Systematic review of determinants of mortality in high frequency oscillatory ventilation in acute respiratory distress syndrome

INTRODUCTION: Mechanical ventilation has been shown to cause lung injury and to have a significant impact on mortality in acute respiratory distress syndrome. Theoretically, high frequency oscillatory ventilation seems an ideal lung protective ventilation mode. This review evaluates determinants of mortality during use of high frequency oscillatory ventilation. METHODS: PubMed was searched for literature reporting randomized trials and cohort studies of high frequency ventilation in adult patients with acute respiratory distress syndrome. Data on mortality and determinants were extracted for patients treated with high frequency oscillatory ventilation. Linear regression analyses were conducted to produce graphical representations of adjusted effects of determinants of mortality. RESULTS: Cohorts of patients treated with high frequency oscillatory ventilation from two randomized trials and seven observational studies were included. Data from cohorts comparing survivors with non-survivors showed differences in age (42.3 versus 51.2 years), prior time on conventional mechanical ventilation (4.0 versus 6.2 days), APACHE II score (22.4 versus 26.1), pH (7.33 versus 7.26) and oxygenation index (26 versus 34). Each extra day on conventional ventilation was associated with a 20% higher mortality adjusted for age and APACHE II score (relative risk (RR) 1.20, 95% confidence interval (CI) 1.15–1.25). However, this association was confounded by differences in pH (pH adjusted RR 1.03, 95% CI 0.73–1.46). Oxygenation index seemed to have an independent effect on mortality (RR 1.10, 95% CI 0.95–1.28). CONCLUSION: Prolonged ventilation on conventional mechanical ventilation prior to high frequency oscillatory ventilation was not related to mortality. Oxygenation index was a determinant of mortality independent of other disease severity markers

The cultural capitalists: notes on the ongoing reconfiguration of trafficking culture in Asia

Most analysis of the international flows of the illicit art market has described a global situation in which a postcolonial legacy of acquisition and collection exploits cultural heritage by pulling it westwards towards major international trade nodes in the USA and Europe. As the locus of consumptive global economic power shifts, however, these traditional flows are pulled in other directions: notably for the present commentary, towards and within Asia

High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial [ISRCTN24242669]

INTRODUCTION: To compare the safety and efficacy of high frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CV) for early intervention in adult respiratory distress syndrome (ARDS), a multi-centre randomized trial in four intensive care units was conducted. METHODS: Patients with ARDS were randomized to receive either HFOV or CV. In both treatment arms a priority was given to maintain lung volume while minimizing peak pressures. CV ventilation strategy was aimed at reducing tidal volumes. In the HFOV group, an open lung strategy was used. Respiratory and circulatory parameters were recorded and clinical outcome was determined at 30 days of follow up. RESULTS: The study was prematurely stopped. Thirty-seven patients received HFOV and 24 patients CV (average APACHE II score 21 and 20, oxygenation index 25 and 18 and duration of mechanical ventilation prior to randomization 2.1 and 1.5 days, respectively). There were no statistically significant differences in survival without supplemental oxygen or on ventilator, mortality, therapy failure, or crossover. Adjustment by a priori defined baseline characteristics showed an odds ratio of 0.80 (95% CI 0.22–2.97) for survival without oxygen or on ventilator, and an odds ratio for mortality of 1.15 (95% CI 0.43–3.10) for HFOV compared with CV. The response of the oxygenation index (OI) to treatment did not differentiate between survival and death. In the HFOV group the OI response was significantly higher than in the CV group between the first and the second day. A post hoc analysis suggested that there was a relatively better treatment effect of HFOV compared with CV in patients with a higher baseline OI. CONCLUSION: No significant differences were observed, but this trial only had power to detect major differences in survival without oxygen or on ventilator. In patients with ARDS and higher baseline OI, however, there might be a treatment benefit of HFOV over CV. More research is needed to establish the efficacy of HFOV in the treatment of ARDS. We suggest that future studies are designed to allow for informative analysis in patients with higher OI

The Sacarosa Tephra-fall Deposit Emplaced by a Plinian Eruption of Misti Volcano, Southern Peru at <=33.7 ka

