Impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: a randomized controlled trial

Objectives: To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation.Design: A prospective, randomized controlled trial.Setting: Two pediatric intensive care units at university hospitals in Brazil.Patients: the trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs.Interventions: Patients were randomly assigned to one of two weaning protocols. in the test group, the children underwent a daily evaluation to check readiness for weaning with a spontaneous breathing test with 10 cm H(2)O pressure support and a positive end-expiratory pressure of 5 cm H(2)O for 2 hrs. the spontaneous breathing test was repeated the next day for children who failed it. in the control group, weaning was performed according to standard care procedures.Measurements and Main Results: A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. the time to extubation was shorter in the test group, where the median mechanical ventilation duration was 3.5 days (95% confidence interval, 3.0 to 4.0) as compared to 4.7 days (95% confidence interval, 4.1 to 5.3) in the control group (p = .0127). This significant reduction in the mechanical ventilation duration for the intervention group was not associated with increased rates of extubation failure or noninvasive ventilation. It represents a 30% reduction in the risk of remaining on mechanical ventilation (hazard ratio: 0.70).Conclusions: A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the mechanical ventilation duration for children on mechanical ventilation for > 24 hrs, without increasing the extubation failure rate or the need for noninvasive ventilation. (Crit Care Med 2011; 39: 2526-2533)Hosp Sirio Libanes, Intens Care Unit, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Pediat, Hosp Clin, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Pneumol, Hosp Clin, São Paulo, BrazilHosp Albert Einstein, Intens Care Unit, São Paulo, BrazilUniv Buenos Aires, Hosp Ninos R Gutierrez, Intens Care Unit, Buenos Aires, DF, ArgentinaUniv São Paulo, Sch Med, Intens Care Unit, Univ Hosp, São Paulo, BrazilWeb of Scienc

Entanglement distribution and quantum discord

Establishing entanglement between distant parties is one of the most important problems of quantum technology, since long-distance entanglement is an essential part of such fundamental tasks as quantum cryptography or quantum teleportation. In this lecture we review basic properties of entanglement and quantum discord, and discuss recent results on entanglement distribution and the role of quantum discord therein. We also review entanglement distribution with separable states, and discuss important problems which still remain open. One such open problem is a possible advantage of indirect entanglement distribution, when compared to direct distribution protocols.Comment: 7 pages, 2 figures, contribution to "Lectures on general quantum correlations and their applications", edited by Felipe Fanchini, Diogo Soares-Pinto, and Gerardo Adess

Quantum Discord and entropic measures of quantum correlations: Optimization and behavior in finite XYXY spin chains

We discuss a generalization of the conditional entropy and one-way information deficit in quantum systems, based on general entropic forms. The formalism allows to consider simple entropic forms for which a closed evaluation of the associated optimization problem in qudit-qubit systems is shown to become feasible, allowing to approximate that of the quantum discord. As application, we examine quantum correlations of spin pairs in the exact ground state of finite $XY$ spin chains in a magnetic field through the quantum discord and information deficit. While these quantities show a similar behavior, their optimizing measurements exhibit significant differences, which can be understood and predicted through the previous approximations. The remarkable behavior of these quantities in the vicinity of transverse and non-transverse factorizing fields is also discussed.Comment: 10 pages, 3 figure

Unconscious Thinking, Feeling and Behavior Towards Products and Brands: Introduction to a Journal of Brand Management Special Issue

This introduction reviews the motivating forces behind this issue, exploring the role of nonconscious consumer behavior in branding environments. The article establishes a foundation of unconscious research in psychology and consumer behavior, and then provides an introduction to the four articles that follow. The article concludes with a call to adopt an inclusive interpretive-positivistic stance to the study of unconscious consumer-brand behavior, attitudes and beliefs

Predominance of entanglement of formation over quantum discord under quantum channels

We present a study of the behavior of two different figures of merit for quantum correlations, entanglement of formation and quantum discord, under quantum channels showing how the former can, counterintuitively, be more resilient to such environments spoiling effects. By exploiting strict conservation relations between the two measures and imposing necessary constraints on the initial conditions we are able to explicitly show this predominance is related to build-up of the system-environment correlations.Comment: 7 pages, 5 figures, RevTeX

Trajectories of Early Adolescent Loneliness: Implications for Physical Health and Sleep

The current study examines the relationship between prolonged loneliness, physical health, and sleep among young adolescents (10–13 years; N = 1214; 53% girls). Loneliness was measured at 10, 12 and 13 years of age along with parent-reported health and sleep outcomes. Using growth mixture modelling, 6 distinct trajectories were identified: ‘low increasing to high loneliness’ (n = 23, 2%), ‘high reducing loneliness’ (n = 28, 3%), ‘medium stable loneliness’ (n = 60, 5%), ‘medium reducing loneliness’ (n = 185, 15%), ‘low increasing to medium loneliness’ (n = 165, 14%), and ‘low stable loneliness’ (n = 743, 61%). Further analyses found non-significant differences between the loneliness trajectories and parent-report health and sleep outcomes including visits to health professionals, perceived general health, and sleep quality. The current study offers an important contribution to the literature on loneliness and health. Results show that the relationship may not be evident in early adolescence when parent reports of children’s health are used. The current study highlights the importance of informant choice when reporting health. The implications of the findings for future empirical work are discussed

Quality-of-life assessment in dementia: the use of DEMQOL and DEMQOL-Proxy total scores

