were significantly decreased, while SaO2 (P = 0.001, oxygenation index (P = 0.000 and GCS scores (P = 0.004, 0.017 were significantly increased in both groups of patients after training. There was no statistically significant difference between 2 groups on respiratory function indexes and GCS scores after training (P > 0.05, for all. Conclusions Respiratory function training did not significantly improve the respiratory function and conscious state of patients with SCVD, yet to be further studied. Randomized controlled clinical trials with larger, layered samples and long-term prognosis observation are needed. Examination method of respiratory function of SCVD patients is also a topic to be explored.  DOI: 10.3969/j.issn.1672-6731.2017.04.007

  17. Static respiratory muscle work during immersion with positive and negative respiratory loading.

    Science.gov (United States)

    Taylor, N A; Morrison, J B

    1999-10-01

    Upright immersion imposes a pressure imbalance across the thorax. This study examined the effects of air-delivery pressure on inspiratory muscle work during upright immersion. Eight subjects performed respiratory pressure-volume relaxation maneuvers while seated in air (control) and during immersion. Hydrostatic, respiratory elastic (lung and chest wall), and resultant static respiratory muscle work components were computed. During immersion, the effects of four air-delivery pressures were evaluated: mouth pressure (uncompensated); the pressure at the lung centroid (PL,c); and at PL,c +/-0.98 kPa. When breathing at pressures less than the PL,c, subjects generally defended an expiratory reserve volume (ERV) greater than the immersed relaxation volume, minus residual volume, resulting in additional inspiratory muscle work. The resultant static inspiratory muscle work, computed over a 1-liter tidal volume above the ERV, increased from 0.23 J. l(-1), when subjects were breathing at PL,c, to 0.83 J. l(-1) at PL,c -0.98 kPa (P work was minimal. When breathing at PL,c +0.98 kPa, subjects adopted an ERV less than the immersed relaxation volume, minus residual volume, resulting in 0.36 J. l(-1) of expiratory muscle work. Thus static inspiratory muscle work varied with respiratory loading, whereas PL,c air supply minimized this work during upright immersion, restoring lung-tissue, chest-wall, and static muscle work to levels obtained in the control state.

  18. VIOLATION OF CONVERSATION MAXIM ON TV ADVERTISEMENTS

    Directory of Open Access Journals (Sweden)

    Desak Putu Eka Pratiwi

    2015-07-01

    Full Text Available Maxim is a principle that must be obeyed by all participants textually and interpersonally in order to have a smooth communication process. Conversation maxim is divided into four namely maxim of quality, maxim of quantity, maxim of relevance, and maxim of manner of speaking. Violation of the maxim may occur in a conversation in which the information the speaker has is not delivered well to his speaking partner. Violation of the maxim in a conversation will result in an awkward impression. The example of violation is the given information that is redundant, untrue, irrelevant, or convoluted. Advertisers often deliberately violate the maxim to create unique and controversial advertisements. This study aims to examine the violation of maxims in conversations of TV ads. The source of data in this research is food advertisements aired on TV media. Documentation and observation methods are applied to obtain qualitative data. The theory used in this study is a maxim theory proposed by Grice (1975. The results of the data analysis are presented with informal method. The results of this study show an interesting fact that the violation of maxim in a conversation found in the advertisement exactly makes the advertisements very attractive and have a high value.

  19. Maximizing ROI (return on information)

    Energy Technology Data Exchange (ETDEWEB)

    McDonald, B.

    2000-05-01

    The role and importance of managing information are discussed, underscoring the importance by quoting from the report of the International Data Corporation, according to which Fortune 500 companies lost $ 12 billion in 1999 due to inefficiencies resulting from intellectual re-work, substandard performance , and inability to find knowledge resources. The report predicts that this figure will rise to $ 31.5 billion by 2003. Key impediments to implementing knowledge management systems are identified as : the cost and human resources requirement of deployment; inflexibility of historical systems to adapt to change; and the difficulty of achieving corporate acceptance of inflexible software products that require changes in 'normal' ways of doing business. The author recommends the use of model, document and rule-independent systems with a document centered interface (DCI), employing rapid application development (RAD) and object technologies and visual model development, which eliminate these problems, making it possible for companies to maximize their return on information (ROI), and achieve substantial savings in implementation costs.

  20. Maximizing the optical network capacity.

    Science.gov (United States)

    Bayvel, Polina; Maher, Robert; Xu, Tianhua; Liga, Gabriele; Shevchenko, Nikita A; Lavery, Domaniç; Alvarado, Alex; Killey, Robert I

    2016-03-06

    Most of the digital data transmitted are carried by optical fibres, forming the great part of the national and international communication infrastructure. The information-carrying capacity of these networks has increased vastly over the past decades through the introduction of wavelength division multiplexing, advanced modulation formats, digital signal processing and improved optical fibre and amplifier technology. These developments sparked the communication revolution and the growth of the Internet, and have created an illusion of infinite capacity being available. But as the volume of data continues to increase, is there a limit to the capacity of an optical fibre communication channel? The optical fibre channel is nonlinear, and the intensity-dependent Kerr nonlinearity limit has been suggested as a fundamental limit to optical fibre capacity. Current research is focused on whether this is the case, and on linear and nonlinear techniques, both optical and electronic, to understand, unlock and maximize the capacity of optical communications in the nonlinear regime. This paper describes some of them and discusses future prospects for success in the quest for capacity. © 2016 The Authors.

  1. Neurological Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Mohan Rudrappa

    2018-01-01

    Full Text Available West Nile virus infection in humans is mostly asymptomatic. Less than 1% of neuro-invasive cases show a fatality rate of around 10%. Acute flaccid paralysis of respiratory muscles leading to respiratory failure is the most common cause of death. Although the peripheral nervous system can be involved, isolated phrenic nerve palsy leading to respiratory failure is rare and described in only two cases in the English literature. We present another case of neurological respiratory failure due to West Nile virus-induced phrenic nerve palsy. Our case reiterates the rare, but lethal, consequences of West Nile virus infection, and the increase of its awareness among physicians.

  2. Respiratory analysis system and method

    Science.gov (United States)

    Liu, F. F. (Inventor)

    1973-01-01

    A system is described for monitoring the respiratory process in which the gas flow rate and the frequency of respiration and expiration cycles can be determined on a real time basis. A face mask is provided with one-way inlet and outlet valves where the gas flow is through independent flowmeters and through a mass spectrometer. The opening and closing of a valve operates an electrical switch, and the combination of the two switches produces a low frequency electrical signal of the respiratory inhalation and exhalation cycles. During the time a switch is operated, the corresponsing flowmeter produces electric pulses representative of the flow rate; the electrical pulses being at a higher frequency than that of the breathing cycle and combined with the low frequency signal. The high frequency pulses are supplied to conventional analyzer computer which also receives temperature and pressure inputs and computes mass flow rate and totalized mass flow of gas. From the mass spectrometer, components of the gas are separately computed as to flow rate. The electrical switches cause operation of up-down inputs of a reversible counter. The respective up and down cycles can be individually monitored and combined for various respiratory measurements.

  3. Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease.

    Science.gov (United States)

    Kazmaier, S; Weyland, A; Buhre, W; Stephan, H; Rieke, H; Filoda, K; Sonntag, H

    1998-10-01

    Variation of the arterial carbon dioxide partial pressure (PaCO2) is not uncommon in anesthetic practice. However, little is known about the myocardial consequences of respiratory alkalosis and acidosis, particularly in patients with coronary artery disease. The aim of the current study was to investigate the effects of variation in PaCO2 on myocardial blood flow (MBF), metabolism, and systemic hemodynamics in patients before elective coronary artery bypass graft surgery. In 10 male anesthetized patients, measurements of MBF, myocardial contractility, metabolism, and systemic hemodynamics were made in a randomized sequence at PaCO2 levels of 30, 40, and 50 mmHg, respectively. The MBF was measured using the Kety-Schmidt technique with argon as a tracer. End-diastolic left ventricular pressure and the maximal increase of left ventricular pressure were assessed using a manometer-tipped catheter. The cardiac index significantly changed with varying PaCO2 levels (hypocapnia, - 9%; hypercapnia, 13%). This reaction was associated with inverse changes in systemic vascular resistance index levels. The MBF significantly increased by 15% during hypercapnia, whereas no change was found during hypocapnia. Myocardial oxygen and glucose uptake and the maximal increase of left ventricular pressure were not affected by varying PaCO2 levels. In anesthetized patients with coronary artery disease, short-term variations in PaCO2 have significant effects on MBF but do not influence global myocardial oxygen and glucose uptake. Changes in systemic hemodynamics associated with respiratory alkalosis and acidosis are caused by changes in systemic vascular resistance rather than by alterations in myocardial contractility.

  4. The effect of aging on respiratory synergy.

    Science.gov (United States)

    Kweon, Migyoung; Son, Sung Min; Kwon, Yong Hyun

    2015-04-01

    [Purpose] The purpose of this study was to investigate the effect of aging on respiratory synergy, through the comparison of an elderly group and a young group, to help further understanding of postural control in the elderly. [Subjects and Methods] Ten community-dwelling elderly subjects and ten young subjects performed standing under two different respiratory conditions: quiet breathing and apnea. Center of foot pressure displacement and joint angular movements of the head, trunk, pelvis, hips, knees and ankles were measured. [Results] The results of this study showed that the elderly group had a respiratory synergy different from that of the young group. The elderly group in quiet stance used significantly more hip and pelvis movements when compensating for respiratory disturbance than standing with apnea, while the young group used significantly more whole body segments. There were no differences in angular displacements in the quiet stance between the elderly and the young groups. [Conclusion] The elderly group demonstrated a respiratory synergy pattern different from that of the young group. The findings indicate that aging changes the respiratory synergy pattern and this change is not due to decreased functioning of the ankle joint alone.

  5. Do 12-Week Yoga Program Influence Respiratory Function Of Elderly Women?

    Directory of Open Access Journals (Sweden)

    Bezerra Lídia Aguiar

    2014-12-01

    Full Text Available Aging produces several respiratory limitations and reduces tolerance to physical efforts, sometimes leading to pulmonary diseases in the elderly. The literature draws attention to the possible benefits of Yoga practice among the elderly, presenting evidence for significant improvements in quality of life. It was hypothesized that yoga practice can improve respiratory function in the elderly. The effects of a yoga program on pulmonary volumes and respiratory muscle strength were verified in 36 elderly women divided into a yoga group [YG] (63.1 ± 13.3 years of age and a control group (61.0 ± 6.9 years of age. Maximal inspiratory and expiratory pressure (MIP and MEP were assessed by a manovacuometer and tidal volume (VT, vital capacity (VC and minute ventilation (VE were measured by a ventilometer. The program comprised 65 min sessions, 3 times/week during 12 weeks. The heart rate and respiratory rate decreased significantly in the YG (76-39 ± 8-03 vs. 74-61±10.26 bpm and 18.61 ± 3.15 vs. 16.72 ± 3.12 resp/min, respectively. In the YG, VT and VE increased significantly (0.55 ± 0.22 vs. 0.64 ± 0.2 ml and 9.19 ± 2.39 vs. 10.05 ± 2.11 ml, respectively, as well as VC (1.48 ± 0.45 vs. 2.03 ± 0.72 ml. Improvements were also found in MIP and MEP in the YG (62.17 ± 14.77 vs. 73.06 ± 20.16 cmH2O and 80.56 ± 23.94 vs. 86.39 ± 20.16 cmH2O, respectively. It was concluded that a 12-week yoga program significantly improves pulmonary function of aged women.

  6. Do 12-week yoga program influence respiratory function of elderly women?

    Science.gov (United States)

    Bezerra, Lídia Aguiar; de Melo, Helton Fabrício; Garay, Ana Paula; Reis, Victor Machado; Aidar, Felipe José; Bodas, Ana Rita; Garrido, Nuno Domingos; de Oliveira, Ricardo Jacó

    2014-09-29

    Aging produces several respiratory limitations and reduces tolerance to physical efforts, sometimes leading to pulmonary diseases in the elderly. The literature draws attention to the possible benefits of Yoga practice among the elderly, presenting evidence for significant improvements in quality of life. It was hypothesized that yoga practice can improve respiratory function in the elderly. The effects of a yoga program on pulmonary volumes and respiratory muscle strength were verified in 36 elderly women divided into a yoga group [YG] (63.1 ± 13.3 years of age) and a control group (61.0 ± 6.9 years of age). Maximal inspiratory and expiratory pressure (MIP and MEP) were assessed by a manovacuometer and tidal volume (VT), vital capacity (VC) and minute ventilation (VE) were measured by a ventilometer. The program comprised 65 min sessions, 3 times/week during 12 weeks. The heart rate and respiratory rate decreased significantly in the YG (76-39 ± 8-03 vs. 74-61±10.26 bpm and 18.61 ± 3.15 vs. 16.72 ± 3.12 resp/min, respectively). In the YG, VT and VE increased significantly (0.55 ± 0.22 vs. 0.64 ± 0.2 ml and 9.19 ± 2.39 vs. 10.05 ± 2.11 ml, respectively), as well as VC (1.48 ± 0.45 vs. 2.03 ± 0.72 ml). Improvements were also found in MIP and MEP in the YG (62.17 ± 14.77 vs. 73.06 ± 20.16 cmH2O and 80.56 ± 23.94 vs. 86.39 ± 20.16 cmH2O, respectively). It was concluded that a 12-week yoga program significantly improves pulmonary function of aged women.

  7. Does mental exertion alter maximal muscle activation?

    Directory of Open Access Journals (Sweden)

    Vianney eRozand

    2014-09-01

    Full Text Available Mental exertion is known to impair endurance performance, but its effects on neuromuscular function remain unclear. The purpose of this study was to test the hypothesis that mental exertion reduces torque and muscle activation during intermittent maximal voluntary contractions of the knee extensors. Ten subjects performed in a randomized order three separate mental exertion conditions lasting 27 minutes each: i high mental exertion (incongruent Stroop task, ii moderate mental exertion (congruent Stroop task, iii low mental exertion (watching a movie. In each condition, mental exertion was combined with ten intermittent maximal voluntary contractions of the knee extensor muscles (one maximal voluntary contraction every 3 minutes. Neuromuscular function was assessed using electrical nerve stimulation. Maximal voluntary torque, maximal muscle activation and other neuromuscular parameters were similar across mental exertion conditions and did not change over time. These findings suggest that mental exertion does not affect neuromuscular function during intermittent maximal voluntary contractions of the knee extensors.

  8. AUC-Maximizing Ensembles through Metalearning.

    Science.gov (United States)

    LeDell, Erin; van der Laan, Mark J; Petersen, Maya

    2016-05-01

    Area Under the ROC Curve (AUC) is often used to measure the performance of an estimator in binary classification problems. An AUC-maximizing classifier can have significant advantages in cases where ranking correctness is valued or if the outcome is rare. In a Super Learner ensemble, maximization of the AUC can be achieved by the use of an AUC-maximining metalearning algorithm. We discuss an implementation of an AUC-maximization technique that is formulated as a nonlinear optimization problem. We also evaluate the effectiveness of a large number of different nonlinear optimization algorithms to maximize the cross-validated AUC of the ensemble fit. The results provide evidence that AUC-maximizing metalearners can, and often do, out-perform non-AUC-maximizing metalearning methods, with respect to ensemble AUC. The results also demonstrate that as the level of imbalance in the training data increases, the Super Learner ensemble outperforms the top base algorithm by a larger degree.

  9. On maximal massive 3D supergravity

    OpenAIRE

    Bergshoeff , Eric A; Hohm , Olaf; Rosseel , Jan; Townsend , Paul K

    2010-01-01

    ABSTRACT We construct, at the linearized level, the three-dimensional (3D) N = 4 supersymmetric " general massive supergravity " and the maximally supersymmetric N = 8 " new massive supergravity ". We also construct the maximally supersymmetric linearized N = 7 topologically massive supergravity, although we expect N = 6 to be maximal at the non-linear level. (Bergshoeff, Eric A) (Hohm, Olaf) (Rosseel, Jan) P.K.Townsend@da...

  10. Inclusive Fitness Maximization:An Axiomatic Approach

    OpenAIRE

    Okasha, Samir; Weymark, John; Bossert, Walter

    2014-01-01

    Kin selection theorists argue that evolution in social contexts will lead organisms to behave as if maximizing their inclusive, as opposed to personal, fitness. The inclusive fitness concept allows biologists to treat organisms as akin to rational agents seeking to maximize a utility function. Here we develop this idea and place it on a firm footing by employing a standard decision-theoretic methodology. We show how the principle of inclusive fitness maximization and a related principle of qu...

  11. Effects of respiratory muscle work on respiratory and locomotor blood flow during exercise.

    Science.gov (United States)

    Dominelli, Paolo B; Archiza, Bruno; Ramsook, Andrew H; Mitchell, Reid A; Peters, Carli M; Molgat-Seon, Yannick; Henderson, William R; Koehle, Michael S; Boushel, Robert; Sheel, A William

    2017-11-01

    What is the central question of this study? Does manipulation of the work of breathing during high-intensity exercise alter respiratory and locomotor muscle blood flow? What is the main finding and its importance? We found that when the work of breathing was reduced during exercise, respiratory muscle blood flow decreased, while locomotor muscle blood flow increased. Conversely, when the work of breathing was increased, respiratory muscle blood flow increased, while locomotor muscle blood flow decreased. Our findings support the theory of a competitive relationship between locomotor and respiratory muscles during intense exercise. Manipulation of the work of breathing (WOB) during near-maximal exercise influences leg blood flow, but the effects on respiratory muscle blood flow are equivocal. We sought to assess leg and respiratory muscle blood flow simultaneously during intense exercise while manipulating WOB. Our hypotheses were as follows: (i) increasing the WOB would increase respiratory muscle blood flow and decrease leg blood flow; and (ii) decreasing the WOB would decrease respiratory muscle blood flow and increase leg blood flow. Eight healthy subjects (n = 5 men, n = 3 women) performed a maximal cycle test (day 1) and a series of constant-load exercise trials at 90% of peak work rate (day 2). On day 2, WOB was assessed with oesophageal balloon catheters and was increased (via resistors), decreased (via proportional assist ventilation) or unchanged (control) during the trials. Blood flow was assessed using near-infrared spectroscopy optodes placed over quadriceps and the sternocleidomastoid muscles, coupled with a venous Indocyanine Green dye injection. Changes in WOB were significantly and positively related to changes in respiratory muscle blood flow (r = 0.73), whereby increasing the WOB increased blood flow. Conversely, changes in WOB were significantly and inversely related to changes in locomotor blood flow (r = 0.57), whereby decreasing the

  12. Treatment of respiratory failure in COPD

    Directory of Open Access Journals (Sweden)

    Stephan Budweiser

    2008-12-01

    Full Text Available Stephan Budweiser1, Rudolf A Jörres2, Michael Pfeifer1,31Center for Pneumology, Hospital Donaustauf, Donaustauf, Germany; 2Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany; 3Department of Internal Medicine II, Division of Respirology, University of Regensburg, Regensburg, GermanyAbstract: Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients with chronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positive pressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failure became a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients’ adherence to therapy.Keywords: respiratory failure, COPD, mechanical ventilation, non-invasive ventilation long-term oxygen therapy, chronic

  13. Activity versus outcome maximization in time management.

    Science.gov (United States)

    Malkoc, Selin A; Tonietto, Gabriela N

    2018-04-30

    Feeling time-pressed has become ubiquitous. Time management strategies have emerged to help individuals fit in more of their desired and necessary activities. We provide a review of these strategies. In doing so, we distinguish between two, often competing, motives people have in managing their time: activity maximization and outcome maximization. The emerging literature points to an important dilemma: a given strategy that maximizes the number of activities might be detrimental to outcome maximization. We discuss such factors that might hinder performance in work tasks and enjoyment in leisure tasks. Finally, we provide theoretically grounded recommendations that can help balance these two important goals in time management. Published by Elsevier Ltd.

  14. On the maximal superalgebras of supersymmetric backgrounds

    International Nuclear Information System (INIS)

    Figueroa-O'Farrill, Jose; Hackett-Jones, Emily; Moutsopoulos, George; Simon, Joan

    2009-01-01

    In this paper we give a precise definition of the notion of a maximal superalgebra of certain types of supersymmetric supergravity backgrounds, including the Freund-Rubin backgrounds, and propose a geometric construction extending the well-known construction of its Killing superalgebra. We determine the structure of maximal Lie superalgebras and show that there is a finite number of isomorphism classes, all related via contractions from an orthosymplectic Lie superalgebra. We use the structure theory to show that maximally supersymmetric waves do not possess such a maximal superalgebra, but that the maximally supersymmetric Freund-Rubin backgrounds do. We perform the explicit geometric construction of the maximal superalgebra of AdS 4 X S 7 and find that it is isomorphic to osp(1|32). We propose an algebraic construction of the maximal superalgebra of any background asymptotic to AdS 4 X S 7 and we test this proposal by computing the maximal superalgebra of the M2-brane in its two maximally supersymmetric limits, finding agreement.

  15. Task-oriented maximally entangled states

    International Nuclear Information System (INIS)

    Agrawal, Pankaj; Pradhan, B

    2010-01-01

    We introduce the notion of a task-oriented maximally entangled state (TMES). This notion depends on the task for which a quantum state is used as the resource. TMESs are the states that can be used to carry out the task maximally. This concept may be more useful than that of a general maximally entangled state in the case of a multipartite system. We illustrate this idea by giving an operational definition of maximally entangled states on the basis of communication tasks of teleportation and superdense coding. We also give examples and a procedure to obtain such TMESs for n-qubit systems.

  16. Effect of extracorporeal CO2 removal on right ventricular and hemodynamic parameters in a patient with acute respiratory distress syndrome

    NARCIS (Netherlands)

    Cherpanath, Thomas G. V.; Landburg, Pearl P.; Lagrand, Wim K.; Schultz, Marcus J.; Juffermans, Nicole P.

    2016-01-01

    We present a female patient with severe acute respiratory distress syndrome (ARDS) necessitating intubation and mechanical ventilation on the intensive care unit (ICU). High ventilatory pressures were needed because of hypoxia and severe hypercapnia with respiratory acidosis, resulting in right

  17. Effect of extracorporeal CO2 removal on right ventricular and hemodynamic parameters in a patient with acute respiratory distress syndrome

    NARCIS (Netherlands)

    Cherpanath, Thomas G. V.; Landburg, Pearl P.; Lagrand, Wim K.; Schultz, Marcus J.; Juffermans, Nicole P.

    We present a female patient with severe acute respiratory distress syndrome (ARDS) necessitating intubation and mechanical ventilation on the intensive care unit (ICU). High ventilatory pressures were needed because of hypoxia and severe hypercapnia with respiratory acidosis, resulting in right

  18. Assessment of respiratory muscle strength in children according to the classification of body mass index

    Directory of Open Access Journals (Sweden)

    George Jung da Rosa

    2014-06-01

    Full Text Available OBJECTIVE: To assess and compare the respiratory muscle strength among eutrophic, overweight and obese school children, as well as to identify anthropometric and respiratory variables related to the results.METHODS: Cross-sectional survey with healthy schoolchildren aged 7-9 years old, divided into three groups: Normal weight, Overweight and Obese. The International Study of Asthma and Allergies in Childhood (ISAAC questionnaire was applied. The body mass index (BMI was evaluated, as well as the forced expiratory volume in one second (FEV1 with a portable digital device. The maximal inspiratory and expiratory pressures (MIP and MEP were measured by a digital manometer. Comparisons between the groups were made by Kruskal-Wallis test. Spearman's correlation coefficient was used to analyze the correlations among the variables.RESULTS: MIP of eutrophic school children was higher than MIP found in overweight (p=0.043 and obese (p=0.013 children. MIP was correlated with BMI percentile and weight classification (r=-0.214 and r=-0.256 and MEP was correlated with height (r=0.328. Both pressures showed strong correlation with each other in all analyses (r≥0.773, and less correlation with FEV1 (MIP - r=0.362 and MEP - r=0.494. FEV1 correlated with MEP in all groups (r: 0.429 - 0.569 and with MIP in Obese Group (r=0.565. Age was correlated with FEV1 (r=0.578, MIP (r=0.281 and MEP (r=0.328.CONCLUSIONS: Overweight and obese children showed lower MIP values, compared to eutrophic ones. The findings point to the influence of anthropometric variables on respiratory muscle strength in children.

  19. Maximally Entangled Multipartite States: A Brief Survey

    International Nuclear Information System (INIS)

    Enríquez, M; Wintrowicz, I; Życzkowski, K

    2016-01-01

    The problem of identifying maximally entangled quantum states of a composite quantum systems is analyzed. We review some states of multipartite systems distinguished with respect to certain measures of quantum entanglement. Numerical results obtained for 4-qubit pure states illustrate the fact that the notion of maximally entangled state depends on the measure used. (paper)

  20. Utility maximization and mode of payment

    NARCIS (Netherlands)

    Koning, R.H.; Ridder, G.; Heijmans, R.D.H.; Pollock, D.S.G.; Satorra, A.

    2000-01-01

    The implications of stochastic utility maximization in a model of choice of payment are examined. Three types of compatibility with utility maximization are distinguished: global compatibility, local compatibility on an interval, and local compatibility on a finite set of points. Keywords:

  1. Corporate Social Responsibility and Profit Maximizing Behaviour

    OpenAIRE

    Becchetti, Leonardo; Giallonardo, Luisa; Tessitore, Maria Elisabetta

    2005-01-01

    We examine the behavior of a profit maximizing monopolist in a horizontal differentiation model in which consumers differ in their degree of social responsibility (SR) and consumers SR is dynamically influenced by habit persistence. The model outlines parametric conditions under which (consumer driven) corporate social responsibility is an optimal choice compatible with profit maximizing behavior.

  2. Respiratory medicine of reptiles.

    Science.gov (United States)

    Schumacher, Juergen

    2011-05-01

    Noninfectious and infectious causes have been implicated in the development of respiratory tract disease in reptiles. Treatment modalities in reptiles have to account for species differences in response to therapeutic agents as well as interpretation of diagnostic findings. Data on effective drugs and dosages for the treatment of respiratory diseases are often lacking in reptiles. Recently, advances have been made on the application of advanced imaging modalities, especially computed tomography for the diagnosis and treatment monitoring of reptiles. This article describes common infectious and noninfectious causes of respiratory disease in reptiles, including diagnostic and therapeutic regimen. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Inclusive fitness maximization: An axiomatic approach.

    Science.gov (United States)

    Okasha, Samir; Weymark, John A; Bossert, Walter

    2014-06-07

    Kin selection theorists argue that evolution in social contexts will lead organisms to behave as if maximizing their inclusive, as opposed to personal, fitness. The inclusive fitness concept allows biologists to treat organisms as akin to rational agents seeking to maximize a utility function. Here we develop this idea and place it on a firm footing by employing a standard decision-theoretic methodology. We show how the principle of inclusive fitness maximization and a related principle of quasi-inclusive fitness maximization can be derived from axioms on an individual׳s 'as if preferences' (binary choices) for the case in which phenotypic effects are additive. Our results help integrate evolutionary theory and rational choice theory, help draw out the behavioural implications of inclusive fitness maximization, and point to a possible way in which evolution could lead organisms to implement it. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Maximal Entanglement in High Energy Physics

    Directory of Open Access Journals (Sweden)

    Alba Cervera-Lierta, José I. Latorre, Juan Rojo, Luca Rottoli

    2017-11-01

    Full Text Available We analyze how maximal entanglement is generated at the fundamental level in QED by studying correlations between helicity states in tree-level scattering processes at high energy. We demonstrate that two mechanisms for the generation of maximal entanglement are at work: i $s$-channel processes where the virtual photon carries equal overlaps of the helicities of the final state particles, and ii the indistinguishable superposition between $t$- and $u$-channels. We then study whether requiring maximal entanglement constrains the coupling structure of QED and the weak interactions. In the case of photon-electron interactions unconstrained by gauge symmetry, we show how this requirement allows reproducing QED. For $Z$-mediated weak scattering, the maximal entanglement principle leads to non-trivial predictions for the value of the weak mixing angle $\\theta_W$. Our results are a first step towards understanding the connections between maximal entanglement and the fundamental symmetries of high-energy physics.

  5. The deflation limb of the pressure-volume relationship in infants during high-frequency ventilation.

    Science.gov (United States)

    Tingay, David G; Mills, John F; Morley, Colin J; Pellicano, Anastasia; Dargaville, Peter A

    2006-02-15

    The importance of applying high-frequency oscillatory ventilation with a high lung volume strategy in infants is well established. Currently, a lack of reliable methods for assessing lung volume limits clinicians' ability to achieve the optimum volume range. To map the pressure-volume relationship of the lung during high-frequency oscillatory ventilation in infants, to determine at what point ventilation is being applied clinically, and to describe the relationship between airway pressure, lung volume, and oxygenation. In 12 infants, a partial inflation limb and the deflation limb of the pressure-volume relationship were mapped using a quasi-static lung volume optimization maneuver. This involved stepwise airway pressure increments to total lung capacity, followed by decrements until the closing pressure of the lung was identified. Lung volume and oxygen saturation were recorded at each airway pressure. Lung volume was measured using respiratory inductive plethysmography. A distinct deflation limb could be mapped in each infant. Overall, oxygenation and lung volume were improved by applying ventilation on the deflation limb. Maximal lung volume and oxygenation occurred on the deflation limb at a mean airway pressure of 3 and 5 cm H(2)O below the airway pressure approximating total lung capacity, respectively. Using current ventilation strategies, all infants were being ventilated near the inflation limb. It is possible to delineate the deflation limb in infants receiving high-frequency oscillatory ventilation; in doing so, greater lung volume and oxygenation can be achieved, often at lower airway pressures.

  6. Respiratory Syncytial Virus (RSV)

    Centers for Disease Control (CDC) Podcasts

    2013-02-04

    Respiratory Syncytial Virus, or RSV, causes cold-like symptoms but can be serious for infants and older adults. In this podcast, CDC’s Dr. Eileen Schneider discusses this common virus and offers tips to prevent its spread.  Created: 2/4/2013 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases (DVD).   Date Released: 2/13/2013.

  7. Obesity and respiratory diseases

    OpenAIRE

    Zammit, Christopher; Liddicoat, Helen; Moonsie, Ian; Makker, Himender

    2010-01-01

    Christopher Zammit, Helen Liddicoat, Ian Moonsie, Himender MakkerSleep and Ventilation Unit, Department of Respiratory Medicine, North Middlesex University Hospital, London, UKAbstract: The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ produ...

  8. Acute respiratory distress syndrome

    OpenAIRE

    Confalonieri, Marco; Salton, Francesco; Fabiano, Francesco

    2017-01-01

    Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foste...

  9. Respiratory Syncytial Virus Vaccines

    OpenAIRE

    Dudas, Robert A.; Karron, Ruth A.

    1998-01-01

    Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract illness (LRI) in infants and children worldwide and causes significant LRI in the elderly and in immunocompromised patients. The goal of RSV vaccination is to prevent serious RSV-associated LRI. There are several obstacles to the development of successful RSV vaccines, including the need to immunize very young infants, who may respond inadequately to vaccination; the existence of two antigenically d...

  10. Postperfusion lung syndrome: Respiratory mechanics, respiratory indices and biomarkers

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2015-01-01

    Full Text Available Postperfusion lung syndrome is rare but lethal. Secondary inflammatory response was the popularly accepted theory for the underlying etiology. Respiratory index (RI and arterial oxygen tension/fractional inspired oxygen can be reliable indices for the diagnosis of this syndrome as X-ray appearance is always insignificant at the early stage of the onset. Evaluations of extravascular lung water content and pulmonary compliance are also helpful in the definite diagnosis. Multiorgan failure and triple acid-base disturbances that might develop secondary to postperfusion lung syndrome are responsible for the poor prognosis and increased mortality rather than postperfusion lung syndrome itself. Mechanical ventilation with low tidal volume (TV and proper positive end-expiratory pressure can be an effective treatment strategy. Use of ulinastatin and propofol may benefit the patients through different mechanisms.

  11. Managing respiratory problems in athletes.

    Science.gov (United States)

    Hull, James H; Ansley, Les; Robson-Ansley, Paula; Parsons, Jonathan P

    2012-08-01

    Respiratory problems are common in athletes of all abilities and can significantly impact upon their health and performance. In this article, we provide an overview of respiratory physiology in athletes. We also discuss the assessment and management of common clinical respiratory conditions as they pertain to athletes, including airways disease, respiratory tract infection and pneumothorax. We focus on providing a pragmatic approach and highlight important caveats for the physician treating respiratory conditions in this highly specific population.

  12. Predischarge maximal exercise test identifies risk for cardiac death in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, J R; Mickley, H; Damsgaard, E M

    1990-01-01

    A maximal exercise test was performed in 54 patients with acute myocardial infarction (AMI) before discharge and in 49 age-matched control subjects. The long-term prognosis was assessed after an average follow-up of 7.6 years in AMI patients and 5.8 years in control subjects. The maximal work...... capacity and systolic blood pressure increase in AMI patients was 59% that of control subjects (p less than 0.001). Seventeen AMI patients had significant ST-segment shifts, 13 with ST depression and 4 with ST elevation. In AMI patients experiencing a cardiac death during follow-up the maximal work...... were of no significant value. In this study maximal work capacity turned out to be the best single exercise variable for identifying groups of AMI patients with very low and relative high risk of cardiac death. When all 3 exercise variables were combined, the predischarge maximal exercise test...

