Measuring Gas Composition and Pressure Within Sealed Containers Using Acoustic Resonance Spectroscopy

Interim and long-term storage of carefully prepared plutonium material within hermetically sealed containers may generate dangerous gas pressures and compositions. The authors have been investigating the application of acoustic resonance spectroscopy to non-intrusively monitor changes in these parameters within sealed containers. In this approach a drum-like gas cavity is formed within the storage container which is excited using a piezoelectric transducer mounted on the outside of the container. The frequency response spectrum contains a series of peaks whose positions and widths are determined by the composition of the gas and the geometry of the cylindrical resonator; the intensities are related to the gas pressure. Comparing observed gas frequencies with theory gives excellent agreement. Small changes in gas composition, better than 1:1000, are readily measurable

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on \u2018new\u2019 conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings

Volatile Agents in Medical and Surgical Intensive Care Units: A Meta-Analysis of Randomized Clinical Trials

Objective To comprehensively assess published randomized peer-reviewed studies related to volatile agents used for sedation in intensive care unit (ICU) settings, with the hypothesis that volatile agents could reduce time to extubation in adult patients. Design Systematic review and meta-analysis of randomized trials. Setting Intensive care units. Participants Critically ill patients. Interventions None. Measurements and Main Results The BioMedCentral, PubMed, Embase, and Cochrane Central Register databases of clinical trials were searched systematically for studies on volatile agents used in the ICU setting. Articles were assessed by trained investigators, and divergences were resolved by consensus. Inclusion criteria included random allocation to treatment (volatile agents versus any intravenous comparator, with no restriction on dose or time of administration) in patients requiring mechanical ventilation in the ICU. Twelve studies with 934 patients were included in the meta-analysis. The use of halogenated agents reduced the time to extubation (standardized mean difference = \u20130.78 [\u20131.01 to \u20130.55] hours; p for effect<0.00001; p for heterogeneity = 0.18; I2 = 32% in 7 studies with 503 patients). Results for time to extubation were confirmed in all subanalyses (eg, medical and surgical patients) and sensitivity analyses. No differences in length of hospital stay, ICU stay, and mortality were recorded. Conclusions In this meta-analysis of randomized trials, volatile anesthetics reduced time to extubation in medical and surgical ICU patients. The results of this study should be confirmed by large and high-quality randomized controlled studies

Interventions affecting mortality in critically ill and perioperative patients: A systematic review of contemporary trials

Purpose Confounders in randomized controlled trials (RCTs) reporting significant effects on mortality in critically ill patients using non-surgical techniques have not been systematically explored. We aimed to identify factors unrelated to the reported intervention that might have affected the findings and robustness of such trials. Methods We searched Pubmed/MEDLINE for all RCTs on any non-surgical interventions reporting an effect on unadjusted mortality in critically ill patients between 1/1/2000 and 1/12/2015. We assessed: the number needed to treat/harm (NNT or NNH), sample size, trial design (blinded/unblinded, single or multinational, single or multicenter (sRCT or mRCT)), intention to treat (ITT) analysis, and countries of origin. Results Almost half of RCTs were sRCTs. Median sample size was small, and 1/3 were not analyzed according to ITT principle. Lack of ITT analysis was associated with greater effect size (p&nbsp;=&nbsp;0.0028). Harm was more likely in mRCTs (p&nbsp;=&nbsp;0.002) and/or in blinded RCTs (p&nbsp;=&nbsp;0.003). Blinded RCTs had double sample size (p&nbsp;=&nbsp;0.007) and an increased NNT/NNH (p&nbsp;=&nbsp;0.002). Finally, mRCTs had higher NNT (p&nbsp;=&nbsp;0.005) and NNH (p&nbsp;=&nbsp;0.02), and harm was only detected in studies from Western countries (p&nbsp;=&nbsp;0.007). Conclusions These observations imply that major systematic biases exist and affect trial findings irrespective of the intervention being studied