Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2-8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5-9) cmH20, plateau pressure was 20 cmH20 (IQR = 17-23), driving pressure was 12 cmH20 (IQR = 10-15), mechanical power 16.2 J/min (IQR = 12.1-21.8), ventilatory ratio was 1.27 (IQR = 1.04-1.6), and respiratory rate was 17 breaths/minute (IQR = 14-20). Median partial pressure of oxygen was 87 mmHg (IQR = 75-105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36-45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003-1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001-1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes

Data mining to evaluate operational risk in technological processes

RESUMEN: Un riesgo operativo es un riesgo de negocio principalmente en empresas que actúan en el sector financiero. Este tipo de riesgo puede ser tratado con diferentes marcos regulatorios, los específicos de riesgo, los de seguridad y los de evaluación de procesos tecnológicos como COBIT del Instituto de Gobernanza de TI. Identificar y tratar el riesgo no siempre es tarea fácil aun con muchos estudios. En esta investigación se utiliza la metodología Data Mining con la técnica de Machine Learning basada en árboles de decisión, para analizar el proceso de Evaluación y Gestión de Riesgos (PO9) del dominio Organización y Planificación de COBIT. La base de datos se fundamenta en el grado de madurez respondido por 548 empresas en 34 procesos diferentes. Los resultados encontrados se corresponden con la jerarquía de relaciones representadas en el árbol de decisión y con la representación de otros algoritmos utilizados en un previo clasificador de transparencia de esta misma base de datos.ABSTRACT: An operational risk is a business risk mainly in companies that operate in the financial sector. This type of risk can be dealt with different regulatory frameworks, as risk specific, security and technological process evaluation such as COBIT from the IT Governance Institute. To Identify and treat risk is not always easy, even with many studies. In this research Data Mining methodology is used with Machine Learning technique based on decision trees, to analyze the Risk Assessment and Management (PO9) process of the Planning and Organization domain of COBIT. The database is based on the maturity level of 548 companies in 34 different processes. The results found correspond to the hierarchy of relations represented in the decision tree and with the representation of other algorithms used in a previous transparency classifier of this same database

Macrobioerosión de corales constructores de arrecifes y su impacto en la dinámica de carbonatos en los arrecifes de Huatulco, México

Background. Coral reefs exist thanks to the delicate balance between calcification and erosion processes. However, due to anthropogenic pressures, bioerosive processes have become the main forcing factors in reef growth patterns. Nevertheless, due to the morphology of the reefs located in the Mexican South Pacific (extensive plates of pociloporids), estimating internal macrobioerosion is a challenge, resulting in a critical gap in bioerosion processes, particularly those occurring inside corals. Objectives. To measure the internal macrobioerosion of the main coral species and to know its impact on carbonate production in reefs. Methods. We used a computed tomography (CT) based approach to measure the volume of CaCO3 removed by different groups of macrobioeroders. Results. We estimated percentages of internal macrobioerosion between 16.80 % and 26.67 % of the total volume of the colonies. We observed that sponges and mollusks are the guilds that most bioerode species of branching and massive morphology, respectively. We found macrobioerosion rates of 1.51 ± 0.11 kg CaCO3 m-2 yr-1 for branched species and 0.53 ± 0.03 kg CaCO3 m-2 yr-1 for massive species. The measured bioerosion processes accounted for 39.02 % and 43.86 % of CaCO3 production. Conclusions. Although CT scanning represents higher costs than other approaches (i.e., X-rays), it is the only approach capable of measuring the internal macrobioerosion that occurs within the entire coral skeleton. This approach will allow us to produce more accurate carbonate balances than those that do not consider internal macrobioerosion, improving our estimates of the state of health of the reefs.Antecedentes. Los arrecifes de coral subsisten gracias al delicado balance entre procesos de acreción y de erosión. No obstante, debido a presiones antropogénicas, los procesos bioerosivos se han convertido en los principales factores que condicionan los patrones de crecimiento de los arrecifes. Debido a la morfología de los arrecifes ubicados en el Pacífico sur mexicano (placas extensas de pocilopóridos), estimar la macrobioerosión interna se convierte en un reto, lo que resulta en una importante brecha sobre los procesos de bioerosión, particularmente los que ocurren al interior de los corales. Objetivo. Medir la macrobioerosión interna de las principales especies de coral y conocer el impacto que ejerce sobre la producción de carbonatos en los arrecifes. Métodos. Empleamos un enfoque basado en tomografía computarizada (TC) que permite medir el volumen de CaCO3 removido por diferentes grupos de macrobioerosionadores. Resultados. Estimamos porcentajes de macrobioerosión interna entre el 16.80 % y el 26.67 % del volumen total de las colonias de coral. Observamos que las esponjas y moluscos son los grupos que más bioerosionan las especies de coral con morfología ramificada y masiva, respectivamente. Encontramos tasas de macrobioerosión de 1.51 ± 0.11 kg CaCO3 m-2 año-1 para las especies ramificadas y de 0.53 ± 0.03 de kg CaCO3 m-2año-1 para las especies masivas. Los procesos de bioerosión representaron entre el 39.02 % y 43.86 % de la producción de CaCO3, que fue calculada mediante la metodología ReefBudget. Conclusiones. A pesar que emplear TC representa costos más elevados que otros enfoques (p. ej., rayos-X), hasta ahora es el único enfoque capaz de medir la macrobioerosión interna de todo el esqueleto de coral. Este enfoque permitirá producir balances de carbonatos más certeros que aquellos que no consideran la macrobioerosión interna, mejorando nuestras estimaciones del estado de salud en que se encuentran los arrecifes

