Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

Biophysical Gradients and Performance of Whitebark Pine Plantings in the Greater Yellowstone Ecosystem

Research Highlights: The efficacy of planting for restoration is important for ecosystem managers. Planting efforts represent an opportunity for conserving and managing species during a population crisis. Background and Objectives: Federal agencies have been planting whitebark pine (WBP), an important subalpine species that is late to mature and long-lived, for three decades in the Greater Yellowstone Ecosystem (GYE). These efforts have been met with varying success, and they have not been evaluated beyond the first five years post-planting. Ecosystem managers will continue to plant WBP in the GYE for years to come, and this research helps to inform and identify higher quality habitat during a period of changing climate and high GYE WBP mortality rates. Materials and Methods: We use a combination of field sampling and a water balance model to investigate local biophysical gradients as explanatory variables for WBP performance at twenty-nine GYE planting sites. Results: We found that the WBP growth rate was positively correlated with actual evapotranspiration (AET) and was greatest when cumulative growing season AET was above 350 mm. Growth rate was not strongly affected by competition at the levels found in this study. However, site density change over time was negatively affected by mean growing season temperature and when more than five competitors were present within 3.59 m radius. Conclusions: If they make it to maturity, trees that are planted this season will not begin to produce cones until the latter half of this century. We recommend planting efforts that optimize AET for growth rate objectives, minimize water deficit (WD) that cause stress and mortality, and removing competitors if they exceed five within a short distance of seedlings.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

A process synthesis approach for isolation of isoflavones from okara

Owing to the complexity of food matrices, process synthesis methodologies have not been as widely applied in the food industry as in the chemical industry. Here, we describe the application of a process synthesis methodology to design a system to separate valuable components from a byproduct of the soymilk production. The method yielded a number of potential processing pathways and relevant mechanistic questions, which required experimental input. The combination of considering the overall system on the level of general transformations, heuristics, and additional insights through experiments resulted in a simplified conceptual process design for the separation of isoflavones from okara with a globally more sustainable choice. The holistic approach within process design as an implication of the methodology is discussed