Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands

Objective: Compare duration of mechanical ventilation (MV), weaning time, ICU-LOS (ICU-LOS), efficacy and safety of remifentanil-based regimen with conventional sedation and analgesia. Design: Centre randomised, open-label, crossover, 'real-life' study. Setting: 15 Dutch hospitals. Patients: Adult medical and post-surgical ICU patients with anticipated short-term (2-3 days) MV. Interventions: Patient cohorts were randomised to remifentanil-based regimen (n = 96) with propofol as required, for a maximum of 10 days, or to conventional regimens (n = 109) of propofol, midazolam or lorazepam combined with fentanyl or morphine. Measurements and main results: Outcomes were weaning time, duration of MV, ICU-LOS, sedation- and analgesia levels, intensivist/ICU nurse satisfaction, adverse events, mean arterial pressure, heart rate. Median duration of ventilation (MV) was 5.1 days with conventional treatment versus 3.9 days with remifentanil (NS). The remifentanil-based regimen reduced median weaning time by 18.9 h (P = 0.0001). Median ICU-LOS was 7.9 days versus 5.9 days, respectively (NS). However, the treatment effects on duration of MV and ICU stay were time-dependent: patients were almost twice as likely to be extubated (P = 0.018) and discharged from the ICU (P = 0.05) on day 1-3. Propofol doses were reduced by 20% (P = 0.05). Remifentanil also improved sedation-agitation scores (P < 0.0001) and intensivist/ICU nurse satisfaction (P < 0.0001). All other outcomes were comparable. Conclusions: In patients with an expected short-term duration of MV, remifentanil significantly improves sedation and agitation levels and reduces weaning time. This contributes to a shorter duration of MV and ICU-LOS

A cross-sectional study to investigate current social adjustment of offspring of patients with schizophrenia

Objective To investigate the impact of parental disorder in the life of adult offspring by evaluating education, current employment and marital status of a sample of offspring of patients with schizophrenia and comparing findings with population rates. Methods A sample of 489 patients with DSM-IV diagnoses of schizophrenia was identified in the public outpatient mental health services of the city of Cuiaba, Brazil. Of these patients, 294 had children, and a total of 828 offspring were identified. Data for 431 offspring aged 18 years or older were collected using a structured questionnaire answered by the patient-parent and a family member. Results The percentage of age-grade discrepancy for offspring aged 18 and 19 years was 59.2% (95% CI 45.4-73.0), not significantly different from the discrepancy rate for the same age group in the general population, which was 71.1%. Offspring of patients with schizophrenia had a significantly poorer employment situation than the general population (66.7% and 75.6%; 95% CI 62.1-71.3). Fewer male offspring were married than males in the general population (54.7% and 66.0%; 95% CI 48.2-61.2). Conclusion Adult offspring of patients with schizophrenia had social adjustment problems that were markedly reflected in employment and marital status

Differences in relative abundance and size structure of the sea stars Pisaster ochraceus and Evasterias troschelii among habitat types in Puget Sound, Washington, USA

We surveyed patterns in the relative abundance and size structure of the sea stars Pisaster ochraceus and Evasterias troschelii in five habitat types of varying structural complexity and prey availability (sand/cobble, boulder, and rocky intertidal; pilings; and floating docks) in Puget Sound and the San Juan Islands, Washington. For both species, small sea stars were most abundant in the most structurally complex habitat type (boulder), where they occurred almost exclusively under boulders during low tide. Larger individuals became more abundant as structural complexity decreased, occurring more frequently in open habitat types (rocky shores, pilings, and docks) known to have greater abundances of prey resources. Gull foraging observations and experiments demonstrated that exposed small sea stars of both species were highly vulnerable to predation, suggesting that small sea stars require structural complexity (crevice microhabitat) as a predation refuge. Large sea stars, once attaining a size refuge from predation, appear to migrate to more exposed habitat types with more abundant food resources. These results suggest parallel ontogenetic habitat shifts in two co-occurring consumer species related to a shared predation risk at early life stages and demonstrate how the relative importance of top-down and bottom-up processes may differ with ontogeny

SPIRou: A NIR Spectropolarimeter/High-Precision Velocimeter for the CFHT

International audienceSPIRou is a near-infrared (nIR) spectropolarimeter/velocimeter for the Canada-France-Hawaii Telescope (CFHT) that will focus on two forefront science topics, (i) the quest for habitable Earthlike planets around nearby M stars and (ii) the study of low-mass star/planet formation in the presence of magnetic fields. SPIRou will also efficiently tackle many key programs beyond these two main goals, from weather patterns on brown dwarfs to solar system planet and exoplanet atmospheres. SPIRou will cover a wide spectral domain in a single exposure (0.98-2.44 μm) at a resolving power of 70 K, yielding unpolarized and polarized spectra of low-mass stars with a 15% average throughput at a radial velocity (RV) precision of 1 m s-1. It consists of a Cassegrain unit mounted at the Cassegrain focus of CFHT and featuring an achromatic polarimeter, coupled to a cryogenic spectrograph cooled down at 80 K through a fluoride fiber link. SPIRou is currently integrated at IRAP/OMP and will be mounted at CFHT in 2018 Q1 for a first light scheduled in early 2018. Science operation is predicted to begin in 2018 S2, allowing many fruitful synergies with major ground and space instruments such as the JWST, TESS, ALMA, and later-on PLATO and the ELT

The inverse problem of bioelectricity: an evaluation

Item does not contain fulltextThis invited paper presents a personal view on the current status of the solution to the inverse problem of bioelectricity. Its focus lies on applications in the field of electrocardiography. The topic discussed is also relevant in other medical domains, such as electroencephalography, electroneurography and electromyography. In such domains the methodology involved rests on the same basic principles of physics and electrophysiology as well as on the applied techniques of signal analysis and numerical analysis