  13. Bipartite Bell Inequality and Maximal Violation

    International Nuclear Information System (INIS)

    Li Ming; Fei Shaoming; Li-Jost Xian-Qing

    2011-01-01

    We present new bell inequalities for arbitrary dimensional bipartite quantum systems. The maximal violation of the inequalities is computed. The Bell inequality is capable of detecting quantum entanglement of both pure and mixed quantum states more effectively. (general)

  14. HEALTH INSURANCE: CONTRIBUTIONS AND REIMBURSEMENT MAXIMAL

    CERN Document Server

    HR Division

    2000-01-01

    Affected by both the salary adjustment index on 1.1.2000 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maximal, has changed significantly. An adjustment of the amounts of the reimbursement maximal and the fixed contributions is therefore necessary, as from 1 January 2000.Reimbursement maximalThe revised reimbursement maximal will appear on the leaflet summarising the benefits for the year 2000, which will soon be available from the divisional secretariats and from the AUSTRIA office at CERN.Fixed contributionsThe fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions):voluntarily insured member of the personnel, with complete coverage:815,- (was 803,- in 1999)voluntarily insured member of the personnel, with reduced coverage:407,- (was 402,- in 1999)voluntarily insured no longer dependent child:326,- (was 321...

  15. Maximal Inequalities for Dependent Random Variables

    DEFF Research Database (Denmark)

    Hoffmann-Jorgensen, Jorgen

    2016-01-01

    Maximal inequalities play a crucial role in many probabilistic limit theorem; for instance, the law of large numbers, the law of the iterated logarithm, the martingale limit theorem and the central limit theorem. Let X-1, X-2,... be random variables with partial sums S-k = X-1 + ... + X-k. Then a......Maximal inequalities play a crucial role in many probabilistic limit theorem; for instance, the law of large numbers, the law of the iterated logarithm, the martingale limit theorem and the central limit theorem. Let X-1, X-2,... be random variables with partial sums S-k = X-1 + ... + X......-k. Then a maximal inequality gives conditions ensuring that the maximal partial sum M-n = max(1) (...

  16. Maximizing Function through Intelligent Robot Actuator Control

    Data.gov (United States)

    National Aeronautics and Space Administration — Maximizing Function through Intelligent Robot Actuator Control Successful missions to Mars and beyond will only be possible with the support of high-performance...

  17. An ethical justification of profit maximization

    DEFF Research Database (Denmark)

    Koch, Carsten Allan

    2010-01-01

    In much of the literature on business ethics and corporate social responsibility, it is more or less taken for granted that attempts to maximize profits are inherently unethical. The purpose of this paper is to investigate whether an ethical argument can be given in support of profit maximizing...... behaviour. It is argued that some form of consequential ethics must be applied, and that both profit seeking and profit maximization can be defended from a rule-consequential point of view. It is noted, however, that the result does not apply unconditionally, but requires that certain form of profit (and...... utility) maximizing actions are ruled out, e.g., by behavioural norms or formal institutions....

  18. A definition of maximal CP-violation

    International Nuclear Information System (INIS)

    Roos, M.

    1985-01-01

    The unitary matrix of quark flavour mixing is parametrized in a general way, permitting a mathematically natural definition of maximal CP violation. Present data turn out to violate this definition by 2-3 standard deviations. (orig.)

  19. A cosmological problem for maximally symmetric supergravity

    International Nuclear Information System (INIS)

    German, G.; Ross, G.G.

    1986-01-01

    Under very general considerations it is shown that inflationary models of the universe based on maximally symmetric supergravity with flat potentials are unable to resolve the cosmological energy density (Polonyi) problem. (orig.)

  20. Insulin resistance and maximal oxygen uptake

    DEFF Research Database (Denmark)

    Seibaek, Marie; Vestergaard, Henrik; Burchardt, Hans

    2003-01-01

    BACKGROUND: Type 2 diabetes, coronary atherosclerosis, and physical fitness all correlate with insulin resistance, but the relative importance of each component is unknown. HYPOTHESIS: This study was undertaken to determine the relationship between insulin resistance, maximal oxygen uptake......, and the presence of either diabetes or ischemic heart disease. METHODS: The study population comprised 33 patients with and without diabetes and ischemic heart disease. Insulin resistance was measured by a hyperinsulinemic euglycemic clamp; maximal oxygen uptake was measured during a bicycle exercise test. RESULTS......: There was a strong correlation between maximal oxygen uptake and insulin-stimulated glucose uptake (r = 0.7, p = 0.001), and maximal oxygen uptake was the only factor of importance for determining insulin sensitivity in a model, which also included the presence of diabetes and ischemic heart disease. CONCLUSION...

  1. Maximal supergravities and the E10 model

    International Nuclear Information System (INIS)

    Kleinschmidt, Axel; Nicolai, Hermann

    2006-01-01

    The maximal rank hyperbolic Kac-Moody algebra e 10 has been conjectured to play a prominent role in the unification of duality symmetries in string and M theory. We review some recent developments supporting this conjecture

  2. Gaussian maximally multipartite-entangled states

    Science.gov (United States)

    Facchi, Paolo; Florio, Giuseppe; Lupo, Cosmo; Mancini, Stefano; Pascazio, Saverio

    2009-12-01

    We study maximally multipartite-entangled states in the context of Gaussian continuous variable quantum systems. By considering multimode Gaussian states with constrained energy, we show that perfect maximally multipartite-entangled states, which exhibit the maximum amount of bipartite entanglement for all bipartitions, only exist for systems containing n=2 or 3 modes. We further numerically investigate the structure of these states and their frustration for n≤7 .

  3. Gaussian maximally multipartite-entangled states

    International Nuclear Information System (INIS)

    Facchi, Paolo; Florio, Giuseppe; Pascazio, Saverio; Lupo, Cosmo; Mancini, Stefano

    2009-01-01

    We study maximally multipartite-entangled states in the context of Gaussian continuous variable quantum systems. By considering multimode Gaussian states with constrained energy, we show that perfect maximally multipartite-entangled states, which exhibit the maximum amount of bipartite entanglement for all bipartitions, only exist for systems containing n=2 or 3 modes. We further numerically investigate the structure of these states and their frustration for n≤7.

  4. Neutrino mass textures with maximal CP violation

    International Nuclear Information System (INIS)

    Aizawa, Ichiro; Kitabayashi, Teruyuki; Yasue, Masaki

    2005-01-01

    We show three types of neutrino mass textures, which give maximal CP violation as well as maximal atmospheric neutrino mixing. These textures are described by six real mass parameters: one specified by two complex flavor neutrino masses and two constrained ones and the others specified by three complex flavor neutrino masses. In each texture, we calculate mixing angles and masses, which are consistent with observed data, as well as Majorana CP phases

  5. Why firms should not always maximize profits

    OpenAIRE

    Kolstad, Ivar

    2006-01-01

    Though corporate social responsibility (CSR) is on the agenda of most major corporations, corporate executives still largely support the view that corporations should maximize the returns to their owners. There are two lines of defence for this position. One is the Friedmanian view that maximizing owner returns is the corporate social responsibility of corporations. The other is a position voiced by many executives, that CSR and profits go together. This paper argues that the first position i...

  6. Maximally Informative Observables and Categorical Perception

    OpenAIRE

    Tsiang, Elaine

    2012-01-01

    We formulate the problem of perception in the framework of information theory, and prove that categorical perception is equivalent to the existence of an observable that has the maximum possible information on the target of perception. We call such an observable maximally informative. Regardless whether categorical perception is real, maximally informative observables can form the basis of a theory of perception. We conclude with the implications of such a theory for the problem of speech per...

  7. Use of radiotelemetry to evaluate respiratory depression produced by chronic methadone administration.

    Science.gov (United States)

    Lewanowitsch, Tanya; White, Jason M; Irvine, Rodney J

    2004-01-26

    Illicit and therapeutic opioid administration can result in overdose due to opioid-induced respiratory depression. Research investigating the respiratory depressant effects of opioids has been limited due to difficulties associated with acquiring long-term respiratory data. This study examined the novel use of radiotelemetry to measure respiratory rate, heart rate, locomotor activity and blood pressure in rats treated chronically with methadone. Over 4 days of treatment, respiratory rate decreased, but partial tolerance appeared to develop during active (night) periods. Decreased heart rate was observed during the night periods and tolerance appeared to develop to this effect. Activity and blood pressure did not change with treatment. The effects of naloxone hydrochloride and naloxone methiodide administration on the methadone-treated rats were also examined and both antagonists increased respiratory rate and heart rate, with only naloxone hydrochloride producing significant increases in activity. Radiotelemetry offers a means of evaluating drug effects on respiratory rate continually in ambulatory, unstressed animals.

  8. Cellular defense of the avian respiratory system: effects of Pasteurella multocida on respiratory burst activity of avian respiratory tract phagocytes.

    Science.gov (United States)

    Ochs, D L; Toth, T E; Pyle, R H; Siegel, P B

    1988-12-01

    The respiratory tract of healthy chickens contain few free-residing phagocytic cells. Intratracheal inoculation with Pasteurella multocida stimulated a significant (P less than 0.05) migration of cells to the lungs and air sacs of White Rock chickens within 2 hours after inoculation. We found the maximal number of avian respiratory tract phagocytes (22.9 +/- 14.0 x 10(6] at 8 hours after inoculation. Flow cytometric analysis of these cells revealed 2 populations on the basis of cell-size and cellular granularity. One of these was similar in size and granularity to those of blood heterophils. Only this population was capable of generating oxidative metabolites in response to phorbol myristate acetate. The ability of the heterophils to produce hydrogen peroxide, measured as the oxidation of intracellularly loaded 2',7'-dichlorofluorescein, decreased with time after inoculation. These results suggest that the migration of heterophils, which are capable of high levels of oxidative metabolism, to the lungs and air sacs may be an important defense mechanism of poultry against bacterial infections of the respiratory tract.

  9. Obesity and respiratory diseases

    Directory of Open Access Journals (Sweden)

    Christopher Zammit

    2010-10-01

    Full Text Available Christopher Zammit, Helen Liddicoat, Ian Moonsie, Himender MakkerSleep and Ventilation Unit, Department of Respiratory Medicine, North Middlesex University Hospital, London, UKAbstract: The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ producing systemic inflammation and effecting central respiratory control. Obesity plays a key role in the development of obstructive sleep apnea and obesity hypoventilation syndrome. Asthma is more common and often harder to treat in the obese population, and in this study, we review the effects of obesity on airway inflammation and respiratory mechanics. We also discuss the compounding effects of obesity on chronic obstructive pulmonary disease (COPD and the paradoxical interaction of body mass index and COPD severity. Many practical challenges exist in caring for obese patients, and we highlight the complications faced by patients undergoing surgical procedures, especially given the increased use of bariatric surgery. Ultimately, a greater understanding of the effects of obesity on the respiratory disease and the provision of adequate health care resources is vital in order to care for this increasingly important patient population.Keywords: obesity, lung function, obstructive sleep apnea, obesity hypoventilation syndrome, anesthesia

  10. Effect of sonic driving on maximal aerobic performance.

    Science.gov (United States)

    Brilla, L.R.; Hatcher, Stefanie

    2000-07-01

    The study purpose was to evaluate antecedent binaural stimulation (ABS) on maximal aerobic physical performance. Twenty-two healthy, physically active subjects, 21-34 years, randomly received one of two preparations for each session: 15 min of quiet (BLANK) or percussive sonic driving at 200+ beats per minute (bpm) using a recorded compact disc (FSS, Mill Valley, CA) with headphones (ABS). Baseline HR, blood pressure (BP), and breathing frequency (f(br)) were obtained. During each condition, HR and f(br) were recorded at 3-min intervals. The graded maximal treadmill testing was administered immediately postpreparation session on separate days, with at least 48 h rest between sessions. There were significant differences in the antecedent period means between the two conditions, ABS (HR: 70.2 +/- 10.7 bpm; f(br): 18.5 +/- 3.3 br min(-1); BP: 134.5/87.9 +/- 13.6/9.2 mm Hg) and BLANK (HR: 64.6 +/- 7.9; f(br): 14.3 +/- 2.9; BP: 126.7/80.3 +/- 12.1/8.6). Differences were noted for each 3-min interval and pre- postantecedent period. The maximal graded exercise test (GXT) results showed that there was a small but significant (P 0.05). There may be a latency to ABS related to entrainment or imagery-enhanced warm-up. Am. J. Hum. Biol. 12:558-565, 2000. Copyright 2000 Wiley-Liss, Inc.

  11. Assessing the effects of pharmacological agents on respiratory dynamics using time-series modeling.

    Science.gov (United States)

    Wong, Kin Foon Kevin; Gong, Jen J; Cotten, Joseph F; Solt, Ken; Brown, Emery N

    2013-04-01

    Developing quantitative descriptions of how stimulant and depressant drugs affect the respiratory system is an important focus in medical research. Respiratory variables-respiratory rate, tidal volume, and end tidal carbon dioxide-have prominent temporal dynamics that make it inappropriate to use standard hypothesis-testing methods that assume independent observations to assess the effects of these pharmacological agents. We present a polynomial signal plus autoregressive noise model for analysis of continuously recorded respiratory variables. We use a cyclic descent algorithm to maximize the conditional log likelihood of the parameters and the corrected Akaike's information criterion to choose simultaneously the orders of the polynomial and the autoregressive models. In an analysis of respiratory rates recorded from anesthetized rats before and after administration of the respiratory stimulant methylphenidate, we use the model to construct within-animal z-tests of the drug effect that take account of the time-varying nature of the mean respiratory rate and the serial dependence in rate measurements. We correct for the effect of model lack-of-fit on our inferences by also computing bootstrap confidence intervals for the average difference in respiratory rate pre- and postmethylphenidate treatment. Our time-series modeling quantifies within each animal the substantial increase in mean respiratory rate and respiratory dynamics following methylphenidate administration. This paradigm can be readily adapted to analyze the dynamics of other respiratory variables before and after pharmacologic treatments.

  12. Reliability and validity of the test of incremental respiratory endurance measures of inspiratory muscle performance in COPD.

    Science.gov (United States)

    Formiga, Magno F; Roach, Kathryn E; Vital, Isabel; Urdaneta, Gisel; Balestrini, Kira; Calderon-Candelario, Rafael A; Campos, Michael A; Cahalin, Lawrence P

    2018-01-01

    The Test of Incremental Respiratory Endurance (TIRE) provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP) over time. The integration of MIP over inspiratory duration (ID) provides the sustained maximal inspiratory pressure (SMIP). Evidence on the reliability and validity of these measurements in COPD is not currently available. Therefore, we assessed the reliability, responsiveness and construct validity of the TIRE measures of inspiratory muscle performance in subjects with COPD. Test-retest reliability, known-groups and convergent validity assessments were implemented simultaneously in 81 male subjects with mild to very severe COPD. TIRE measures were obtained using the portable PrO2 device, following standard guidelines. All TIRE measures were found to be highly reliable, with SMIP demonstrating the strongest test-retest reliability with a nearly perfect intraclass correlation coefficient (ICC) of 0.99, while MIP and ID clustered closely together behind SMIP with ICC values of about 0.97. Our findings also demonstrated known-groups validity of all TIRE measures, with SMIP and ID yielding larger effect sizes when compared to MIP in distinguishing between subjects of different COPD status. Finally, our analyses confirmed convergent validity for both SMIP and ID, but not MIP. The TIRE measures of MIP, SMIP and ID have excellent test-retest reliability and demonstrated known-groups validity in subjects with COPD. SMIP and ID also demonstrated evidence of moderate convergent validity and appear to be more stable measures in this patient population than the traditional MIP.

  13. Shareholder, stakeholder-owner or broad stakeholder maximization

    OpenAIRE

    Mygind, Niels

    2004-01-01

    With reference to the discussion about shareholder versus stakeholder maximization it is argued that the normal type of maximization is in fact stakeholder-owner maxi-mization. This means maximization of the sum of the value of the shares and stake-holder benefits belonging to the dominating stakeholder-owner. Maximization of shareholder value is a special case of owner-maximization, and only under quite re-strictive assumptions shareholder maximization is larger or equal to stakeholder-owner...

  14. Respiratory manifestations of hypothyroidism

    DEFF Research Database (Denmark)

    Sorensen, Jesper Roed; Winther, Kristian Hillert; Bonnema, Steen Joop

    2016-01-01

    BACKGROUND: Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. We conducted a systematic review to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency. METHODS: PubMed and EMBASE databases were...... searched for relevant literature from January 1950 through January 2015 with study eligibility criteria: English-language publications; Adult subclinical or overt hypothyroid patients; Intervention, observational or retrospective studies; and respiratory manifestations. We followed the PRISMA statement...... and used the Cochrane's risk of bias tool. RESULTS: A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full text analyses, of which 22 were included in the review. We identified possible mechanisms explaining respiratory...

  15. Respiratory care manpower issues.

    Science.gov (United States)

    Mathews, Paul; Drumheller, Lois; Carlow, John J

    2006-03-01

    Although respiratory care is a relatively new profession, its practitioners are deeply involved in providing patient care in the critical care. In preparation for writing this article, we sought to explore the respiratory therapy manpower needs and activities designed to fulfill those needs in critical care practice. We began by delineating the historical development of respiratory care as a profession, the development of its education, and the professional credentialing system. We then conducted several literature reviews with few articles generated. We requested and received data from the American Association for Respiratory Care (AARC), The National Board for Respiratory Care (NBRC), and the Committee on Accreditation of Respiratory Care education (CoARC) relative to their membership, number of credentialed individuals, and educational program student and graduate data for 2000 through 2004. We then conducted two electronic surveys. Survey 1 was a six-item survey that examined the use of mandatory overtime in respiratory care departments. We used a convenience sample of 30 hospitals stratified by size (or=500 beds). Survey 2 was a five-item instrument distributed by blast E-mail to the Society of Critical Care Medicine's Respiratory Care Section members and members of the RC_World list serve. This survey elicited 51 usable and non-duplicative responses from geographically and size-varied institutions. We analyzed these data in several ways from distribution analysis to one-way analysis of variance procedure and appropriate post hoc analysis techniques. Where appropriate, a matched-pairs analysis was performed and these were compared across the variables intensive care unit (ICU) beds per actual number of respiratory care practitioners (RCPs) and ICU beds per preferred number of RCPs. The data gathered from the professional organizations indicated a relatively stable attrition rate (35.2%+/-1.7-3.1%), even in the face of varying enrollments (6,231 in 2004 vs. 4

  16. Personalizing mechanical ventilation for acute respiratory distress syndrome.

    Science.gov (United States)

    Berngard, S Clark; Beitler, Jeremy R; Malhotra, Atul

    2016-03-01

    Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient's unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual's hemodynamics and respiratory mechanics should influence PEEP decisions as well as response to therapy (recruitability). This summary will emphasize the potential role of personalized therapy in mechanical ventilation.

  17. Personalizing mechanical ventilation for acute respiratory distress syndrome

    OpenAIRE

    Berngard, S. Clark; Beitler, Jeremy R.; Malhotra, Atul

    2016-01-01

    Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient's unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual's hemodynamics and respiratory mechanics should influence PEEP decisions as well as response ...

  18. Model-based respiratory motion compensation for emission tomography image reconstruction

    International Nuclear Information System (INIS)

    Reyes, M; Malandain, G; Koulibaly, P M; Gonzalez-Ballester, M A; Darcourt, J

    2007-01-01

    In emission tomography imaging, respiratory motion causes artifacts in lungs and cardiac reconstructed images, which lead to misinterpretations, imprecise diagnosis, impairing of fusion with other modalities, etc. Solutions like respiratory gating, correlated dynamic PET techniques, list-mode data based techniques and others have been tested, which lead to improvements over the spatial activity distribution in lungs lesions, but which have the disadvantages of requiring additional instrumentation or the need of discarding part of the projection data used for reconstruction. The objective of this study is to incorporate respiratory motion compensation directly into the image reconstruction process, without any additional acquisition protocol consideration. To this end, we propose an extension to the maximum likelihood expectation maximization (MLEM) algorithm that includes a respiratory motion model, which takes into account the displacements and volume deformations produced by the respiratory motion during the data acquisition process. We present results from synthetic simulations incorporating real respiratory motion as well as from phantom and patient data

  19. Combined electrocardiography- and respiratory-triggered CT of the lung to reduce respiratory misregistration artifacts between imagining slabs in free-breathing children: Initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Allmendinger, Thomas [Siemens Healthcare, GmbH, Computed Tomography Division, Forchheim (Germany)

    2017-09-15

    Cardiac and respiratory motion artifacts degrade the image quality of lung CT in free-breathing children. The aim of this study was to evaluate the effect of combined electrocardiography (ECG) and respiratory triggering on respiratory misregistration artifacts on lung CT in free-breathing children. In total, 15 children (median age 19 months, range 6 months–8 years; 7 boys), who underwent free-breathing ECG-triggered lung CT with and without respiratory-triggering were included. A pressure-sensing belt of a respiratory gating system was used to obtain the respiratory signal. The degree of respiratory misregistration artifacts between imaging slabs was graded on a 4-point scale (1, excellent image quality) on coronal and sagittal images and compared between ECG-triggered lung CT studies with and without respiratory triggering. A p value < 0.05 was considered significant. Lung CT with combined ECG and respiratory triggering showed significantly less respiratory misregistration artifacts than lung CT with ECG triggering only (1.1 ± 0.4 vs. 2.2 ± 1.0, p = 0.003). Additional respiratory-triggering reduces respiratory misregistration artifacts on ECG-triggered lung CT in free-breathing children.

  20. Combined electrocardiography- and respiratory-triggered CT of the lung to reduce respiratory misregistration artifacts between imagining slabs in free-breathing children: Initial experience

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Allmendinger, Thomas

    2017-01-01

    Cardiac and respiratory motion artifacts degrade the image quality of lung CT in free-breathing children. The aim of this study was to evaluate the effect of combined electrocardiography (ECG) and respiratory triggering on respiratory misregistration artifacts on lung CT in free-breathing children. In total, 15 children (median age 19 months, range 6 months–8 years; 7 boys), who underwent free-breathing ECG-triggered lung CT with and without respiratory-triggering were included. A pressure-sensing belt of a respiratory gating system was used to obtain the respiratory signal. The degree of respiratory misregistration artifacts between imaging slabs was graded on a 4-point scale (1, excellent image quality) on coronal and sagittal images and compared between ECG-triggered lung CT studies with and without respiratory triggering. A p value < 0.05 was considered significant. Lung CT with combined ECG and respiratory triggering showed significantly less respiratory misregistration artifacts than lung CT with ECG triggering only (1.1 ± 0.4 vs. 2.2 ± 1.0, p = 0.003). Additional respiratory-triggering reduces respiratory misregistration artifacts on ECG-triggered lung CT in free-breathing children

  1. Cigarette smoking decreases dynamic inspiratory capacity during maximal exercise in patients with type 2 diabetes.

    Science.gov (United States)

    Kitahara, Yoshihiro; Hattori, Noboru; Yokoyama, Akihito; Yamane, Kiminori; Sekikawa, Kiyokazu; Inamizu, Tsutomu; Kohno, Nobuoki

    2012-06-01

    To investigate the influence of cigarette smoking on exercise capacity, respiratory responses and dynamic changes in lung volume during exercise in patients with type 2 diabetes. Forty-one men with type, 2 diabetes without cardiopulmonary disease were recruited and divided into 28 non-current smokers and 13 current smokers. All subjects received lung function tests and cardiopulmonary exercise testing using tracings of the flow-volume loop. Exercise capacity was compared using the percentage of predicted oxygen uptake at maximal workload (%VO2max). Respiratory variables and inspiratory capacity (IC) were compared between the two groups at rest and at 20%, 40%, 60%, 80% and 100% of maximum workload. Although there was no significant difference in lung function tests between the two groups, venous carboxyhemoglobin (CO-Hb) levels were significantly higher in current smokers. %VO2max was inversely correlated with CO-Hb levels. Changing patterns in respiratory rate, respiratory equivalent and IC were significantly different between the two groups. Current smokers had rapid breathing, a greater respiratory equivalent and a limited increase in IC during exercise. Cigarette smoking diminishes the increase in dynamic IC in patients with type 2 diabetes. As this effect of smoking on dynamic changes in lung volume will exacerbate dynamic hyperinflation in cases complicated by chronic obstructive pulmonary disease, physicians should consider smoking habits and lung function when evaluating exercise capacity in patients with type 2 diabetes.

  2. A multicentre, randomised controlled, non-inferiority trial, comparing nasal high flow with nasal continuous positive airway pressure as primary support for newborn infants with early respiratory distress born in Australian non-tertiary special care nurseries (the HUNTER trial): study protocol.

    Science.gov (United States)

    Manley, Brett J; Roberts, Calum T; Arnolda, Gaston R B; Wright, Ian M R; Owen, Louise S; Dalziel, Kim M; Foster, Jann P; Davis, Peter G; Buckmaster, Adam G

    2017-06-23

    Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial. Infants are eligible if born at a gestational age ≥31 weeks with birth weight ≥1200 g and admitted to a participating non-tertiary SCN, are 1 hour. Infants are randomised to treatment with either nHF or CPAP. The primary outcome is treatment failure within 72 hours of randomisation, as determined by objective oxygenation, apnoea or blood gas criteria or by a clinical decision that urgent intubation and mechanical ventilation, or transfer to a tertiary NICU, is required. Secondary outcomes include incidence of pneumothorax requiring drainage, duration of respiratory support, supplemental oxygen and hospitalisation, costs associated with hospital care, cost-effectiveness, parental stress and satisfaction and nursing workload. Multisite ethical approval for the study has been granted by The Royal Children's Hospital, Melbourne, Australia (Trial Reference No. 34222), and by each participating site. The trial is currently recruiting in eight centres in Victoria and New South Wales, Australia, with one previous site no longer recruiting. The trial results will be published in a peer-reviewed journal and will be presented at national and international conferences. Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001203640; pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted

  3. Vacua of maximal gauged D=3 supergravities

    International Nuclear Information System (INIS)

    Fischbacher, T; Nicolai, H; Samtleben, H

    2002-01-01

    We analyse the scalar potentials of maximal gauged three-dimensional supergravities which reveal a surprisingly rich structure. In contrast to maximal supergravities in dimensions D≥4, all these theories possess a maximally supersymmetric (N=16) ground state with negative cosmological constant Λ 2 gauged theory, whose maximally supersymmetric groundstate has Λ = 0. We compute the mass spectra of bosonic and fermionic fluctuations around these vacua and identify the unitary irreducible representations of the relevant background (super)isometry groups to which they belong. In addition, we find several stationary points which are not maximally supersymmetric, and determine their complete mass spectra as well. In particular, we show that there are analogues of all stationary points found in higher dimensions, among them are de Sitter (dS) vacua in the theories with noncompact gauge groups SO(5, 3) 2 and SO(4, 4) 2 , as well as anti-de Sitter (AdS) vacua in the compact gauged theory preserving 1/4 and 1/8 of the supersymmetries. All the dS vacua have tachyonic instabilities, whereas there do exist nonsupersymmetric AdS vacua which are stable, again in contrast to the D≥4 theories

  4. Runners maintain locomotor-respiratory coupling following isocapnic voluntary hyperpnea to task failure.

    Science.gov (United States)

    Stickford, Abigail S L; Stickford, Jonathon L; Tanner, David A; Stager, Joel M; Chapman, Robert F

    2015-11-01

    Evidence has long suggested that mammalian ventilatory and locomotor rhythms are linked, yet determinants and implications of locomotor-respiratory coupling (LRC) continue to be investigated. Anecdotally, respiratory muscle fatigue seen at the end of heavy exercise may result in an uncoupling of movement-ventilation rhythms; however, there is no scientific evidence to substantiate this claim. We sought to determine whether or not fatigue of the respiratory muscles alters locomotor-respiratory coupling patterns typically observed in highly trained individuals while running. A related query was to examine the relationship between the potential changes in LRC and measures of running economy. Twelve male distance runners ran at four submaximal workloads (68-89 % VO2peak) on two separate days while LRC was quantified. One LRC trial served as a control (CON), while the other was performed following an isocapnic voluntary hyperpnea to task failure to induce respiratory muscle fatigue (FT+). LRC was assessed as stride-to-breathing frequency ratios (SF/fB) and degree of LRC (percentage of breaths occurring during the same decile of the step cycle). Hyperpnea resulted in significant declines in maximal voluntary inspiratory (MIP) and expiratory (MEP) mouth pressures (ΔMIP = -10 ± 12 cm H2O; ΔMEP = -6 ± 9 cm H2O). There were no differences in minute ventilation between CON and FT+ (CON, all speeds pooled = 104 ± 25 L min(-1); FT+ pooled = 106 ± 23 L min(-1)). Stride frequency was not different between trials; however, breathing frequency was significantly greater during FT+ compared to CON at all speeds (CON pooled = 47 ± 10 br min(-1); FT+ pooled = 52 ± 9 br min(-1)), resulting in smaller corresponding SF/fB. Yet, the degree of LRC was the same during CON and FT+ (CON pooled = 63 ± 15 %; FT+ pooled = 64 ± 18 %). The results indicate that trained runners are able to continue entraining breath and step cycles, despite marked changes in exercise breathing frequency

  5. A Debate on Pharyngolaryngeal Histopathologic Examination of the Cadaver Suspected of Pressure on Vital Elements of Neck: Death Cause

    Directory of Open Access Journals (Sweden)

    Fares Najari

    2016-12-01

    Full Text Available Pressure on the neck is one of the oldest and controversial types of death. However, the only hypoxia as the cause of speed death is not always correct. Many victims die immediately without classic symptoms of respiratory failure (Shirzad & Gharedaghi, 2007. Most of the deaths which occur in less than one to three minutes are falls in this category. Pressure on the neck leads to airway obstruction, neck veins obstruction, blocking the carotid arteries, and affect the nerves. A variety of causes is associated with fatal pressure on the neck, including strangulation by hand, strangulation with a ligature, and hanging. Hanging is the method used maximally in suicide as compared to other methods of suicide (Graham et al., 2000; Gould & Kramer, 2001. Including Iran, it is the most common method adopted for suicide in Asian countries (Morovatdar et al., 2013; Shojaei et al., 2014, especially adopted by men, older and especially illeterate people (Pridmore & Walter, 2013.

  6. Avaliação da frequência cardíaca à medida de pressão expiratória máxima estática e à manobra de Valsalva em jovens saudáveis Heart rate assessment during maximal static expiratory pressure and Valsalva maneuver in healthy young men

    Directory of Open Access Journals (Sweden)

    Vinicius Minatel

    2012-10-01

    Full Text Available CONTEXTUALIZAÇÃO: A medida de pressão expiratória máxima (PEmáx possui algumas contraindicações, pois acredita-se que as respostas obtidas nessa medida são similares às respostas encontradas na manobra de Valsalva (MV. OBJETIVOS: O objetivo principal é avaliar a resposta da frequência cardíaca (FC durante a medida da PEmáx e da MV em jovens saudáveis, em diferentes posturas, para identificar se e em qual condição a PEmáx reproduz as respostas obtidas na MV e, adicionalmente, estimar o trabalho realizado nas manobras. MÉTODO: Doze jovens saudáveis foram avaliados, orientados e familiarizados com as manobras. A MV foi composta por um esforço expiratório (40 mmHg durante 15 segundos contra um manômetro. A PEmáx foi executada segundo a American Thoracic Society. Ambas as medidas foram realizadas nas posturas supino e sentado. Para a análise da variação da frequência cardíaca (∆FC, índice de Valsalva (IV, índice da PEmáx (IPEmáx e o trabalho estimado das manobras (Wtotal, Wisotime, Wtotal/∆FCtotal e Wisotime/∆FCisotime , utilizou-se ANOVA two-way com post-hoc de Holm-Sidak (pBACKGROUND: The measure of the maximal expiratory pressure (MEP has some contraindications, as it is believed that the responses obtained in this measure are similar to the Valsalva maneuver (VM. OBJECTIVE: The main purpose of this study was to evaluate the heart rate responses (HR during the MEP and the VM measures in healthy young men into different postures aiming to identify whether and in which situation the MEP reproduces the responses obtained in the VM. Additionally we aim to estimate the workload realized during the maneuvers. METHOD: Twelve healthy young men were evaluated, instructed and familiarized with the maneuvers. The VM was characterized by an expiratory effort (40 mmHg against a manometer for 15 seconds. The MEP measure has been performed according to the American Thoracic Society. Both measures were performed at sitting

  7. The microbiota of the respiratory tract : Gatekeeper to respiratory health

    NARCIS (Netherlands)

    Man, Wing Ho; De Steenhuijsen Piters, Wouter A.A.; Bogaert, Debby

    2017-01-01

    The respiratory tract is a complex organ system that is responsible for the exchange of oxygen and carbon dioxide. The human respiratory tract spans from the nostrils to the lung alveoli and is inhabited by niche-specific communities of bacteria. The microbiota of the respiratory tract probably acts

  8. Adult respiratory distress syndrome

    International Nuclear Information System (INIS)

    Svendsen, J.; Jespersen, J.; Skjoedt, T.

    1986-01-01

    Our present-day knowledge concerning the clinico-chemical and radiological findings in adult respiratory distress syndrome are described. Three typical case histories have been selected to illustrate this condition; they were due to multiple trauma or sepsis. It is stressed that radiology is in a key position for making the diagnosis and for observing the course of the illness. (orig) [de

  9. European Respiratory Society statement

    DEFF Research Database (Denmark)

    Miravitlles, Marc; Dirksen, Asger; Ferrarotti, Ilaria

    2017-01-01

    lung disease. A large proportion of individuals affected remain undiagnosed and therefore without access to appropriate care and treatment.The most recent international statement on AATD was published by the American Thoracic Society and the European Respiratory Society in 2003. Since then there has...

  10. Respiratory Syncytial Virus (RSV)

    Centers for Disease Control (CDC) Podcasts

    Respiratory Syncytial Virus, or RSV, causes cold-like symptoms but can be serious for infants and older adults. In this podcast, CDC’s Dr. Eileen Schneider discusses this common virus and offers tips to prevent its spread.

