Prone position: Does it help with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)?

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. The patient remained hypoxic despite optimum medical and ventilator management and required veno-venous extracorporeal membrane oxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior consolidation. Despite ARDSnet ventilation support, antiviral therapy and ECMO support, there was no clinical improvement. High frequency oscillatory ventilation was initiated on ECMO day #13, which resulted in no respiratory improvement over the next 5 days. On ECMO day #18, the patient was placed on a Rotaprone? bed Therapy, utilizing a proning strategy of 16 hours a day. The clinical improvements observed were resolving of the consolidation on CXR, improvements in ventilatory parameters and decreased oxygen requirements. The patient was successfully weaned off ECMO on POD#25 (8 days post prone bed). Conclusions: Prone position improved oxygen saturation and pulmonary compliance in severe ARDS requiring ECMO and it might facilitate early weaning

Incorporation Of Certification Revocation And Time Concept Into A Trust Model For Information Security System

In large open networks, handling trust and authenticity adequately is an important prerequisite for security policy. Trust issues influence not only the specification of security policies but also the techniques needed to manage and implement security policies for systems. Certification is one of the main components of trust models and is known as a common mechanism for authentic public key distribution. In order to obtain a public key, verifiers need to extract a certificate path from a network of certificates, which is called the public key infrastructure (PKI). There are two classifications of PKI; namely the centralized and decentralized PKIs. In this thesis, attention is paid the decentralized PKIs, such as Maurer’s model. This model is comprised of two parts; the deterministic and probabilistic models. An important limitation in this model is that certification revocation is not considered. Revocation happens in cases, among others, such as the loss of private key. Another limitation of Maurer’s model is that it lacks time consideration, which is important as trust changes over time. In this thesis, a novel trust model is developed, addressing the limitations of other models. Negative values such as revocation of certification have been incorporated, making a complete trust model that includes both positive and negative evidences. Particularly, certification is considered as positive evidence while certification revocation is considered negative. The time concept is then added to the model in order to address the change of trusts status over time. Hence, the complete trust model is able to incorporate certification revocation and time concept into both deterministic and probabilistic parts of a model. Incorporating two new concepts into Maurer’s model increases the generality and expressive power of the model. Novel extension of the trust model enabling it to capture all aspects of public key certification which includes trust, recommendations, confidence values for trust metric and authenticity of public keys, multiple certification paths, certification revocation and the time concept. Experimental results show that after incorporating the new concept, a decrease in confidence value in comparison to Maurer’s model was observed, resulting to a more realistic model

Preparation of Pure DyBa2Cu3O7-X Nanocluster Superconductors using Biopolymer Chitosan

We used sol-gel method for synthesizing nanoclusters of DyBa2Cu3O7-X high TC type II superconductor in presence of biopolymer chitosan. In the first stage, the precursor and biopolymer aggregated into amorphous matrix and hydrogels are then formed by thermogelling. The fibrous nature of the biopolymer chitosan is retained at high temperatures up to 500 °C. After heating to 900 °C, complete decomposition of BaCO3 and formation of the superconductor nanoparticles (with a diameter of 10-20 nm) occurred subsequently. Characterization of specimens was performed using scanning electron microscopy and transmission electron microscopy, supported by other techniques including XRD diffraction, energy dispersive X-ray, FT-IR spectrum and magnetic susceptibility measurements. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/3495

Assessment of Heavy Metal Pollution in Floor Dust of Yazd Mechanical Workplaces

Background: Workplaces have increased the risk of environmental pollutions. The aim of this study was to evaluate heavy metal pollution in the floor dust of mechanical workplaces in Yazd city. Methods: This cross-sectional analytic study was conducted in 2014. Through stratified random sampling, 30 mechanical workplaces in Yazd, Iran were selected. After sampling, the concentration of heavy metals in samples was measured by atomic absorption spectrometry (AAS). The potential environmental risk index (RI), integrated pollution index (IPI), contamination factor (Cf), the modified degree of Contamination (mCd) and Pearson correlation coefficient in SPSS v.23 were used for data analyses. Results: The trend of concentration of heavy metals in the floor dust particles of mechanical workplaces was Fe>Zn>Cu>Pb>Mn>Cr>Cd. Hence, mean concentration of Fe in the samples was 27095 mg kg-1 and that of Cd was 31 mg kg-1. According to Pearson correlation test, Mn had a significant correlation with Cr, Fe, and Cu at the 0.01 significance level. Also, RI showed that Yazd mechanical workplaces have a considerable degree of risk. Conclusion: The results showed very high levels of pollution by cadmium, lead and copper in mechanical workshops that can be due to the interaction of heavy metals in workplace scraps with dust from man-made origin

An Investigation on Adoption of Socio-Culturally Based Teaching Strategies Among Iranian Clinical Nurse Educators

Background: In today’s complex healthcare environments, the traditional teaching strategies and learning models are unable to prepare learners to confront with rapid changes. Some education scholars believe that the teaching strategies based on socioculturally theory are more responsible and efficient. Objectives: The present study was conducted to investigate socio-culturally-based teaching strategies being adopted or assigned by Iranian clinical nurse educators as high priorities. Patients and Methods: A descriptive study was conducted on 38 nurse educators from two nursing and midwifery faculties in Tabriz and Urmia, Iran. Data were collected over a period of 2 months in 2010 using the Phillip’s Adoption Appraisal Instrument, developed by Bonk & Kim. The instrument items have been ranked on a 4-point Likert-type scale and ordered in 10 subscales. The data were analyzed using SPSS software version 13.0. The overall mean, standard deviation, and confidence interval 95% were calculated for each subscale to determine the rank distribution of subscales. Results: All strategies were known as a moderate adoption (2.72 ± 0.44 of 4), however prioritizing in adoption of socio-culturally-based teaching strategies from clinical nurse educators’ viewpoints indicated that 60% of strategies were evaluated as the most adopted strategies, 10% as the least, and the other 30% in moderate mode. Conclusions: Due to the importance of socio-culturally-based theory strategies in clinical settings and the moderate adoption of strategies from clinical nurse educators’ viewpoints,educational planners and policymakers should prepare required prepositions to progress the adoption and the usage of these strategies