Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks

Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPapp and intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEPtot from flow and pressure tracings during ongoing mechanical ventilation. Ten pigs were mechanically ventilated, and the time constant of their respiratory system (τRS) was measured. We shortened their expiratory time (TE) according to multiples of τRS, obtaining different respiratory patterns (Rpat). Pressure (PAW) and flow (V′AW) at the airway opening during ongoing mechanical ventilation were simultaneously recorded, with and without the addition of external resistance. The last breath of each Rpat included an EEHM, which was used to compute the reference PEEPtot. The entire protocol was repeated after the induction of ALI with i.v. injection of oleic acid, and 382 tracings were obtained. The ANN had to extract the PEEPtot, from the tracings without an EEHM. ANN agreement with reference PEEPtot was assessed with the Bland–Altman method. Bland Altman analysis of estimation error by ANN showed −0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmH2O). The ANNs estimated the PEEPtot well at different levels of PEEPapp under dynamic conditions, opening up new possibilities in monitoring PEEPi in critically ill patients who require ventilator treatment

Conclusion: The science of conflict

This chapter discusses the application of scientific approaches to conflict studies. The emphasis is on recent advances in the field of biomolecular archaeology applied to human remains, most notably isotopic analyses, ancient DNA and radiocarbon dating. These techniques have the potential to address crucial questions regarding skeletons demonstrating violent injuries, such as the identity and origins of those involved. In addition, high-resolution dating can be crucial to determining whether a multiple burial represents a single or multiple events, as well as linking periods exhibiting greater violence with other social and/or environmental variables. This allows archaeologists to address broader questions concerning the role(s) of violent interactions in past societies

Individual geographic mobility in a Viking-Age emporium—Burial practices and strontium isotope analyses of Ribe’s earliest inhabitants

Individual geographic mobility is a key social dynamic of early Viking-Age urbanization in Scandinavia. We present the first comprehensive geographic mobility study of Scandinavia’s earliest emporium, Ribe, which emerged around AD 700 in the North Sea region of Denmark. This article presents the results of strontium isotope analyses of 21 individuals buried at Ribe, combined with an in-depth study of the varied cultural affinities reflected by the burial practices. In order to investigate geographic mobility in early life/childhood, we sampled multiple teeth and/or petrous bone of individuals, which yielded a total of 43 strontium isotope analyses. Most individuals yielded strontium isotope values that fell within a relatively narrow range, between 87Sr/86Sr = 0.709 to 0.711. Only two individuals yielded values >87Sr/86Sr = 0.711. This suggests that most of these individuals had local origins but some had cultural affinities beyond present-day Denmark. Our results raise new questions concerning our understanding of the social and cultural dynamics behind the urbanization of Scandinavia