Giant topological Hall effect in correlated oxide thin films

Strong electronic correlations can produce remarkable phenomena such as metal–insulator transitions and greatly enhance superconductivity, thermoelectricity or optical nonlinearity. In correlated systems, spatially varying charge textures also amplify magnetoelectric effects or electroresistance in mesostructures. However, how spatially varying spin textures may influence electron transport in the presence of correlations remains unclear. Here we demonstrate a very large topological Hall effect (THE) in thin films of a lightly electron-doped charge-transfer insulator, (Ca,Ce)MnO3. Magnetic force microscopy reveals the presence of magnetic bubbles, whose density as a function of magnetic field peaks near the THE maximum. The THE critically depends on carrier concentration and diverges at low doping, near the metal–insulator transition. We discuss the strong amplification of the THE by correlation effects and give perspectives for its non-volatile control by electric fields.The authors thank V. Cros, V. Dobrosavljevic, J. Iñiguez, J.-V. Kim, D. Maccariello, J. Matsuno, I. Mertig, N. Nagaosa and N. Reyren for useful discussions, J.-Y. Chauleau and M. Viret for second harmonic generation experiments, N. Jaouen for resonant magnetic X-ray diffraction, J. Varignon for preparing Fig. 1a and J.-M. George for his help with some magnetotransport measurements. This research received financial support from the ERC Consolidator grant ‘MINT’ (contract no. 615759) and ANR project ‘FERROMON’. This work was also supported by a public grant overseen by the ANR as part of the ‘Investissement d’Avenir’ programme (LABEX NanoSaclay, ref. ANR-10-LABX-0035) through projects ‘FERROMOTT’ and ‘AXION’ and by the Spanish Government through project no. MAT2014-56063-C2-1-R and MAT2017-85232-R (AEI/FEDER, UE), and Severo Ochoa SEV-2015-0496 and the Generalitat de Catalunya (2014SGR 734 project). B.C. acknowledges grant no. FPI BES-2012-059023, R.C. acknowledges support from CNPq-Brazil, and J.S. thanks the University Paris-Saclay (D’Alembert programme) and CNRS for financing his stay at CNRS/Thales. Work at Rutgers was supported by the Office of Basic Energy Sciences, Division of Materials Sciences and Engineering, US Department of Energy under award no. DE-SC0018153. H.K. is supported by JSPS KAKENHI grants nos. 25400339, 15H05702 and 17H02929. K.N. is supported by a Grant-in-Aid for JSPS Research Fellow grant no. 16J05516, and by a Program for Leading Graduate Schools ‘Integrative Graduate Education and Research in Green Natural Sciences’.Peer reviewe

The Standard European Vector Architecture (SEVA): a coherent platform for the analysis and deployment of complex prokaryotic phenotypes

The 'Standard European Vector Architecture' database (SEVA-DB, http://seva.cnb.csic.es) was conceived as a user-friendly, web-based resource and a material clone repository to assist in the choice of optimal plasmid vectors for de-constructing and re-constructing complex prokaryotic phenotypes. The SEVA-DB adopts simple design concepts that facilitate the swapping of functional modules and the extension of genome engineering options to microorganisms beyond typical laboratory strains. Under the SEVA standard, every DNA portion of the plasmid vectors is minimized, edited for flaws in their sequence and/or functionality, and endowed with physical connectivity through three inter-segment insulators that are flanked by fixed, rare restriction sites. Such a scaffold enables the exchangeability of multiple origins of replication and diverse antibiotic selection markers to shape a frame for their further combination with a large variety of cargo modules that can be used for varied end-applications. The core collection of constructs that are available at the SEVA-DB has been produced as a starting point for the further expansion of the formatted vector platform. We argue that adoption of the SEVA format can become a shortcut to fill the phenomenal gap between the existing power of DNA synthesis and the actual engineering of predictable and efficacious bacteria

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

Background: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. Methods: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. Results: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). Conclusion: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO