Extracorporeal CO2 removal in hypercapnic patients who fail noni nvasive ventialtion and refuse endotracheal intubation. a case series

Noninvasive ventilation (NIV) represents the standard of care for patients with exacerbation of chronic obstructive pulmonary disease. However, NIV fails in almost 40% of the most severe forms of acute hypercapnic respiratory failure and patients must undergo endotracheal intubation and invasive ventilation. Such transition from NIV to invasive ventilation is associated to increased mortality. Under these circumstances, patients may express a clear intention not to be intubated

A multilevel study of social networks and collective reactions to organizational change

The purpose of this study is to examine the micro-level dynamics underlying macro-level associations between organizational change and its outcomes, focusing in particular on the role of networks in shaping individual reactions to change. Drawing upon multilevel research on situational and individual antecedents of change, we first argue that the magnitude of change at the unit level has a nonlinear effect on change recipients' tendency to resist change, which in turn influences their adaptive behaviors. We argue, further, that the attitudinal and structural composition of the professional networks in which change recipients are embedded account for differences in their adaptive behaviors. Finally, we argue that individual adaptivity coalesces at the collective, that is, unit level, and predicts the attainment of desired change goals. We find general support for our arguments in a longitudinal study using multi-source data on 170 physicians in 29 units of a large hospital that experienced a major restructuring intervention. Results confirm that multilevel mechanisms involving individuals and their social context fundamentally undergird macro-level outcomes of change. We discuss the theoretical and practical implications of bringing a network perspective to bear on issues of individual and collective reactions to organizational change

Glued laminated timber beams reinforced with sisal fibres

The current appeal for sustainable building materials has expanded the use of timber in construction. However, due to timber be a raw material, natural defects are present, what reduce its strength capacity and cause, in particular, brittle failures in the tensile region of timber beams. In order to increase the mechanical properties of these beams, fibre reinforcement can be applied. In this context, natural fibres, such as Sisal fibres, already used in various fields of construction, are an alternative for reinforcement of timber structural elements, by taking into account their adequate mechanical properties and, in special, for low-mechanical resistance wood species, such as Pinu sp, a species used widely in timber construction. This paper deals with an experimental analysis glued laminated timber beams (Glulam) of Pinus sp species, reinforced by Sisal fibres. Bending tests were performed on six beams with the following dimensions, 53 mm-width by 180 mm-height by 3000 mm-length, which were prepared with eight lamellas by 8 mm-thickness. These beams were reinforced with Sisal strips that were glued by Epoxy adhesive on the bottom part of these beams. In addition, comparisons of result with non-reinforced Glulam were carried out. From the analyses of the experimental results, a decrease of 20 to 30% for the normal stresses, 5 to 10% for the shear stresses and 8 to 12 % for the displacements in relation to non-reinforced beams were verified8439039

Laboratorio online: tutoring e vantaggi per lo studente universitario

Il presente lavoro nasce con l’intento di realizzare una ricerca che ha come obiettivo principale quello di analizzare la funzione del tutoring e dei laboratori online su un gruppo di matricole frequentanti il primo anno del Corso di Laurea di Scienze dell’Educazione dell’Università di Cagliari. In tali attività, ruolo cruciale è svolto dal tutor online che funge da facilitatore e contribuisce a chiarire e a raggiungere il conseguimento degli obiettivi educativi e delle interazioni. Il tutor induce lo sviluppo di apprendimento autonomo dei singoli discenti, facendo leva sulla loro curiosità, individuando il loro bisogni formativi, formulando obiettivi compatibili con le loro possibilità e identificando le risorse per loro più adeguate. Partendo da questi presupposti ci siamo chiesti quale sia stata la soddisfazione generale sul ruolo del tutor e l’efficacia del laboratorio in termini di percezione dell’aumento delle proprie abilità di problem solving, dell’autostima, della motivazione, del locus of control e delle competenze informatiche. In generale, si può affermare che l’esperienza del laboratorio di didattica si è rivelata positiva e ha rappresentato un elemento di supporto per gli studenti che vi hanno partecipato

Expression analysis of HLA-E and NKG2A and NKG2C receptors points at a role for natural killer function in ankylosing spondylitis

Background. Ankylosing Spondylitis (AS) is a complex chronic inflammatory disease strongly associated with the majority of HLA-B27 alleles. HLA-E are non-classical MHC class I molecules that specifically interact with the natural killer receptors NKG2A (inhibitory) and NKG2C (activating), and have been recently proposed to be involved in AS pathogenesis. Objectives: To analyze the expression of HLA-E and the CD94/NKG2 pair of receptors in HLA-B27 positive AS patients and healthy controls (HC) bearing the AS-associated, B*2705 and the non-AS-associated, B*2709 allele. Methods: The level of surface expression of HLA-E molecules on CD14 positive peripheral blood mononuclear cell was evaluated in 21 HLA-B*2705 patients with AS, 12 HLA-B*2705 HC, 12 HLA-B*2709 HC and 6 HLA-B27 negative HC, using the monoclonal antibody MEM-E/08 by quantitative cytofluorimetric analysis. The percentage and density of expression of HLA-E ligands NKG2A and NKG2C were also measured on CD3-CD56+ NK cells. Results. HLA-E expression in CD14 positive cells was significantly higher in AS patients (587.0 IQR 424-830) compared to B*2705 HC (389 IQR 251.3-440.5, p=0.0007), B*2709 HC (294.5 IQR 209.5-422, p=0.0004) and HLA-B27 negative HC (380 IQR 197.3-515.0, p=0.01). A higher number of NK cells expressing NKG2A compared to NKG2C was found in all cohort analysed as well as a higher cell surface density. Conclusion: The higher surface level of HLA-E molecules in AS patients compared to HC, concurrently with a prevalent expression of NKG2A, suggests that the crosstalk between these two molecules might play a role in AS pathogenesis accounting for the previously reported association between HLA-E and AS

Dust attenuation law in JWST galaxies at z = 7-8

Attenuation curves in galaxies depend on dust chemical composition, content, and grain size distribution. Such parameters are related to intrinsic galaxy properties such as metallicity, star formation rate, and stellar age. Due to the lack of observational constraints at high redshift, dust empirical curves measured in the local Universe (e.g. Calzetti and SMC curves) have been employed to describe the dust attenuation at early epochs. We exploit the high sensitivity and spectral resolution of the JWST to constrain the dust attenuation curves in high-z galaxies. Our goals are to check whether dust attenuation curves evolve with redshift and quantify the dependence of the inferred galaxy properties on the assumed dust attenuation law. We develop a modified version of the SED fitting code BAGPIPES by including a detailed dust attenuation curve parametrization. Dust parameters are derived, along with galaxy properties, from the fit to the data from FUV to mm bands. Once applied to three star-forming galaxies at z = 7-8, we find that their attenuation curves differ from local templates. One out of three galaxies shows a characteristic MW bump, typically associated to the presence of small carbonaceous dust grains such as PAHs. This is one of the first evidences suggesting the presence of PAHs in early galaxies. Galaxy properties such as stellar mass and SFR inferred from SED fitting are strongly affected by the assumed attenuation curve, though the adopted star formation history also plays a major role. Our results highlight the importance of accounting for the potential diversity of dust attenuation laws when analyzing the properties of galaxies at the EoR, whose dust properties are still poorly understood. The application of our method to a larger sample of galaxies observed with JWST can provide us important insights into the properties of dust and galaxies in the early universe.Comment: 19 pages, 10 figure