  11. Respiratory problems in foals.

    Science.gov (United States)

    Beech, J

    1985-04-01

    Despite major advances in our knowledge and ability to treat respiratory diseases in neonatal foals, neonatal respiratory medicine is still in its infancy. It is hoped that this article may serve as a guideline for diagnosis and treatment. Specific antibiotic regimens and emergency procedures are covered in other articles in this symposium. Because management factors play a critical role in the pathogenesis of respiratory disease, education of clients as to their importance would help both prophylactically and therapeutically. The necessity of very careful monitoring of neonates, which is critical to early detection of disease, should be stressed. As respiratory diseases can be fulminant and rapidly fatal, it is imperative not to delay diagnosis and therapy. Thorough examination and implementation of appropriate diagnostic techniques, as well as prompt early referral to a more sophisticated facility when indicated, would prevent many deaths. Although sophisticated support systems are vital for survival of some of these foals, good basic intensive nursing care combined with selection of appropriate drug therapy very early in the course of the disease is all that many foals require and can significantly improve survival rates.

  12. Respiratory Symptoms in Firefighters

    NARCIS (Netherlands)

    Greven, Frans E.; Rooyackers, Jos M.; Kerstjens, Huib A. M.; Heederik, Dick J.

    Background The aim of the present study was to determine the prevalence and risk factors associated with respiratory symptoms in common firefighters in the Netherlands. Methods A total of 1,330 firefighters from the municipal fire brigades of three provinces of the Netherlands were included in the

  13. Textbook of respiratory medicine

    International Nuclear Information System (INIS)

    Murray, J.F.; Nadel, J.

    1987-01-01

    This book presents a clinical reference of respiratory medicine. It also details basic science aspects of pulmonary physiology and describes recently developed, sophisticated diagnostic tools and therapeutic methods. It also covers anatomy, physiology, pharmacology, and pathology; microbiologic, radiologic, nuclear medicine, and biopsy methods for diagnosis

  14. An information maximization model of eye movements

    Science.gov (United States)

    Renninger, Laura Walker; Coughlan, James; Verghese, Preeti; Malik, Jitendra

    2005-01-01

    We propose a sequential information maximization model as a general strategy for programming eye movements. The model reconstructs high-resolution visual information from a sequence of fixations, taking into account the fall-off in resolution from the fovea to the periphery. From this framework we get a simple rule for predicting fixation sequences: after each fixation, fixate next at the location that minimizes uncertainty (maximizes information) about the stimulus. By comparing our model performance to human eye movement data and to predictions from a saliency and random model, we demonstrate that our model is best at predicting fixation locations. Modeling additional biological constraints will improve the prediction of fixation sequences. Our results suggest that information maximization is a useful principle for programming eye movements.

  15. Utility Maximization in Nonconvex Wireless Systems

    CERN Document Server

    Brehmer, Johannes

    2012-01-01

    This monograph formulates a framework for modeling and solving utility maximization problems in nonconvex wireless systems. First, a model for utility optimization in wireless systems is defined. The model is general enough to encompass a wide array of system configurations and performance objectives. Based on the general model, a set of methods for solving utility maximization problems is developed. The development is based on a careful examination of the properties that are required for the application of each method. The focus is on problems whose initial formulation does not allow for a solution by standard convex methods. Solution approaches that take into account the nonconvexities inherent to wireless systems are discussed in detail. The monograph concludes with two case studies that demonstrate the application of the proposed framework to utility maximization in multi-antenna broadcast channels.

  16. Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis - a randomized controlled trial.

    Science.gov (United States)

    Westerdahl, Elisabeth; Wittrin, Anna; Kånåhols, Margareta; Gunnarsson, Martin; Nilsagård, Ylva

    2016-11-01

    Breathing exercises with positive expiratory pressure are often recommended to patients with advanced neurological deficits, but the potential benefit in multiple sclerosis (MS) patients with mild and moderate symptoms has not yet been investigated in randomized controlled trials. To study the effects of 2 months of home-based breathing exercises for patients with mild to moderate MS on respiratory muscle strength, lung function, and subjective breathing and health status outcomes. Forty-eight patients with MS according to the revised McDonald criteria were enrolled in a randomized controlled trial. Patients performing breathing exercises (n = 23) were compared with a control group (n = 25) performing no breathing exercises. The breathing exercises were performed with a positive expiratory pressure device (10-15 cmH 2 O) and consisted of 30 slow deep breaths performed twice a day for 2 months. Respiratory muscle strength (maximal inspiratory and expiratory pressure at the mouth), spirometry, oxygenation, thoracic excursion, subjective perceptions of breathing and self-reported health status were evaluated before and after the intervention period. Following the intervention, there was a significant difference between the breathing group and the control group regarding the relative change in lung function, favoring the breathing group (vital capacity: P < 0.043; forced vital capacity: P < 0.025). There were no other significant differences between the groups. Breathing exercises may be beneficial in patients with mild to moderate stages of MS. However, the clinical significance needs to be clarified, and it remains to be seen whether a sustainable effect in delaying the development of respiratory dysfunction in MS can be obtained. © 2015 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

  17. ARDS (Acute Respiratory Distress Syndrome)

    Science.gov (United States)

    ... Also known as What Is ARDS, or acute respiratory distress syndrome, is a lung condition that leads ... treat ARDS. Other Names Acute lung injury Adult respiratory distress syndrome Increased-permeability pulmonary edema Noncardiac pulmonary ...

  18. Respiratory gating in cardiac PET

    DEFF Research Database (Denmark)

    Lassen, Martin Lyngby; Rasmussen, Thomas; Christensen, Thomas E

    2017-01-01

    BACKGROUND: Respiratory motion due to breathing during cardiac positron emission tomography (PET) results in spatial blurring and erroneous tracer quantification. Respiratory gating might represent a solution by dividing the PET coincidence dataset into smaller respiratory phase subsets. The aim...... of our study was to compare the resulting imaging quality by the use of a time-based respiratory gating system in two groups administered either adenosine or dipyridamole as the pharmacological stress agent. METHODS AND RESULTS: Forty-eight patients were randomized to adenosine or dipyridamole cardiac...... stress (82)RB-PET. Respiratory rates and depths were measured by a respiratory gating system in addition to registering actual respiratory rates. Patients undergoing adenosine stress showed a decrease in measured respiratory rate from initial to later scan phase measurements [12.4 (±5.7) vs 5.6 (±4...

  19. Middle East Respiratory Syndrome (MERS)

    Science.gov (United States)

    Middle East Respiratory Syndrome Coronavirus; MERS-CoV; Novel coronavirus; nCoV ... for Disease Control and Prevention website. Middle East Respiratory Syndrome (MERS): Frequently asked questions and answers. www. ...

  20. Acute respiratory infections at children

    OpenAIRE

    Delyagin, V.

    2009-01-01

    The common signs of virus respiratory diseases, role of pathological inclination to infections, value of immunodeficiency are presented at lecture. Features of most often meeting respiratory virus infections are given.

  1. Maximizing band gaps in plate structures

    DEFF Research Database (Denmark)

    Halkjær, Søren; Sigmund, Ole; Jensen, Jakob Søndergaard

    2006-01-01

    periodic plate using Bloch theory, which conveniently reduces the maximization problem to that of a single base cell. Secondly, we construct a finite periodic plate using a number of the optimized base cells in a postprocessed version. The dynamic properties of the finite plate are investigated......Band gaps, i.e., frequency ranges in which waves cannot propagate, can be found in elastic structures for which there is a certain periodic modulation of the material properties or structure. In this paper, we maximize the band gap size for bending waves in a Mindlin plate. We analyze an infinite...... theoretically and experimentally and the issue of finite size effects is addressed....

  2. Singularity Structure of Maximally Supersymmetric Scattering Amplitudes

    DEFF Research Database (Denmark)

    Arkani-Hamed, Nima; Bourjaily, Jacob L.; Cachazo, Freddy

    2014-01-01

    We present evidence that loop amplitudes in maximally supersymmetric (N=4) Yang-Mills theory (SYM) beyond the planar limit share some of the remarkable structures of the planar theory. In particular, we show that through two loops, the four-particle amplitude in full N=4 SYM has only logarithmic ...... singularities and is free of any poles at infinity—properties closely related to uniform transcendentality and the UV finiteness of the theory. We also briefly comment on implications for maximal (N=8) supergravity theory (SUGRA)....

  3. Learning curves for mutual information maximization

    International Nuclear Information System (INIS)

    Urbanczik, R.

    2003-01-01

    An unsupervised learning procedure based on maximizing the mutual information between the outputs of two networks receiving different but statistically dependent inputs is analyzed [S. Becker and G. Hinton, Nature (London) 355, 161 (1992)]. For a generic data model, I show that in the large sample limit the structure in the data is recognized by mutual information maximization. For a more restricted model, where the networks are similar to perceptrons, I calculate the learning curves for zero-temperature Gibbs learning. These show that convergence can be rather slow, and a way of regularizing the procedure is considered

  4. Finding Maximal Pairs with Bounded Gap

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting; Lyngsø, Rune B.; Pedersen, Christian N. S.

    1999-01-01

    . In this paper we present methods for finding all maximal pairs under various constraints on the gap. In a string of length n we can find all maximal pairs with gap in an upper and lower bounded interval in time O(n log n+z) where z is the number of reported pairs. If the upper bound is removed the time reduces...... to O(n+z). Since a tandem repeat is a pair where the gap is zero, our methods can be seen as a generalization of finding tandem repeats. The running time of our methods equals the running time of well known methods for finding tandem repeats....

  5. Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers.

    Science.gov (United States)

    Loring, Stephen H; O'Donnell, Carl R; Butler, James P; Lindholm, Peter; Jacobson, Francine; Ferrigno, Massimo

    2007-03-01

    Throughout life, most mammals breathe between maximal and minimal lung volumes determined by respiratory mechanics and muscle strength. In contrast, competitive breath-hold divers exceed these limits when they employ glossopharyngeal insufflation (GI) before a dive to increase lung gas volume (providing additional oxygen and intrapulmonary gas to prevent dangerous chest compression at depths recently greater than 100 m) and glossopharyngeal exsufflation (GE) during descent to draw air from compressed lungs into the pharynx for middle ear pressure equalization. To explore the mechanical effects of these maneuvers on the respiratory system, we measured lung volumes by helium dilution with spirometry and computed tomography and estimated transpulmonary pressures using an esophageal balloon after GI and GE in four competitive breath-hold divers. Maximal lung volume was increased after GI by 0.13-2.84 liters, resulting in volumes 1.5-7.9 SD above predicted values. The amount of gas in the lungs after GI increased by 0.59-4.16 liters, largely due to elevated intrapulmonary pressures of 52-109 cmH(2)O. The transpulmonary pressures increased after GI to values ranging from 43 to 80 cmH(2)O, 1.6-2.9 times the expected values at total lung capacity. After GE, lung volumes were reduced by 0.09-0.44 liters, and the corresponding transpulmonary pressures decreased to -15 to -31 cmH(2)O, suggesting closure of intrapulmonary airways. We conclude that the lungs of some healthy individuals are able to withstand repeated inflation to transpulmonary pressures far greater than those to which they would normally be exposed.

  6. Fifty Years of Research in ARDS. Respiratory Mechanics in Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Henderson, William R; Chen, Lu; Amato, Marcelo B P; Brochard, Laurent J

    2017-10-01

    Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, although lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small Vt, low plateau and driving pressures, and high levels of positive end-expiratory pressure. Collectively, these interventions are termed "lung-protective ventilation." Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population-based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation. This review outlines the measurement and application of clinically applicable pulmonary mechanical concepts, such as plateau pressures, driving pressure, transpulmonary pressures, stress index, and measurement of strain. In addition, the concept of the "baby lung" and the utility of dynamic in addition to static measures of pulmonary mechanical variables are discussed.

  7. Hemodynamic and arterial stiffness differences between African-Americans and Caucasians after maximal exercise.

    Science.gov (United States)

    Yan, Huimin; Ranadive, Sushant M; Heffernan, Kevin S; Lane, Abbi D; Kappus, Rebecca M; Cook, Marc D; Wu, Pei-Tzu; Sun, Peng; Harvey, Idethia S; Woods, Jeffrey A; Wilund, Kenneth R; Fernhall, Bo

    2014-01-01

    African-American (AA) men have higher arterial stiffness and augmentation index (AIx) than Caucasian-American (CA) men. Women have greater age-associated increases in arterial stiffness and AIx than men. This study examined racial and sex differences in arterial stiffness and central hemodynamics at rest and after an acute bout of maximal exercise in young healthy individuals. One hundred young, healthy individuals (28 AA men, 24 AA women, 25 CA men, and 23 CA women) underwent measurements of aortic blood pressure (BP) and arterial stiffness at rest and 15 and 30 min after an acute bout of graded maximal aerobic exercise. Aortic BP and AIx were derived from radial artery applanation tonometry. Aortic stiffness (carotid-femoral) was measured via pulse wave velocity. Aortic stiffness was increased in AA subjects but not in CA subjects (P < 0.05) after an acute bout of maximal cycling exercise, after controlling for body mass index. Aortic BP decreased after exercise in CA subjects but not in AA subjects (P < 0.05). Women exhibited greater reductions in AIx after maximal aerobic exercise compared with men (P < 0.05). In conclusion, race and sex impact vascular and central hemodynamic responses to exercise. Young AA and CA subjects exhibited differential responses in central stiffness and central BP after acute maximal exercise. Premenopausal women had greater augmented pressure at rest and after maximal aerobic exercise than men. Future research is needed to examine the potential mechanisms.

  8. Climate change and respiratory disease: European Respiratory Society position statement.

    Science.gov (United States)

    Ayres, J G; Forsberg, B; Annesi-Maesano, I; Dey, R; Ebi, K L; Helms, P J; Medina-Ramón, M; Windt, M; Forastiere, F

    2009-08-01

    Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear. The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following a 2-day workshop held in Leuven (Belgium) in March 2008. Key areas of concern for the respiratory community arising from climate change are discussed and recommendations made to address gaps in knowledge. The most important recommendation was the development of more accurate predictive models for predicting the impact of climate change on respiratory health. Respiratory healthcare workers also have an advocatory role in persuading governments and the European Union to maintain awareness and appropriate actions with respect to climate change, and these areas are also discussed in the position statement.

  9. Respiratory function after selective respiratory motor neuron death from intrapleural CTB–saporin injections

    Science.gov (United States)

    Nichols, Nicole L.; Vinit, Stéphane; Bauernschmidt, Lorene; Mitchell, Gordon S.

    2015-01-01

    Amyotrophic lateral sclerosis (ALS) causes progressive motor neuron degeneration, paralysis and death by ventilatory failure. In rodent ALS models: 1) breathing capacity is preserved until late in disease progression despite major respiratory motor neuron death, suggesting unknown forms of compensatory respiratory plasticity; and 2) spinal microglia become activated in association with motor neuron cell death. Here, we report a novel experimental model to study the impact of respiratory motor neuron death on compensatory responses without many complications attendant to spontaneous motor neuron disease. In specific, we used intrapleural injections of cholera toxin B fragment conjugated to saporin (CTB–SAP) to selectively kill motor neurons with access to the pleural space. Motor neuron survival, CD11b labeling (microglia), ventilatory capacity and phrenic motor output were assessed in rats 3–28 days after intrapleural injections of: 1) CTB–SAP (25 and 50 μg), or 2) unconjugated CTB and SAP (i.e. control; (CTB + SAP). CTB–SAP elicited dose-dependent phrenic and intercostal motor neuron death; 7 days post-25 μg CTB–SAP, motor neuron survival approximated that in end-stage ALS rats (phrenic: 36 ± 7%; intercostal: 56 ± 10% of controls; n = 9; p phrenic motor nucleus, indicating microglial activation; 2) decreased breathing during maximal chemoreceptor stimulation; and 3) diminished phrenic motor output in anesthetized rats (7 days post-25 μg, CTB–SAP: 0.3 ± 0.07 V; CTB + SAP: 1.5 ± 0.3; n = 9; p < 0.05). Intrapleural CTB–SAP represents a novel, inducible model of respiratory motor neuron death and provides an opportunity to study compensation for respiratory motor neuron loss. PMID:25476493

  10. Maximizing the Range of a Projectile.

    Science.gov (United States)

    Brown, Ronald A.

    1992-01-01

    Discusses solutions to the problem of maximizing the range of a projectile. Presents three references that solve the problem with and without the use of calculus. Offers a fourth solution suitable for introductory physics courses that relies more on trigonometry and the geometry of the problem. (MDH)

  11. Robust Utility Maximization Under Convex Portfolio Constraints

    International Nuclear Information System (INIS)

    Matoussi, Anis; Mezghani, Hanen; Mnif, Mohamed

    2015-01-01

    We study a robust maximization problem from terminal wealth and consumption under a convex constraints on the portfolio. We state the existence and the uniqueness of the consumption–investment strategy by studying the associated quadratic backward stochastic differential equation. We characterize the optimal control by using the duality method and deriving a dynamic maximum principle

  12. Ehrenfest's Lottery--Time and Entropy Maximization

    Science.gov (United States)

    Ashbaugh, Henry S.

    2010-01-01

    Successful teaching of the Second Law of Thermodynamics suffers from limited simple examples linking equilibrium to entropy maximization. I describe a thought experiment connecting entropy to a lottery that mixes marbles amongst a collection of urns. This mixing obeys diffusion-like dynamics. Equilibrium is achieved when the marble distribution is…

  13. Reserve design to maximize species persistence

    Science.gov (United States)

    Robert G. Haight; Laurel E. Travis

    2008-01-01

    We develop a reserve design strategy to maximize the probability of species persistence predicted by a stochastic, individual-based, metapopulation model. Because the population model does not fit exact optimization procedures, our strategy involves deriving promising solutions from theory, obtaining promising solutions from a simulation optimization heuristic, and...

  14. Maximal indecomposable past sets and event horizons

    International Nuclear Information System (INIS)

    Krolak, A.

    1984-01-01

    The existence of maximal indecomposable past sets MIPs is demonstrated using the Kuratowski-Zorn lemma. A criterion for the existence of an absolute event horizon in space-time is given in terms of MIPs and a relation to black hole event horizon is shown. (author)

  15. Maximization of eigenvalues using topology optimization

    DEFF Research Database (Denmark)

    Pedersen, Niels Leergaard

    2000-01-01

    to localized modes in low density areas. The topology optimization problem is formulated using the SIMP method. Special attention is paid to a numerical method for removing localized eigenmodes in low density areas. The method is applied to numerical examples of maximizing the first eigenfrequency, One example...

  16. Maximizing Resource Utilization in Video Streaming Systems

    Science.gov (United States)

    Alsmirat, Mohammad Abdullah

    2013-01-01

    Video streaming has recently grown dramatically in popularity over the Internet, Cable TV, and wire-less networks. Because of the resource demanding nature of video streaming applications, maximizing resource utilization in any video streaming system is a key factor to increase the scalability and decrease the cost of the system. Resources to…

  17. A THEORY OF MAXIMIZING SENSORY INFORMATION

    NARCIS (Netherlands)

    Hateren, J.H. van

    1992-01-01

    A theory is developed on the assumption that early sensory processing aims at maximizing the information rate in the channels connecting the sensory system to more central parts of the brain, where it is assumed that these channels are noisy and have a limited dynamic range. Given a stimulus power

  18. Maximizing scientific knowledge from randomized clinical trials

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Atar, Dan; Pitt, Bertram

    2010-01-01

    Trialists have an ethical and financial responsibility to plan and conduct clinical trials in a manner that will maximize the scientific knowledge gained from the trial. However, the amount of scientific information generated by randomized clinical trials in cardiovascular medicine is highly vari...

  19. A Model of College Tuition Maximization

    Science.gov (United States)

    Bosshardt, Donald I.; Lichtenstein, Larry; Zaporowski, Mark P.

    2009-01-01

    This paper develops a series of models for optimal tuition pricing for private colleges and universities. The university is assumed to be a profit maximizing, price discriminating monopolist. The enrollment decision of student's is stochastic in nature. The university offers an effective tuition rate, comprised of stipulated tuition less financial…

  20. Logit Analysis for Profit Maximizing Loan Classification

    OpenAIRE

    Watt, David L.; Mortensen, Timothy L.; Leistritz, F. Larry

    1988-01-01

    Lending criteria and loan classification methods are developed. Rating system breaking points are analyzed to present a method to maximize loan revenues. Financial characteristics of farmers are used as determinants of delinquency in a multivariate logistic model. Results indicate that debt-to-asset and operating ration are most indicative of default.

  1. Dimensión respiratoria de la escala ALSFRS-R y la función respiratoria en la esclerosis lateral amiotrófica Respiratory domain of revised amyotrophic lateral sclerosis: Functional Rating Scale

    Directory of Open Access Journals (Sweden)

    Sandra E. Lima

    2009-10-01

    Full Text Available Virtualmente todos los pacientes con esclerosis lateral amiotrófica tendrán disnea, que es quizá el síntoma más penoso de esta devastadora enfermedad. El objetivo de este estudio fue correlacionar la dimensión respiratoria de la escala ALSFRS-R, la capacidad vital forzada y las presiones estáticas máximas bucales. Se estudiaron prospectivamente 20 pacientes consecutivos sin disnea durante 24 meses. El puntaje total de la escala ALSFRS-R disminuyó de 34.3 ± 10.3 a 22.1 ± 8.0 (p = 0.0325; la contribución de la dimensión respiratoria fue insignificante. En quienes refirieron disnea (n: 12, la capacidad vital forzada cayó un 41 ± 21 % del valor inicial pero con similar caída (46 ± 23%, 8 pacientes no refirieron disnea. La correlación entre la escala ALSFRS-R con la capacidad vital forzada (litros fue r: 0.73, (p = 0.0016 y con la presión inspiratoria máxima (cm H2O, r: 0.84, p = 0.0038. La correlación entre la capacidad vital forzada (% con la disnea fue r s: 0.23, p = 0.1400. La correlación de la disnea con la presión inspiratoria máxima (% fue r s: 0.58, p = 0.0300 y con la presión espiratoria máxima (%, r s: 0.49, p = 0.0400. La dimensión respiratoria de la escala ALSFRS-R no permitió predecir el grado de deterioro funcional respiratorio. Esto sugiere que dicha dimensión no reemplaza a las mediciones funcionales respiratorias y, debido a que la insuficiencia respiratoria puede no ser evidente, la realización de dichas pruebas provee una base objetiva de seguimiento y permite planear medidas con anticipación.Virtually all patients with amyotrophic lateral sclerosis will complain of dyspnea, which is perhaps the most distressing symptom of this devastating disease. The objective was to correlate respiratory domain of ALSFRS-R with forced vital capacity and maximal static pressures in the mouth. We designed a prospective study in 20 consecutive patients without dyspnea during 24 months. The global decline of ALSFRS

  2. Developing maximal neuromuscular power: Part 1--biological basis of maximal power production.

    Science.gov (United States)

    Cormie, Prue; McGuigan, Michael R; Newton, Robert U

    2011-01-01

    This series of reviews focuses on the most important neuromuscular function in many sport performances, the ability to generate maximal muscular power. Part 1 focuses on the factors that affect maximal power production, while part 2, which will follow in a forthcoming edition of Sports Medicine, explores the practical application of these findings by reviewing the scientific literature relevant to the development of training programmes that most effectively enhance maximal power production. The ability of the neuromuscular system to generate maximal power is affected by a range of interrelated factors. Maximal muscular power is defined and limited by the force-velocity relationship and affected by the length-tension relationship. The ability to generate maximal power is influenced by the type of muscle action involved and, in particular, the time available to develop force, storage and utilization of elastic energy, interactions of contractile and elastic elements, potentiation of contractile and elastic filaments as well as stretch reflexes. Furthermore, maximal power production is influenced by morphological factors including fibre type contribution to whole muscle area, muscle architectural features and tendon properties as well as neural factors including motor unit recruitment, firing frequency, synchronization and inter-muscular coordination. In addition, acute changes in the muscle environment (i.e. alterations resulting from fatigue, changes in hormone milieu and muscle temperature) impact the ability to generate maximal power. Resistance training has been shown to impact each of these neuromuscular factors in quite specific ways. Therefore, an understanding of the biological basis of maximal power production is essential for developing training programmes that effectively enhance maximal power production in the human.

  3. Evaluation of respiratory pattern during respiratory-gated radiotherapy

    International Nuclear Information System (INIS)

    Dobashi, Suguru; Mori, Shinichiro

    2014-01-01

    The respiratory cycle is not strictly regular, and generally varies in amplitude and period from one cycle to the next. We evaluated the characteristics of respiratory patterns acquired during respiratory gating treatment in more than 300 patients. A total 331 patients treated with respiratory-gated carbon-ion beam therapy were selected from a group of patients with thoracic and abdominal conditions. Respiratory data were acquired for a total of 3,171 fractions using an external respiratory sensing monitor and evaluated for respiratory cycle, duty cycle, magnitude of baseline drift, and intrafractional/interfractional peak inhalation/exhalation positional variation. Results for the treated anatomical sites and patient positioning were compared. Mean ± SD respiratory cycle averaged over all patients was 4.1 ± 1.3 s. Mean ± SD duty cycle averaged over all patients was 36.5 ± 7.3 %. Two types of baseline drift were seen, the first decremental and the second incremental. For respiratory peak variation, the mean intrafractional variation in peak-inhalation position relative to the amplitude in the first respiratory cycle (15.5 ± 9.3 %) was significantly larger than that in exhalation (7.5 ± 4.6 %). Interfractional variations in inhalation (17.2 ± 18.5 %) were also significantly greater than those in exhalation (9.4 ± 10.0 %). Statistically significant differences were observed between patients in the supine position and those in the prone position in mean respiratory cycle, duty cycle, and intra-/interfractional variations. We quantified the characteristics of the respiratory curve based on a large number of respiratory data obtained during treatment. These results might be useful in improving the accuracy of respiratory-gated treatment.

  4. Understanding Violations of Gricean Maxims in Preschoolers and Adults

    Directory of Open Access Journals (Sweden)

    Mako eOkanda

    2015-07-01

    Full Text Available This study used a revised Conversational Violations Test to examine Gricean maxim violations in 4- to 6-year-old Japanese children and adults. Participants’ understanding of the following maxims was assessed: be informative (first maxim of quantity, avoid redundancy (second maxim of quantity, be truthful (maxim of quality, be relevant (maxim of relation, avoid ambiguity (second maxim of manner, and be polite (maxim of politeness. Sensitivity to violations of Gricean maxims increased with age: 4-year-olds’ understanding of maxims was near chance, 5-year-olds understood some maxims (first maxim of quantity and maxims of quality, relation, and manner, and 6-year-olds and adults understood all maxims. Preschoolers acquired the maxim of relation first and had the greatest difficulty understanding the second maxim of quantity. Children and adults differed in their comprehension of the maxim of politeness. The development of the pragmatic understanding of Gricean maxims and implications for the construction of developmental tasks from early childhood to adulthood are discussed.

  5. Respiratory guiding system for respiratory motion management in respiratory gated radiotherapy

    International Nuclear Information System (INIS)

    Kang, Seong Hee; Kim, Dong Su; Kim, Tae Ho; Suh, Tae Suk

    2013-01-01

    Respiratory guiding systems have been shown to improve the respiratory regularity. This, in turn, improves the efficiency of synchronized moving aperture radiation therapy, and it reduces the artifacts caused by irregular breathing in imaging techniques such as four-dimensional computed tomography (4D CT), which is used for treatment planning in RGRT. We have previously developed a respiratory guiding system that incorporates an individual-specific guiding waveform, which is easy to follow for each volunteer, to improve the respiratory regularity. The present study evaluates the application of this system to improve the respiratory regularity for respiratory-gated radiation therapy (RGRT). In this study, we evaluated the effectiveness of an in-house-developed respiratory guiding system incorporating an individual specific guiding waveform to improve the respiratory regularity for RGRT. Most volunteers showed significantly less residual motion at each phase during guided breathing owing to the improvement in respiratory regularity. Therefore, the respiratory guiding system can clearly reduce the residual, or respiratory, motion in each phase. From the result, the CTV and the PTV margins during RGRT can be reduced by using the respiratory guiding system, which reduces the residual motions, thus improving the accuracy of RGRT

  6. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

    NARCIS (Netherlands)

    Kneyber, Martin C. J.; van Heerde, Marc; Twisk, Jos W. R.; Plotz, Frans B.; Markhors, Dick G.

    2009-01-01

    Introduction Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of

  7. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

    NARCIS (Netherlands)

    Kneijber, M.C.J.; van Heerde, M.; Twisk, J.W.R.; Plotz, F.; Markhorst, D.G.

    2009-01-01

    Introduction: Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of

  8. Noninvasive ventilation in hypoxemic respiratory failure

    Directory of Open Access Journals (Sweden)

    Raja Dhar

    2016-01-01

    Full Text Available Noninvasive ventilation (NIV refers to positive pressure ventilation delivered through a noninvasive interface (nasal mask, facemask, or nasal plugs etc. Over the past decade its use has become more common as its benefits are increasingly recognized. This review will focus on the evidence supporting the use of NIV in various conditions resulting in acute hypoxemic respiratory failure (AHRF, that is, non-hypercapnic patients having acute respiratory failure in the absence of a cardiac origin or underlying chronic pulmonary disease. Outcomes depend on the patient's diagnosis and clinical characteristics. Patients should be monitored closely for signs of noninvasive ventilation failure and promptly intubated before a crisis develops. The application of noninvasive ventilation by a trained and experienced team, with careful patient selection, should optimize patient outcomes.

  9. Maternal and neonatal outcomes of respiratory failure during pregnancy.

    Science.gov (United States)

    Hung, Chen-Yiu; Hu, Han-Chung; Chiu, Li-Chung; Chang, Chih-Hao; Li, Li-Fu; Huang, Chung-Chi; Kao, Chuan-Chi; Cheng, Po-Jen; Kao, Kuo-Chin

    2018-05-01

    Obstetric patients comprise a limited portion of intensive care unit patients, but they often present with unfamiliar conditions and exhibit the potential for catastrophic deterioration. This study evaluated the maternal and neonatal outcomes of respiratory failure during pregnancy. Information on 71 patients at >25 weeks gestation in the ICU with respiratory failure was recorded between 2009 and 2013. The characteristics and outcomes of mothers and fetuses were determined through a retrospective chart review and evaluated using Student's t test, chi-square test, and Fisher's exact test. The leading causes of respiratory failure were postpartum hemorrhage and severe preeclampsia in the obstetric causes group and pneumonia in the nonobstetric causes group during pregnancy and the peripartum period. The non-obstetric causes group exhibited a higher incidence of acute respiratory distress syndrome and renal replacement therapy as well as requiring more ventilator days. The patients in the obstetric causes group showed significant improvement after delivery in the partial pressure of arterial oxygen to the fraction of inspired oxygen and peak inspiratory pressure decrease. Both groups exhibited high incidences of neonatal respiratory distress syndrome. Neonatal complications resulting from meconium aspiration syndrome (MAS) and sepsis were more common in the non-obstetric causes group; however, neurological development impairment was more common in the obstetric causes group. Obstetric cause was associated with longer ventilator free days and fewer episodes of ARDS after delivery. Neonatal complications resulting from different etiologies of respiratory failure were found to differ. Copyright © 2017. Published by Elsevier B.V.

  10. Ocular Tropism of Respiratory Viruses

    Science.gov (United States)

    Rota, Paul A.; Tumpey, Terrence M.

    2013-01-01

    SUMMARY Respiratory viruses (including adenovirus, influenza virus, respiratory syncytial virus, coronavirus, and rhinovirus) cause a broad spectrum of disease in humans, ranging from mild influenza-like symptoms to acute respiratory failure. While species D adenoviruses and subtype H7 influenza viruses are known to possess an ocular tropism, documented human ocular disease has been reported following infection with all principal respiratory viruses. In this review, we describe the anatomical proximity and cellular receptor distribution between ocular and respiratory tissues. All major respiratory viruses and their association with human ocular disease are discussed. Research utilizing in vitro and in vivo models to study the ability of respiratory viruses to use the eye as a portal of entry as well as a primary site of virus replication is highlighted. Identification of shared receptor-binding preferences, host responses, and laboratory modeling protocols among these viruses provides a needed bridge between clinical and laboratory studies of virus tropism. PMID:23471620

  11. Nanotechnology in respiratory medicine.

    Science.gov (United States)

    Omlor, Albert Joachim; Nguyen, Juliane; Bals, Robert; Dinh, Quoc Thai

    2015-05-29

    Like two sides of the same coin, nanotechnology can be both boon and bane for respiratory medicine. Nanomaterials open new ways in diagnostics and treatment of lung diseases. Nanoparticle based drug delivery systems can help against diseases such as lung cancer, tuberculosis, and pulmonary fibrosis. Moreover, nanoparticles can be loaded with DNA and act as vectors for gene therapy in diseases like cystic fibrosis. Even lung diagnostics with computer tomography (CT) or magnetic resonance imaging (MRI) profits from new nanoparticle based contrast agents. However, the risks of nanotechnology also have to be taken into consideration as engineered nanomaterials resemble natural fine dusts and fibers, which are known to be harmful for the respiratory system in many cases. Recent studies have shown that nanoparticles in the respiratory tract can influence the immune system, can create oxidative stress and even cause genotoxicity. Another important aspect to assess the safety of nanotechnology based products is the absorption of nanoparticles. It was demonstrated that the amount of pulmonary nanoparticle uptake not only depends on physical and chemical nanoparticle characteristics but also on the health status of the organism. The huge diversity in nanotechnology could revolutionize medicine but makes safety assessment a challenging task.

  12. Adult respiratory distress syndrome

    International Nuclear Information System (INIS)

    Murphy, C.H.; Colvin, R.S.

    1987-01-01

    Due to improved emergency resuscitation procedures, and with advancing medical technology in the field of critical care, an increasing number of patients survive the acute phase of shock and catastrophic trauma. Patients who previously died of massive sepsis, hypovolemic or hypotensive shock, multiple fractures, aspiration, toxic inhalation, and massive embolism are now surviving long enough to develop previously unsuspected and unrecognized secondary effects. With increasing frequency, clinicians are recognizing the clinical and radiographic manifestations of pathologic changes in the lungs occurring secondary to various types of massive insult. This paper gives a list of diseases that have been shown to precipitate or predispose to diffuse lung damage. Various terms have been used to describe the lung damage and respiratory failure secondary to these conditions. The term adult respiratory distress syndrome (ARDS) is applied to several cases of sudden respiratory failure in patients with previously healthy lungs following various types of trauma or shock. Numerous investigations and experiments have studied the pathologic changes in ARDS, and, while there is still no clear indication of why it develops, there is now some correlation of the sequential pathologic developments with the clinical and radiographic changes

  13. Maximal frustration as an immunological principle.

    Science.gov (United States)

    de Abreu, F Vistulo; Mostardinha, P

    2009-03-06

    A fundamental problem in immunology is that of understanding how the immune system selects promptly which cells to kill without harming the body. This problem poses an apparent paradox. Strong reactivity against pathogens seems incompatible with perfect tolerance towards self. We propose a different view on cellular reactivity to overcome this paradox: effector functions should be seen as the outcome of cellular decisions which can be in conflict with other cells' decisions. We argue that if cellular systems are frustrated, then extensive cross-reactivity among the elements in the system can decrease the reactivity of the system as a whole and induce perfect tolerance. Using numerical and mathematical analyses, we discuss two simple models that perform optimal pathogenic detection with no autoimmunity if cells are maximally frustrated. This study strongly suggests that a principle of maximal frustration could be used to build artificial immune systems. It would be interesting to test this principle in the real adaptive immune system.

  14. Derivative pricing based on local utility maximization

    OpenAIRE

    Jan Kallsen

    2002-01-01

    This paper discusses a new approach to contingent claim valuation in general incomplete market models. We determine the neutral derivative price which occurs if investors maximize their local utility and if derivative demand and supply are balanced. We also introduce the sensitivity process of a contingent claim. This process quantifies the reliability of the neutral derivative price and it can be used to construct price bounds. Moreover, it allows to calibrate market models in order to be co...

  15. Control of Shareholders’ Wealth Maximization in Nigeria

    OpenAIRE

    A. O. Oladipupo; C. O. Okafor

    2014-01-01

    This research focuses on who controls shareholder’s wealth maximization and how does this affect firm’s performance in publicly quoted non-financial companies in Nigeria. The shareholder fund was the dependent while explanatory variables were firm size (proxied by log of turnover), retained earning (representing management control) and dividend payment (representing measure of shareholders control). The data used for this study were obtained from the Nigerian Stock Exchange [NSE] fact book an...

  16. Definable maximal discrete sets in forcing extensions

    DEFF Research Database (Denmark)

    Törnquist, Asger Dag; Schrittesser, David

    2018-01-01

    Let  be a Σ11 binary relation, and recall that a set A is -discrete if no two elements of A are related by . We show that in the Sacks and Miller forcing extensions of L there is a Δ12 maximal -discrete set. We use this to answer in the negative the main question posed in [5] by showing...

  17. Dynamic Convex Duality in Constrained Utility Maximization

    OpenAIRE

    Li, Yusong; Zheng, Harry

    2016-01-01

    In this paper, we study a constrained utility maximization problem following the convex duality approach. After formulating the primal and dual problems, we construct the necessary and sufficient conditions for both the primal and dual problems in terms of FBSDEs plus additional conditions. Such formulation then allows us to explicitly characterize the primal optimal control as a function of the adjoint process coming from the dual FBSDEs in a dynamic fashion and vice versa. Moreover, we also...

  18. Maternal and neonatal outcomes of respiratory failure during pregnancy

    Directory of Open Access Journals (Sweden)

    Chen-Yiu Hung

    2018-05-01

    Full Text Available Background: Obstetric patients comprise a limited portion of intensive care unit patients, but they often present with unfamiliar conditions and exhibit the potential for catastrophic deterioration. This study evaluated the maternal and neonatal outcomes of respiratory failure during pregnancy. Methods: Information on 71 patients at >25 weeks gestation in the ICU with respiratory failure was recorded between 2009 and 2013. The characteristics and outcomes of mothers and fetuses were determined through a retrospective chart review and evaluated using Student's t test, chi-square test, and Fisher's exact test. Results: The leading causes of respiratory failure were postpartum hemorrhage and severe preeclampsia in the obstetric causes group and pneumonia in the nonobstetric causes group during pregnancy and the peripartum period. The non-obstetric causes group exhibited a higher incidence of acute respiratory distress syndrome and renal replacement therapy as well as requiring more ventilator days. The patients in the obstetric causes group showed significant improvement after delivery in the partial pressure of arterial oxygen to the fraction of inspired oxygen and peak inspiratory pressure decrease. Both groups exhibited high incidences of neonatal respiratory distress syndrome. Neonatal complications resulting from meconium aspiration syndrome (MAS and sepsis were more common in the non-obstetric causes group; however, neurological development impairment was more common in the obstetric causes group. Conclusion: Obstetric cause was associated with longer ventilator free days and fewer episodes of ARDS after delivery. Neonatal complications resulting from different etiologies of respiratory failure were found to differ. Keywords: Acute respiratory distress syndrome, Neonatal, Obstetric, Outcome, Respiratory failure

  19. Single maximal versus combination punch kinematics.

    Science.gov (United States)

    Piorkowski, Barry A; Lees, Adrian; Barton, Gabor J

    2011-03-01

    The aim of this study was to determine the influence of punch type (Jab, Cross, Lead Hook and Reverse Hook) and punch modality (Single maximal, 'In-synch' and 'Out of synch' combination) on punch speed and delivery time. Ten competition-standard volunteers performed punches with markers placed on their anatomical landmarks for 3D motion capture with an eight-camera optoelectronic system. Speed and duration between key moments were computed. There were significant differences in contact speed between punch types (F(2,18,84.87) = 105.76, p = 0.001) with Lead and Reverse Hooks developing greater speed than Jab and Cross. There were significant differences in contact speed between punch modalities (F(2,64,102.87) = 23.52, p = 0.001) with the Single maximal (M+/- SD: 9.26 +/- 2.09 m/s) higher than 'Out of synch' (7.49 +/- 2.32 m/s), 'In-synch' left (8.01 +/- 2.35 m/s) or right lead (7.97 +/- 2.53 m/s). Delivery times were significantly lower for Jab and Cross than Hook. Times were significantly lower 'In-synch' than a Single maximal or 'Out of synch' combination mode. It is concluded that a defender may have more evasion-time than previously reported. This research could be of use to performers and coaches when considering training preparations.

  20. Formation Control for the MAXIM Mission

    Science.gov (United States)

    Luquette, Richard J.; Leitner, Jesse; Gendreau, Keith; Sanner, Robert M.

    2004-01-01

    Over the next twenty years, a wave of change is occurring in the space-based scientific remote sensing community. While the fundamental limits in the spatial and angular resolution achievable in spacecraft have been reached, based on today s technology, an expansive new technology base has appeared over the past decade in the area of Distributed Space Systems (DSS). A key subset of the DSS technology area is that which covers precision formation flying of space vehicles. Through precision formation flying, the baselines, previously defined by the largest monolithic structure which could fit in the largest launch vehicle fairing, are now virtually unlimited. Several missions including the Micro-Arcsecond X-ray Imaging Mission (MAXIM), and the Stellar Imager will drive the formation flying challenges to achieve unprecedented baselines for high resolution, extended-scene, interferometry in the ultraviolet and X-ray regimes. This paper focuses on establishing the feasibility for the formation control of the MAXIM mission. MAXIM formation flying requirements are on the order of microns, while Stellar Imager mission requirements are on the order of nanometers. This paper specifically addresses: (1) high-level science requirements for these missions and how they evolve into engineering requirements; and (2) the development of linearized equations of relative motion for a formation operating in an n-body gravitational field. Linearized equations of motion provide the ground work for linear formation control designs.

  1. Gradient Dynamics and Entropy Production Maximization

    Science.gov (United States)

    Janečka, Adam; Pavelka, Michal

    2018-01-01

    We compare two methods for modeling dissipative processes, namely gradient dynamics and entropy production maximization. Both methods require similar physical inputs-how energy (or entropy) is stored and how it is dissipated. Gradient dynamics describes irreversible evolution by means of dissipation potential and entropy, it automatically satisfies Onsager reciprocal relations as well as their nonlinear generalization (Maxwell-Onsager relations), and it has statistical interpretation. Entropy production maximization is based on knowledge of free energy (or another thermodynamic potential) and entropy production. It also leads to the linear Onsager reciprocal relations and it has proven successful in thermodynamics of complex materials. Both methods are thermodynamically sound as they ensure approach to equilibrium, and we compare them and discuss their advantages and shortcomings. In particular, conditions under which the two approaches coincide and are capable of providing the same constitutive relations are identified. Besides, a commonly used but not often mentioned step in the entropy production maximization is pinpointed and the condition of incompressibility is incorporated into gradient dynamics.

  2. A importância da pressão pleural na avaliação da mecânica respiratória La importancia de la presión pleural en la evaluación de la mecánica respiratoria Importance of pleural pressure for the evaluation of respiratory mechanics

    Directory of Open Access Journals (Sweden)

    Cláudia Regina Fernandes

    2006-06-01

    respiratory system mechanical measurements into their lung and chest wall components. This review aimed at discussing alternative methods to obtain pleural pressure to calculate pulmonary mechanics, at reporting peculiarities of the esophageal balloon method for obtaining indirect pleural pressure, peculiarities of esophageal pressure measurement in sedated or anesthetized patients, at discussing direct pleural pressure and its correlation with esophageal pressure, in addition to reporting on the impact of PEEP on pleural and esophageal pressures. CONTENTS: Esophageal pressure variation reflects pleural pressure variation and may be used as alternative to direct pleural pressure in the study of lungs and chest wall mechanics. Esophageal pressure may be obtained with a delicate balloon placed inside the esophagus. Method and technique were observed and validated in humans and animals in different conditions and body positions. PEEP is a consolidated method for patients under mechanically controlled ventilation, however there are controversies about the close correlation between esophageal and pleural pressure in patients ventilated with PEEP, which may result in wrong respiratory mechanics calculation based on the esophageal pressure. CONCLUSIONS: The esophageal balloon is the most common method to obtain indirect pleural pressure. In sedated or anesthetized patients without major respiratory compliance changes, esophageal pressure variation corresponds to pleural pressure variation when PEEP is applied.

  3. SU-E-J-48: Development of An Abdominal Compression Device for Respiratory Correlated Radiation Therapy

    International Nuclear Information System (INIS)

    Kim, T; Kang, S; Kim, D; Suh, T; Kim, S

    2014-01-01

    Purpose: The aim of this study is to develop the abdominal compression device which could control pressure level according to the abdominal respiratory motion and evaluate its feasibility. Methods: In this study, we focused on developing the abdominal compression device which could control pressure level at any point of time so the developed device is possible to use a variety of purpose (gating technique or respiratory training system) while maintaining the merit of the existing commercial device. The compression device (air pad form) was designed to be able to compress the front and side of abdomen and the pressure level of the abdomen is controlled by air flow. Pressure level of abdomen (air flow) was determined using correlation data between external abdominal motion and respiratory volume signal measured by spirometer. In order to verify the feasibility of the device, it was necessary to confirm the correlation between the abdominal respiratory motion and respiratory volume signal and cooperation with respiratory training system also checked. Results: In the previous study, we could find that the correlation coefficient ratio between diaphragm and respiratory volume signal measured by spirometer was 0.95. In this study, we confirmed the correlation between the respiratory volume signal and the external abdominal motion measured by belt-transducer (correlation coefficient ratio was 0.92) and used the correlated respiratory volume data as an abdominal pressure level. It was possible to control the pressure level with negligible time delay and respiratory volume data based guiding waveforms could be properly inserted into the respiratory training system. Conclusion: Through this feasibility study, we confirmed the correlation between the respiratory volume signal and the external abdominal motion. Also initial assessment of the device and its compatibility with the respiratory training system were verified. Further study on application in respiratory gated

  4. Crossover and maximal fat-oxidation points in sedentary healthy subjects: methodological issues.

    Science.gov (United States)

    Gmada, N; Marzouki, H; Haboubi, M; Tabka, Z; Shephard, R J; Bouhlel, E

    2012-02-01

    Our study aimed to assess the influence of protocol on the crossover point and maximal fat-oxidation (LIPOX(max)) values in sedentary, but otherwise healthy, young men. Maximal oxygen intake was assessed in 23 subjects, using a progressive maximal cycle ergometer test. Twelve sedentary males (aged 20.5±1.0 years) whose directly measured maximal aerobic power (MAP) values were lower than their theoretical maximal values (tMAP) were selected from this group. These individuals performed, in random sequence, three submaximal graded exercise tests, separated by three-day intervals; work rates were based on the tMAP in one test and on MAP in the remaining two. The third test was used to assess the reliability of data. Heart rate, respiratory parameters, blood lactate, the crossover point and LIPOX(max) values were measured during each of these tests. The crossover point and LIPOX(max) values were significantly lower when the testing protocol was based on tMAP rather than on MAP (PtMAP at 30, 40, 50 and 60% of maximal aerobic power (PtMAP rather than MAP (P<0.001). During the first 5 min of recovery, EPOC(5 min) and blood lactate were significantly correlated (r=0.89; P<0.001). Our data show that, to assess the crossover point and LIPOX(max) values for research purposes, the protocol must be based on the measured MAP rather than on a theoretical value. Such a determination should improve individualization of training for initially sedentary subjects. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  5. Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery

    Directory of Open Access Journals (Sweden)

    Roberto de Cleva

    2014-07-01

    Full Text Available OBJECTIVE:Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior.METHODS:We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique.RESULTS:The mean age of the patients was 56±13 years, and 41.6% 25 were female; 50 patients (83.3% had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior. The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6±0.6 L and FVC (2.0±0.7 L with maintenance of FEV1/FVC of 0.8±0.2 in both groups. The maximum intra-abdominal pressure values were similar (p= 0.59 for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed.CONCLUSIONS:Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.

  6. Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery.

    Science.gov (United States)

    Cleva, Roberto de; Assumpção, Marianna Siqueira de; Sasaya, Flavia; Chaves, Natalia Zuniaga; Santo, Marco Aurelio; Fló, Claudia; Lunardi, Adriana C; Jacob Filho, Wilson

    2014-07-01

    Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior). We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique. The mean age of the patients was 56 ± 13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6 ± 0.6 L) and FVC (2.0 ± 0.7 L) with maintenance of FEV1/FVC of 0.8 ± 0.2 in both groups. The maximum intra-abdominal pressure values were similar (p=0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed. Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.

  7. Submersion and acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2014-01-01

    Conclusions: Submersion patients who are hypothermic on arrival of emergency department (ED are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  8. Management of Postoperative Respiratory Failure.

    Science.gov (United States)

    Mulligan, Michael S; Berfield, Kathleen S; Abbaszadeh, Ryan V

    2015-11-01

    Despite best efforts, postoperative complications such as postoperative respiratory failure may occur and prompt recognition of the process and management is required. Postoperative respiratory failure, such as postoperative pneumonia, postpneumonectomy pulmonary edema, acute respiratory distress-like syndromes, and pulmonary embolism, are associated with high morbidity and mortality. The causes of these complications are multifactorial and depend on preoperative, intraoperative, and postoperative factors, some of which are modifiable. The article identifies some of the risk factors, causes, and treatment strategies for successful management of the patient with postoperative respiratory failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Does respiratory muscle training increase physical performance?

    Science.gov (United States)

    Sperlich, Billy; Fricke, Hannes; de Marées, Markus; Linville, John W; Mester, Joachim

    2009-09-01

    Special force units and military personnel undergo demanding physical exercise and might benefit from high-intensity respiratory muscle training (RMT) by increasing their endurance performance. This study examined the effects of a 6-week high-intensity RMT on running performance and oxygen uptake (VO2max) in a group of German Special Force Squad members. 17 participants were randomly assigned to a training or control group. Baseline and post-testing included a ramp test, as well as an incremental test on a treadmill, performed to physical exhaustion. VO2, respiratory exchange ratio, and heart rate were measured breath by breath. Furthermore, maximum running speed (V(max)), 4 mmol x 1(-1) lactate threshold (V4) and perception of respiratory effort were determined. During pulmonary testing, sustained maximum inspiratory and expiratory pressure (PI(max) and PE(max)) were obtained. RMT was performed daily at approximately 90% PI(max) for 6 weeks with 2 x 30 breath cycles using an Ultrabreathe lung trainer. No statistical differences were detected between the groups for any parameter after RMT. High-intensity RMT did not show any benefits on VO2max and endurance performance and are unlikely to be of benefit to military or paramilitary training programs for an increase in endurance performance.

  10. Respiratory diagnostic possibilities during closed circuit anesthesia.

    Science.gov (United States)

    Verkaaik, A P; Erdmann, W

    1990-01-01

    An automatic feed back controlled totally closed circuit system (Physioflex) has been developed for quantitative practice of inhalation anesthesia and ventilation. In the circuit system the gas is moved unidirectionally around by a blower at 70 l/min. In the system four membrane chambers are integrated for ventilation. Besides end-expiratory feed back control of inhalation anesthetics, and inspiratory closed loop control of oxygen, the system offers on-line registration of flow, volume and respiratory pressures as well as a capnogram and oxygen consumption. Alveolar ventilation and static compliance can easily be derived. On-line registration of oxygen consumption has proven to be of value for determination of any impairment of tissue oxygen supply when the oxygen delivery has dropped to critical values. Obstruction of the upper or lower airways are immediately detected and differentiated. Disregulations of metabolism, e.g. in malignant hyperthermia, are seen in a pre-crisis phase (increase of oxygen consumption and of CO2 production), and therapy can be started extremely early and before a disastrous condition has developed. Registration of compliance is only one of the continuously available parameters that guarantee a better and adequate control of lung function (e.g. atalectasis is early detected). The newly developed sophisticated anesthesia device enlarges tremendously the monitoring and respiratory diagnostic possibilities of artificial ventilation, gives new insights in the (patho)physiology and detects disturbances of respiratory parameters and metabolism in an early stage.

  11. Respiratory mass spectrometer

    Energy Technology Data Exchange (ETDEWEB)

    Mostert, J.W. (Pretoria Univ. (South Africa). Dept. of Anesthesiology)

    1983-06-01

    The high degree of technical perfection of the respiratory mass spectrometer has rendered the instrument feasible for routine monitoring of anesthetized patients. It is proposed that the difference between inspired and expired oxygen tension in mm Hg be equated with whole body oxygen consumption in ml/min/M/sup 2/ body-surface area at STPD, by the expedient of multiplying tension-differences by a factor of 2. Years of experience have confirmed the value of promptly recognizing sudden drops in this l/E tension difference below 50 mm Hg indicative of metabolic injury from hypovolemia or respiratory depression. Rises in l/E tension-differences were associated with shivering as well as voluntary muscle activity. Tension differences of less than 25 mm Hg (equated with a whole-body O/sub 2/ consumption of less than 50 ml O/sub 2//min/M/sup 2/) occurred in a patient in the sitting position for posterior fossa exploration without acidosis, hypoxia or hypotension for several hours prior to irreversible cardiac arrest. The value of clinical monitoring by mass spectrometry is especially impressive in open-heart surgery.

  12. The respiratory mass spectrometer

    International Nuclear Information System (INIS)

    Mostert, J.W.

    1983-01-01

    The high degree of technical perfection of the respiratory mass spectrometer has rendered the instrument feasible for routine monitoring of anesthetized patients. It is proposed that the difference between inspired and expired oxygen tension in mm Hg be equated with whole body oxygen consumption in ml/min/M 2 body-surface area at STPD, by the expedient of multiplying tension-differences by a factor of 2. Years of experience have confirmed the value of promptly recognizing sudden drops in this l/E tension difference below 50 mm Hg indicative of metabolic injury from hypovolemia or respiratory depression. Rises in l/E tension-differences were associated with shivering as well as voluntary muscle activity. Tension differences of less than 25 mm Hg (equated with a whole-body O 2 consumption of less than 50 ml O 2 /min/M 2 ) occurred in a patient in the sitting position for posterior fossa exploration without acidosis, hypoxia or hypotension for several hours prior to irreversible cardiac arrest. The value of clinical monitoring by mass spectrometry is especially impressive in open-heart surgery

  13. Respiratory symptoms of megaesophagus

    Directory of Open Access Journals (Sweden)

    Fabio Di Stefano

    2013-03-01

    Full Text Available Megaesophagus as the end result of achalasia is the consequence of disordered peristalsis and the slow decompensation of the esophageal muscular layer. The main symptoms of achalasia are dysphagia, regurgitation, chest pain and weight loss, but respiratory symptoms, such as coughing, particularly when patients lie in a horizontal position, may also be common due to microaspiration. A 70-year old woman suffered from a nocturnal cough and shortness of breath with stridor. She reported difficulty in swallowing food over the past ten years, but had adapted by eating a semi-liquid diet. Chest X-ray showed right hemithorax patchy opacities projecting from the posterior mediastinum. Chest computed tomography scan showed a marked dilatation of the esophagus with abundant food residues. Endoscopy confirmed the diagnosis of megaesophagus due to esophageal achalasia, excluding other causes of obstruction, such as secondary esophagitis, polyps, leiomyoma or leiomyosarcoma. In the elderly population, swallowing difficulties due to esophageal achalasia are often underestimated and less troublesome than the respiratory symptoms that are caused by microaspiration. The diagnosis of esophageal achalasia, although uncommon, should be considered in patients with nocturnal chronic coughs and shortness of breath with stridor when concomitant swallowing difficulties are present.

  14. Acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Marco Confalonieri

    2017-04-01

    Full Text Available Since its first description, the acute respiratory distress syndrome (ARDS has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in at-risk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care.

  15. Postactivation potentiation biases maximal isometric strength assessment.

    Science.gov (United States)

    Lima, Leonardo Coelho Rabello; Oliveira, Felipe Bruno Dias; Oliveira, Thiago Pires; Assumpção, Claudio de Oliveira; Greco, Camila Coelho; Cardozo, Adalgiso Croscato; Denadai, Benedito Sérgio

    2014-01-01

    Postactivation potentiation (PAP) is known to enhance force production. Maximal isometric strength assessment protocols usually consist of two or more maximal voluntary isometric contractions (MVCs). The objective of this study was to determine if PAP would influence isometric strength assessment. Healthy male volunteers (n = 23) performed two five-second MVCs separated by a 180-seconds interval. Changes in isometric peak torque (IPT), time to achieve it (tPTI), contractile impulse (CI), root mean square of the electromyographic signal during PTI (RMS), and rate of torque development (RTD), in different intervals, were measured. Significant increases in IPT (240.6 ± 55.7 N·m versus 248.9 ± 55.1 N·m), RTD (746 ± 152 N·m·s(-1) versus 727 ± 158 N·m·s(-1)), and RMS (59.1 ± 12.2% RMSMAX  versus 54.8 ± 9.4% RMSMAX) were found on the second MVC. tPTI decreased significantly on the second MVC (2373 ± 1200 ms versus 2784 ± 1226 ms). We conclude that a first MVC leads to PAP that elicits significant enhancements in strength-related variables of a second MVC performed 180 seconds later. If disconsidered, this phenomenon might bias maximal isometric strength assessment, overestimating some of these variables.

  16. Gain maximization in a probabilistic entanglement protocol

    Science.gov (United States)

    di Lorenzo, Antonio; Esteves de Queiroz, Johnny Hebert

    Entanglement is a resource. We can therefore define gain as a monotonic function of entanglement G (E) . If a pair with entanglement E is produced with probability P, the net gain is N = PG (E) - (1 - P) C , where C is the cost of a failed attempt. We study a protocol where a pair of quantum systems is produced in a maximally entangled state ρm with probability Pm, while it is produced in a partially entangled state ρp with the complementary probability 1 -Pm . We mix a fraction w of the partially entangled pairs with the maximally entangled ones, i.e. we take the state to be ρ = (ρm + wUlocρpUloc+) / (1 + w) , where Uloc is an appropriate unitary local operation designed to maximize the entanglement of ρ. This procedure on one hand reduces the entanglement E, and hence the gain, but on the other hand it increases the probability of success to P =Pm + w (1 -Pm) , therefore the net gain N may increase. There may be hence, a priori, an optimal value for w, the fraction of failed attempts that we mix in. We show that, in the hypothesis of a linear gain G (E) = E , even assuming a vanishing cost C -> 0 , the net gain N is increasing with w, therefore the best strategy is to always mix the partially entangled states. Work supported by CNPq, Conselho Nacional de Desenvolvimento Científico e Tecnológico, proc. 311288/2014-6, and by FAPEMIG, Fundação de Amparo à Pesquisa de Minas Gerais, proc. IC-FAPEMIG2016-0269 and PPM-00607-16.

  17. The Role of Heated Humidified High-flow Nasal Cannula as Noninvasive Respiratory Support in Neonates

    Directory of Open Access Journals (Sweden)

    Ke-Yun Chao

    2017-08-01

    Full Text Available Recently, heated humidified high-flow nasal cannula (HHHFNC has been introduced and applied as a noninvasive respiratory support in neonates. Although HHHFNC is widely used in neonates presenting with respiratory distress, the efficiency and safety when compared with nasal continuous positive airway pressure or noninvasive positive pressure ventilation are still controversial. This review aims to evaluate the performance and applications of HHHFNC in neonates.

  18. Maximizing percentage depletion in solid minerals

    International Nuclear Information System (INIS)

    Tripp, J.; Grove, H.D.; McGrath, M.

    1982-01-01

    This article develops a strategy for maximizing percentage depletion deductions when extracting uranium or other solid minerals. The goal is to avoid losing percentage depletion deductions by staying below the 50% limitation on taxable income from the property. The article is divided into two major sections. The first section is comprised of depletion calculations that illustrate the problem and corresponding solutions. The last section deals with the feasibility of applying the strategy and complying with the Internal Revenue Code and appropriate regulations. Three separate strategies or appropriate situations are developed and illustrated. 13 references, 3 figures, 7 tables

  19. What currency do bumble bees maximize?

    Directory of Open Access Journals (Sweden)

    Nicholas L Charlton

    2010-08-01

    Full Text Available In modelling bumble bee foraging, net rate of energetic intake has been suggested as the appropriate currency. The foraging behaviour of honey bees is better predicted by using efficiency, the ratio of energetic gain to expenditure, as the currency. We re-analyse several studies of bumble bee foraging and show that efficiency is as good a currency as net rate in terms of predicting behaviour. We suggest that future studies of the foraging of bumble bees should be designed to distinguish between net rate and efficiency maximizing behaviour in an attempt to discover which is the more appropriate currency.

  20. New Maximal Two-distance Sets

    DEFF Research Database (Denmark)

    Lisonek, Petr

    1996-01-01

    A two-distance set in E^d is a point set X inthe d-dimensional Euclidean spacesuch that the distances between distinct points in Xassume only two different non-zero values. Based on results from classical distance geometry, we developan algorithm to classify, for a given dimension, all maximal...... (largest possible)two-distance sets in E^d.Using this algorithm we have completed the full classificationfor all dimensions less than or equal to 7, andwe have found one set in E^8 whosemaximality follows from Blokhuis' upper bound on sizes of s-distance sets.While in the dimensions less than or equal to 6...

  1. Maximizing policy learning in international committees

    DEFF Research Database (Denmark)

    Nedergaard, Peter

    2007-01-01

    , this article demonstrates that valuable lessons can be learned about policy learning, in practice and theoretically, by analysing the cooperation in the OMC committees. Using the Advocacy Coalition Framework as the starting point of analysis, 15 hypotheses on policy learning are tested. Among other things......, it is concluded that in order to maximize policy learning in international committees, empirical data should be made available to committees and provided by sources close to the participants (i.e. the Commission). In addition, the work in the committees should be made prestigious in order to attract well...

  2. Pouliot type duality via a-maximization

    International Nuclear Information System (INIS)

    Kawano, Teruhiko; Ookouchi, Yutaka; Tachikawa, Yuji; Yagi, Futoshi

    2006-01-01

    We study four-dimensional N=1Spin(10) gauge theory with a single spinor and N Q vectors at the superconformal fixed point via the electric-magnetic duality and a-maximization. When gauge invariant chiral primary operators hit the unitarity bounds, we find that the theory with no superpotential is identical to the one with some superpotential at the infrared fixed point. The auxiliary field method in the electric theory offers a satisfying description of the infrared fixed point, which is consistent with the better picture in the magnetic theory. In particular, it gives a clear description of the emergence of new massless degrees of freedom in the electric theory

  3. Longitudinal modelling of respiratory symptoms in children

    Science.gov (United States)

    Schlink, Uwe; Fritz, Gisela; Herbarth, Olf; Richter, Matthias

    2002-08-01

    A panel of 277 children, aged 3-7 years, was used to study the association between air pollution (O3, SO2, NO2, and total suspended particles), meteorological factors (global radiation, maximum daytime temperature, daily averages of vapour pressure and air humidity) and respiratory symptoms. For 759 days the symptoms were recorded in a diary and modelling was based on a modification of the method proposed by Korn and Whittemore (Biometrics 35: 795-798, 1979). This approach (1) comprises an extension using environmental parameters at different time scales, (2) addresses the suitability of using the daily fraction of symptomatic individuals to account for inter-individual interactions and (3) enables the most significant weather effects to be identified. The resulting model consisted of (1) an individual specific intercept that takes account of the population's heterogeneity, (2) the individual's health status the day before, (3) a long-term meteorological effect, which may be either the squared temperature or global radiation in interaction with temperature, (4) the short-term effect of sulfur dioxide, and (5) the short-term effect of an 8-h ozone concentration above 60 µg/m3. Using the estimated parameters as input to a simulation study, we checked the quality of the model and demonstrate that the annual cycle of the prevalence of respiratory symptoms is associated to atmospheric covariates. Individuals suffering from allergy have been identified as a group of a particular susceptibility to ozone. The duration of respiratory symptoms appears to be free of scale and follows an exponential distribution function, which confirms that the symptom record of each individual follows a Poisson point-process. This supports the assumption that not only respiratory diseases, but also respiratory symptoms can be considered an independent measure for the health status of a population sample. Since a point process is described by only one parameter (namely the intensity of the

  4. Developing maximal neuromuscular power: part 2 - training considerations for improving maximal power production.

    Science.gov (United States)

    Cormie, Prue; McGuigan, Michael R; Newton, Robert U

    2011-02-01

    This series of reviews focuses on the most important neuromuscular function in many sport performances: the ability to generate maximal muscular power. Part 1, published in an earlier issue of Sports Medicine, focused on the factors that affect maximal power production while part 2 explores the practical application of these findings by reviewing the scientific literature relevant to the development of training programmes that most effectively enhance maximal power production. The ability to generate maximal power during complex motor skills is of paramount importance to successful athletic performance across many sports. A crucial issue faced by scientists and coaches is the development of effective and efficient training programmes that improve maximal power production in dynamic, multi-joint movements. Such training is referred to as 'power training' for the purposes of this review. Although further research is required in order to gain a deeper understanding of the optimal training techniques for maximizing power in complex, sports-specific movements and the precise mechanisms underlying adaptation, several key conclusions can be drawn from this review. First, a fundamental relationship exists between strength and power, which dictates that an individual cannot possess a high level of power without first being relatively strong. Thus, enhancing and maintaining maximal strength is essential when considering the long-term development of power. Second, consideration of movement pattern, load and velocity specificity is essential when designing power training programmes. Ballistic, plyometric and weightlifting exercises can be used effectively as primary exercises within a power training programme that enhances maximal power. The loads applied to these exercises will depend on the specific requirements of each particular sport and the type of movement being trained. The use of ballistic exercises with loads ranging from 0% to 50% of one-repetition maximum (1RM) and

  5. Prolonged lateral steep position impairs respiratory mechanics during continuous lateral rotation therapy in respiratory failure.

    Science.gov (United States)

    Schellongowski, Peter; Losert, Heidrun; Locker, Gottfried J; Laczika, Klaus; Frass, Michael; Holzinger, Ulrike; Bojic, Andja; Staudinger, Thomas

    2007-04-01

    To establish whether prolonged lateral steep position during continuous rotation therapy leads to improvement on pulmonary gas exchange, respiratory mechanics and hemodynamics. Prospective observational study. Intensive care unit of a university hospital. Twelve consecutive patients suffering from acute lung injury or adult respiratory distress syndrome undergoing continuous rotation therapy. Blood gas analysis, static lung compliance, blood pressure, cardiac index and pulmonary shunt fraction were measured in supine as well as in left and right lateral steep position at 62 degrees during continuous rotation therapy (phase I). Rotation was then stopped for 30 min with the patients in supine position, left and right lateral steep position, and the same measurements were performed every 10 min (phase II). Phase I and II revealed no significant changes in PaO(2)/FiO(2) ratio, mean arterial blood pressure, pulmonary shunt fraction, or cardiac index. Significantly lower static compliance was observed in lateral steep position than in supine position (pposition than in left and right lateral steep position (ppositioning impairs the compliance of the respiratory system. Prolonged lateral steep position does not lead to benefits with respect to oxygenation or hemodynamics. Individual response to the different positions is unpredictable. The pauses in "extreme" positions should be as short as possible.

