Evaluation of the catheter positioning for neurally adjusted ventilatory assist

During neurally adjusted ventilatory assist (NAVA) the ventilator is driven by the patients electrical activation of the diaphragm (EAdi), detected by a special esophageal catheter. A reliable positioning of the EAdi-catheter is mandatory to trace a representative EAdi signal. We aimed to determine whether a formula that is based on the measurement from nose to ear lobe to xiphoid process of the sternum (NEX distance) modified for EAdi-catheter placement (NEX(mod)) is sufficient for predicting the accurate catheter position. Twenty-six patients were enrolled in this study. The optimal EAdi-catheter position (OPT) was defined by: (1) stable EAdi signal, (2) electrical activity highlighted in central leads of the catheter positioning tool, and (3) absence of p-wave in distal lead. Afterwards NEX(mod) was calculated and compared to the OPT finding. At NEX(mod) the EAdi signal was suitable for running NAVA in 18 out of 25 patients (72%). NEX(mod) was identical with OPT in four patients (16%). NAVA was possible in all patients at OPT. Median OPT position was 2 cm caudal of the NEX(mod) ranging from 3 cm too cranial to a position 12 cm too caudal (P < 0.01). In one patient excluded from further analysis EAdi-catheter placement led to the diagnosis of bilateral injury of the phrenic nerves. EAdi-catheter placement based on the NEX(mod) formula allows running NAVA in about two-thirds of all patients. The additional tools provided are efficient and facilitate the correct positioning of the EAdi-catheter for neurally adjusted ventilatory assist

Childlessness in France

Even though the average age at first childbirth has been increasing and education and employment options for women have improved immensely in recent decades, in France, unlike in other European countries, these developments have not led to a major increase in childlessness. Birth rates remain high and the share of the population who are childless is among the lowest in western Europe. This article discusses the historical roots as well as the societal conditions, institutional regulations, and political decisions that may explain the low levels of childlessness in France. We also discuss differences in rates of childlessness by education and occupation. Using a large representative survey on family life that was conducted parallel to the French census in 2011, we study the fertility histories of men and women born between the 1920s and late 1970s. We find that while the differences in fertility by level of education seem to have declined, having a higher education is still an obstacle to parenthood for women. For men, having a low educational and occupational status is associated with a greater likelihood of being childless. A large part of the differences in rates of childlessness between social groups can be traced back to the men and women who have never lived in a couple relationship; thus, partnership status can be regarded as a decisive parameter of the extent of childlessness

Řízení tepelného systému s použitím neuronové sítě a genetického algoritmu

Predictive Controller of a laboratory thermal process is presented in the paper. Process model is approximated by a neural network. On-line optimization is done by a genetic algorithm. Control algorithm is tested on the laboratory thermal process and compared to the standard control methods like predictive controller with the transfer and state-space linear model and the quadratic programming optimization method or a PI controller.V článku je prezentováno řízení tepelného systému. Model je vytvořen pomocí neuronové sítě. Online optimalizace je prováděna genetických algoritmem. Výsledky jsou porovnány se standardními metodami, kterými jsou prediktivní regulátor s přenosem a stavovým popisem a kvadratickým programováním a PI regulátor