Short-Term Effects of High-Frequency Chest Compression and Positive Expiratory Pressure in Patients With Cystic Fibrosis

Abstract BACKGROUND: Cystic fibrosis patients require daily airway clearance therapies. The primary objective of this study was to compare the short-term efficacy of high-frequency chest compression and positive expiratory pressure mask on expectorated sputum, pulmonary function, and oxygen saturation in patients with CF hospitalized for an acute pulmonary exacerbation. METHODS: A controlled randomized cross-over trial with 24 hours between treatments was used. Thirty-four CF patients (26 ± 6.5 years) were included in the study. Before and 30 minutes after each treatment were recorded: pulmonary function testing, oxygen saturation, and perceived dyspnea. Preference for the two devices was assessed. RESULTS: No statistically significant difference between high-frequency chest compression and positive expiratory pressure mask was found in sputum production and in lung function testing. A reduction in SpO(2) was found after positive expiratory pressure mask (98 ± 1.0% versus 97 ± 1.2%; P < 0.001). Both treatments induced a statistically significant increase in Borg scale for dyspnea without differences between them. Patients reported greater satisfaction with positive expiratory pressure mask than with high-frequency chest compression (P < 0.001). CONCLUSION: High-frequency chest compression and positive expiratory pressure mask have comparable short-term effects on expectorated sputum and lung function. Although positive expiratory pressure mask was associated with a lower SpO(2), it was better tolerated than high-frequency chest compression

Baseline exercise tolerance and perceived dyspnea to identify the ideal candidate to pulmonary rehabilitation: a risk chart in COPD patients.

Background The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR). Methods We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 minutes (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes. Results- (p&lt;0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p&lt;0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased. Conclusion- This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR

Ultrasound-guided epidural catheter placement with a new technique: preliminary cadaveric study.

Several methods are described in veterinary medicine to perform and assess correct epidural needle placement to provide effective epidural analgesia (Adami et al 2017). The aim of this study is to evaluate the feasibility of an ultrasound longitudinal sagittal approach to epidural catheter placement using a biopsy needle guide. Seven dog cadavers were used in the study. With the cadaver in sternal recumbence, a 5-8 MHz microconvex transducer provided with a 16-gauge biopsy guide was positioned to obtain a longitudinal sagittal scan of the spinal process of L7 and the sacral crest; the epidural space was identified between two parallel hyperechoic lines and, as the trajectory of the biopsy guide crossed them, a 17G Tuohy needle was used to insert a 19G epidural catheter. Correct catheter placement was visualised through a resection of the column between L2 and L3. Firstly, an expert echographist (operator C1) visualised the ultrasonographic landmarks, while catheter placement was performed by an expert anaesthetist (operator A), a student (operator B) and another expert echographist (operator C2) (double-operator technique); secondly, operator A and C2 performed alone the whole procedure (single-operator technique); lastly all operators performed a blind procedure (Jones 2001). Operator A failed 2/7 single-operator procedures; time to perform the blind technique was statistically lower than the double-operator technique (75 ± 132.4 vs 91.6 ± 79.3 seconds). Operator C2 failed 3/7 blind procedures, scoring the higher total time of performance (329.3 ± 271.2 seconds), but was able to perform both the double- and single-operator technique without significant difference with operator A, despite a faster time in positioning the probe. Operator B showed a higher repositioning attempts of the needle with the double-operator procedure compared to the blind one. Ultrasound guidance appears to be a promising technique to ease catheter placement also by operators inexperienced of locoregional techniques

Results from the Cuore Experiment

The Cryogenic Underground Observatory for Rare Events (CUORE) is the first bolometric experiment searching for neutrinoless double beta decay that has been able to reach the 1-ton scale. The detector consists of an array of 988 TeO2 crystals arranged in a cylindrical compact structure of 19 towers, each of them made of 52 crystals. The construction of the experiment was completed in August 2016 and the data taking started in spring 2017 after a period of commissioning and tests. In this work we present the neutrinoless double beta decay results of CUORE from examining a total TeO2 exposure of 86.3kg yr, characterized by an effective energy resolution of 7.7 keV FWHM and a background in the region of interest of 0.014 counts/ (keV kg yr). In this physics run, CUORE placed a lower limit on the decay half- life of neutrinoless double beta decay of 130Te > 1.3.1025 yr (90% C. L.). Moreover, an analysis of the background of the experiment is presented as well as the measurement of the 130Te 2vo3p decay with a resulting half- life of T2 2. [7.9 :- 0.1 (stat.) :- 0.2 (syst.)] x 10(20) yr which is the most precise measurement of the half- life and compatible with previous results

The commissioning of the CUORE experiment: the mini-tower run

CUORE is a ton-scale experiment approaching the data taking phase in Gran Sasso National Laboratory. Its primary goal is to search for the neutrinoless double-beta decay in 130Te using 988 crystals of tellurim dioxide. The crystals are operated as bolometers at about 10 mK taking advantage of one of the largest dilution cryostat ever built. Concluded in March 2016, the cryostat commissioning consisted in a sequence of cool down runs each one integrating new parts of the apparatus. The last run was performed with the fully configured cryostat and the thermal load at 4 K reached the impressive mass of about 14 tons. During that run the base temperature of 6.3 mK was reached and maintained for more than 70 days. An array of 8 crystals, called mini-tower, was used to check bolometers operation, readout electronics and DAQ. Results will be presented in terms of cooling power, electronic noise, energy resolution and preliminary background measurements

L'Histoire derrière le rideau

Comment l'Histoire s'écrit-elle derrière les rideaux de scène ? Quels processus créatifs les auteurs mettent-ils en œuvre pour lui donner voix et corps dans le présent singulier, réel et fictif à la fois, de la représentation théâtrale ? De tout temps, les « poètes » dramatiques ont cherché à problématiser l'histoire sur les scènes, mais rarement avec autant d'intensité qu'au XIXe siècle, alors que dans l'Europe entière se pose la question des nationalités. L'Italie en construction n'échappe pas à ce questionnement. Dès la fin du XVIIIe siècle, la scène théâtrale italienne devient le lieu privilégié où s'invente l'idée de la patrie unie, et où se fabrique une histoire du Risorgimento. S'y affirme d'abord la volonté de trouver dans les grands événements de l'histoire passée de la péninsule les fondements d'une idée commune de la « nation ». S'y construit également, au fil des luttes armées et des interventions politiques menant à l'unité, à travers l'émergence de formes spectaculaires non académiques et la mise en question des grands « mythes » risorgimentali, une historiographie particulière où se mêlent célébration, témoignage, mémoire et interprétation. La commémoration du bicentenaire de l'Unité en 2011 a été l'occasion de revenir sur ce pan méconnu de l'histoire du théâtre italien que certains appellent scena risorgimentale. À la lumière des débats historiographiques suscités par cette commémoration, les contributions réunies dans ce volume envisagent les diverses modalités d'écriture dramatique et scénique qui ont accompagné la formation de l'unité italienne tout au long des XIXe et XXe siècles, et celles qui, aujourd'hui encore, quand les identités nationales sont partout questionnées, continuent d'explorer la mémoire de l'un des moments les plus complexes de l'histoire de la péninsule

Modeling of Josephson Traveling Wave Parametric Amplifiers

The recent developments in quantum technologies, as well as advanced detection experiments, have raised the need to detect extremely weak signals in the microwave frequency spectrum. To this aim, the Josephson travelling wave parametric amplifier, a device capable of reaching the quantum noise limit while providing a wide bandwidth, has been proposed as a suitable cryogenic front-end amplifier. This work deals with the numerical study of a Josephson travelling wave parametric amplifier, without approximations regarding the nonlinearity of the key elements. In particular, we focus on the investigation of the system of coupled nonlinear differential equations representing all the cells of the Josephson travelling wave parametric amplifier, with proper input and output signals at the boundaries. The investigation of the output signals generated by the parametric amplification process explores the phase-space and the Fourier spectral analysis of the output voltage, as a function of the parameters describing the pump and signal tones that excite the device. Beside the expected behavior, i.e., the signal amplification, we show that, depending on the system operation, unwanted effects (such as pump tone harmonics, incommensurate frequency generation, and noise rise), which are not accounted for in simple linearized approaches, can be generated in the whole nonlinear system

Characterization of Traveling-Wave Josephson Parametric Amplifiers at T = 0.3 K

The growing interest in quantum technologies, from fundamental physics experiments to quantum computing, demands for extremely performing electronics only adding the minimum amount of noise admitted by quantum mechanics to the input signal (i.e., quantum-limited electronics). Superconducting microwave amplifiers, due to their dissipationless nature, exhibit outstanding performances in terms of noise (quantum limited), and gain. However, bandwidth and saturation power still show space for substantial improvement. Within the DARTWARS 1 1 DARTWARS (Detector Array Readout with Traveling Wave AmplifieRS), funded by Italian National Nuclear Institute (INFN), is a quantum technologies project targeted at the development of wideband superconducting amplifiers with noise at the quantum limit and the implementation of a quantum-limited readout in different types of superconducting detectors and qubit. We are developing state-of-the-art microwave superconducting amplifiers based on Josephson junction arrays and on distributed kinetic inductance transmission lines. Here we report the realization of a setup for the characterization of the performances of Josephson traveling-wave parametric amplifiers at a temperature of 300 mK. Although in the final experimental setup, these amplifiers will operate at a base temperature of about 20 mK, their characterization at 300 mK allows to evidence the main aspects of their performances, but the ultimate noise level. This represents a quick and relatively inexpensive way to test these superconductive devices that can be of help to improve their design and fabrication

CUORE: first results and prospects

International audienceCUORE is the first bolometric tonne-scale experiment aiming at the investigation of neutrinoless double-beta (0$\nu$2$\beta$) decay of $^{130}$Te. The cryogenic commissioning followed by the detector installation and cool down took place during 2016. After the optimisation of all the detectors, the data-taking started in spring 2017. We report about the results of the first dataset acquired in May, which led to a limit on the 0$\nu$2$\beta$ half-life of $^{130}$Te of 6.6$\times$10$^{24}$ yr. An upgrade of CUORE, named CUPID, is planned to improve the 0$\nu$2$\beta$-decay sensitivity via passive and active background reduction and crystal enrichment. Some technologies for CUPID are currently under study and two of them are presented here, involving the detection of Cherenkov and scintillation light emitted by enriched $^{130}$TeO$_2$ and Li$^{100}_2$MoO$_4$ crystals respectively. This will allow us to reject the currently dominant a background