  6. 10 CFR 850.28 - Respiratory protection.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Respiratory protection. 850.28 Section 850.28 Energy... Respiratory protection. (a) The responsible employer must establish a respiratory protection program that complies with the respiratory protection program requirements of 29 CFR 1910.134, Respiratory Protection...

  7. Monitoring of pulmonary mechanics in acute respiratory distress syndrome to titrate therapy.

    Science.gov (United States)

    Gattinoni, Luciano; Eleonora, Carlesso; Caironi, Pietro

    2005-06-01

    This paper reviews recent findings regarding the respiratory mechanics during acute respiratory distress syndrome as a tool for tailoring its ventilatory management. The pressure-volume curve has been used for many years as a descriptor of the respiratory mechanics in patients affected by acute respiratory distress syndrome. The use of the sigmoidal equation introduced by Venegas for the analysis of the pressure-volume curve seems to be the most rigorous mathematical approach to assessing lung mechanics. Increasing attention has been focused on the deflation limb for titration of positive end-expiratory pressure. Based on physiologic reasoning, a novel parameter, the stress index, has been proposed for tailoring a safe mechanical ventilation, although its clinical impact has still to be proved. Evidence has confirmed that a variety of underlying pathologies may lead to acute respiratory distress syndrome, making unrealistic any attempt to unify the ventilatory approach. Although extensively proposed to tailor mechanical ventilation during acute respiratory distress syndrome, there is no evidence that the pressure-volume curve may be useful in setting a lung-protective strategy in the presence of different potentials for recruitment. The Venegas approach should be the standard analysis of pressure-volume curves. In any patient, the potential for recruitment should be assessed, as a basis for tailoring the most effective mechanical ventilation. Further studies are needed to clarify the potential use of the pressure-volume curve to guide a lung-protective ventilatory strategy.

  8. Maximization techniques for oilfield development profits

    International Nuclear Information System (INIS)

    Lerche, I.

    1999-01-01

    In 1981 Nind provided a quantitative procedure for estimating the optimum number of development wells to emplace on an oilfield to maximize profit. Nind's treatment assumed that there was a steady selling price, that all wells were placed in production simultaneously, and that each well's production profile was identical and a simple exponential decline with time. This paper lifts these restrictions to allow for price fluctuations, variable with time emplacement of wells, and production rates that are more in line with actual production records than is a simple exponential decline curve. As a consequence, it is possible to design production rate strategies, correlated with price fluctuations, so as to maximize the present-day worth of a field. For price fluctuations that occur on a time-scale rapid compared to inflation rates it is appropriate to have production rates correlate directly with such price fluctuations. The same strategy does not apply for price fluctuations occurring on a time-scale long compared to inflation rates where, for small amplitudes in the price fluctuations, it is best to sell as much product as early as possible to overcome inflation factors, while for large amplitude fluctuations the best strategy is to sell product as early as possible but to do so mainly on price upswings. Examples are provided to show how these generalizations of Nind's (1981) formula change the complexion of oilfield development optimization. (author)

  9. Activation of respiratory muscles during weaning from mechanical ventilation.

    Science.gov (United States)

    Walterspacher, Stephan; Gückler, Julia; Pietsch, Fabian; Walker, David Johannes; Kabitz, Hans-Joachim; Dreher, Michael

    2017-04-01

    Respiratory muscle dysfunction is a key component of weaning failure. Balancing respiratory muscle loading and unloading by applying different ventilation modes along with spontaneous breathing episodes are established weaning strategies. However, the effects of body positioning on the respiratory muscles during weaning remains unclear. This study aimed at assessing respiratory drive by surface electromyography (EMG) of the diaphragm (EMG dia ) and parasternal muscles (EMG para ) in tracheotomized patients during prolonged weaning in 3 randomized body positions-supine, 30° semirecumbent, and 80° sitting-during mechanical ventilation and spontaneous breathing. Nine patients were included for analysis. Cardiorespiratory parameters (heart rate, blood pressure, arterial oxygen saturation, dyspnea) did not change under each condition (all P>.05). EMG para and EMG dia did not change under mechanical ventilation (both P>.05). EMG dia changed under spontaneous breathing from supine to sitting (0.45±0.26 vs 0.32±0.19; P=.012) and between semirecumbent to sitting (0.41±0.23 vs 0.32±0.19; P=.039), whereas EMG para did not change. This is the first study to show that body positioning influences respiratory drive to the diaphragm in tracheotomized patients with prolonged weaning from mechanical ventilation during unassisted breathing. Sitting position reduces respiratory drive compared with semirecumbent and supine positioning and might therefore be favored during spontaneous breathing trials. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition

    Directory of Open Access Journals (Sweden)

    Fu-Tai Wang

    2015-07-01

    Full Text Available Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD can decompose a signal into several intrinsic mode functions (IMFs that disclose nonstationary components as well as stationary components and, similarly, capture respiratory episodes from thoracic impedance. However, upper-body movements usually produce motion artifacts that are not easily removed by digital filtering. Moreover, large motion artifacts disable the EMD to decompose respiratory components. In this paper, motion artifacts are detected and replaced by the data mirrored from the prior and the posterior before EMD processing. A novel intrinsic respiratory reconstruction index that considers both global and local properties of IMFs is proposed to define respiration-related IMFs for respiration reconstruction and instantaneous respiratory estimation. Based on the experiments performing a series of static and dynamic physical activates, our results showed the proposed method had higher cross correlations between respiratory frequencies estimated from thoracic impedance and those from oronasal airflow based on small window size compared to the Fourier transform-based method.

  11. Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition.

    Science.gov (United States)

    Wang, Fu-Tai; Chan, Hsiao-Lung; Wang, Chun-Li; Jian, Hung-Ming; Lin, Sheng-Hsiung

    2015-07-07

    Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD) can decompose a signal into several intrinsic mode functions (IMFs) that disclose nonstationary components as well as stationary components and, similarly, capture respiratory episodes from thoracic impedance. However, upper-body movements usually produce motion artifacts that are not easily removed by digital filtering. Moreover, large motion artifacts disable the EMD to decompose respiratory components. In this paper, motion artifacts are detected and replaced by the data mirrored from the prior and the posterior before EMD processing. A novel intrinsic respiratory reconstruction index that considers both global and local properties of IMFs is proposed to define respiration-related IMFs for respiration reconstruction and instantaneous respiratory estimation. Based on the experiments performing a series of static and dynamic physical activates, our results showed the proposed method had higher cross correlations between respiratory frequencies estimated from thoracic impedance and those from oronasal airflow based on small window size compared to the Fourier transform-based method.

  12. A respiratory monitoring device based on clavicular motion

    International Nuclear Information System (INIS)

    Pitts, D G; Aspinall, R; Patel, M K; Lang, P-O; Sinclair, A J

    2013-01-01

    Respiratory rate is one of the key vital signs yet unlike temperature, heart rate or blood pressure, there is no simple and low cost measurement device for medical use. Here we discuss the development of a respiratory sensor based upon clavicular motion and the findings of a pilot study comparing respiratory rate readings derived from clavicular and thoracic motion with an expiratory breath flow reference sensor. Simultaneously sampled data from resting volunteers (n = 8) was analysed to determine the location of individual breaths in the data set and from these, breath periods and frequency were calculated. Clavicular sensor waveforms were found to be more consistent and of greater amplitude than those from the thoracic device, demonstrating good alignment with the reference waveform. On comparing breath by breath periods a close agreement was observed with the reference, with mean clavicular respiratory rate R 2 values of 0.89 (lateral) and 0.98 (longitudinal-axis). This pilot study demonstrates the viability of clavicular respiratory sensing. The sensor is unobtrusive, unaffected by bioelectrical or electrode problems and easier to determine and more consistent than thoracic motion sensing. With relatively basic signal conditioning and processing requirements, it could provide an ideal platform for a low-cost respiratory monitor. (note)

  13. Impact of membrane lung surface area and blood flow on extracorporeal CO2 removal during severe respiratory acidosis.

    Science.gov (United States)

    Karagiannidis, Christian; Strassmann, Stephan; Brodie, Daniel; Ritter, Philine; Larsson, Anders; Borchardt, Ralf; Windisch, Wolfram

    2017-12-01

    Veno-venous extracorporeal CO 2 removal (vv-ECCO 2 R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m 2 . The present study in an animal model with similar CO 2 production as an adult patient was aimed at determining the optimal membrane lung surface area and technical requirements for successful vv-ECCO 2 R. Four different membrane lungs, with varying lung surface areas of 0.4, 0.8, 1.0, and 1.3m 2 were used to perform vv-ECCO 2 R in seven anesthetized, mechanically ventilated, pigs with experimentally induced severe respiratory acidosis (pH 7.0-7.1) using a 20Fr double-lumen catheter with a sweep gas flow rate of 8 L/min. During each experiment, the blood flow was increased stepwise from 250 to 1000 ml/min. Amelioration of severe respiratory acidosis was only feasible when blood flow rates from 750 to 1000 ml/min were used with a membrane lung surface area of at least 0.8 m 2 . Maximal CO 2 elimination was 150.8 ml/min, with pH increasing from 7.01 to 7.30 (blood flow 1000 ml/min; membrane lung 1.3 m 2 ). The membrane lung with a surface of 0.4 m 2 allowed a maximum CO 2 elimination rate of 71.7 mL/min, which did not result in the normalization of pH, even with a blood flow rate of 1000 ml/min. Also of note, an increase of the surface area above 1.0 m 2 did not result in substantially higher CO 2 elimination rates. The pressure drop across the oxygenator was considerably lower (respiratory acidosis, irrespective of the surface area of the membrane lung being used. The converse was also true, low surface membrane lungs (0.4 m 2 ) were not capable of completely correcting severe respiratory acidosis across the range of blood flows used in this study.

  14. Respiratory muscle decline in Duchenne muscular dystrophy.

    Science.gov (United States)

    Khirani, Sonia; Ramirez, Adriana; Aubertin, Guillaume; Boulé, Michèle; Chemouny, Chrystelle; Forin, Véronique; Fauroux, Brigitte

    2014-05-01

    Duchenne muscular dystrophy (DMD) causes progressive respiratory muscle weakness. The aim of the study was to analyze the trend of a large number of respiratory parameters to gain further information on the course of the disease. Retrospective study. 48 boys with DMD, age range between 6 and 19 year old, who were followed in our multidisciplinary neuromuscular clinic between 2001 and 2011. Lung function, blood gases, respiratory mechanics, and muscle strength were measured during routine follow-up over a 10-year period. Only data from patients with at least two measurements were retained. The data of 28 patients were considered for analysis. Four parameters showed an important decline with age. Gastric pressure during cough (Pgas cough) was below normal in all patients with a mean decline of 5.7 ± 3.8 cmH2 O/year. Sniff nasal inspiratory pressure (SNIP) tended to increase first followed by a rapid decline (mean decrease 4.8 ± 4.9 cmH2 O; 5.2 ± 4.4% predicted/year). Absolute forced vital capacity (FVC) values peaked around the age of 13-14 years and remained mainly over 1 L but predicted values showed a mean 4.1 ± 4.4% decline/year. Diaphragmatic tension-time index (TTdi) increased above normal values after the age of 14 years with a mean increase of 0.04 ± 0.04 point/year. This study confirms the previous findings that FVC and SNIP are among the most important parameters to monitor the evolution of DMD. Expiratory muscle strength, assessed by Pgas cough, and the endurance index, TTdi, which are reported for the first time in a large cohort, appeared to be informative too, even though measured through an invasive method. © 2013 Wiley Periodicals, Inc.

  15. Doping and respiratory system.

    Science.gov (United States)

    Casali, L; Pinchi, G; Puxeddu, E

    2007-03-01

    Historically many different drugs have been used to enhance sporting performances. The magic elixir is still elusive and the drugs are still used despite the heavy adverse effects. The respiratory system is regularly involved in this research probably because of its central location in the body with several connections to the cardiovascular system. Moreover people are aware that O2 consumption and its delivery to mitochondria firstly depend on ventilation and on the respiratory exchanges. The second step consists in the tendency to increase V'O2 max and to prolong its availability with the aim of improving the endurance time and to relieve the fatigue. Many methods and substances had been used in order to gain an artificial success. Additional oxygen, autologous and homologous transfusion and erythropoietin, mainly the synthetic type, have been administered with the aim of increasing the amount of oxygen being delivered to the tissues. Some compounds like stimulants and caffeine are endowed of excitatory activity on the CNS and stimulate pulmonary ventilation. They did not prove to have any real activity in supporting the athletic performances. Beta-adrenergic drugs, particularly clenbuterol, when administered orally or parenterally develop a clear illicit activity on the myosin fibres and on the muscles as a whole. Salbutamol, terbutaline, salmeterol and formoterol are legally admitted when administrated by MDI in the treatment of asthma. The prevalence of asthma and bronchial hyperactivity is higher in athletes than amongst the general population. This implies that clear rules must be provided to set a correct diagnosis of asthma in the athletes and a correct therapy to align with the actual guidelines according to the same rights of the "other" asthmatic patients.

  16. Evaluation of respiratory muscles activity by means of cross mutual information function at different levels of ventilatory effort.

    Science.gov (United States)

    Alonso, Joan Francesc; Mañanas, Miguel A; Hoyer, Dirk; Topor, Zbigniew L; Bruce, Eugene N

    2007-09-01

    Analysis of respiratory muscles activity is an effective technique for the study of pulmonary diseases such as obstructive sleep apnea syndrome (OSAS). Respiratory diseases, especially those associated with changes in the mechanical properties of the respiratory apparatus, are often associated with disruptions of the normally highly coordinated contractions of respiratory muscles. Due to the complexity of the respiratory control, the assessment of OSAS related dysfunctions by linear methods are not sufficient. Therefore, the objective of this study was the detection of diagnostically relevant nonlinear complex respiratory mechanisms. Two aims of this work were: (1) to assess coordination of respiratory muscles contractions through evaluation of interactions between respiratory signals and myographic signals through nonlinear analysis by means of cross mutual information function (CMIF); (2) to differentiate between functioning of respiratory muscles in patients with OSAS and in normal subjects. Electromyographic (EMG) and mechanomyographic (MMG) signals were recorded from three respiratory muscles: genioglossus, sternomastoid and diaphragm. Inspiratory pressure and flow were also acquired. All signals were measured in eight patients with OSAS and eight healthy subjects during an increased respiratory effort while awake. Several variables were defined and calculated from CMIF in order to describe correlation between signals. The results indicate different nonlinear couplings of respiratory muscles in both populations. This effect is progressively more evident at higher levels of respiratory effort.

  17. Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis

    Science.gov (United States)

    ... Home » Health Info » Voice, Speech, and Language Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis On this page: What ... find additional information about RRP? What is recurrent respiratory papillomatosis? Recurrent respiratory papillomatosis (RRP) is a disease ...

  18. Is recurrent respiratory infection associated with allergic respiratory disease?

    Science.gov (United States)

    de Oliveira, Tiago Bittencourt; Klering, Everton Andrei; da Veiga, Ana Beatriz Gorini

    2018-03-13

    Respiratory infections cause high morbidity and mortality worldwide. This study aims to estimate the relationship between allergic respiratory diseases with the occurrence of recurrent respiratory infection (RRI) in children and adolescents. The International Study of Asthma and Allergies in Childhood questionnaire and a questionnaire that provides data on the history of respiratory infections and the use of antibiotics were used to obtain data from patients. The relationship between the presence of asthma or allergic rhinitis and the occurrence of respiratory infections in childhood was analyzed. We interviewed the caregivers of 531 children aged 0 to 15 years. The average age of participants was 7.43 years, with females accounting for 52.2%. This study found significant relationship between: presence of asthma or allergic rhinitis with RRI, with prevalence ratio (PR) of 2.47 (1.51-4.02) and 1.61 (1.34-1.93), respectively; respiratory allergies with use of antibiotics for respiratory problems, with PR of 5.32 (2.17-13.0) for asthma and of 1.64 (1.29-2.09) for allergic rhinitis; asthma and allergic rhinitis with diseases of the lower respiratory airways, with PR of 7.82 (4.63-13.21) and 1.65 (1.38-1.96), respectively. In contrast, no relationship between upper respiratory airway diseases and asthma and allergic rhinitis was observed, with PR of 0.71 (0.35-1.48) and 1.30 (0.87-1.95), respectively. RRI is associated with previous atopic diseases, and these conditions should be considered when treating children.

  19. Shareholder, stakeholder-owner or broad stakeholder maximization

    DEFF Research Database (Denmark)

    Mygind, Niels

    2004-01-01

    With reference to the discussion about shareholder versus stakeholder maximization it is argued that the normal type of maximization is in fact stakeholder-owner maxi-mization. This means maximization of the sum of the value of the shares and stake-holder benefits belonging to the dominating...... including the shareholders of a company. Although it may be the ultimate goal for Corporate Social Responsibility to achieve this kind of maximization, broad stakeholder maximization is quite difficult to give a precise definition. There is no one-dimensional measure to add different stakeholder benefits...... not traded on the mar-ket, and therefore there is no possibility for practical application. Broad stakeholder maximization instead in practical applications becomes satisfying certain stakeholder demands, so that the practical application will be stakeholder-owner maximization un-der constraints defined...

  20. Primordial two-component maximally symmetric inflation

    Science.gov (United States)

    Enqvist, K.; Nanopoulos, D. V.; Quirós, M.; Kounnas, C.

    1985-12-01

    We propose a two-component inflation model, based on maximally symmetric supergravity, where the scales of reheating and the inflation potential at the origin are decoupled. This is possible because of the second-order phase transition from SU(5) to SU(3)×SU(2)×U(1) that takes place when φ≅φcinflation at the global minimum, and leads to a reheating temperature TR≅(1015-1016) GeV. This makes it possible to generate baryon asymmetry in the conventional way without any conflict with experimental data on proton lifetime. The mass of the gravitinos is m3/2≅1012 GeV, thus avoiding the gravitino problem. Monopoles are diluted by residual inflation in the broken phase below the cosmological bounds if φcUSA.

  1. Distributed-Memory Fast Maximal Independent Set

    Energy Technology Data Exchange (ETDEWEB)

    Kanewala Appuhamilage, Thejaka Amila J.; Zalewski, Marcin J.; Lumsdaine, Andrew

    2017-09-13

    The Maximal Independent Set (MIS) graph problem arises in many applications such as computer vision, information theory, molecular biology, and process scheduling. The growing scale of MIS problems suggests the use of distributed-memory hardware as a cost-effective approach to providing necessary compute and memory resources. Luby proposed four randomized algorithms to solve the MIS problem. All those algorithms are designed focusing on shared-memory machines and are analyzed using the PRAM model. These algorithms do not have direct efficient distributed-memory implementations. In this paper, we extend two of Luby’s seminal MIS algorithms, “Luby(A)” and “Luby(B),” to distributed-memory execution, and we evaluate their performance. We compare our results with the “Filtered MIS” implementation in the Combinatorial BLAS library for two types of synthetic graph inputs.

  2. Quench dynamics of topological maximally entangled states.

    Science.gov (United States)

    Chung, Ming-Chiang; Jhu, Yi-Hao; Chen, Pochung; Mou, Chung-Yu

    2013-07-17

    We investigate the quench dynamics of the one-particle entanglement spectra (OPES) for systems with topologically nontrivial phases. By using dimerized chains as an example, it is demonstrated that the evolution of OPES for the quenched bipartite systems is governed by an effective Hamiltonian which is characterized by a pseudospin in a time-dependent pseudomagnetic field S(k,t). The existence and evolution of the topological maximally entangled states (tMESs) are determined by the winding number of S(k,t) in the k-space. In particular, the tMESs survive only if nontrivial Berry phases are induced by the winding of S(k,t). In the infinite-time limit the equilibrium OPES can be determined by an effective time-independent pseudomagnetic field Seff(k). Furthermore, when tMESs are unstable, they are destroyed by quasiparticles within a characteristic timescale in proportion to the system size.

  3. Maximizing policy learning in international committees

    DEFF Research Database (Denmark)

    Nedergaard, Peter

    2007-01-01

    , this article demonstrates that valuable lessons can be learned about policy learning, in practice and theoretically, by analysing the cooperation in the OMC committees. Using the Advocacy Coalition Framework as the starting point of analysis, 15 hypotheses on policy learning are tested. Among other things......In the voluminous literature on the European Union's open method of coordination (OMC), no one has hitherto analysed on the basis of scholarly examination the question of what contributes to the learning processes in the OMC committees. On the basis of a questionnaire sent to all participants......, it is concluded that in order to maximize policy learning in international committees, empirical data should be made available to committees and provided by sources close to the participants (i.e. the Commission). In addition, the work in the committees should be made prestigious in order to attract well...

  4. Lovelock black holes with maximally symmetric horizons

    Energy Technology Data Exchange (ETDEWEB)

    Maeda, Hideki; Willison, Steven; Ray, Sourya, E-mail: hideki@cecs.cl, E-mail: willison@cecs.cl, E-mail: ray@cecs.cl [Centro de Estudios CientIficos (CECs), Casilla 1469, Valdivia (Chile)

    2011-08-21

    We investigate some properties of n( {>=} 4)-dimensional spacetimes having symmetries corresponding to the isometries of an (n - 2)-dimensional maximally symmetric space in Lovelock gravity under the null or dominant energy condition. The well-posedness of the generalized Misner-Sharp quasi-local mass proposed in the past study is shown. Using this quasi-local mass, we clarify the basic properties of the dynamical black holes defined by a future outer trapping horizon under certain assumptions on the Lovelock coupling constants. The C{sup 2} vacuum solutions are classified into four types: (i) Schwarzschild-Tangherlini-type solution; (ii) Nariai-type solution; (iii) special degenerate vacuum solution; and (iv) exceptional vacuum solution. The conditions for the realization of the last two solutions are clarified. The Schwarzschild-Tangherlini-type solution is studied in detail. We prove the first law of black-hole thermodynamics and present the expressions for the heat capacity and the free energy.

  5. MAXIMIZING THE BENEFITS OF ERP SYSTEMS

    Directory of Open Access Journals (Sweden)

    Paulo André da Conceição Menezes

    2010-04-01

    Full Text Available The ERP (Enterprise Resource Planning systems have been consolidated in companies with different sizes and sectors, allowing their real benefits to be definitively evaluated. In this study, several interactions have been studied in different phases, such as the strategic priorities and strategic planning defined as ERP Strategy; business processes review and the ERP selection in the pre-implementation phase, the project management and ERP adaptation in the implementation phase, as well as the ERP revision and integration efforts in the post-implementation phase. Through rigorous use of case study methodology, this research led to developing and to testing a framework for maximizing the benefits of the ERP systems, and seeks to contribute for the generation of ERP initiatives to optimize their performance.

  6. Maximal energy extraction under discrete diffusive exchange

    Energy Technology Data Exchange (ETDEWEB)

    Hay, M. J., E-mail: hay@princeton.edu [Department of Astrophysical Sciences, Princeton University, Princeton, New Jersey 08544 (United States); Schiff, J. [Department of Mathematics, Bar-Ilan University, Ramat Gan 52900 (Israel); Fisch, N. J. [Department of Astrophysical Sciences, Princeton University, Princeton, New Jersey 08544 (United States); Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543 (United States)

    2015-10-15

    Waves propagating through a bounded plasma can rearrange the densities of states in the six-dimensional velocity-configuration phase space. Depending on the rearrangement, the wave energy can either increase or decrease, with the difference taken up by the total plasma energy. In the case where the rearrangement is diffusive, only certain plasma states can be reached. It turns out that the set of reachable states through such diffusive rearrangements has been described in very different contexts. Building upon those descriptions, and making use of the fact that the plasma energy is a linear functional of the state densities, the maximal extractable energy under diffusive rearrangement can then be addressed through linear programming.

  7. Maximizing profitability in a hospital outpatient pharmacy.

    Science.gov (United States)

    Jorgenson, J A; Kilarski, J W; Malatestinic, W N; Rudy, T A

    1989-07-01

    This paper describes the strategies employed to increase the profitability of an existing ambulatory pharmacy operated by the hospital. Methods to generate new revenue including implementation of a home parenteral therapy program, a home enteral therapy program, a durable medical equipment service, and home care disposable sales are described. Programs to maximize existing revenue sources such as increasing the capture rate on discharge prescriptions, increasing "walk-in" prescription traffic and increasing HMO prescription volumes are discussed. A method utilized to reduce drug expenditures is also presented. By minimizing expenses and increasing the revenues for the ambulatory pharmacy operation, net profit increased from +26,000 to over +140,000 in one year.

  8. Maximizing the benefits of a dewatering system

    International Nuclear Information System (INIS)

    Matthews, P.; Iverson, T.S.

    1999-01-01

    The use of dewatering systems in the mining, industrial sludge and sewage waste treatment industries is discussed, also describing some of the problems that have been encountered while using drilling fluid dewatering technology. The technology is an acceptable drilling waste handling alternative but it has had problems associated with recycled fluid incompatibility, high chemical costs and system inefficiencies. This paper discussed the following five action areas that can maximize the benefits and help reduce costs of a dewatering project: (1) co-ordinate all services, (2) choose equipment that fits the drilling program, (3) match the chemical treatment with the drilling fluid types, (4) determine recycled fluid compatibility requirements, and (5) determine the disposal requirements before project start-up. 2 refs., 5 figs

  9. Mixtures of maximally entangled pure states

    Energy Technology Data Exchange (ETDEWEB)

    Flores, M.M., E-mail: mflores@nip.up.edu.ph; Galapon, E.A., E-mail: eric.galapon@gmail.com

    2016-09-15

    We study the conditions when mixtures of maximally entangled pure states remain entangled. We found that the resulting mixed state remains entangled when the number of entangled pure states to be mixed is less than or equal to the dimension of the pure states. For the latter case of mixing a number of pure states equal to their dimension, we found that the mixed state is entangled provided that the entangled pure states to be mixed are not equally weighted. We also found that one can restrict the set of pure states that one can mix from in order to ensure that the resulting mixed state is genuinely entangled. Also, we demonstrate how these results could be applied as a way to detect entanglement in mixtures of the entangled pure states with noise.

  10. Maximally reliable Markov chains under energy constraints.

    Science.gov (United States)

    Escola, Sean; Eisele, Michael; Miller, Kenneth; Paninski, Liam

    2009-07-01

    Signal-to-noise ratios in physical systems can be significantly degraded if the outputs of the systems are highly variable. Biological processes for which highly stereotyped signal generations are necessary features appear to have reduced their signal variabilities by employing multiple processing steps. To better understand why this multistep cascade structure might be desirable, we prove that the reliability of a signal generated by a multistate system with no memory (i.e., a Markov chain) is maximal if and only if the system topology is such that the process steps irreversibly through each state, with transition rates chosen such that an equal fraction of the total signal is generated in each state. Furthermore, our result indicates that by increasing the number of states, it is possible to arbitrarily increase the reliability of the system. In a physical system, however, an energy cost is associated with maintaining irreversible transitions, and this cost increases with the number of such transitions (i.e., the number of states). Thus, an infinite-length chain, which would be perfectly reliable, is infeasible. To model the effects of energy demands on the maximally reliable solution, we numerically optimize the topology under two distinct energy functions that penalize either irreversible transitions or incommunicability between states, respectively. In both cases, the solutions are essentially irreversible linear chains, but with upper bounds on the number of states set by the amount of available energy. We therefore conclude that a physical system for which signal reliability is important should employ a linear architecture, with the number of states (and thus the reliability) determined by the intrinsic energy constraints of the system.

  11. Dysrhythmias of the respiratory oscillator

    Science.gov (United States)

    Paydarfar, David; Buerkel, Daniel M.

    1995-03-01

    Breathing is regulated by a central neural oscillator that produces rhythmic output to the respiratory muscles. Pathological disturbances in rhythm (dysrhythmias) are observed in the breathing pattern of children and adults with neurological and cardiopulmonary diseases. The mechanisms responsible for genesis of respiratory dysrhythmias are poorly understood. The present studies take a novel approach to this problem. The basic postulate is that the rhythm of the respiratory oscillator can be altered by a variety of stimuli. When the oscillator recovers its rhythm after such perturbations, its phase may be reset relative to the original rhythm. The amount of phase resetting is dependent upon stimulus parameters and the level of respiratory drive. The long-range hypothesis is that respiratory dysrhythmias can be induced by stimuli that impinge upon or arise within the respiratory oscillator with certain combinations of strength and timing relative to the respiratory cycle. Animal studies were performed in anesthetized or decerebrate preparations. Neural respiratory rhythmicity is represented by phrenic nerve activity, allowing use of open-loop experimental conditions which avoid negative chemical feedback associated with changes in ventilation. In animal experiments, respiratory dysrhythmias can be induced by stimuli having specific combinations of strength and timing. Newborn animals readily exhibit spontaneous dysrhythmias which become more prominent at lower respiratory drives. In human subjects, swallowing was studied as a physiological perturbation of respiratory rhythm, causing a pattern of phase resetting that is characterized topologically as type 0. Computational studies of the Bonhoeffer-van der Pol (BvP) equations, whose qualitative behavior is representative of many excitable systems, supports a unified interpretation of these experimental findings. Rhythmicity is observed when the BvP model exhibits recurrent periods of excitation alternating with

  12. A Criterion to Identify Maximally Entangled Four-Qubit State

    International Nuclear Information System (INIS)

    Zha Xinwei; Song Haiyang; Feng Feng

    2011-01-01

    Paolo Facchi, et al. [Phys. Rev. A 77 (2008) 060304(R)] presented a maximally multipartite entangled state (MMES). Here, we give a criterion for the identification of maximally entangled four-qubit states. Using this criterion, we not only identify some existing maximally entangled four-qubit states in the literature, but also find several new maximally entangled four-qubit states as well. (general)

  13. Maximal lattice free bodies, test sets and the Frobenius problem

    DEFF Research Database (Denmark)

    Jensen, Anders Nedergaard; Lauritzen, Niels; Roune, Bjarke Hammersholt

    Maximal lattice free bodies are maximal polytopes without interior integral points. Scarf initiated the study of maximal lattice free bodies relative to the facet normals in a fixed matrix. In this paper we give an efficient algorithm for computing the maximal lattice free bodies of an integral m...... method is inspired by the novel algorithm by Einstein, Lichtblau, Strzebonski and Wagon and the Groebner basis approach by Roune....

  14. Respiratory Muscle Training and Exercise Endurance at Altitude.

    Science.gov (United States)

    Helfer, Samuel; Quackenbush, Joseph; Fletcher, Michael; Pendergast, David R

    2016-08-01

    Climbing and trekking at altitude are common recreational and military activities. Physiological effects of altitude are hypoxia and hyperventilation. The hyperventilatory response to altitude may cause respiratory muscle fatigue and reduce sustained submaximal exercise. Voluntary isocapnic hyperpnea respiratory muscle training (VIHT) improves exercise endurance at sea level and at depth. The purpose of this study was to test the hypothesis that VIHT would improve exercise time at altitude [3600 m (11,811 ft)] compared to control and placebo groups. Subjects pedaled an ergometer until exhaustion at simulated altitude in a hypobaric chamber while noninvasive arterial saturation (Sao2), ventilation (VE), and oxygen consumption (Vo2) were measured. As expected, Sao2 decreased to 88 ± 4% saturation at rest and to 81 ± 2% during exercise, and was not affected by VIHT. VIHT resulted in a 40% increase in maximal training VE compared to pre-VIHT. Exercise endurance significantly increased 44% after VIHT (P = altitude post-VIHT increased more (49%) for longer (21 min) and decreased less (11% at 25.4 ± 6.7 min). VIHT improved exercise time at altitude and sustained VE. This suggests that VIHT reduced respiratory muscle fatigue and would be useful to trekkers and military personnel working at altitude. Helfer S, Quackenbush J, Fletcher M, Pendergast DR. Respiratory muscle training and exercise endurance at altitutde. Aerosp Med Hum Perform. 2016; 87(8):704-711.

  15. Atorvastatin affects negatively respiratory function of isolated endothelial mitochondria.

    Science.gov (United States)

    Broniarek, Izabela; Jarmuszkiewicz, Wieslawa

    2018-01-01

    The purpose of this research was to elucidate the direct effects of two popular blood cholesterol-lowering drugs used to treat cardiovascular diseases, atorvastatin and pravastatin, on respiratory function, membrane potential, and reactive oxygen species formation in mitochondria isolated from human umbilical vein endothelial cells (EA.hy926 cell line). Hydrophilic pravastatin did not significantly affect endothelial mitochondria function. In contrast, hydrophobic calcium-containing atorvastatin induced a loss of outer mitochondrial membrane integrity, an increase in hydrogen peroxide formation, and reductions in maximal (phosphorylating or uncoupled) respiratory rate, membrane potential and oxidative phosphorylation efficiency. The atorvastatin-induced changes indicate an impairment of mitochondrial function at the level of ATP synthesis and at the level of the respiratory chain, likely at complex I and complex III. The atorvastatin action on endothelial mitochondria was highly dependent on calcium ions and led to a disturbance in mitochondrial calcium homeostasis. Uptake of calcium ions included in atorvastatin molecule induced mitochondrial uncoupling that enhanced the inhibition of the mitochondrial respiratory chain by atorvastatin. Our results indicate that hydrophobic calcium-containing atorvastatin, widely used as anti-atherosclerotic agent, has a direct negative action on isolated endothelial mitochondria. Copyright © 2017. Published by Elsevier Inc.

  16. Non-invasive measure of respiratory mechanics and conventional respiratory parameters in conscious large animals by high frequency Airwave Oscillometry.

