Ventilator-Associated Pneumonia and PaO2/FIO2 Diagnostic Accuracy: Changing the Paradigm?

BACKGROUND: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO2/FIO2 ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO2/FIO2 ≤ 240 to diagnose VAP. METHODS: Prospective observational study in 255 consecutive patients with suspected VAP, clustered according to PaO2/FIO2 ≤ 240 vs. > 240 at pneumonia onset. The primary analysis was the association between PaO2/FIO2 ≤ 240 and quantitative microbiologic confirmation of pneumonia, the most reliable diagnostic gold-standard. RESULTS: Mean PaO2/FIO2 at VAP onset was 195 ± 82; 171 (67%) cases had PaO2/FIO2 ≤ 240. Patients with PaO2/FIO2 ≤ 240 had a lower APACHE-II score at ICU admission; however, at pneumonia onset they had higher CPIS, SOFA score, acute respiratory distress syndrome criteria and incidence of shock, and less microbiological confirmation of pneumonia (117, 69% vs. 71, 85%, p = 0.008), compared to patients with PaO2/FIO2 > 240. In multivariate logistic regression, PaO2/FIO2 ≤ 240 was independently associated with less microbiological confirmation (adjusted odds-ratio 0.37, 95% confidence interval 0.15-0.89, p = 0.027). The association between PaO2/FIO2 and microbiological confirmation of VAP was poor, with an area under the ROC curve 0.645. Initial non-response to treatment and length of stay were similar between both groups, while hospital mortality was higher in patients with PaO2/FIO2 ≤ 240. CONCLUSION: Adding PaO2/FIO2 ratio ≤ 240 to the clinical and radiographic criteria does not help in the diagnosis of VAP. PaO2/FIO2 ratio > 240 does not exclude this infection. Using this threshold may underestimate the incidence of VAP.info:eu-repo/semantics/publishedVersio

Helical Magnetic Fields from Sphaleron Decay and Baryogenesis

Many models of baryogenesis rely on anomalous particle physics processes to give baryon number violation. By numerically evolving the electroweak equations on a lattice, we show that baryogenesis in these models creates helical cosmic magnetic fields. After a transitory period, electroweak dynamics is found to conserve the Chern-Simons number and the total electromagnetic helicity. We argue that baryogenesis could lead to magnetic fields of nano-Gauss strength today on astrophysical length scales. In addition to being astrophysically relevant, such helical magnetic fields can provide an independent probe of baryogenesis and CP violation in particle physics.Comment: 4 pages, 1 figure. Added references, fixed typo

Development of a targeted and controlled nanoparticle delivery system for FoxO1 inhibitors

Background: Poly (lactic-co-glycolic acid) (PLGA) and polyethylene glycol (PEG) are polymers approved by the United States’ Food and Drug Administration. Drugs for various medical treatments have been encapsulated in PLGA-PEG nanoparticles for targeted delivery and reduction of unwanted side effects. Methods: A flow synthesis method for PLGA-PEG nanoparticles containing FoxO1 inhibitors and adipose vasculature targeting agents was developed. A set of nanoparticles including PLGA and PLGA-PEG-P3 unloaded and drug loaded were generated. The particles were characterized by DLS, fluorescence spectroscopy, TEM, and dialysis. Endotoxin levels were measured using the LAL chromogenic assay. Our approach was compared to over 270 research articles using information extraction tools. Results: Nanoparticle hydrodynamic diameters ranged from 142.4 ±0.4 d.nm to 208.7 ±3.6 d.nm while the polydispersity index was less than 0.500 for all samples (0.057 ±0.021 to 0.369 ±0.038). Zeta potentials were all negative ranging from -4.33 mV to -13.4 mV. Stability testing confirmed that size remained unchanged for up to 4 weeks. For AS1842856, loading was 0.5 mg drug/mL solution and encapsulation efficiency was ~100%. Dialysis indicated burst release of drug in the first 4 hours. Conclusion: PLGA encapsulation of AS1842856 was successful but unsuccessful for the two more hydrophilic drugs. Alternative syntheses such as water/oil/water emulsion or liposomal encapsulation are being considered. Analysis of data from published papers on PLGA nanoparticles indicated that our results were consistent with identified process-structure relationships and few groups reported endotoxin levels even though in vivo testing was performed.https://scholarscompass.vcu.edu/gradposters/1071/thumbnail.jp

Beyond-Constant-Mass-Approximation Magnetic Catalysis in the Gauge Higgs-Yukawa Model

Beyond-constant-mass approximation solutions for magnetically catalyzed fermion and scalar masses are found in a gauge Higgs-Yukawa theory in the presence of a constant magnetic field. The obtained fermion masses are several orders of magnitude larger than those found in the absence of Yukawa interactions. The masses obtained within the beyond-constant-mass approximation exactly reduce to the results within the constant-mass approach when the condition $\nu \ln (\frac{1}{\hat{m}^{2}})\ll 1$ is satisfied. Possible applications to early universe physics and condensed matter are discussed.Comment: Revised numerical results. New figures. Several sections rewritte

Impacts of artificial ocean alkalinization on the carbon cycle and climate in Earth system simulations

Using the state-of-the-art emissions-driven Max-Planck-Institute Earth system model, we explore the impacts of artificial ocean alkalinization (AOA) with a scenario based on the Representative Concentration Pathway (RCP) framework. Addition of 114 Pmol of alkalinity to the surface ocean stabilizes atmospheric CO2 concentration to RCP4.5 levels under RCP8.5 emissions. This scenario removes 940 GtC from the atmosphere and mitigates 1.5 K of global warming within this century. The climate adjusts to the lower CO2 concentration preventing the loss of sea-ice and high sea level rise. Seawater pH and the carbonate saturation state (Ω) rise substantially above levels of the current decade. Pronounced differences in regional sensitivities to AOA are projected, with the Arctic Ocean and tropical oceans emerging as hot spots for biogeochemical changes induced by AOA. Thus, the CO2 mitigation potential of AOA comes at a price of an unprecedented ocean biogeochemistry perturbation with unknown ecological consequences