Misti volcano is one of eight active volcanoes in southern Peru and is within the Central Andean Volcanic Zone. The volcano’s summit is located about 17 km northeast of the historic city center of Arequipa, Peru, a city with a population surpassing one million inhabitants. During the past 40 ky, Misti’s eruptive activity has been dominantly explosive, generating pyroclastic-density currents and tephra falls, but the volcano has also experienced dome growth and collapse and produced voluminous lahars. During this period of eruptive activity, Misti produced an explosive eruption which emplaced a well-sorted tephra-fall deposit informally called the Sacarosa. Few eruptions or their deposits, such as the Sacarosa have been investigated in detail at Misti. We provide the first comprehensive description of the Sacarosa and the eruption that emplaced it. The deposit contains a notable quantity of loose crystals of plagioclase, amphibole, biotite (sometimes bronzy), and scant Fe-Ti oxides, which combined can be 65¬–70 vol.% of the deposit’s fine matrix. The unit’s bright white, sub-angular pumice are dacite (65 wt.% SiO2), have sub-rounded vesicles, and a phenocryst assemblage of 7–10 vol.% plagioclase, 5–7 vol.% amphibole, 2–3 vol.% biotite, and trace Fe-Ti oxides. Altered and rare fresh lithics compose <1 vol.% of the deposit and are usually only present in outcrops most proximal to the volcano. Similar to many of Misti’s other tephra-fall deposits, the Sacarosa has a dispersal axis to the southwest and crops out in Arequipa’s districts of Mariano Melgar, Alto Selva Alegre, Cayma, Cerro Colorado, and Yura. Along its dispersal axis, the unit is 1.2 m thick at about 10 km from Misti’s crater, thinning to 0.24 m thick at about 20 km from the vent. From the unit’s pumice isopleths, an eruption column of ~19 km above sea level is inferred with a wind velocity of about 18 m/s. From the unit’s isopachs, a volume between 0.5 km3 and 2.5 km3 is calculated, allowing the eruption to be classified as a Volcanic Explosivity Index (VEI) 5 Plinian eruption. Charcoal collected at two locations from within the upper 10 cm of a paleosol underlying the Sacarosa yielded uncalibrated 14C ages of 33.7 kBP. The Sacarosa is younger than 33.7 kBP, but the proximity of the charcoal to the paleosurface suggests that emplacement occurred probably within several thousand years or less of the constraining age. There are many tephra-fall deposits at Misti younger than the Sacarosa, including many from likely Holocene eruptions. Compared to these other deposits, the Sacarosa eruption is representative of the volcano’s larger magnitude eruptions. Undoubtedly, Misti will erupt again in the future. If such an eruption were to be a VEI 5, like that inferred to have produced the Sacarosa, it would severely impact Arequipa and result in economic losses on a local, regional, and national scale

Excess Early Postnatal Weight Gain Leads to Increased Abdominal Fat in Young Children

Background. Increased childhood weight gain has been associated with later adiposity. Whether excess early postnatal weight gain plays a role in childhood abdominal fat is unknown. Design. In the ongoing Wheezing Illnesses Study Leidsche Rijn (WHISTLER), birth cohort weight and length from birth to age 3 months were obtained. In the first 316 five-year-olds, intra-abdominal and subcutaneous fat were measured ultrasonographically. Individual weight and length gain rates were assessed in each child. Internal Z-scores of weight for length gain (WLG) were calculated. Multiple imputation was used to deal with missing covariates. Results. Per-1-unit increase in Z-score WLG from birth to 3 months, BMI, waist circumference, and subcutaneous fat were significantly higher; 0.51 kg/m2, 0.84 cm, and 0.50 mm, respectively. After multiple imputation, a trend towards significance was observed for intra-abdominal fat as well (0.51 mm/SD). In the associations with 5-year adiposity, no interaction between postnatal Z-score WLG and birth size was found. Conclusion. Excess early postnatal weight gain is associated with increased general and central adiposity, characterized by more subcutaneous and likely more intra-abdominal fat at 5 years of age

The late Pleistocene Sacarosa tephra-fall deposit, Misti Volcano, Arequipa, Peru: its magma, eruption, and implications for past and future activity