    Science.gov (United States)

    Bassett, Leanne; Troncy, Eric; Robichaud, Annette; Schuessler, Thomas F; Pouliot, Mylène; Ascah, Alexis; Authier, Simon

    2014-01-01

    A number of drugs in clinical trials are discontinued due to potentially life-threatening airway obstruction. As some drugs may not cause changes in core battery parameters such as tidal volume (Vt), respiratory rate (RR) or minute ventilation (MV), including measurements of respiratory mechanics in safety pharmacology studies represents an opportunity for design refinement. The present study aimed to test a novel non-invasive methodology to concomitantly measure respiratory system resistance (Rrs) and conventional respiratory parameters (Vt, RR, MV) in conscious Beagle dogs and cynomolgus monkeys. An Airwave Oscillometry system (tremoFlo; THORASYS Inc., Montreal, Canada) was used to concomitantly assess Rrs and conventional respiratory parameters before and after intravenous treatment with a bronchoactive agent. Respiratory mechanics measurements were performed by applying a short (i.e. 16s) single high frequency (19Hz) waveform at the subject's airway opening via a face mask. During measurements, pressure and flow signals were recorded. After collection of baseline measurements, methacholine was administered intravenously to Beagle dogs (n=6) and cynomolgus monkeys (n=4) at 8 and 68μg/kg, respectively. In dogs, methacholine induced significant increases in Vt, RR and MV while in monkeys, it only augmented RR. A significant increase in Rrs was observed after methacholine administration in both species with mean percentage peak increases from baseline of 88 (53)% for dogs and 28 (16)% for cynomolgus monkeys. Airwave Oscillometry appears to be a promising non-invasive methodology to enable respiratory mechanics measurements in conscious large animals, a valuable refinement in respiratory safety pharmacology. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Respiratory muscle involvement in sarcoidosis.

    Science.gov (United States)

    Schreiber, Tina; Windisch, Wolfram

    2018-07-01

    In sarcoidosis, muscle involvement is common, but mostly asymptomatic. Currently, little is known about respiratory muscle and diaphragm involvement and function in patients with sarcoidosis. Reduced inspiratory muscle strength and/or a reduced diaphragm function may contribute to exertional dyspnea, fatigue and reduced health-related quality of life. Previous studies using volitional and non-volitional tests demonstrated a reduced inspiratory muscle strength in sarcoidosis compared to control subjects, and also showed that respiratory muscle function may even be significantly impaired in a subset of patients. Areas covered: This review examines the evidence on respiratory muscle involvement and its implications in sarcoidosis with emphasis on pathogenesis, diagnosis and treatment of respiratory muscle dysfunction. The presented evidence was identified by a literature search performed in PubMed and Medline for articles about respiratory and skeletal muscle function in sarcoidosis through to January 2018. Expert commentary: Respiratory muscle involvement in sarcoidosis is an underdiagnosed condition, which may have an important impact on dyspnea and health-related quality of life. Further studies are needed to understand the etiology, pathogenesis and extent of respiratory muscle involvement in sarcoidosis.

  18. Use of Respiratory Support in the Biphase Ventilation Airway Mode in the Newborn

    OpenAIRE

    S. N. Koval; A. Ye. Kulagin

    2006-01-01

    Biphasic positive airway pressure (BIPAP) (also known as DuoPAP, BiLevel, BiVent, PCV+, SPAP) is a mode of ventilation with cycling variations between two continuous positive airway pressure levels. It is a mixture of pressure controlled ventilation and spontaneous breathing, which is unrestricted in each phase of the respiratory cycle. The volume displacement caused by the difference between Phigh and Plow airway pressure level. The phase time ratio (PTR — the BIPAP frequency) is calculated ...

  19. Evaluation of respiratory conditions in early phase of hematopoietic stem cell transplantation Avaliação das condições respiratórias na fase inicial do transplante de células tronco hematopoiéticas

    Directory of Open Access Journals (Sweden)

    Eliane Aparecida Bom

    2012-01-01

    Full Text Available OBJECTIVE: To investigate the effectiveness of respiratory physiotherapy based on clinical evidence and analyze the improvement in respiratory parameters. METHODS: A prospective study was carried out in the Bone Marrow Transplant Unit of the Universidade Estadual de Campinas (UNICAMP. Two different previously established respiratory physiotherapy protocols were applied from days D-1 to D+7 that aimed to improve airway clearance, pulmonary re-expansion and the strengthening of respiratory muscles. Group A were subjected to diaphragmatic proprioceptive stimulation, breathing exercises, incentive spirometry with Respiron®, inspiratory muscle training with the Threshold® Inspiratory Muscle Training device, bronchial hygienization with Shaker® and cough stimulation. Group B performed a protocol that only used incentive spirometry. The parameters analyzed were: tidal volume, minute volume, maximal inspiratory pressure, maximal expiratory pressure, oxygen saturation, heart rate and respiratory frequency. RESULTS: Sixty-seven patients submitted to myeloablative hematopoietic stem cell transplantation were included in this study. Among these, thirty-nine were evaluated and randomized in the two groups. There were significant differences between the groups for tidal volume at D+2 (p-value = 0.007 and maximal inspiratory pressure (p-value = 0.03, maximal expiratory pressure (p-value = 0.03 and tidal volume (p-value = 0.004 at D+7. CONCLUSION: On comparing Group A with Group B, the authors concluded that the protocol of respiratory physiotherapy applied in this study resulted in an improvement in ventilation and in respiratory muscle strength of patients submitted to hematopoietic stem cell transplantation.OBJETIVO: investigar a eficácia da fisioterapia respiratória (FR baseada em evidência clínica e nos parâmetros respiratórios. Estudo prospectivo realizado na Unidade de Transplante de Medula Óssea da Universidade Estadual de Campinas. Dois

  20. Auscultation of the respiratory system

    Science.gov (United States)

    Sarkar, Malay; Madabhavi, Irappa; Niranjan, Narasimhalu; Dogra, Megha

    2015-01-01

    Auscultation of the lung is an important part of the respiratory examination and is helpful in diagnosing various respiratory disorders. Auscultation assesses airflow through the trachea-bronchial tree. It is important to distinguish normal respiratory sounds from abnormal ones for example crackles, wheezes, and pleural rub in order to make correct diagnosis. It is necessary to understand the underlying pathophysiology of various lung sounds generation for better understanding of disease processes. Bedside teaching should be strengthened in order to avoid erosion in this age old procedure in the era of technological explosion. PMID:26229557

  1. Auscultation of the respiratory system

    Directory of Open Access Journals (Sweden)

    Malay Sarkar

    2015-01-01

    Full Text Available Auscultation of the lung is an important part of the respiratory examination and is helpful in diagnosing various respiratory disorders. Auscultation assesses airflow through the trachea-bronchial tree. It is important to distinguish normal respiratory sounds from abnormal ones for example crackles, wheezes, and pleural rub in order to make correct diagnosis. It is necessary to understand the underlying pathophysiology of various lung sounds generation for better understanding of disease processes. Bedside teaching should be strengthened in order to avoid erosion in this age old procedure in the era of technological explosion.

  2. Higher levels of spontaneous breathing reduce lung injury in experimental moderate acute respiratory distress syndrome.

    Science.gov (United States)

    Carvalho, Nadja C; Güldner, Andreas; Beda, Alessandro; Rentzsch, Ines; Uhlig, Christopher; Dittrich, Susanne; Spieth, Peter M; Wiedemann, Bärbel; Kasper, Michael; Koch, Thea; Richter, Torsten; Rocco, Patricia R; Pelosi, Paolo; de Abreu, Marcelo Gama

    2014-11-01

    To assess the effects of different levels of spontaneous breathing during biphasic positive airway pressure/airway pressure release ventilation on lung function and injury in an experimental model of moderate acute respiratory distress syndrome. Multiple-arm randomized experimental study. University hospital research facility. Thirty-six juvenile pigs. Pigs were anesthetized, intubated, and mechanically ventilated. Moderate acute respiratory distress syndrome was induced by repetitive saline lung lavage. Biphasic positive airway pressure/airway pressure release ventilation was conducted using the airway pressure release ventilation mode with an inspiratory/expiratory ratio of 1:1. Animals were randomly assigned to one of four levels of spontaneous breath in total minute ventilation (n = 9 per group, 6 hr each): 1) biphasic positive airway pressure/airway pressure release ventilation, 0%; 2) biphasic positive airway pressure/airway pressure release ventilation, > 0-30%; 3) biphasic positive airway pressure/airway pressure release ventilation, > 30-60%, and 4) biphasic positive airway pressure/airway pressure release ventilation, > 60%. The inspiratory effort measured by the esophageal pressure time product increased proportionally to the amount of spontaneous breath and was accompanied by improvements in oxygenation and respiratory system elastance. Compared with biphasic positive airway pressure/airway pressure release ventilation of 0%, biphasic positive airway pressure/airway pressure release ventilation more than 60% resulted in lowest venous admixture, as well as peak and mean airway and transpulmonary pressures, redistributed ventilation to dependent lung regions, reduced the cumulative diffuse alveolar damage score across lungs (median [interquartile range], 11 [3-40] vs 18 [2-69]; p ventilation more than 0-30% and more than 30-60% showed a less consistent pattern of improvement in lung function, inflammation, and damage compared with biphasic positive airway

  3. Evaluation of Respiratory Muscle Strength in the Acute Phase of Stroke: The Role of Aging and Anthropometric Variables.

    Science.gov (United States)

    Luvizutto, Gustavo José; Dos Santos, Maria Regina Lopes; Sartor, Lorena Cristina Alvarez; da Silva Rodrigues, Josiela Cristina; da Costa, Rafael Dalle Molle; Braga, Gabriel Pereira; de Oliveira Antunes, Letícia Cláudia; Souza, Juli Thomaz; de Carvalho Nunes, Hélio Rubens; Bazan, Silméia Garcia Zanati; Bazan, Rodrigo

    2017-10-01

    During hospitalization, stroke patients are bedridden due to neurologic impairment, leading to loss of muscle mass, weakness, and functional limitation. There have been few studies examining respiratory muscle strength (RMS) in the acute phase of stroke. This study aimed to evaluate the RMS of patients with acute stroke compared with predicted values and to relate this to anthropometric variables, risk factors, and neurologic severity. This is a cross-sectional study in the acute phase of stroke. After admission, RMS was evaluated by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP); anthropometric data were collected; and neurologic severity was evaluated by the National Institutes of Health Stroke Scale. The analysis of MIP and MEP with predicted values was performed by chi-square test, and the relationship between anthropometric variables, risk factors, and neurologic severity was determined through multiple linear regression followed by residue analysis by the Shapiro-Wilk test; P < .05 was considered statistically significant. In the 32 patients studied, MIP and MEP were reduced when compared with the predicted values. MIP declined significantly by 4.39 points for each 1 kg/m 2 increase in body mass index (BMI), and MEP declined significantly by an average of 3.89 points for each 1 kg/m 2 increase in BMI. There was no statistically significant relationship between MIP or MEP and risk factors, and between MIP or MIP and neurologic severity in acute phase of stroke. There is a reduction of RMS in the acute phase of stroke, and RMS was lower in individuals with increased age and BMI. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Assessment of Respiratory Function in Students, Residing in Different Industrial Areas

    Directory of Open Access Journals (Sweden)

    Aiman E. Konkabaeva

    2013-01-01

    Full Text Available The article considers the results of the examination of three groups of apparently healthy volunteer students of one social group, both men and women, without bad habits, aged 19-22. Students live in three different industrial areas of Central Khazakhstan, containing ironworks (Temirtau and non-ferrous smelters (Balkhash, Zhezkazgan. It determined the necessity of respiratory function examination, using automated lung tester. The examination of respiratory function determined the decrease of the following parameters: lung vital capacity, maximal expiratory flow volume, forced expiratory volume 1, peak expiratory flow rate, cardiac minute output 25-50 if compared to proper parameters. The examination enabled us to make the conclusion that respiratory function is restricted due to high respiratory load, caused by air pollution. Changes intensity is different and can indicate the pollution in the examined areas.

  5. On maximal surfaces in asymptotically flat space-times

    International Nuclear Information System (INIS)

    Bartnik, R.; Chrusciel, P.T.; O Murchadha, N.

    1990-01-01

    Existence of maximal and 'almost maximal' hypersurfaces in asymptotically flat space-times is established under boundary conditions weaker than those considered previously. We show in particular that every vacuum evolution of asymptotically flat data for Einstein equations can be foliated by slices maximal outside a spatially compact set and that every (strictly) stationary asymptotically flat space-time can be foliated by maximal hypersurfaces. Amongst other uniqueness results, we show that maximal hypersurface can be used to 'partially fix' an asymptotic Poincare group. (orig.)

  6. Respiratory Viruses in Febrile Neutropenic Patients with Respiratory Symptoms

    Directory of Open Access Journals (Sweden)

    Mohsen Meidani

    2018-01-01

    Full Text Available Background: Respiratory infections are a frequent cause of fever in neutropenic patients, whereas respiratory viral infections are not frequently considered as a diagnosis, which causes high morbidity and mortality in these patients. Materials and Methods: This prospective study was performed on 36 patients with neutropenia who admitted to hospital were eligible for inclusion with fever (single temperature of >38.3°C or a sustained temperature of >38°C for more than 1 h, upper and lower respiratory symptoms. Sampling was performed from the throat of the patient by the sterile swab. All materials were analyzed by quantitative real-time multiplex polymerase chain reaction covering the following viruses; influenza, parainfluenza virus (PIV, rhinovirus (RV, human metapneumovirus, and respiratory syncytial virus (RSV. Results: RV was the most frequently detected virus and then RSV was the most. PIV was not present in any of the tested samples. Furthermore, no substantial differences in the distribution of specific viral species were observed based on age, sex, neutropenia duration, hematological disorder, and respiratory tract symptoms and signs (P > 0.05. Conclusion: Our prospective study supports the hypothesis that respiratory viruses play an important role in the development of neutropenic fever, and thus has the potential to individualize infection treatment and to reduce the extensive use of antibiotics in immunocompromised patients with neutropenia.

  7. Visual and Quantitative Analysis Methods of Respiratory Patterns for Respiratory Gated PET/CT.

    Science.gov (United States)

    Son, Hye Joo; Jeong, Young Jin; Yoon, Hyun Jin; Park, Jong-Hwan; Kang, Do-Young

    2016-01-01

    We integrated visual and quantitative methods for analyzing the stability of respiration using four methods: phase space diagrams, Fourier spectra, Poincaré maps, and Lyapunov exponents. Respiratory patterns of 139 patients were grouped based on the combination of the regularity of amplitude, period, and baseline positions. Visual grading was done by inspecting the shape of diagram and classified into two states: regular and irregular. Quantitation was done by measuring standard deviation of x and v coordinates of Poincaré map (SD x , SD v ) or the height of the fundamental peak ( A 1 ) in Fourier spectrum or calculating the difference between maximal upward and downward drift. Each group showed characteristic pattern on visual analysis. There was difference of quantitative parameters (SD x , SD v , A 1 , and MUD-MDD) among four groups (one way ANOVA, p = 0.0001 for MUD-MDD, SD x , and SD v , p = 0.0002 for A 1 ). In ROC analysis, the cutoff values were 0.11 for SD x (AUC: 0.982, p quantitative indices of respiratory stability and determining quantitative cutoff value for differentiating regular and irregular respiration.

  8. Managing corporate assets to maximize value

    International Nuclear Information System (INIS)

    Rubin, L.

    1992-01-01

    As the utility industry environment becomes more complex, pressures grow for managers to make more effective use of all their assets - including fuel, equipment, and personnel. Improving the management of assets leads to the delivery of greater value to ratepayers, stockholders, and society. EPRI is sponsoring a broad research program to help utilities effectively apply the tools needed in these changing business conditions, especially the latest in cost and quality management and asset management techniques

  9. Correlação entre a pressão de perda à manobra de Valsalva e a pressão máxima de fechamento uretral com a história clínica em mulheres com incontinência urinária de esforço Correlation of Valsalva leak point pressure and maximal urethral closure pressure with clinical history in women with stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Paulo Cezar Feldner Jr

    2002-08-01

    Full Text Available Objetivo: analisar a relação entre a pressão de perda com manobra de Valsalva e a pressão máxima de fechamento uretral com a queixa clínica em mulheres com incontinência urinária de esforço. Métodos: estudo retrospectivo no qual foram incluídas 164 pacientes com diagnóstico de incontinência urinária de esforço ou mista atendidas no setor de Uroginecologia e Cirurgia Vaginal do Departamento de Ginecologia da UNIFESP/EPM. As pacientes submeteram-se à anamnese padronizada, exame físico e estudo urodinâmico. A pressão de perda foi mensurada sob manobra de Valsalva (Valsalva leak point pressure - VLPP, com volume vesical de 200 mL. O perfil uretral foi realizado utilizando-se cateter de fluxo número 8, sendo medida a pressão máxima de fechamento uretral (PMFU. As pacientes foram agrupadas conforme a queixa clínica de perda urinária aos esforços e realizou-se análise estatística por meio do teste de chi² para verificar a proporção entre as variáveis. Utilizou-se, a seguir, a análise de variância (ANOVA para verificar diferenças entre VLPP e PMFU com relação à gravidade subjetiva da incontinência. Resultados: a média de idade foi de 51,2 anos (19-82, sendo que 79 encontravam-se no menacme (48,2% e 85 (51,8% na pós-menopausa. A paridade média foi de 4,0 filhos (0-18. Houve correlação entre o número de pacientes com VLPP inferior a 60 cmH2O e a queixa clínica (pPurpose: to analyze the correlation between Valsalva leak point pressure and maximum urethral closure pressure and clinical symptoms in women with stress urinary incontinence. Methods: we analyzed retrospectively 164 patients with urodynamic diagnosis of stress and mixed urinary incontinence established by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM. All patients were submmited to medical interview, physical examination and urodynamic study. Patients were divided into groups according to the subjective degree of stress urinary

  10. On the respiratory flow in the cuttlefish sepia officinalis.

    Science.gov (United States)

    Bone, Q; Brown, E; Travers, G

    1994-09-01

    The respiratory flow of water over the gills of the cuttlefish Sepia officinalis at rest is produced by the alternate activity of the radial muscles of the mantle and the musculature of the collar flaps; mantle circular muscle fibres are not involved. Inspiration takes place as the radial fibres contract, thinning the mantle and expanding the mantle cavity. The rise in mantle cavity pressure (up to 0.15 kPa), expelling water via the siphon during expiration, is brought about by inward movement of the collar flaps and (probably) mainly by elastic recoil of the mantle connective tissue network 'wound up' by radial fibre contraction during inspiration. Sepia also shows a second respiratory pattern, in which mantle cavity pressures during expiration are greater (up to 0.25 kPa). Here, the mantle circular fibres are involved, as they are during the large pressure transients (up to 10 kPa) seen during escape jetting. Active contraction of the muscles of the collar flaps is seen in all three patterns of expulsion of water from the mantle cavity, electrical activity increasing with increasing mantle cavity pressures. Respiratory expiration in the resting squid Loligo vulgaris is probably driven as in Sepia, whereas in the resting octopus Eledone cirrhosa, the mantle circular musculature is active during expiration. The significance of these observations is discussed.

  11. Vena Cava Responsiveness to Controlled Isovolumetric Respiratory Efforts.

    Science.gov (United States)

    Folino, Anna; Benzo, Marco; Pasquero, Paolo; Laguzzi, Andrea; Mesin, Luca; Messere, Alessandro; Porta, Massimo; Roatta, Silvestro

    2017-10-01

    Respirophasic variation of inferior vena cava (IVC) size is affected by large variability with spontaneous breathing. This study aims at characterizing the dependence of IVC size on controlled changes in intrathoracic pressure. Ten healthy subjects, in supine position, performed controlled isovolumetric respiratory efforts at functional residual capacity, attaining positive (5, 10, and 15 mmHg) and negative (-5, -10, and -15 mmHg) alveolar pressure levels. The isovolumetric constraint implies that equivalent changes are exhibited by alveolar and intrathoracic pressures during respiratory tasks. The IVC cross-sectional area equal to 2.88 ± 0.43 cm 2 at baseline (alveolar pressure = 0 mmHg) was progressively decreased by both expiratory and inspiratory efforts of increasing strength, with diaphragmatic efforts producing larger effects than thoracic ones: -55 ± 15% decrease, at +15 mmHg of alveolar pressure (P < .01), -80 ± 33 ± 12% at -15 mmHg diaphragmatic (P < .01), -33 ± 12% at -15 mmHg thoracic. Significant IVC changes in size (P < .01) and pulsatility (P < .05), along with non significant reduction in the response to respiratory efforts, were also observed during the first 30 minutes of supine rest, detecting an increase in vascular filling, and taking place after switching from the standing to the supine position. This study quantified the dependence of the IVC cross-sectional area on controlled intrathoracic pressure changes and evidenced the stronger influence of diaphragmatic over thoracic activity. Individual variability in thoracic/diaphragmatic respiratory pattern should be considered in the interpretation of the respirophasic modulations of IVC size. © 2017 by the American Institute of Ultrasound in Medicine.

  12. House Dust Mite Respiratory Allergy

    DEFF Research Database (Denmark)

    Calderón, Moisés A; Kleine-Tebbe, Jörg; Linneberg, Allan

    2015-01-01

    Although house dust mite (HDM) allergy is a major cause of respiratory allergic disease, specific diagnosis and effective treatment both present unresolved challenges. Guidelines for the treatment of allergic rhinitis and asthma are well supported in the literature, but specific evidence on the e......Although house dust mite (HDM) allergy is a major cause of respiratory allergic disease, specific diagnosis and effective treatment both present unresolved challenges. Guidelines for the treatment of allergic rhinitis and asthma are well supported in the literature, but specific evidence...... not extend beyond the end of treatment. Finally, allergen immunotherapy has a poor but improving evidence base (notably on sublingual tablets) and its benefits last after treatment ends. This review identifies needs for deeper physician knowledge on the extent and impact of HDM allergy in respiratory disease...... and therapy of HDM respiratory allergy in practice....

  13. Employee guide to respiratory protection

    International Nuclear Information System (INIS)

    Wright, E.M.

    1982-01-01

    This employee guide discusses use of respiratory protective equipment for particulates, gases, vapors, supplied air, and self-contained breathing apparatus. It also covers equipment selection medical factors, fitting criteria; care; and employee responsibilities

  14. A Note of Caution on Maximizing Entropy

    Directory of Open Access Journals (Sweden)

    Richard E. Neapolitan

    2014-07-01

    Full Text Available The Principle of Maximum Entropy is often used to update probabilities due to evidence instead of performing Bayesian updating using Bayes’ Theorem, and its use often has efficacious results. However, in some circumstances the results seem unacceptable and unintuitive. This paper discusses some of these cases, and discusses how to identify some of the situations in which this principle should not be used. The paper starts by reviewing three approaches to probability, namely the classical approach, the limiting frequency approach, and the Bayesian approach. It then introduces maximum entropy and shows its relationship to the three approaches. Next, through examples, it shows that maximizing entropy sometimes can stand in direct opposition to Bayesian updating based on reasonable prior beliefs. The paper concludes that if we take the Bayesian approach that probability is about reasonable belief based on all available information, then we can resolve the conflict between the maximum entropy approach and the Bayesian approach that is demonstrated in the examples.

  15. Optimal topologies for maximizing network transmission capacity

    Science.gov (United States)

    Chen, Zhenhao; Wu, Jiajing; Rong, Zhihai; Tse, Chi K.

    2018-04-01

    It has been widely demonstrated that the structure of a network is a major factor that affects its traffic dynamics. In this work, we try to identify the optimal topologies for maximizing the network transmission capacity, as well as to build a clear relationship between structural features of a network and the transmission performance in terms of traffic delivery. We propose an approach for designing optimal network topologies against traffic congestion by link rewiring and apply them on the Barabási-Albert scale-free, static scale-free and Internet Autonomous System-level networks. Furthermore, we analyze the optimized networks using complex network parameters that characterize the structure of networks, and our simulation results suggest that an optimal network for traffic transmission is more likely to have a core-periphery structure. However, assortative mixing and the rich-club phenomenon may have negative impacts on network performance. Based on the observations of the optimized networks, we propose an efficient method to improve the transmission capacity of large-scale networks.

  16. New features of the maximal abelian projection

    International Nuclear Information System (INIS)

    Bornyakov, V.G.; Polikarpov, M.I.; Syritsyn, S.N.; Schierholz, G.; Suzuki, T.

    2005-12-01

    After fixing the Maximal Abelian gauge in SU(2) lattice gauge theory we decompose the nonabelian gauge field into the so called monopole field and the modified nonabelian field with monopoles removed. We then calculate respective static potentials and find that the potential due to the modified nonabelian field is nonconfining while, as is well known, the monopole field potential is linear. Furthermore, we show that the sum of these potentials approximates the nonabelian static potential with 5% or higher precision at all distances considered. We conclude that at large distances the monopole field potential describes the classical energy of the hadronic string while the modified nonabelian field potential describes the string fluctuations. Similar decomposition was observed to work for the adjoint static potential. A check was also made of the center projection in the direct center gauge. Two static potentials, determined by projected Z 2 and by modified nonabelian field without Z 2 component were calculated. It was found that their sum is a substantially worse approximation of the SU(2) static potential than that found in the monopole case. It is further demonstrated that similar decomposition can be made for the flux tube action/energy density. (orig.)

  17. Maximal muscular vascular conductances during whole body upright exercise in humans

    Science.gov (United States)

    Calbet, J A L; Jensen-Urstad, M; van Hall, G; Holmberg, H -C; Rosdahl, H; Saltin, B

    2004-01-01

    That muscular blood flow may reach 2.5 l kg−1 min−1 in the quadriceps muscle has led to the suggestion that muscular vascular conductance must be restrained during whole body exercise to avoid hypotension. The main aim of this study was to determine the maximal arm and leg muscle vascular conductances (VC) during leg and arm exercise, to find out if the maximal muscular vasodilatory response is restrained during maximal combined arm and leg exercise. Six Swedish elite cross-country skiers, age (mean ± s.e.m.) 24 ± 2 years, height 180 ± 2 cm, weight 74 ± 2 kg, and maximal oxygen uptake (V̇O2,max) 5.1 ± 0.1 l min−1 participated in the study. Femoral and subclavian vein blood flows, intra-arterial blood pressure, cardiac output, as well as blood gases in the femoral and subclavian vein, right atrium and femoral artery were determined during skiing (roller skis) at ∼76% of V̇O2,max and at V̇O2,max with different techniques: diagonal stride (combined arm and leg exercise), double poling (predominantly arm exercise) and leg skiing (predominantly leg exercise). During submaximal exercise cardiac output (26–27 l min−1), mean blood pressure (MAP) (∼87 mmHg), systemic VC, systemic oxygen delivery and pulmonary V̇O2 (∼4 l min−1) attained similar values regardless of exercise mode. The distribution of cardiac output was modified depending on the musculature engaged in the exercise. There was a close relationship between VC and V̇O2 in arms (r = 0.99, P arm VC (63.7 ± 5.6 ml min−1 mmHg−1) was attained during double poling, while peak leg VC was reached at maximal exercise with the diagonal technique (109.8 ± 11.5 ml min−1 mmHg−1) when arm VC was 38.8 ± 5.7 ml min−1 mmHg−1. If during maximal exercise arms and legs had been vasodilated to the observed maximal levels then mean arterial pressure would have dropped at least to 75–77 mmHg in our experimental conditions. It is concluded that skeletal muscle vascular conductance is

  18. [Effect of high blood levels of bile acid on respiratory functions of New Zealand rabbits].

    Science.gov (United States)

    Wang, Fei; Zhao, Cong; Tian, Yinghong; Yin, Yanru

    2013-08-01

    To compare the patterns of respiratory function variations resulting from the classical reflex of blood pressure fall and high blood levels of bile acid, so as to provide evidence for the regulation of respiratory function via bile acids. Seventy New Zealand male Rabbits, under general anesthesia with 20% urethane, were subjected to tracheal intubations and carotid artery cannulations via median incisions of the neck. Using a biological signal acquisition system, the changes in the breathing and blood pressure were observed in response to stimulation of the pneumogastric nerves or to ear vein injections of diluted bile acids or the water solutions of 5 dissociated bile acids. Stimulation of the pneumogastric nerves and injections of diluted bile acids both lowered the blood pressure without significant differences in the total reaction time (T). However, the total respiratory reaction time of bile acids, RT(bile acids), was 9-10 times longer than the total reaction time of blood pressure T(bile acids) (Pacids) were higher than that RR(pneumogastric nerves)resulting from the classical reflex (Pacids), the values of RR(bile acids) were significantly higher than those of RR(bile acids) in RT2(bile acids) interval. UDCA produced no significant influence on blood pressure or respiratory function (Pacid reagents did (Pacids not only act through reflex factors but also have direct effects on respiratory function regulation. Under our experimental conditions, UDCA has no effect on blood pressure or respiratory function, but the other 4 dissociated bile acid reagents can all dose-dependently lower blood pressure and significantly affect respiratory function.

  19. Climate Change and Respiratory Infections.

    Science.gov (United States)

    Mirsaeidi, Mehdi; Motahari, Hooman; Taghizadeh Khamesi, Mojdeh; Sharifi, Arash; Campos, Michael; Schraufnagel, Dean E

    2016-08-01

    The rate of global warming has accelerated over the past 50 years. Increasing surface temperature is melting glaciers and raising the sea level. More flooding, droughts, hurricanes, and heat waves are being reported. Accelerated changes in climate are already affecting human health, in part by altering the epidemiology of climate-sensitive pathogens. In particular, climate change may alter the incidence and severity of respiratory infections by affecting vectors and host immune responses. Certain respiratory infections, such as avian influenza and coccidioidomycosis, are occurring in locations previously unaffected, apparently because of global warming. Young children and older adults appear to be particularly vulnerable to rapid fluctuations in ambient temperature. For example, an increase in the incidence in childhood pneumonia in Australia has been associated with sharp temperature drops from one day to the next. Extreme weather events, such as heat waves, floods, major storms, drought, and wildfires, are also believed to change the incidence of respiratory infections. An outbreak of aspergillosis among Japanese survivors of the 2011 tsunami is one such well-documented example. Changes in temperature, precipitation, relative humidity, and air pollution influence viral activity and transmission. For example, in early 2000, an outbreak of Hantavirus respiratory disease was linked to a local increase in the rodent population, which in turn was attributed to a two- to threefold increase in rainfall before the outbreak. Climate-sensitive respiratory pathogens present challenges to respiratory health that may be far greater in the foreseeable future.

  20. 33 CFR 142.39 - Respiratory protection.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Respiratory protection. 142.39... Respiratory protection. (a) Personnel in an atmosphere specified under ANSI Z88.2, requiring the use of respiratory protection equipment shall wear the type of respiratory protection equipment specified in ANSI Z88...

  1. The Clinical Utilisation of Respiratory Elastance Software (CURE Soft): a bedside software for real-time respiratory mechanics monitoring and mechanical ventilation management.

    Science.gov (United States)

    Szlavecz, Akos; Chiew, Yeong Shiong; Redmond, Daniel; Beatson, Alex; Glassenbury, Daniel; Corbett, Simon; Major, Vincent; Pretty, Christopher; Shaw, Geoffrey M; Benyo, Balazs; Desaive, Thomas; Chase, J Geoffrey

    2014-09-30

    Real-time patient respiratory mechanics estimation can be used to guide mechanical ventilation settings, particularly, positive end-expiratory pressure (PEEP). This work presents a software, Clinical Utilisation of Respiratory Elastance (CURE Soft), using a time-varying respiratory elastance model to offer this ability to aid in mechanical ventilation treatment. CURE Soft is a desktop application developed in JAVA. It has two modes of operation, 1) Online real-time monitoring decision support and, 2) Offline for user education purposes, auditing, or reviewing patient care. The CURE Soft has been tested in mechanically ventilated patients with respiratory failure. The clinical protocol, software testing and use of the data were approved by the New Zealand Southern Regional Ethics Committee. Using CURE Soft, patient's respiratory mechanics response to treatment and clinical protocol were monitored. Results showed that the patient's respiratory elastance (Stiffness) changed with the use of muscle relaxants, and responded differently to ventilator settings. This information can be used to guide mechanical ventilation therapy and titrate optimal ventilator PEEP. CURE Soft enables real-time calculation of model-based respiratory mechanics for mechanically ventilated patients. Results showed that the system is able to provide detailed, previously unavailable information on patient-specific respiratory mechanics and response to therapy in real-time. The additional insight available to clinicians provides the potential for improved decision-making, and thus improved patient care and outcomes.