Purpose There is a need to determine whether health-related quality-of-life (HRQL) assessments in dementia capture what is important, to form a coherent basis for guiding research and clinical and policy decisions. This study investigated structural validity of HRQL assessments made using the DEMQOL system, with particular interest in studying domains that might be central to HRQL, and the external validity of these HRQL measurements. Methods HRQL of people with dementia was evaluated by 868 self-reports (DEMQOL) and 909 proxy reports (DEMQOL-Proxy) at a community memory service. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted using bifactor models to investigate domains that might be central to general HRQL. Reliability of the general and specific factors measured by the bifactor models was examined using omega (?) and omega hierarchical (? h) coefficients. Multiple-indicators multiple-causes models were used to explore the external validity of these HRQL measurements in terms of their associations with other clinical assessments. Results Bifactor models showed adequate goodness of fit, supporting HRQL in dementia as a general construct that underlies a diverse range of health indicators. At the same time, additional factors were necessary to explain residual covariation of items within specific health domains identified from the literature. Based on these models, DEMQOL and DEMQOL-Proxy overall total scores showed excellent reliability (? h > 0.8). After accounting for common variance due to a general factor, subscale scores were less reliable (? h < 0.7) for informing on individual differences in specific HRQL domains. Depression was more strongly associated with general HRQL based on DEMQOL than on DEMQOL-Proxy (?0.55 vs ?0.22). Cognitive impairment had no reliable association with general HRQL based on DEMQOL or DEMQOL-Proxy. Conclusions The tenability of a bifactor model of HRQL in dementia suggests that it is possible to retain theoretical focus on the assessment of a general phenomenon, while exploring variation in specific HRQL domains for insights on what may lie at the ‘heart’ of HRQL for people with dementia. These data suggest that DEMQOL and DEMQOL-Proxy total scores are likely to be accurate measures of individual differences in HRQL, but that subscale scores should not be used. No specific domain was solely responsible for general HRQL at dementia diagnosis. Better HRQL was moderately associated with less depressive symptoms, but this was less apparent based on informant reports. HRQL was not associated with severity of cognitive impairment

Approaches in biotechnological applications of natural polymers

Natural polymers, such as gums and mucilage, are biocompatible, cheap, easily available and non-toxic materials of native origin. These polymers are increasingly preferred over synthetic materials for industrial applications due to their intrinsic properties, as well as they are considered alternative sources of raw materials since they present characteristics of sustainability, biodegradability and biosafety. As definition, gums and mucilages are polysaccharides or complex carbohydrates consisting of one or more monosaccharides or their derivatives linked in bewildering variety of linkages and structures. Natural gums are considered polysaccharides naturally occurring in varieties of plant seeds and exudates, tree or shrub exudates, seaweed extracts, fungi, bacteria, and animal sources. Water-soluble gums, also known as hydrocolloids, are considered exudates and are pathological products; therefore, they do not form a part of cell wall. On the other hand, mucilages are part of cell and physiological products. It is important to highlight that gums represent the largest amounts of polymer materials derived from plants. Gums have enormously large and broad applications in both food and non-food industries, being commonly used as thickening, binding, emulsifying, suspending, stabilizing agents and matrices for drug release in pharmaceutical and cosmetic industries. In the food industry, their gelling properties and the ability to mold edible films and coatings are extensively studied. The use of gums depends on the intrinsic properties that they provide, often at costs below those of synthetic polymers. For upgrading the value of gums, they are being processed into various forms, including the most recent nanomaterials, for various biotechnological applications. Thus, the main natural polymers including galactomannans, cellulose, chitin, agar, carrageenan, alginate, cashew gum, pectin and starch, in addition to the current researches about them are reviewed in this article.. }To the Conselho Nacional de Desenvolvimento Cientfíico e Tecnológico (CNPq) for fellowships (LCBBC and MGCC) and the Coordenação de Aperfeiçoamento de Pessoal de Nvíel Superior (CAPES) (PBSA). This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2013 unit, the Project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462) and COMPETE 2020 (POCI-01-0145-FEDER-006684) (JAT)

Design, construction and operation of the ProtoDUNE-SP Liquid Argon TPC

The ProtoDUNE-SP detector is a single-phase liquid argon time projection chamber (LArTPC) that was constructed and operated in the CERN North Area at the end of the H4 beamline. This detector is a prototype for the first far detector module of the Deep Underground Neutrino Experiment (DUNE), which will be constructed at the Sandford Underground Research Facility (SURF) in Lead, South Dakota, U.S.A. The ProtoDUNE-SP detector incorporates full-size components as designed for DUNE and has an active volume of 7 × 6 × 7.2 m3. The H4 beam delivers incident particles with well-measured momenta and high-purity particle identification. ProtoDUNE-SP's successful operation between 2018 and 2020 demonstrates the effectiveness of the single-phase far detector design. This paper describes the design, construction, assembly and operation of the detector components

Low exposure long-baseline neutrino oscillation sensitivity of the DUNE experiment

The Deep Underground Neutrino Experiment (DUNE) will produce world-leading neutrino oscillation measurements over the lifetime of the experiment. In this work, we explore DUNE's sensitivity to observe charge-parity violation (CPV) in the neutrino sector, and to resolve the mass ordering, for exposures of up to 100 kiloton-megawatt-years (kt-MW-yr). The analysis includes detailed uncertainties on the flux prediction, the neutrino interaction model, and detector effects. We demonstrate that DUNE will be able to unambiguously resolve the neutrino mass ordering at a 3σ (5σ) level, with a 66 (100) kt-MW-yr far detector exposure, and has the ability to make strong statements at significantly shorter exposures depending on the true value of other oscillation parameters. We also show that DUNE has the potential to make a robust measurement of CPV at a 3σ level with a 100 kt-MW-yr exposure for the maximally CP-violating values \delta_{\rm CP}} = \pm\pi/2. Additionally, the dependence of DUNE's sensitivity on the exposure taken in neutrino-enhanced and antineutrino-enhanced running is discussed. An equal fraction of exposure taken in each beam mode is found to be close to optimal when considered over the entire space of interest