Entre 38.5 ka cal BP y 32.4 ka cal BP el volcán Misti generó una erupción dacítica con Indice de Explosividad Volcánica 5 que emplazo el depósito de caída de tefra “Sacarosa”. La presencia de fenocristales de biotita, el tamaño fino de sus granos, escasos líticos y la abundancia de cristales libres caracterizan el depósito en los lugares muestreados. El magma tuvo una temperatura de ~ 800 °C, el cual ascendió rápidamente de ~ 10 km de profundidad y resultó en una erupción Pliniana que tuvo una tasa de descarga de masa de 7.7 × 106– 4.1 × 107 kg/s, y deposito alrededor de 3 km3 de tefra dentro de decenas de horas. El depósito tiene dos capas con espesores casi similares, separados por un contacto difuso y con una capa superior que se caracteriza por contener granos un poco más gruesos y ser un poco menos sorteado que la capa inferior. La capa superior gruesa indica condiciones culminantes o un menor grado de fragmentación durante la última mitad de la erupción. Fuertes vientos distribuyeron el depósito al suroeste del Misti cubriendo al menos 800 km2, incluyendo la actual ciudad de Arequipa donde el depósito de tefra tiene hasta 100 cm de espesor. El depósito “Sacarosa” es el primero entre los depósitos de la etapa Cayma (un grupo distintivo de unidades félsicas que contienen biotita) que es descrito detalladamente y con su erupción caracterizada. Varios depósitos de la etapa Cayma fueron generados por erupciones explosivas voluminosas similares a la erupción “Sacarosa”, representando un intervalo de ~ 8.9–15.5 ky de poderosas erupciones. Una erupción tan explosiva hoy amenazaría a los más de 1,100,000 habitantes de Arequipa, muchos de ellos viven dentro del área de distribución del depósito “Sacarosa”

Postnatal Acute Famine and Risk of Overweight: The Dutch Hungerwinter Study

Objective. To examine the association between undernutrition during postnatal periods of development and the risk of overweight in adulthood. Methods. We studied 8,091 women from Prospect-EPIC, exposed to the Dutch famine at ages between 0 and 21 years, recruited at ages between 49 and 70 years. We used linear and logistic regression models to explore the effect of famine on BMI, waist circumference, and the risk of overweight. Results. Overall, postnatal famine exposure was associated with increased BMI and waist circumference in a dose-dependent manner (P  for trend < 0.01). Furthermore, risk of overweight was increased following famine exposure (P  for trend = 0.01), with those severely exposed at ages 0–9 years having 25% (95% CI 1.05 to 1.50) higher risk compared to unexposed women. Conclusions. This study is the first to directly show a positive association between short and transient undernutrition during postnatal development and BMI, waist circumference, and overweight in adulthood

Utilization of black locust

The wood of black locust, Robinia pseudoacacia, is used chiefly for insulator pins, wagon hubs, treenails, fence posts, and mine timbers. For these uses it is admirable because of its hardness, strength, and durability. A valuable characteristic of the tree is its rapid growth on many types of soils during the first 20 to 30 years of its life. This rapid growth and the extensive network of roots developed by black locust make it well suited for planting to check erosion. The greatest obstacle to more extensive cultivation and utilization of black locust is the locust borer, Oyllene robiicae, a black or brown and yellow-striped, long-horned beetle that attacks small trees and riddles the wood. The numerous holes that it makes may render the wood valueless and often so weaken the trees that they are easily broken by the wind. The damage from the borer has not been nearly so serious in the West as in the East. Under some conditions, plantations of black locust may be at least Partly protected from the borer if the locusts are planted in thick stands or so mixed with other trees as to produce dense shade. So grown they are more apt to be free from locust attacks and will early drop off their lower branches and develop clean, straight poles during the first 10 to 15 years of growth

Estudio preliminar de la erupción del volcán Misti ocurrida hace 33,600 años AP que emplazo el depósito de caída de tefra “Sacarosa” en Arequipa

El volcán Misti (5822 msnm), es uno de los siete volcanes activos del sur peruano, cuyo cráter está localizado a 17 km al noreste del centro de la ciudad de Arequipa, donde radican aproximadamente un millón de habitantes (INEI, 2016). Dicho volcán actualmente presenta emisiones de gases en el interior del cráter que indica que el volcán está en un continuo proceso de desgasificación. A través del estudio de uno de los depósitos emplazados por una erupción del Misti ocurrida hace ~30000 años AP, conocido como “Sacarosa” nosotros deseamos comprender mejor el comportamiento pasado del volcán para contribuir a la prevención y mitigación de riesgo volcánico en Arequipa, esto en caso de una posible reactivación del volcán Misti