  2. Avaliação da função pulmonar de recém-nascidos com síndrome do desconforto respiratório em diferentes pressões finais expiratórias positivas Assessment of pulmonary function of preterm newborn infants with respiratory distress syndrome at different positive end expiratory pressure levels

    Directory of Open Access Journals (Sweden)

    Luiz C.T. Consolo

    2002-09-01

    Full Text Available RESUMO\tABSTRACT \t Objetivo: verificar as alterações da função pulmonar: complacência dinâmica (Cdyn, volume corrente inspiratório (V Tinsp, pressão arterial de dióxido de carbono (PaCO2, em recém-nascidos pré-termo com síndrome do desconforto respiratório. Pacientes e Métodos: estudo de caso controle, incluindo 11 pré-termos com idade gestacional Objective: to verify the alterations of pulmonary function in preterm newborn infants with respiratory distress syndrome (RDS. The parameters analyzed were Dynamic Compliance (Cdyn, Inspiratory Tidal Volume (TVinsp, partial arterial pressure of carbon dioxide (PaCO2. Methods: eleven preterm newborn infants, with gestational age < 35 weeks, and birth weight < 2.500 g, were include in a control case study. All infants presented RDS and were treated with 120 mg/Kg of porcine surfactant. The initial positive end expiratory pressure (PEEP was 3 cm H2O. A pneumotachograph with a graphical monitor was used to assess the pulmonary function. After each increase in the PEEP (4 and 6 cm H2O, there was an interval of 20 minutes before measuring the arterial data of pulmonary function and arterial gases. Results: there were three males and eight females (1:2,7 among the infants with RDS. The mean gestational age was 30.78. 2.05 weeks, ranging from 26 to 34 weeks. The increase in the PEEP from 3 to 6 cm H2O caused significant decrease in the TVinsp (6.46 ±3.43 to 4.20 ±2.35, P=0.0262. With the increase in the PEEP from 4 to 6 cm H2O, there was also a decrease in the TVinsp (5.98.± 3.33 to 4.20.± 2.35, (P=0.0044. Regarding the Cdyn, when there was an increase in the PEEP from 3 to 6 cm H2O, the reduction was statistically significant (0.58.± 0.27 to 0.46± 0.25, P=0.0408 and from 4 to 6 cm H2O, the reduction in the Cdyn was also important (0.77± 0.27 to 0.46± 0.25, (P=0.0164. Increases in the PEEP from 4 to 6 cm H2O caused increases in the PaCO2 (52.81± 15.49 to 64.90± 12.69, (P= 0,0141. A

  3. Cardio-respiratory capacity as an important biomarker of health

    Directory of Open Access Journals (Sweden)

    Jaroslav Novák

    2016-12-01

    Full Text Available Background: Cardio-respiratory capacity is an important factor in human health. It's quality depends on many objective factors (such as age and gender, but it can be influenced also by others (physical activity, nutrition. Low level of cardio-respiratory capacity significantly correlates with numerous health failures. Objective: Evaluation of the cardio-respiratory capacity in athletes enables a prediction of performance. In a non-sporting population a critically low level of cardio-respiratory capacity could be a warning signal of a high risk of diseases. The Spiroergometric examination needs very sophisticated technical equipment including O2-CO2 analyzer. The aim of the study was to examine the possibility of how to replace direct measurement of oxygen consumption by the method. Methods: 2 777 protocols from the data base of examinations performed in the period of 1994 till 2015 were used. Cardio-respiratory capacity in all examinations was evaluated according to maximal oxygen uptake VO2max, physical working capacity W170 and maximal performance on the cyclo-ergometer. Step-vice increased workload on cyclo-ergometer based on procedure used in International Biological Program was applied to obtain the characteristics of cardio-respiratory capacity of each subject (2 015 men and 762 women. Results: Correlation coefficients r and regression equations of cardio-respiratory capacity characteristics (W170, W170/kg, VO2max, VO2max/kg, Wmax, Wmax/kg were calculated. The highest correlation was found between VO2max and Wmax and between VO2max/kg and Wmax/kg, both in men and women (r = .89 in men and r = .85 in women for VO2max and Wmax. The most important regression equations are: (men VO2max = 0.0095 . Wmax + 0.54 (l/min (r = .89, VO2max/kg = 8.3 . Wmax/kg + 13 (ml/min/kg (r = .83; (women VO2max = 0.0083 . Wmax + 0.67 (l/min (r = .85, VO2max/kg = 8.0 . max/kg + 13 (ml/min/kg (r = .83. Conclusions: It was proved that VO2max and VO2max/kg values

  4. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts.

    Science.gov (United States)

    Myint, Phyo K; Kamath, Ajay V; Vowler, Sarah L; Maisey, David N; Harrison, Brian D W

    2006-05-01

    To assess the usefulness of the British Thoracic Society guidelines for severity assessment of community-acquired pneumonia (CAP) in predicting mortality and to explore alternative criteria which could be more useful in older patients. Compilation study of two prospective observational cohorts. A University hospital in Norfolk, UK with a catchment population of 568,000. Subjects were 195 patients (median age = 77 years) who were included in two prospective studies of CAP. All-cause mortality occurring within the 6 week follow-up. sensitivity, specificity, positive and negative predictive values for study outcome using CURB and CURB-65 were assessed in 189 patients, and CRB-65 in 192 patients out of a total of 195 patients. Our results were comparable with the original study by Lim et al. Although CURB-65 and CRB-65 included age criteria, in effect they did not materially improve the specificity in predicting high-risk patients in both studies. We found that oxygenation measured by ventilation perfusion mismatch (PaO2:FiO2) was the best predictor of outcome in this slightly older cohort [odds ratio (OR) = 0.99 (0.98-0.99), P = 0.0001]. We derived a new set of criteria; SOAR (systolic blood pressure, oxygenation, age and respiratory rate) based on our findings. Their sensitivity, specificity, positive and negative predictive values were 81.0% (58.1-94.6), 59.3% (49.6-68.4), 27.0% (16.6-39.7) and 94.4% (86.2-98.4), respectively, confirming their comparability with existing criteria. Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.

  5. Antagonism of morphine-induced central respiratory depression by donepezil in the anesthetized rabbit

    Directory of Open Access Journals (Sweden)

    MIKI TSUJITA

    2007-01-01

    Full Text Available Morphine is often used in cancer pain and postoperative analgesic management but induces respiratory depression. Therefore, there is an ongoing search for drug candidates that can antagonize morphine-induced respiratory depression but have no effect on morphine-induced analgesia. Acetylcholine is an excitatory neurotransmitter in central respiratory control and physostigmine antagonizes morphine-induced respiratory depression. However, physostigmine has not been applied in clinical practice because it has a short action time, among other characteristics. We therefore asked whether donepezil (a long-acting acetylcholinesterase inhibitor used in the treatment of Alzheimer's disease can antagonize morphine-induced respiratory depression. Using the anesthetized rabbit as our model, we measured phrenic nerve discharge as an index of respiratory rate and amplitude. We compared control indices with discharges after the injection of morphine and after the injection of donepezil. Morphine-induced depression of respiratory rate and respiratory amplitude was partly antagonized by donepezil without any effect on blood pressure and end-tidal C0(2. In the other experiment, apneic threshold PaC0(2 was also compared. Morphine increased the phrenic nerve apnea threshold but this was antagonized by donepezil. These findings indicate that systemically administered donepezil partially restores morphine-induced respiratory depression and morphine-deteriorated phrenic nerve apnea threshold in the anesthetized rabbit

  6. Value maximizing maintenance policies under general repair

    International Nuclear Information System (INIS)

    Marais, Karen B.

    2013-01-01

    One class of maintenance optimization problems considers the notion of general repair maintenance policies where systems are repaired or replaced on failure. In each case the optimality is based on minimizing the total maintenance cost of the system. These cost-centric optimizations ignore the value dimension of maintenance and can lead to maintenance strategies that do not maximize system value. This paper applies these ideas to the general repair optimization problem using a semi-Markov decision process, discounted cash flow techniques, and dynamic programming to identify the value-optimal actions for any given time and system condition. The impact of several parameters on maintenance strategy, such as operating cost and revenue, system failure characteristics, repair and replacement costs, and the planning time horizon, is explored. This approach provides a quantitative basis on which to base maintenance strategy decisions that contribute to system value. These decisions are different from those suggested by traditional cost-based approaches. The results show (1) how the optimal action for a given time and condition changes as replacement and repair costs change, and identifies the point at which these costs become too high for profitable system operation; (2) that for shorter planning horizons it is better to repair, since there is no time to reap the benefits of increased operating profit and reliability; (3) how the value-optimal maintenance policy is affected by the system's failure characteristics, and hence whether it is worthwhile to invest in higher reliability; and (4) the impact of the repair level on the optimal maintenance policy. -- Highlights: •Provides a quantitative basis for maintenance strategy decisions that contribute to system value. •Shows how the optimal action for a given condition changes as replacement and repair costs change. •Shows how the optimal policy is affected by the system's failure characteristics. •Shows when it is

  7. Reliability and validity of the test of incremental respiratory endurance measures of inspiratory muscle performance in COPD

    Directory of Open Access Journals (Sweden)

    Formiga MF

    2018-05-01

    Full Text Available Magno F Formiga,1,2 Kathryn E Roach,1 Isabel Vital,3 Gisel Urdaneta,3 Kira Balestrini,3 Rafael A Calderon-Candelario,3,4 Michael A Campos,3,4,* Lawrence P Cahalin1,* 1Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA; 2CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil; 3Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA; 4Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA *These authors contributed equally to this work Purpose: The Test of Incremental Respiratory Endurance (TIRE provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP over time. The integration of MIP over inspiratory duration (ID provides the sustained maximal inspiratory pressure (SMIP. Evidence on the reliability and validity of these measurements in COPD is not currently available. Therefore, we assessed the reliability, responsiveness and construct validity of the TIRE measures of inspiratory muscle performance in subjects with COPD. Patients and methods: Test–retest reliability, known-groups and convergent validity assessments were implemented simultaneously in 81 male subjects with mild to very severe COPD. TIRE measures were obtained using the portable PrO2 device, following standard guidelines. Results: All TIRE measures were found to be highly reliable, with SMIP demonstrating the strongest test–retest reliability with a nearly perfect intraclass correlation coefficient (ICC of 0.99, while MIP and ID clustered closely together behind SMIP with ICC values of about 0.97. Our findings also demonstrated known-groups validity of all TIRE measures, with SMIP and ID yielding larger effect sizes when compared to MIP in distinguishing between subjects of different COPD status. Finally, our analyses confirmed convergent validity for both SMIP

  8. The scientific basis for postoperative respiratory care.

    Science.gov (United States)

    Branson, Richard D

    2013-11-01

    Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic complications. Preventing and treating PPCs is a major focus of respiratory therapists, using a wide variety of techniques and devices, including incentive spirometry, CPAP, positive expiratory pressure, intrapulmonary percussive ventilation, and chest physical therapy. The scientific evidence for these techniques is lacking. CPAP has some evidence of benefit in high risk patients with hypoxemia. Incentive spirometry is used frequently, but the evidence suggests that incentive spirometry alone has no impact on PPC. Chest physical therapy, which includes mechanical clapping and postural drainage, appears to worsen atelectasis secondary to pain and splinting. As with many past respiratory therapy techniques, the profession needs to take a hard look at these techniques and work to provide only practices based on good evidence. The idea of a PPC bundle has merit and should be studied in larger, multicenter trials. Additionally, intraoperative ventilation may play a key role in the development of PPCs and should receive greater attention.

  9. Respiratory Information Extraction from Electrocardiogram Signals

    KAUST Repository

    Amin, Gamal El Din Fathy

    2010-12-01

    The Electrocardiogram (ECG) is a tool measuring the electrical activity of the heart, and it is extensively used for diagnosis and monitoring of heart diseases. The ECG signal reflects not only the heart activity but also many other physiological processes. The respiratory activity is a prominent process that affects the ECG signal due to the close proximity of the heart and the lungs. In this thesis, several methods for the extraction of respiratory process information from the ECG signal are presented. These methods allow an estimation of the lung volume and the lung pressure from the ECG signal. The potential benefit of this is to eliminate the corresponding sensors used to measure the respiration activity. A reduction of the number of sensors connected to patients will increase patients’ comfort and reduce the costs associated with healthcare. As a further result, the efficiency of diagnosing respirational disorders will increase since the respiration activity can be monitored with a common, widely available method. The developed methods can also improve the detection of respirational disorders that occur while patients are sleeping. Such disorders are commonly diagnosed in sleeping laboratories where the patients are connected to a number of different sensors. Any reduction of these sensors will result in a more natural sleeping environment for the patients and hence a higher sensitivity of the diagnosis.

  10. Prediction of maximal lactate steady state in runners with an incremental test on the field.

    Science.gov (United States)

    Leti, Thomas; Mendelson, Monique; Laplaud, David; Flore, Patrice

    2012-01-01

    During a maximal incremental ergocycle test, the power output associated with Respiratory Exchange Ratio equal to 1.00 (RER = 1.00) predicts maximal lactate steady state (MLSS). We hypothesised that these results are transferable for runners on the field. Fourteen runners performed a maximal progressive test, to assess the speed associated with RER = 1.00, and several 30 minutes constant velocity tests to determine the speed at MLSS. We observed that the speeds at RER = 1.00, at the second ventilatory threshold (VT2) and at MLSS did not differ (15.7 ± 1.1 km · h⁻¹, 16.2 ± 1.4 km · h⁻¹, 15.5 ± 1.1 km · h⁻¹ respectively). The speed associated with RER = 1.00 was better correlated with that at MLSS (r = 0.79; p = 0.0008) than that at VT2 (r = 0.73; p = 0.002). Neither the concentration of blood lactate nor the heart rate differed between the speed at RER = 1.00 and that at MLSS from the 10th and the 30th minute of the constant velocity test. Bland and Altman analysis showed a fair agreement between the speed at MLSS and that at RER (0.2 ± 1.4 km · h⁻¹). This study demonstrated that the speed associated with RER = 1.00 determined during maximal progressive track running allows a fair estimation of the speed associated with MLSS, markedly decreasing the burden of numerous invasive tests required to assess it.

  11. Blood pressure

    Science.gov (United States)

    Normal blood pressure is important for proper blood flow to the body's organs and tissues. The force of the blood on the walls of the arteries is called blood pressure. Blood pressure is measured both as the heart ...

  12. Respiratory system mechanics during laparoscopic cholecystectomy.

    Science.gov (United States)

    Rizzotti, L; Vassiliou, M; Amygdalou, A; Psarakis, Ch; Rasmussen, T R; Laopodis, V; Behrakis, P

    2002-04-01

    The influence of laparoscopic cholecystectomy (LC) on the mechanical properties of the respiratory system (RS) was examined using multiple regression analysis (MRA). Measurements of airway pressure (PaO) and flow (V') were obtained from 32 patients at four distinct stages of the LC procedure: 1) Immediately before the application of pneumoperitoneum (PP) at supine position, 2) 5 min after the induction of PP at Trendelenburg position, 3) 5 min after the patients position at reverse Trendelenburg, and 4) 5 min after the end ofthe surgical procedure with the patient again in supine position. Evaluated parameters were the RS elastance (Ers), resistance (Rrs), impedance (Zrs), the angle theta indicating the balance between the elastic and resistive components of the impedance, as well as the end-expiratory elastic recoil pressure (EEP). Ers and Zrs increased considerably during PP and remained elevated immediately after abolishing PP Rrs, on the contrary, returned to pre-operative levels right after the operation. Change of body position from Trendelenburg (T) to reverseTrendelenburg (rT) mainly induced a significant change in theta, thus indicating an increased dominance of the elastic component of Zrs on changing fromT to rT. There was no evidence of increased End-Expiratory Pressure during PP

  13. Nasal continuous positive airway pressure: does bubbling improve gas exchange?

    Science.gov (United States)

    Morley, C J; Lau, R; De Paoli, A; Davis, P G

    2005-07-01

    In a randomised crossover trial, 26 babies, treated with Hudson prong continuous positive airway pressure (CPAP) from a bubbling bottle, received vigorous, high amplitude, or slow bubbling for 30 minutes. Pulse oximetry, transcutaneous carbon dioxide, and respiratory rate were recorded. The bubbling rates had no effect on carbon dioxide, oxygenation, or respiratory rate.

  14. Respiratory care management information systems.

    Science.gov (United States)

    Ford, Richard M

    2004-04-01

    Hospital-wide computerized information systems evolved from the need to capture patient information and perform billing and other financial functions. These systems, however, have fallen short of meeting the needs of respiratory care departments regarding work load assessment, productivity management, and the level of outcome reporting required to support programs such as patient-driven protocols. The respiratory care management information systems (RCMIS) of today offer many advantages over paper-based systems and hospital-wide computer systems. RCMIS are designed to facilitate functions specific to respiratory care, including assessing work demand, assigning and tracking resources, charting, billing, and reporting results. RCMIS incorporate mobile, point-of-care charting and are highly configurable to meet the specific needs of individual respiratory care departments. Important and substantial benefits can be realized with an RCMIS and mobile, wireless charting devices. The initial and ongoing costs of an RCMIS are justified by increased charge capture and reduced costs, by way of improved productivity and efficiency. It is not unusual to recover the total cost of an RCMIS within the first year of its operation. In addition, such systems can facilitate and monitor patient-care protocols and help to efficiently manage the vast amounts of information encountered during the practitioner's workday. Respiratory care departments that invest in RCMIS have an advantage in the provision of quality care and in reducing expenses. A centralized respiratory therapy department with an RCMIS is the most efficient and cost-effective way to monitor work demand and manage the hospital-wide allocation of respiratory care services.

  15. POLITENESS MAXIM OF MAIN CHARACTER IN SECRET FORGIVEN

    Directory of Open Access Journals (Sweden)

    Sang Ayu Isnu Maharani

    2017-06-01

    Full Text Available Maxim of Politeness is an interesting subject to be discussed, since politeness has been criticized from our childhood. We are obliques to be polite to anyone either in speaking or in acting. Somehow we are manage to show politeness in our spoken expression though our intention might be not so polite. For example we must appriciate others opinion although we feel objection toward the opinion. In this article the analysis of politeness is based on maxim proposes by Leech. He proposed six types of politeness maxim. The discussion shows that the main character (Kristen and Kami use all types of maxim in their conversation. The most commonly used are approbation maxim and agreement maxim

  16. Instantaneous Respiratory Estimation from Thoracic Impedance by Empirical Mode Decomposition

    OpenAIRE

    Wang, Fu-Tai; Chan, Hsiao-Lung; Wang, Chun-Li; Jian, Hung-Ming; Lin, Sheng-Hsiung

    2015-01-01

    Impedance plethysmography provides a way to measure respiratory activity by sensing the change of thoracic impedance caused by inspiration and expiration. This measurement imposes little pressure on the body and uses the human body as the sensor, thereby reducing the need for adjustments as body position changes and making it suitable for long-term or ambulatory monitoring. The empirical mode decomposition (EMD) can decompose a signal into several intrinsic mode functions (IMFs) that disclos...

  17. Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation.

    Science.gov (United States)

    Cruces, Pablo; González-Dambrauskas, Sebastián; Quilodrán, Julio; Valenzuela, Jorge; Martínez, Javier; Rivero, Natalia; Arias, Pablo; Díaz, Franco

    2017-10-06

    Analysis of respiratory mechanics during mechanical ventilation (MV) is able to estimate resistive, elastic and inertial components of the working pressure of the respiratory system. Our aim was to discriminate the components of the working pressure of the respiratory system in infants on MV with severe bronchiolitis admitted to two PICU's. Infants younger than 1 year old with acute respiratory failure caused by severe bronchiolitis underwent neuromuscular blockade, tracheal intubation and volume controlled MV. Shortly after intubation studies of pulmonary mechanics were performed using inspiratory and expiratory breath hold. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory (PIP), plateau (PPL) and total expiratory pressures (tPEEP) were measured. Inspiratory and expiratory resistances (RawI and RawE) and Time Constants (K TI and K TE ) were calculated. We included 16 patients, of median age 2.5 (1-5.8) months. Bronchiolitis due to respiratory syncytial virus was the main etiology (93.8%) and 31.3% had comorbidities. Measured respiratory pressures were PIP 29 (26-31), PPL 24 (20-26), tPEEP 9 [8-11] cmH2O. Elastic component of the working pressure was significantly higher than resistive and both higher than threshold (tPEEP - PEEP) (P mechanics of infants with severe bronchiolitis receiving MV shows that the elastic component of the working pressure of the respiratory system is the most important. The elastic and resistive components in conjunction with flow profile are characteristic of restrictive diseases. A better understanding of lung mechanics in this group of patients may lead to change the traditional ventilatory approach to severe bronchiolitis.

  18. Maximizers versus satisficers: Decision-making styles, competence, and outcomes

    OpenAIRE

    Andrew M. Parker; Wändi Bruine de Bruin; Baruch Fischhoff

    2007-01-01

    Our previous research suggests that people reporting a stronger desire to maximize obtain worse life outcomes (Bruine de Bruin et al., 2007). Here, we examine whether this finding may be explained by the decision-making styles of self-reported maximizers. Expanding on Schwartz et al.\\ (2002), we find that self-reported maximizers are more likely to show problematic decision-making styles, as evidenced by self-reports of less behavioral coping, greater dependence on others when making decision...

  19. Validation of a Maximal Incremental Skating Test Performed on a Slide Board: Comparison With Treadmill Skating.

    Science.gov (United States)

    Piucco, Tatiane; Diefenthaeler, Fernando; Soares, Rogério; Murias, Juan M; Millet, Guillaume Y

    2017-11-01

    To investigate the criterion validity of a maximal incremental skating test performed on a slide board (SB). Twelve subelite speed skaters performed a maximal skating test on a treadmill and on a SB. Gas exchange threshold (GET), respiratory compensation point (RCP), and maximal variables were determined. Oxygen uptake ([Formula: see text]) (31.0 ± 3.2 and 31.4 ± 4.1 mL·min -1 ·kg -1 ), percentage of maximal [Formula: see text] ([Formula: see text]) (66.3 ± 4 and 67.7 ± 7.1%), HR (153 ± 14 and 150 ±12 bpm), and ventilation (59.8 ± 11.8 and 57.0 ± 10.7 L·min -1 ) at GET, and [Formula: see text] (42.5 ± 4.4 and 42.9 ± 4.8 mL·min -1 ·kg -1 ), percentage of [Formula: see text] (91.1 ± 3.3 and 92.4 ± 2.1%), heart rate (HR) (178 ± 9 and 178 ± 6 bpm), and ventilation (96.5 ± 19.2 and 92.1 ± 12.7 L·min -1 ) at RCP were not different between skating on a treadmill and on a SB. [Formula: see text] (46.7 ± 4.4 vs 46.4 ±6.1 mL·min -1 ·kg -1 ) and maximal HR (195 ± 6 vs 196 ± 10 bpm) were not significantly different and correlated (r = .80 and r = .87, respectively; P  .8) with athletes' best times on 1500 m. The incremental skating test on a SB was capable to distinguish maximal ([Formula: see text] and HR) and submaximal ([Formula: see text], % [Formula: see text], HR, and ventilation) parameters known to determine endurance performance. Therefore, the SB test can be considered as a specific and practical alternative to evaluate speed skaters.

  20. Continuous positive airway pressure (CPAP).

    Science.gov (United States)

    Sahni, R; Wung, J T

    1998-01-01

    Progress in neonatal intensive care is closely linked to improvements in the management of respiratory failure in small infants. This applies to the care of the preterm infants with immature lungs, and also to treatment of the preterm or full term infants with specific diseases that are associated with respiratory failure. Respiratory distress of the newborn continues to account for significant morbidity in the intensive care unit. The spectrum of disease ranges from mild distress to severe respiratory failure requiring varying degrees of support. The current modalities of ventilatory assistance range from the more benign continuous positive airway pressure (CPAP) to conventional mechanical ventilation, and on to high frequency ventilation. It is a reasonable supposition that the type of ventilatory assistance provided to these infants should be graded according to the severity of the disease. However, the principal objective in selecting the mode of respiratory support should be to use a modality which results in minimal volo- or barotrauma to the infant. The following detailed description on CPAP explains its physiological effects, delivery system, indications for use, application, maintenance, and associated complications. The equipment described is simple to use, has a greater cost benefit, and has a more universal application, which is of help to smaller units including those in the developing parts of the world. We have also included our institutional clinical experience of CPAP usage in very low birth weight infants from the periods before and after commercial availability of surfactant in the United States.

  1. Natural maximal νμ-ντ mixing

    International Nuclear Information System (INIS)

    Wetterich, C.

    1999-01-01

    The naturalness of maximal mixing between myon- and tau-neutrinos is investigated. A spontaneously broken nonabelian generation symmetry can explain a small parameter which governs the deviation from maximal mixing. In many cases all three neutrino masses are almost degenerate. Maximal ν μ -ν τ -mixing suggests that the leading contribution to the light neutrino masses arises from the expectation value of a heavy weak triplet rather than from the seesaw mechanism. In this scenario the deviation from maximal mixing is predicted to be less than about 1%. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  2. On the way towards a generalized entropy maximization procedure

    International Nuclear Information System (INIS)

    Bagci, G. Baris; Tirnakli, Ugur

    2009-01-01

    We propose a generalized entropy maximization procedure, which takes into account the generalized averaging procedures and information gain definitions underlying the generalized entropies. This novel generalized procedure is then applied to Renyi and Tsallis entropies. The generalized entropy maximization procedure for Renyi entropies results in the exponential stationary distribution asymptotically for q element of (0,1] in contrast to the stationary distribution of the inverse power law obtained through the ordinary entropy maximization procedure. Another result of the generalized entropy maximization procedure is that one can naturally obtain all the possible stationary distributions associated with the Tsallis entropies by employing either ordinary or q-generalized Fourier transforms in the averaging procedure.

  3. Violating Bell inequalities maximally for two d-dimensional systems

    International Nuclear Information System (INIS)

    Chen Jingling; Wu Chunfeng; Oh, C. H.; Kwek, L. C.; Ge Molin

    2006-01-01

    We show the maximal violation of Bell inequalities for two d-dimensional systems by using the method of the Bell operator. The maximal violation corresponds to the maximal eigenvalue of the Bell operator matrix. The eigenvectors corresponding to these eigenvalues are described by asymmetric entangled states. We estimate the maximum value of the eigenvalue for large dimension. A family of elegant entangled states |Ψ> app that violate Bell inequality more strongly than the maximally entangled state but are somewhat close to these eigenvectors is presented. These approximate states can potentially be useful for quantum cryptography as well as many other important fields of quantum information

  4. Respiratory Support for Pharmacologically Induced Hypoxia in Neonatal Calves

    Directory of Open Access Journals (Sweden)

    C. G. Donnelly

    2016-01-01

    Full Text Available Practical methods to provide respiratory support to bovine neonates in a field setting are poorly characterised. This study evaluated the response of healthy neonatal calves with pharmacologically induced respiratory suppression to nasal oxygen insufflation and to continuous positive airway pressure (CPAP delivered via an off-the-shelf device. Ten calves were randomised to receive either nasal oxygen insufflation (Group 1, n=5 or CPAP (Group 2, n=5 as a first treatment after induction of respiratory depression by intravenous administration of xylazine, fentanyl, and diazepam. Calves received the alternate treatment after 10 minutes of breathing ambient air. Arterial blood gas samples were obtained prior to sedation, following sedation, following the first and second treatment, and after breathing ambient air before and after the second treatment. Oxygen insufflation significantly increased arterial oxygen partial pressure (PaO2 but was also associated with significant hypercapnia. When used as the first treatment, CPAP was associated with significantly decreased arterial partial pressure of carbon dioxide but did not increase PaO2. These results suggest that the use of CPAP may represent a practical method for correction of hypercapnia associated with inadequate ventilation in a field setting, and further research is required to characterise the use of CPAP with increased inspired oxygen concentrations.

  5. Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica Respiratory physiotherapy associated with airway positive pressure in the postoperative bariatric surgery evolution

    Directory of Open Access Journals (Sweden)

    Fabiana Sobral Peixoto-Souza

    2012-09-01

    Full Text Available Analisar volume corrente (VC, volume minuto (VM e frequência respiratória (FR de obesas mórbidas no pós-operatório de cirurgia bariátrica (CB, após a fisioterapia respiratória convencional (FRC associada ou não à pressão positiva contínua nas vias aéreas (CPAP no pré-operatório. Foram estudadas 36 mulheres, com idade de 40,1±8,41 anos, que seriam submetidas à CB por laparotomia e que realizaram FRC (exercícios respiratórios diafragmáticos, de inspirações profundas, fracionadas e associados a movimentos de membros superiores, 1 série de 10 repetições de cada exercício por 30 dias antes da cirurgia. Após internação, 18 delas foram submetidas a 20 minutos de CPAP, 1 hora antes da indução anestésica e compuseram o grupo FRC+CPAP. As outras 18 não receberam o CPAP e compuseram o grupo FRC. Foram avaliados VM, VC e FR por meio do ventilômetro, no momento da internação e 24 horas após a realização da cirurgia. Constatou-se que as medidas de VC, VM e FR não apresentaram significância estatística quando comparados os resultados do pré e pós-operatório em ambos os grupos, bem como quando comparados os dois grupos entre si tanto no pré como no pós-operatório. Os resultados sugerem que a tanto a aplicação da FRC como a aplicação da FRC+CPAP no período pré-operatório contribui para a manutenção das variáveis respiratórias no pós-operatório. A aplicação do CPAP antes da indução anestésica não promoveu benefícios adicionais no pós-operatório de CB no que se refere aos volumes pulmonares.To assess the tidal volume (VT, minute volume (MV and respiratory rate (RR of morbidly obese women in postoperative bariatric surgery (BS, after the conventional respiratory physiotherapy (CRP with or without preoperatively continuous positive airway pressure (CPAP. Thirty-six women, aged 40.1±8.41 years, that would be submitted to BS by laparotomy were studied. All of them underwent preoperative outpatient

  6. Innovations in Agriculture in Oregon: Farmers Irrigation District Improves Water Quality, Maximizes Water Conservation, and Generates Clean, Renewable Energy

    Science.gov (United States)

    The Hood River Farmers Irrigation District used $36.2 million in CWSRF loans for a multiple-year endeavor to convert the open canal system to a piped, pressurized irrigation system to maximize water conservation and restore reliable water delivery to crops

  7. Direct suppressive effect of acute metabolic and respiratory alkalosis on parathyroid hormone secretion in the dog.

    Science.gov (United States)

    Lopez, Ignacio; Rodriguez, Mariano; Felsenfeld, Arnold J; Estepa, Jose Carlos; Aguilera-Tejero, Escolastico

    2003-08-01

    Acute alkalosis may directly affect PTH secretion. The effect of acute metabolic and respiratory alkalosis was studied in 20 dogs. PTH values were lower in the metabolic (5.6 +/- 0.8 pg/ml) and respiratory (1.8 +/- 0.6 pg/ml) alkalosis groups than in the control group (27 +/- 5 pg/ml). Acute alkalosis is an independent factor that decreases PTH values during normocalcemia and delays the PTH response to hypocalcemia. We recently showed that acute metabolic and respiratory acidosis stimulated PTH secretion. This study was designed to evaluate whether acute metabolic and respiratory alkalosis suppressed parathyroid hormone (PTH) secretion. Three groups of 10 dogs were studied: control, acute metabolic alkalosis, and acute respiratory alkalosis. Metabolic alkalosis was induced with an infusion of sodium bicarbonate and respiratory alkalosis by hyperventilation. Calcium chloride was infused to prevent alkalosis-induced hypocalcemia during the first 60 minutes. During the next 30 minutes, disodium EDTA was infused to induce hypocalcemia and to evaluate the PTH response to hypocalcemia. Because the infusion of sodium bicarbonate resulted in hypernatremia, the effect of hypernatremia was studied in an additional group that received hypertonic saline. After 60 minutes of a normocalcemic clamp, PTH values were less (p respiratory (1.8 +/- 0.6 pg/ml) alkalosis groups than in the control group (27 +/- 5 pg/ml); the respective blood pH values were 7.61 +/- 0.01, 7.59 +/- 0.02, and 7.39 +/- 0.02. The maximal PTH response to hypocalcemia was similar among the three groups. However, the maximal PTH response was observed after a decrease in ionized calcium of 0.20 mM in the control group but not until a decrease of 0.40 mM in the metabolic and respiratory alkalosis groups. In contrast to the metabolic alkalosis group, hypernatremia (157 +/- 2 mEq/liter) in the hypertonic saline group was associated with an increased PTH value (46 +/- 4 pg/ml). Finally, the half-life of intact PTH

  8. Maximization of energy recovery inside supersonic separator in the presence of condensation and normal shock wave

    International Nuclear Information System (INIS)

    Shooshtari, S.H. Rajaee; Shahsavand, A.

    2017-01-01

    Natural gases provide around a quarter of energy consumptions around the globe. Supersonic separators (3S) play multifaceted role in natural gas industry processing, especially for water and hydrocarbon dew point corrections. These states of the art devices have minimum energy requirement and favorable process economy compared to conventional facilities. Their relatively large pressure drops may limit their application in some situations. To maximize the energy recovery of the dew point correction facility, the pressure loss across the 3S unit should be minimized. The optimal structure of 3s unit (including shock wave location and diffuser angle) is selected using simultaneous combination of normal shock occurrence and condensation in the presence of nucleation and growth processes. The condense-free gas enters the non-isentropic normal shock wave. The simulation results indicate that the normal shock location, pressure recovery coefficient and onset position strongly vary up to a certain diffuser angle (β = 8°) with the maximum pressure recovery of 0.88 which leads to minimum potential energy loss. Computational fluid dynamic simulations show that separation of boundary layer does not happen for the computed optimal value of β and it is essentially constant when the inlet gas temperatures and pressures vary over a relatively broad range. - Highlights: • Supersonic separators have found numerous applications in oil and gas industries. • Maximum pressure recovery is crucial for such units to maximize energy efficiency. • Simultaneous condensation and shock wave occurrence are studied for the first time. • Diverging nozzle angle of 8° can provide maximum pressure recovery of 0.88. • The optimal diffuser angle remains constant over a broad range of inlet conditions.

  9. Weighted expectation maximization reconstruction algorithms with application to gated megavoltage tomography

    International Nuclear Information System (INIS)

    Zhang Jin; Shi Daxin; Anastasio, Mark A; Sillanpaa, Jussi; Chang Jenghwa

    2005-01-01

    We propose and investigate weighted expectation maximization (EM) algorithms for image reconstruction in x-ray tomography. The development of the algorithms is motivated by the respiratory-gated megavoltage tomography problem, in which the acquired asymmetric cone-beam projections are limited in number and unevenly sampled over view angle. In these cases, images reconstructed by use of the conventional EM algorithm can contain ring- and streak-like artefacts that are attributable to a combination of data inconsistencies and truncation of the projection data. By use of computer-simulated and clinical gated fan-beam megavoltage projection data, we demonstrate that the proposed weighted EM algorithms effectively mitigate such image artefacts. (note)

  10. [Respiratory treatments in neuromuscular disease].