Spectral stability of noncharacteristic isentropic Navier-Stokes boundary layers

Building on work of Barker, Humpherys, Lafitte, Rudd, and Zumbrun in the shock wave case, we study stability of compressive, or "shock-like", boundary layers of the isentropic compressible Navier-Stokes equations with gamma-law pressure by a combination of asymptotic ODE estimates and numerical Evans function computations. Our results indicate stability for gamma in the interval [1, 3] for all compressive boundary-layers, independent of amplitude, save for inflow layers in the characteristic limit (not treated). Expansive inflow boundary-layers have been shown to be stable for all amplitudes by Matsumura and Nishihara using energy estimates. Besides the parameter of amplitude appearing in the shock case, the boundary-layer case features an additional parameter measuring displacement of the background profile, which greatly complicates the resulting case structure. Moreover, inflow boundary layers turn out to have quite delicate stability in both large-displacement and large-amplitude limits, necessitating the additional use of a mod-two stability index studied earlier by Serre and Zumbrun in order to decide stability

Skin rash and response to cetuximab treatment: a retrospective single-center analysis

Background: The standard of care for patients with recurrent/metastatic head and neck squamous cell cancer (R/M HNSCC) not susceptible for surgery or reirradiation is chemotherapy with 5-FU and cisplatin plus cetuximab. Skin rash (SR) is a common adverse event of cetuximab. In patients treated with cetuximab for colorectal cancer there is strong evidence of a better outcome in those who undergo moderate or high grade of SR, and some retrospective data seem to confirm this finding in HNSCC. We report our experience. Materials and methods: We retrospectively reviewed 107 patients treated with cetuximab for R/M HNSCC from January 2014 to December 2016. Patients were divided in two groups by the grade of SR (G0-1 and G2-4), conforming to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. Progression-free survival (PFS) was computed as time of progression or death since the date of assessment of recurrent/metastatic disease. Overall response rate (ORR) was computed as the sum of partial and complete responses and evaluated according to RECIST 1.1. PFS and ORR were correlated to the grade of rash. Results: 67 patients were evaluable for PFS: among them PFS was significantly longer (p 0.0014) in those who underwent a G2-4 rash (9,3 months) vs G0-1 (4,9 months). Hazard Ratio was 2,445 (CI 1.412-4.232). 95 patients were evaluable for ORR: among them G0-1 group had 4,2%, while G2-4 group had 36,8% of ORR. Conclusions: Our results support data of literature on improved outcome according to the development of skin rash in HNSCC. SR might be considered a predictive marker of response in these patients; nonetheless further ad hoc studies would be interesting

Parylene C-based, breathable tattoo electrode for high-quality biopotential measurements

A breathable tattoo electrode for bio-potential recording based on a Parylene C nanofilm is presented in this study. The proposed approach allows for the fabrication of micro-perforated epidermal submicrometer-thick electrodes that conjugate the unobtrusiveness of Parylene C nanofilms and the very important feature of breathability. The electrodes were fully validated for electrocardiography (ECG) measurements showing performance comparable to that of conventional disposable gelled Ag/AgCl electrodes, with no visible negative effect on the skin even many hours after their application. This result introduces interesting perspectives in the field of epidermal electronics, particularly in applications where critical on-body measurements are involved

Comparing the effects of combined numerical and visuospatial psychoeducational trainings conducted by curricular teachers and external trainers. Preliminary evidence across kindergarteners

The aim of this study was to verify the efficacy of two pencil-and-paper trainings empowering numerical and visuo-spatial abilities in Italian five-year-old kindergarteners. Specifically, the trainings were respectively carried out by the curricular teacher or by an external trainer. The former received a specific training in order to use the psychoeducational programmes with her pupils, whereas the latter received a specific education about the role of numerical and visuo-spatial abilities for school achievement and she was also trained to use psychoeducational trainings in kindergarten schools. At pre-test and post-test nonverbal functions and numeracy knowledge were assessed through a battery of standardized tests. The results show that both the numerical psychoeducational programme and the visuo-spatial one are useful tools to enhance mathematical achievements in kindergarteners. However, when the trainings were proposed by the external trainer, the efficacy of the psychoeducational programmes was more significant. These outcomes seem to be related both to the expertise and the novelty effect of the external trainer on the classroom