Visualizing Impending Cerebral Circulatory Arrest Caused by Intracranial Hypertension Following Aneurysmal Subarachnoid Hemorrhage.

Intracranial hypertension may represent an important complication during the early phase following aneurysmal subarachnoid hemorrhage. 1 Timely diagnosis of intracranial hypertension is essential to avoid secondary brain ischemia; however, intracranial pressure (ICP) monitoring requires the insertion of catheters either within the brain ventricles or parenchyma, and hence, invasive ICP monitoring is not frequently utilized.2 Transcranial Doppler can be used for noninvasive ICP estimation through calculation of the pulsatility index (PI).3 We describe a case where noninvasive ICP monitoring with transcranial colorcoded Doppler (TCCD) rapidly identified a condition of severe intracranial hypertension, which led to a life-saving treatment

Economic Sustainability, Innovation, and the ESG Factors: An Empirical Investigation

open3noThe growing attention to sustainability has generated increasing interest in its relevant determi-nants and a possible relationship with economic growth's main drivers. Our paper contributes - in three ways - to this literature by proposing an empirical analysis of most innovative companies listed worldwide (909 firms over the 2013-17 time-span): firstly, market-perceived innovation - proxied by the interaction between R&D intensity and the market-to-book ratio - has a positive impact on economic sustainability; secondly, when the three ESG pillars are considered, the social one turns out to have the highest effect on economic sustainability; thirdly, results are confirmed even when we control for context-specific conditions.openLuca Di Simone, Barbara Petracci, Maria Cristina PivaLuca Di Simone, Barbara Petracci, Maria Cristina Piv

Intensive care unit–acquired weakness: unanswered questions and targets for future research [version 1; peer review: 3 approved]

Intensive care unit–acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient’s ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness

Numerical Prediction of Cavitation Inception in Centrifugal Impellers

Cavitation is a fundamental issue in pump design since it yields significant decrease of performances and pump life, damaging impeller surfaces and triggering harmful flow instabilities. This topic is usually addressed through costly experimental tests. The aim of this paper is to assess numerical methodologies for the correct evaluation and prediction of the cavitation inception in centrifugal impellers during the design phase. Preliminary analyses were performed to individuate the most promising approach by using two cavitation models on a 2D test case representing the NACA 0009 hydrofoil. Then, two CFD approaches were considered for the evaluation of the NPSHr in actual pumps. RANS two-phase calculations including the selected cavitation model were performed on a geometry provided by WEIR Gabbioneta srl. Monophase simulations have been performed as well and an in-house heuristic model has been proposed to evaluate the NPSHr curve from a non cavitating pressure field. The heuristic post-processor has been tuned using both the two-phase and the monophase data, and validated using the available experimental values provided by WEIR Gabbioneta srl

Economic Sustainability, Innovation, and the ESG Factors: An Empirical Investigation

The growing attention to sustainability has generated increasing interest in its relevant determinants and a possible relationship with economic growth’s main drivers. Our paper contributes to this literature in three ways, by proposing the following empirical analysis of most innovative companies listed worldwide (909 firms over the 2013–2017 time-span): firstly, market-perceived innovation—proxied by the interaction between R&D intensity and the market-to-book ratio—has a positive impact on economic sustainability; secondly, when the three ESG pillars are considered, the social one turns out to have the highest effect on economic sustainability; thirdly, results are confirmed even when we control for context-specific conditions

Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients

Introduction: Immobilisation in the intensive care unit (ICU) leads to muscle weakness and is associated with increased costs and long-term functional disability. Previous studies showed early mobilisation of medical ICU patients improves clinical outcomes. The Surgical ICU Optimal Mobilisation Score (SOMS) trial aims to test whether a budget-neutral intervention to facilitate goal-directed early mobilisation in the surgical ICU improves participant mobilisation and associated clinical outcomes. Methods and analysis The SOMS trial is an international, multicentre, randomised clinical study being conducted in the USA and Europe. We are targeting 200 patients. The primary outcome is average daily SOMS level and key secondary outcomes are ICU length of stay until discharge readiness and ‘mini’ modified Functional Independence Measure (mmFIM) at hospital discharge. Additional secondary outcomes include quality of life assessed at 3 months after hospital discharge and global muscle strength at ICU discharge. Exploratory outcomes will include: ventilator-free days, ICU and hospital length of stay and 3-month mortality. We will explore genetic influences on the effectiveness of early mobilisation and centre-specific effects of early mobilisation on outcomes. Ethics and dissemination Following Institutional Review Board (IRB) approval in three institutions, we started study recruitment and plan to expand to additional centres in Germany and Italy. Safety monitoring will be the domain of the Data and Safety Monitoring Board (DSMB). The SOMS trial will also explore the feasibility of a transcontinental study on early mobilisation in the surgical ICU. Results: The results of this study, along with those of ancillary studies, will be made available in the form of manuscripts and presentations at national and international meetings. Registration This study has been registered at clinicaltrials.gov (NCT01363102)

Sex-differences in the longitudinal recovery of neuromuscular function in COVID-19 associated acute respiratory distress syndrome survivors

IntroductionPatients admitted to the intensive care unit (ICU) following severe acute respiratory syndrome 2 (SARS-CoV-2) infection may have muscle weakness up to 1 year or more following ICU discharge. However, females show greater muscle weakness than males, indicating greater neuromuscular impairment. The objective of this work was to assess sex differences in longitudinal physical functioning following ICU discharge for SARS-CoV-2 infection.MethodsWe performed longitudinal assessment of physical functioning in two groups: 14 participants (7 males, 7 females) in the 3-to-6 month and 28 participants (14 males, 14 females) in the 6-to-12 month group following ICU discharge and assessed differences between the sexes. We examined self-reported fatigue, physical functioning, compound muscle action potential (CMAP) amplitude, maximal strength, and the neural drive to the tibialis anterior muscle.ResultsWe found no sex differences in the assessed parameters in the 3-to-6-month follow-up, indicating significant weakness in both sexes.Sex differences emerged in the 6-to-12-month follow-up. Specifically, females exhibited greater impairments in physical functioning, including lower strength, walking lower distances, and high neural input even 1 year following ICU-discharge.DiscussionFemales infected by SARS-CoV-2 display significant impairments in functional recovery up to 1 year following ICU discharge. The effects of sex should be considered in post-COVID neurorehabilitation

Raízes Vivas: Registro e Promoção da Cultura Popular Paraibana através da Extensão Universitária

O presente trabalho trata-se de um relato de uma ação extensionista da Universidade Federal da Paraíba, destinada a realizar um abrangente inventário da literatura do cordel paraibano, tendo como objetos de registro os autores paraibanos, ou aqueles que residem em nosso Estado, sua biografia, trajeto artístico e suas criações. O projeto de extensão relatado tem como objetivo realizar um amplo e abrangente inventário sobre o mundo do cordel paraibano, que registre a vida e as obras dos agentes desse segmento artístico-cultural popular. A metodologia está pautada na produção de verbetes. O trabalho inventariante se caracteriza como pesquisa participante, metodologia de estreita identidade com ações extensionistas, em que objetivamos contribuir para proporcionar maior visibilidade às artes e culturas regionais. Foram realizadas pesquisas de gabinete (bibliográfica e documental), com coleta de dados em fontes secundárias: pesquisas bibliográficas e na mídia, incluindo sites na Internet; registros e documentos de órgãos públicos, e registrando no site "Paraíba Criativa". Os resultados dos trabalhos inventariantes deram destaque para as narrativas do invisível, aquelas expressões da arte e cultura do Estado da Paraíba desconhecidas