    Science.gov (United States)

    Martínez Carrasco, C; Cols Roig, M; Salcedo Posadas, A; Sardon Prado, O; Asensio de la Cruz, O; Torrent Vernetta, A

    2014-10-01

    In a previous article, a review was presented of the respiratory pathophysiology of the patient with neuromuscular disease, as well as their clinical evaluation and the major complications causing pulmonary deterioration. This article presents the respiratory treatments required to preserve lung function in neuromuscular disease as long as possible, as well as in special situations (respiratory infections, spinal curvature surgery, etc.). Special emphasis is made on the use of non-invasive ventilation, which is changing the natural history of many of these diseases. The increase in survival and life expectancy of these children means that they can continue their clinical care in adult units. The transition from pediatric care must be an active, timely and progressive process. It may be slightly stressful for the patient before the adaptation to this new environment, with multidisciplinary care always being maintained. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  11. Bubble–CPAP vs. Ventilatory–CPAP in Preterm Infants with Respiratory Distress

    OpenAIRE

    Mohammad-Reza Baneshi; Pedram Niknafs; Arash Malekiyan; Bahareh Bahman-Bijari

    2011-01-01

    Objective:Application of Continuous Positive Airway Pressure (CPAP) in neonate with respiratory distress is associated with reduction of respiratory failure, reduced complications and mortality. Bubble CPAP (B-CPAP) and ventilator-derived CPAP (V-CPAP) are two most popular CPAP modes. We aimed to determine whether B-CPAP and V-CPAP would have different survival rate and possible complications. Methods: This prospective clinical trial was performed on 50 preterm neonates weighing 1000-2000 gr ...

  12. Evaluation of anti-hyperglycemic effect of Actinidia kolomikta (Maxim. etRur.) Maxim. root extract.

    Science.gov (United States)

    Hu, Xuansheng; Cheng, Delin; Wang, Linbo; Li, Shuhong; Wang, Yuepeng; Li, Kejuan; Yang, Yingnan; Zhang, Zhenya

    2015-05-01

    This study aimed to evaluate the anti-hyperglycemic effect of ethanol extract from Actinidia kolomikta (Maxim. etRur.) Maxim. root (AKE).An in vitro evaluation was performed by using rat intestinal α-glucosidase (maltase and sucrase), the key enzymes linked with type 2 diabetes. And an in vivo evaluation was also performed by loading maltose, sucrose, glucose to normal rats. As a result, AKE showed concentration-dependent inhibition effects on rat intestinal maltase and rat intestinal sucrase with IC(50) values of 1.83 and 1.03mg/mL, respectively. In normal rats, after loaded with maltose, sucrose and glucose, administration of AKE significantly reduced postprandial hyperglycemia, which is similar to acarbose used as an anti-diabetic drug. High contents of total phenolics (80.49 ± 0.05mg GAE/g extract) and total flavonoids (430.69 ± 0.91mg RE/g extract) were detected in AKE. In conclusion, AKE possessed anti-hyperglycemic effects and the possible mechanisms were associated with its inhibition on α-glucosidase and the improvement on insulin release and/or insulin sensitivity as well. The anti-hyperglycemic activity possessed by AKE maybe attributable to its high contents of phenolic and flavonoid compounds.

  13. Alternative approaches to maximally supersymmetric field theories

    International Nuclear Information System (INIS)

    Broedel, Johannes

    2010-01-01

    The central objective of this work is the exploration and application of alternative possibilities to describe maximally supersymmetric field theories in four dimensions: N=4 super Yang-Mills theory and N=8 supergravity. While twistor string theory has been proven very useful in the context of N=4 SYM, no analogous formulation for N=8 supergravity is available. In addition to the part describing N=4 SYM theory, twistor string theory contains vertex operators corresponding to the states of N=4 conformal supergravity. Those vertex operators have to be altered in order to describe (non-conformal) Einstein supergravity. A modified version of the known open twistor string theory, including a term which breaks the conformal symmetry for the gravitational vertex operators, has been proposed recently. In a first part of the thesis structural aspects and consistency of the modified theory are discussed. Unfortunately, the majority of amplitudes can not be constructed, which can be traced back to the fact that the dimension of the moduli space of algebraic curves in twistor space is reduced in an inconsistent manner. The issue of a possible finiteness of N=8 supergravity is closely related to the question of the existence of valid counterterms in the perturbation expansion of the theory. In particular, the coefficient in front of the so-called R 4 counterterm candidate has been shown to vanish by explicit calculation. This behavior points into the direction of a symmetry not taken into account, for which the hidden on-shell E 7(7) symmetry is the prime candidate. The validity of the so-called double-soft scalar limit relation is a necessary condition for a theory exhibiting E 7(7) symmetry. By calculating the double-soft scalar limit for amplitudes derived from an N=8 supergravity action modified by an additional R 4 counterterm, one can test for possible constraints originating in the E 7(7) symmetry. In a second part of the thesis, the appropriate amplitudes are calculated

  14. Respiratory effects of kynurenic acid microinjected into the ventromedullary surface of the rat

    Directory of Open Access Journals (Sweden)

    F.P. Tolentino-Silva

    1998-10-01

    Full Text Available Several studies demonstrate that, within the ventral medullary surface (VMS, excitatory amino acids are necessary components of the neural circuits involved in the tonic and reflex control of respiration and circulation. In the present study we investigated the cardiorespiratory effects of unilateral microinjections of the broad spectrum glutamate antagonist kynurenic acid (2 nmol/200 nl along the VMS of urethane-anesthetized rats. Within the VMS only one region was responsive to this drug. This area includes most of the intermediate respiratory area, partially overlapping the rostral ventrolateral medulla (IA/RVL. When microinjected into the IA/RVL, kynurenic acid produced a respiratory depression, without changes in mean arterial pressure or heart rate. The respiratory depression observed was characterized by a decrease in ventilation, tidal volume and mean inspiratory flow and an increase in respiratory frequency. Therefore, the observed respiratory depression was entirely due to a reduction in the inspiratory drive. Microinjections of vehicle (200 nl of saline into this area produced no significant changes in breathing pattern, blood pressure or heart rate. Respiratory depression in response to the blockade of glutamatergic receptors inside the rostral VMS suggests that neurons at this site have an endogenous glutamatergic input controlling the respiratory cycle duration and the inspiratory drive transmission.

  15. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+

    Directory of Open Access Journals (Sweden)

    Dimitris Georgopoulos

    2016-09-01

    Full Text Available The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+ after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure, respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy “Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?” [1]. Keywords: Tidal volume, Compliance, Driving pressure

  16. Respiratory tract infection during Hajj

    Directory of Open Access Journals (Sweden)

    Alzeer Abdulaziz

    2009-01-01

    Full Text Available Respiratory tract infection during Hajj (pilgrimage to Mecca is a common illness, and it is responsible for most of the hospital admissions. Influenza virus is the leading cause of upper respiratory tract infection during Hajj, and pneumonia can be serious. Taking into account the close contacts among the pilgrims, as well as the crowding, the potential for transmission of M. tuberculosis is expected to be high. These pilgrims can be a source for spreading infection on their return home. Although vaccination program for influenza is implemented, its efficacy is uncertain in this religious season. Future studies should concentrate on prevention and mitigation of these infections.

  17. Respiratory correlated cone beam CT

    International Nuclear Information System (INIS)

    Sonke, Jan-Jakob; Zijp, Lambert; Remeijer, Peter; Herk, Marcel van

    2005-01-01

    A cone beam computed tomography (CBCT) scanner integrated with a linear accelerator is a powerful tool for image guided radiotherapy. Respiratory motion, however, induces artifacts in CBCT, while the respiratory correlated procedures, developed to reduce motion artifacts in axial and helical CT are not suitable for such CBCT scanners. We have developed an alternative respiratory correlated procedure for CBCT and evaluated its performance. This respiratory correlated CBCT procedure consists of retrospective sorting in projection space, yielding subsets of projections that each corresponds to a certain breathing phase. Subsequently, these subsets are reconstructed into a four-dimensional (4D) CBCT dataset. The breathing signal, required for respiratory correlation, was directly extracted from the 2D projection data, removing the need for an additional respiratory monitor system. Due to the reduced number of projections per phase, the contrast-to-noise ratio in a 4D scan reduced by a factor 2.6-3.7 compared to a 3D scan based on all projections. Projection data of a spherical phantom moving with a 3 and 5 s period with and without simulated breathing irregularities were acquired and reconstructed into 3D and 4D CBCT datasets. The positional deviations of the phantoms center of gravity between 4D CBCT and fluoroscopy were small: 0.13±0.09 mm for the regular motion and 0.39±0.24 mm for the irregular motion. Motion artifacts, clearly present in the 3D CBCT datasets, were substantially reduced in the 4D datasets, even in the presence of breathing irregularities, such that the shape of the moving structures could be identified more accurately. Moreover, the 4D CBCT dataset provided information on the 3D trajectory of the moving structures, absent in the 3D data. Considerable breathing irregularities, however, substantially reduces the image quality. Data presented for three different lung cancer patients were in line with the results obtained from the phantom study. In

  18. Thresholds in chemical respiratory sensitisation.

    Science.gov (United States)

    Cochrane, Stella A; Arts, Josje H E; Ehnes, Colin; Hindle, Stuart; Hollnagel, Heli M; Poole, Alan; Suto, Hidenori; Kimber, Ian

    2015-07-03

    There is a continuing interest in determining whether it is possible to identify thresholds for chemical allergy. Here allergic sensitisation of the respiratory tract by chemicals is considered in this context. This is an important occupational health problem, being associated with rhinitis and asthma, and in addition provides toxicologists and risk assessors with a number of challenges. In common with all forms of allergic disease chemical respiratory allergy develops in two phases. In the first (induction) phase exposure to a chemical allergen (by an appropriate route of exposure) causes immunological priming and sensitisation of the respiratory tract. The second (elicitation) phase is triggered if a sensitised subject is exposed subsequently to the same chemical allergen via inhalation. A secondary immune response will be provoked in the respiratory tract resulting in inflammation and the signs and symptoms of a respiratory hypersensitivity reaction. In this article attention has focused on the identification of threshold values during the acquisition of sensitisation. Current mechanistic understanding of allergy is such that it can be assumed that the development of sensitisation (and also the elicitation of an allergic reaction) is a threshold phenomenon; there will be levels of exposure below which sensitisation will not be acquired. That is, all immune responses, including allergic sensitisation, have threshold requirement for the availability of antigen/allergen, below which a response will fail to develop. The issue addressed here is whether there are methods available or clinical/epidemiological data that permit the identification of such thresholds. This document reviews briefly relevant human studies of occupational asthma, and experimental models that have been developed (or are being developed) for the identification and characterisation of chemical respiratory allergens. The main conclusion drawn is that although there is evidence that the

  19. Stem cells and respiratory diseases

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, Soraia Carvalho; Maron-Gutierrez, Tatiana; Garcia, Cristiane Sousa Nascimento Baez; Morales, Marcelo Marcos; Rocco, Patricia Rieken Macedo [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Inst. de Biofisica Carlos Chagas Filho. Lab. de Investigacao]. E-mail: prmrocco@biof.ufrj.br

    2008-12-15

    Stem cells have a multitude of clinical implications in the lung. This article is a critical review that includes clinical and experimental studies of MedLine and SciElo database in the last 10 years, where we highlight the effects of stem cell therapy in acute respiratory distress syndrome or more chronic disorders such as lung fibrosis and emphysema. Although, many studies have shown the beneficial effects of stem cells in lung development, repair and remodeling; some important questions need to be answered to better understand the mechanisms that control cell division and differentiation, therefore enabling the use of cell therapy in human respiratory diseases. (author)

  20. Stem cells and respiratory diseases

    International Nuclear Information System (INIS)

    Abreu, Soraia Carvalho; Maron-Gutierrez, Tatiana; Garcia, Cristiane Sousa Nascimento Baez; Morales, Marcelo Marcos; Rocco, Patricia Rieken Macedo

    2008-01-01

    Stem cells have a multitude of clinical implications in the lung. This article is a critical review that includes clinical and experimental studies of MedLine and SciElo database in the last 10 years, where we highlight the effects of stem cell therapy in acute respiratory distress syndrome or more chronic disorders such as lung fibrosis and emphysema. Although, many studies have shown the beneficial effects of stem cells in lung development, repair and remodeling; some important questions need to be answered to better understand the mechanisms that control cell division and differentiation, therefore enabling the use of cell therapy in human respiratory diseases. (author)

  1. Simple artificial training device for respiratory muscle strength and lung volumes in healthy young male and female subjects: A pilot study.

    Science.gov (United States)

    Leelarungrayub, Jirakrit; Pinkaew, Decha; Yankai, Araya; Chautrakoon, Busaba; Kuntain, Rungtiwa

    2017-10-01

    The aim of this study was to evaluate the efficiency of a simple artificial device for respiratory muscle strength training and lung volumes using either combined or non-combined exercise with elastic bands in healthy young participants. Forty healthy young participants (20 male and 20 female) aged 19-24 years old were randomized into two main experiments with four sub-groups; (1) artificial device (n = 10) & standard device (n = 10) training, and (2) artificial device training combined with elastic band (EB) exercise (n = 10) & standard device training combined with EB (n = 10) exercise. Respiratory muscle strength with maximal peak inspiratory pressure (PImax), and lung volumes; tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and vital capacity (VC) were evaluated before and after training once daily for 3 weeks. Moreover, the peak dyspnea score and vital sign parameters were compared between the experimental groups after final training. All parameters had no statistical differences (p > 0.5) between the training devices alone and those combined with EB exercise prior to any experiments. Results from the first experiment showed that training with an artificial device increased all parameters (PImax, VC, IRV, ERV) significantly (p artificial device training combined with EB exercise showed a significant increase in all parameters, except for TV, and they were the same as the increased results in training with the standard device combined with EB exercise. There was no significant difference of data between these groups after the training period. Finally, the results of peak dyspnea score and all vital sign parameters from using the artificial device, with or without EB exercise, showed no statistical difference when compared to use of the standard device. This study proposed that a simple artificial device can be used to train the respiratory muscle with or without elastic band exercise in healthy young subjects

  2. Effects of pleural effusion drainage on oxygenation, respiratory mechanics, and hemodynamics in mechanically ventilated patients.

    Science.gov (United States)

    Razazi, Keyvan; Thille, Arnaud W; Carteaux, Guillaume; Beji, Olfa; Brun-Buisson, Christian; Brochard, Laurent; Mekontso Dessap, Armand

    2014-09-01

    In mechanically ventilated patients, the effect of draining pleural effusion on oxygenation is controversial. We investigated the effect of large pleural effusion drainage on oxygenation, respiratory function (including lung volumes), and hemodynamics in mechanically ventilated patients after ultrasound-guided drainage. Arterial blood gases, respiratory mechanics (airway, pleural and transpulmonary pressures, end-expiratory lung volume, respiratory system compliance and resistance), and hemodynamics (blood pressure, heart rate, and cardiac output) were recorded before and at 3 and 24 hours (H24) after pleural drainage. The respiratory settings were kept identical during the study period. The mean volume of effusion drained was 1,579 ± 684 ml at H24. Uncomplicated pneumothorax occurred in two patients. Respiratory mechanics significantly improved after drainage, with a decrease in plateau pressure and a large increase in end-expiratory transpulmonary pressure. Respiratory system compliance, end-expiratory lung volume, and PaO2/FiO2 ratio all improved. Hemodynamics were not influenced by drainage. Improvement in the PaO2/FiO2 ratio from baseline to H24 was positively correlated with the increase in end-expiratory lung volume during the same time frame (r = 0.52, P = 0.033), but not with drained volume. A high value of pleural pressure or a highly negative transpulmonary pressure at baseline predicted limited lung expansion following effusion drainage. A lesser improvement in oxygenation occurred in patients with ARDS. Drainage of large (≥500 ml) pleural effusion in mechanically ventilated patients improves oxygenation and end-expiratory lung volume. Oxygenation improvement correlated with an increase in lung volume and a decrease in transpulmonary pressure, but was less so in patients with ARDS.

  3. Correlation analysis of respiratory signals by using parallel coordinate plots.

    Science.gov (United States)

    Saatci, Esra

    2018-01-01

    The understanding of the bonds and the relationships between the respiratory signals, i.e. the airflow, the mouth pressure, the relative temperature and the relative humidity during breathing may provide the improvement on the measurement methods of respiratory mechanics and sensor designs or the exploration of the several possible applications in the analysis of respiratory disorders. Therefore, the main objective of this study was to propose a new combination of methods in order to determine the relationship between respiratory signals as a multidimensional data. In order to reveal the coupling between the processes two very different methods were used: the well-known statistical correlation analysis (i.e. Pearson's correlation and cross-correlation coefficient) and parallel coordinate plots (PCPs). Curve bundling with the number intersections for the correlation analysis, Least Mean Square Time Delay Estimator (LMS-TDE) for the point delay detection and visual metrics for the recognition of the visual structures were proposed and utilized in PCP. The number of intersections was increased when the correlation coefficient changed from high positive to high negative correlation between the respiratory signals, especially if whole breath was processed. LMS-TDE coefficients plotted in PCP indicated well-matched point delay results to the findings in the correlation analysis. Visual inspection of PCB by visual metrics showed range, dispersions, entropy comparisons and linear and sinusoidal-like relationships between the respiratory signals. It is demonstrated that the basic correlation analysis together with the parallel coordinate plots perceptually motivates the visual metrics in the display and thus can be considered as an aid to the user analysis by providing meaningful views of the data. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery.

    Science.gov (United States)

    Oliveira, Marcio Aparecido; Vidotto, Milena Carlos; Nascimento, Oliver Augusto; Almeida, Renato; Santoro, Ilka Lopes; Sperandio, Evandro Fornias; Jardim, José Roberto; Gazzotti, Mariana Rodrigues

    2015-01-01

    Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. Prospective study in a tertiary-level university hospital. Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

  5. Conventional monitoring is not sufficient to assess respiratory effort during assisted ventilation.

    Science.gov (United States)

    Ruiz Ferrón, F; Serrano Simón, J M

    2018-03-31

    Study the relationship and concordance between calculated respiratory effort using the signals of the ventilator (Pmus) and that measured in esophageal pressure (Pes) on mechanical ventilation with different levels of respiratory assistance. Prospective cohort study. Intensive Care Unit of 2 universitary hospitals. Patients Patients on weaning time. Airway, esophageal and respiratory flow were recorded on CPAP, assist volume control (ACV) and pressure support (PS), with complete (ACV1,PS1) and partial assistance (ACV5,PS5). respiratory variations of Pes and Pmus (Δ: cmH 2 O) and pressure time product (PTPm: cmH 2 O·s/m). Fourty one records were studied, the assistance was in CPAP of 5cmH2O, PS1 of 15±5 reduced to 9±4cmH 2 O. In ACV1 the inspiratory flow was 1±0.2l/s, reduced to 0.49±0.1l/s for ACV5. The increase in respiratory assistance decreases respiratory effort, measured in Delta Pes (CPAP, ACV5, ACV1, PS5, PS1): 11±3, 6±3, 5±3, 9±6, 7±7 and in Pmus 16±5, 10±6, 5±3, 10±6, 5±4cmH 2 O (Prespiratory effort showed unacceptable differences in clinical practice. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  6. Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation.

    Science.gov (United States)

    Das, Anup; Cole, Oana; Chikhani, Marc; Wang, Wenfei; Ali, Tayyba; Haque, Mainul; Bates, Declan G; Hardman, Jonathan G

    2015-01-12

    Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patient-specific computational simulation to analyze how three different RMs act to improve physiological responses, and investigate how different levels of PEEP contribute to maintaining effective lung recruitment. We conducted experiments on five 'virtual' ARDS patients using a computational simulator that reproduces static and dynamic features of a multivariable clinical dataset on the responses of individual ARDS patients to a range of ventilator inputs. Three recruitment maneuvers (sustained inflation (SI), maximal recruitment strategy (MRS) followed by a titrated PEEP, and prolonged recruitment maneuver (PRM)) were implemented and evaluated for a range of different pressure settings. All maneuvers demonstrated improvements in gas exchange, but the extent and duration of improvement varied significantly, as did the observed mechanism of operation. Maintaining adequate post-RM levels of PEEP was seen to be crucial in avoiding cliff-edge type re-collapse of alveolar units for all maneuvers. For all five patients, the MRS exhibited the most prolonged improvement in oxygenation, and we found that a PEEP setting of 35 cm H2O with a fixed driving pressure of 15 cm H2O (above PEEP) was sufficient to achieve 95% recruitment. Subsequently, we found that PEEP titrated to a value of 16 cm H2O was able to maintain 95% recruitment in all five patients. There appears to be significant scope for reducing the peak levels of PEEP originally specified in the MRS and hence to avoid exposing the lung to

  7. Kinetic theory in maximal-acceleration invariant phase space

    International Nuclear Information System (INIS)

    Brandt, H.E.

    1989-01-01

    A vanishing directional derivative of a scalar field along particle trajectories in maximal acceleration invariant phase space is identical in form to the ordinary covariant Vlasov equation in curved spacetime in the presence of both gravitational and nongravitational forces. A natural foundation is thereby provided for a covariant kinetic theory of particles in maximal-acceleration invariant phase space. (orig.)

  8. IIB solutions with N>28 Killing spinors are maximally supersymmetric

    International Nuclear Information System (INIS)

    Gran, U.; Gutowski, J.; Papadopoulos, G.; Roest, D.

    2007-01-01

    We show that all IIB supergravity backgrounds which admit more than 28 Killing spinors are maximally supersymmetric. In particular, we find that for all N>28 backgrounds the supercovariant curvature vanishes, and that the quotients of maximally supersymmetric backgrounds either preserve all 32 or N<29 supersymmetries

  9. Pace's Maxims for Homegrown Library Projects. Coming Full Circle

    Science.gov (United States)

    Pace, Andrew K.

    2005-01-01

    This article discusses six maxims by which to run library automation. The following maxims are discussed: (1) Solve only known problems; (2) Avoid changing data to fix display problems; (3) Aut viam inveniam aut faciam; (4) If you cannot make it yourself, buy something; (5) Kill the alligator closest to the boat; and (6) Just because yours is…

  10. Lifestyle and metabolic approaches to maximizing erectile and vascular health.

    Science.gov (United States)

    Meldrum, D R; Gambone, J C; Morris, M A; Esposito, K; Giugliano, D; Ignarro, L J

    2012-01-01

    Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient

  11. Caffeine Affects Time to Exhaustion and Substrate Oxidation during Cycling at Maximal Lactate Steady State

    Directory of Open Access Journals (Sweden)

    Rogério Santos de Oliveira Cruz

    2015-06-01

    Full Text Available This study analyzed the effects of caffeine intake on whole-body substrate metabolism and exercise tolerance during cycling by using a more individualized intensity for merging the subjects into homogeneous metabolic responses (the workload associated with the maximal lactate steady state—MLSS. MLSS was firstly determined in eight active males (25 ± 4 years, 176 ± 7 cm, 77 ± 11 kg using from two to four constant-load tests of 30 min. On two following occasions, participants performed a test until exhaustion at the MLSS workload 1 h after taking either 6 mg/kg of body mass of caffeine or placebo (dextrose, in a randomized, double-blinded manner. Respiratory exchange ratio was calculated from gas exchange measurements. There was an improvement of 22.7% in time to exhaustion at MLSS workload following caffeine ingestion (95% confidence limits of ±10.3%, p = 0.002, which was accompanied by decrease in respiratory exchange ratio (p = 0.001. These results reinforce findings indicating that sparing of the endogenous carbohydrate stores could be one of the several physiological effects of caffeine during submaximal performance around 1 h.

  12. Automatic optimization of core loading patterns to maximize cycle energy production within operational constraints

    International Nuclear Information System (INIS)

    Hobson, G.H.; Turinsky, P.J.

    1986-01-01

    Computational capability has been developed to automatically determine the core loading pattern which minimizes fuel cycle costs for a pressurized water reactor. Equating fuel cycle cost minimization with core reactivity maximization, the objective is to determine the loading pattern which maximizes core reactivity at end-of-cycle while satisfying the power peaking constraint throughout the cycle and region average discharge burnup limit. The method utilizes a two-dimensional, coarse mesh, finite difference scheme to evaluate core reactivity and fluxes for an initial reference loading pattern as a function of cycle burnup. First order perturbation theory is applied to determine the effects of assembly shuffling on reactivity, power distribution, and end-of-cycle burnup

  13. Climate change and respiratory health.

    Science.gov (United States)

    Gerardi, Daniel A; Kellerman, Roy A

    2014-10-01

    To discuss the nature of climate change and both its immediate and long-term effects on human respiratory health. This review is based on information from a presentation of the American College of Chest Physicians course on Occupational and Environmental Lung Disease held in Toronto, Canada, June 2013. It is supplemented by a PubMed search for climate change, global warming, respiratory tract diseases, and respiratory health. It is also supplemented by a search of Web sites including the Environmental Protection Agency, National Oceanic and Atmospheric Administration, World Meteorological Association, National Snow and Ice Data Center, Carbon Dioxide Information Analysis Center, Inter-Governmental Panel on Climate Change, and the World Health Organization. Health effects of climate change include an increase in the prevalence of certain respiratory diseases, exacerbations of chronic lung disease, premature mortality, allergic responses, and declines in lung function. Climate change, mediated by greenhouse gases, causes adverse health effects to the most vulnerable patient populations-the elderly, children, and those in distressed socioeconomic strata.

  14. [Undernutrition in chronic respiratory diseases].

    Science.gov (United States)

    Zielonka, Tadeusz M; Hadzik-Błaszczyk, Małgorzata

    2015-01-01

    Respiratory diseases such as asthma, COPD, lung cancer, infections, including also tuberculosis constitute the most frequent diseases in the word. Undernutrition frequently accompanies these diseases. Early diagnosis of malnutrition and implementation of appropriate treatment is very important. A nutritional interview and anthropometric examinations, such as body mass index, fat free mass and fat mass are used to diagnose it. Nutritional therapy affects the course and prognosis of these diseases. Diet should be individually adjusted to the calculated caloric intake that increases during exacerbation of disease, because of increased respiratory effort. Too large supply of energy can cause increase metabolism, higher oxygen consumption and PaCO2 increase each dangerous for patients with respiratory insufficiency. Main source of carbohydrates for these patients should be products with low glycemic index and with high dietary fiber contents. Large meals should be avoided since they cause rapid satiety, abdominal discomfort and have negative impact on the work of the respiratory muscles, especially of the diaphragm. Dietary supplements can be used in case of ineffectiveness of diet or for the patients with severe undernutrition.

  15. Respiratory effects of borax dust.

    Science.gov (United States)

    Garabrant, D H; Bernstein, L; Peters, J M; Smith, T J; Wright, W E

    1985-12-01

    The relation of respiratory symptoms, pulmonary function, and abnormalities of chest radiographs to estimated exposures of borax dust has been investigated in a cross sectional study of 629 actively employed borax workers. Ninety three per cent of the eligible workers participated in the study and exposures ranged from 1.1 mg/m3 to 14.6 mg/m3. Symptoms of acute respiratory irritation such as dryness of the mouth, nose, or throat, dry cough, nose bleeds, sore throat, productive cough, shortness of breath, and chest tightness were related to exposures of 4.0 mg/m3 or more, and were infrequent at exposures of 1.1 mg/m3. Symptoms of persistent respiratory irritation meeting the definition of chronic simple bronchitis were related to exposure among non-smokers. Decrements in the FEV1 as a percentage of predicted were seen among smokers who had heavy cumulative borax exposures (greater than or equal to 80 mg/m3 years) but were not seen among less exposed smokers or among non-smokers. Radiographic abnormalities were uncommon and were not related to dust exposure. Borax dust appears to act as a simple respiratory irritant and perhaps causes small changes in the FEV1 among smokers who are heavily exposed.

  16. Guide to industrial respiratory protection

    International Nuclear Information System (INIS)

    Pritchard, J.A.

    1977-03-01

    The Occupational Safety and Health Act of 1970 has increased the emphasis on proper selection and use of respirators in situations where engineering controls are not feasible or are being implemented. Although a great deal of information on respiratory protection has been published, most of it is more technical than necessary for the average user faced with day-to-day problems of respiratory protection in industrial environments. This Guide is to provide the industrial user a single reference source containing enough information for establishing and maintaining a respirator program that meets the OSHA requirements outlined in 29 CFR Part 1910.134. It includes chapters on respirator selection, use, maintenance, and inspection, a complete description of all types of respirators and their advantages and limitations, and chapters on respirator fitting and wearer training, respiratory physiology, respiratory hazards, and physiological and psychological limitations. Also included are samples of the decision logic used in respirator selection, guidance on setting up an adequate respirator program through formulation of written standard operating procedures, and discussion of the meaning of the approved respirator

  17. Prevalence of respiratory symptoms and their correlation to pulmonary function abnormalities in individuals exposed to environmental pollution

    International Nuclear Information System (INIS)

    Khalid, G.H.; Ali, M.; Ahmed, J.; Abbas, M.N.

    1999-01-01

    To find out the prevalence of respiratory symptoms and their correlation to pulmonary function abnormalities in individuals exposed to polluted air, 438 workers, and their family members were studied at Thermal Power Station (TPS), Sheikhmanda (Quetta). Individuals with a stay of less than three years at TPS and patients with known chronic respiratory infections (tuberculosis and its squelae, bronchiectasis) were excluded from the study. Remaining 175 males (mean age 43.4 years) and 71 females (mean age 34.2 years) were divided into three groups A, B, C on the basis of their exposure time to polluted air per day during the three years. Each groups was further subdivided into smoker and non-smoker members. Prevalence of respiratory symptoms was significantly higher in the individuals exposed to polluted air as compared to non-exposed individuals (P<0.05). A strong positive correlation (r=0.91) exists between respiratory symptoms and respiratory function abnormalities in smoker groups; however, no definite correlation (r=0.06) was found between respiratory symptoms and respiratory function abnormalities in non-smoker groups. Function abnormalities was noted only in smoker groups and non-smokers of even maximally exposed group (group C) had almost no respiratory function abnormalities. (author)

  18. Efficacy of Interventions to Improve Respiratory Function After Stroke.

    Science.gov (United States)

    Menezes, Kênia Kp; Nascimento, Lucas R; Avelino, Patrick R; Alvarenga, Maria Tereza Mota; Teixeira-Salmela, Luci F

    2018-07-01

    The aim of this study was to systematically review all current interventions that have been utilized to improve respiratory function and activity after stroke. Specific searches were conducted. The experimental intervention had to be planned, structured, repetitive, purposive, and delivered with the aim of improving respiratory function. Outcomes included respiratory strength (maximum inspiratory pressure [P Imax ], maximum expiratory pressure [P Emax ]) and endurance, lung function (FVC, FEV 1 , and peak expiratory flow [PEF]), dyspnea, and activity. The quality of the randomized trials was assessed by the PEDro scale using scores from the Physiotherapy Evidence Database (www.pedro.org.au), and risk of bias was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The 17 included trials had a mean PEDro score of 5.7 (range 4-8) and involved 616 participants. Meta-analyses showed that respiratory muscle training significantly improved all outcomes of interest: P Imax (weighted mean difference 11 cm H 2 O, 95% CI 7-15, I 2 = 0%), P Emax (8 cm H 2 O, 95% CI 2-15, I 2 = 65%), FVC (0.25 L, 95% CI 0.12-0.37, I 2 = 29%), FEV 1 (0.24 L, 95% CI 0.17-0.30, I 2 = 0%), PEF (0.51 L/s, 95% CI 0.10-0.92, I 2 = 0%), dyspnea (standardized mean difference -1.6 points, 95% CI -2.2 to -0.9; I 2 = 0%), and activity (standardized mean difference 0.78, 95% CI 0.22-1.35, I 2 = 0%). Meta-analyses found no significant results for the effects of breathing exercises on lung function. For the remaining interventions (ie, aerobic and postural exercises) and the addition of electrical stimulation, meta-analyses could not be performed. This systematic review reports 5 possible interventions used to improve respiratory function after stroke. Respiratory muscle training proved to be effective for improving inspiratory and expiratory strength, lung function, and dyspnea, and benefits were carried over to activity. However, there is still no evidence to accept or

  19. The effect of caffeine on maximal oxygen uptake and vertical jump performance in male basketball players.

    Science.gov (United States)

    Tucker, Matthew A; Hargreaves, Jill M; Clarke, Jenny C; Dale, Darren L; Blackwell, Gavin J

    2013-02-01

    This study investigated whether performance enhancement from caffeine described by other researchers transfers to male basketball players. The effects of caffeine ingestion were studied in a maximal-effort test on a treadmill that was followed by a vertical-jump test. Five elite-level male basketball players completed a graded treadmill test that measured maximal oxygen uptake, blood lactate profiles, respiratory exchange ratio, and rating of perceived exertion at each 3-minute stage. After a 15-minute warm-down, the subjects performed 10 vertical rebound jumps. Each subject completed the test twice--once with a 3 mg·kg(-1) of body weight dose of caffeine and once with a placebo, with the dosage administered 60 minutes before commencement of exercise. The test was thus administered according to a double-blind protocol. No substantial trends were found between caffeine and control trials, regardless of trial order. The study showed that the specified dosage had negligible effects on the players' power and endurance performance and had no efficacy as an ergogenic aid for male basketball players.

  20. [Respiratory diseases in metallurgy production workers].

    Science.gov (United States)

    Shliapnikov, D M; Vlasova, E M; Ponomareva, T A

    2012-01-01

    The authors identified features of respiratory diseases in workers of various metallurgy workshops. Cause-effect relationships are defined between occupational risk factors and respiratory diseases, with determining the affection level.