The Role of rescue therapies in the treatment of severe ARDS

ARDS is characterized by a non-cardiogenic pulmonary edema with bilateral chest radiograph opacities and hypoxemia refractory to oxygen therapy. It is a common cause of admission to the ICU due to hypoxemic respiratory failure requiring mechanical ventilation. Corticosteroids are not recommended in ARDS patients. Rescue therapies alleviate hypoxemia in patients unable to maintain reasonable oxygenation: recruitment maneuvers, prone positioning, inhaled nitric oxide, high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation improve oxygenation, but their impact on mortality remains unproven. Restrictive fluid management seems to be a favorable strategy with no significant reduction in 60-d mortality. Future studies are needed to clarify the efficacy of these therapies on outcomes in patients with severe ARDS, and institution of these therapies may be considered on a case-by-case basis

Extracorporeal CO2 removal in hypercapnic patients who fail noni nvasive ventialtion and refuse endotracheal intubation. a case series

Noninvasive ventilation (NIV) represents the standard of care for patients with exacerbation of chronic obstructive pulmonary disease. However, NIV fails in almost 40% of the most severe forms of acute hypercapnic respiratory failure and patients must undergo endotracheal intubation and invasive ventilation. Such transition from NIV to invasive ventilation is associated to increased mortality. Under these circumstances, patients may express a clear intention not to be intubated

Model-Based Fault Detection and Estimation for Linear Time Invariant and Piecewise Affine Systems by Using Quadratic Boundedness

Quadratic boundedness is a notion of stability that is adopted to investigate the design of observers for dynamic systems subject to bounded disturbances. We will show how to exploit such observers for the purpose of fault detection. Toward this end, first of all we present the naive application of quadratic boundedness to construct state observers for linear time-invariant systems with state augmentation, i.e., where additional variables may be introduced to account for the occurrence of a fault. Then a Luenberger observer is designed to estimate the augmented state variable of the system in such a way to detect the fault by using a convenient threshold selection. Finally, such an approach is extended to piecewise affine systems by presenting a hybrid Luenberger observer and its related design based on quadratic boundedness. The design of all the observers for both linear time-invariant and piecewise affine systems can be done by using linear matrix inequalities. Simulation results are provided to show the effectiveness of the proposed approach

Intensive archaeological survey at Piscina Torta: use of a low-cost RTK portable kit to materialise a UTM grid on the ground

We tested the use of a low-cost GPS RTK to set up a grid during the intensive archaeological survey of the Piscina Torta site, in the framework of the Salt and Power project of the University of Groningen. We also suggest not using a local grid but the WGS84 UTM grid and naming the single cells with the coordinates of one of its vertices. This would facilitate the use and exchange of the data (e.g. about the potsherds collected in the cell) among the scientific community

Intensive archaeological survey at Piscina Torta:use of a low-cost RTK portable kit to materialise a UTM grid on the ground

We tested the use of a low-cost GPS RTK to set up a grid during the intensive archaeological survey of the Piscina Torta site, in the framework of the Salt and Power project of the University of Groningen. We also suggest not using a local grid but the WGS84 UTM grid and naming the single cells with the coordinates of one of its vertices. This would facilitate the use and exchange of the data (e.g. about the potsherds collected in the cell) among the scientific community

Intensive archaeological survey at Piscina Torta:use of a low-cost RTK portable kit to materialise a UTM grid on the ground

We tested the use of a low-cost GPS RTK to set up a grid during the intensive archaeological survey of the Piscina Torta site, in the framework of the Salt and Power project of the University of Groningen. We also suggest not using a local grid but the WGS84 UTM grid and naming the single cells with the coordinates of one of its vertices. This would facilitate the use and exchange of the data (e.g. about the potsherds collected in the cell) among the scientific community

Intensive archaeological survey at Piscina Torta:use of a low-cost RTK portable kit to materialise a UTM grid on the ground

We tested the use of a low-cost GPS RTK to set up a grid during the intensive archaeological survey of the Piscina Torta site, in the framework of the Salt and Power project of the University of Groningen. We also suggest not using a local grid but the WGS84 UTM grid and naming the single cells with the coordinates of one of its vertices. This would facilitate the use and exchange of the data (e.g. about the potsherds collected in the cell) among the scientific community

Intensive archaeological survey at Piscina Torta:use of a low-cost RTK portable kit to materialise a UTM grid on the ground

We tested the use of a low-cost GPS RTK to set up a grid during the intensive archaeological survey of the Piscina Torta site, in the framework of the Salt and Power project of the University of Groningen. We also suggest not using a local grid but the WGS84 UTM grid and naming the single cells with the coordinates of one of its vertices. This would facilitate the use and exchange of the data (e.g. about the potsherds collected in the cell) among the scientific community

Increased creatine demand during pregnancy in Arginine: Glycine Amidino-Transferase deficiency: A case report

Background: Creatine (Cr), an amino acid derivative, is one of the most important sources of energy acting as both a spatial and temporal energy buffer through its phosphorylated analogue phosphocreatine (PCr) and creatine kinase (CK). Maternal Cr biosynthesis and metabolism seem to play an important role in pregnancy, as shown in preclinical and in healthy human pregnancy studies. Patients with Arginine:Glycine Amidino-Transferase deficiency (AGAT-d), due to the deficit of the first enzyme involved in Cr synthesis, are at a disadvantage due to their failure to synthesize Cr and their dependence on external intake, in contrast to normal subjects, where changes in Cr biosynthesis supply their needs. We report the outcomes of a pregnancy in an AGAT-d woman, and the challenge we faced in managing her treatment with oral Cr to ensure optimal conditions for her fetus. Case presentation: A 22-year-old AGAT-d woman referred to our Institute for the management of her first conception at 11 weeks of fetal gestational age. Sonographic monitoring at 20 w GA indicated a reduction of fetal growth, in particular of the head circumference that was below the 3rd centile. Biochemical monitoring of Cr in biological fluids of the mother revealed a decline of the Cr concentrations, in particular in the urine sample, requiring prompt correction of the Cr dose. At 35 weeks of gestation the patient delivered a male infant, heterozygous for GATM mutation, with normal brain Cr levels; at one year the baby achieved typical developmental milestones. Conclusions: This rare pregnancy demonstrates that Cr levels in the blood and urine of the mother with AGAT-d decreased since the first months of gestation. The increase of the Cr daily dose administered to the mother seems to have produced beneficial effects also on the fetus

Public Spending on Elders and Children: The gap is Growing

Social welfare programs support the income, education, nutrition, and medical care needs of many of this country’s elders and children. Over the past twenty years, however, three times as many children as elders have lived in poverty, and poverty rates for children have consistently exceeded those for the elderly. Given the continued disparity in poverty rates, it is important to track levels of public spending for each group and the generational balance in allocating limited public funds. This Issue Brief evaluates trends in social welfare spending for children and the elderly from 1980 to 2000, and the relationship of national economic trends to public spending patterns