Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome

INTRODUCTION: Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of this study was to assess the effects of PEEP on gastric mucosal perfusion while applying a protective ventilatory strategy in patients with ARDS. METHODS: Eight patients were included. A pressure–volume curve was traced and ideal PEEP, defined as lower inflection point + 2 cmH(2)O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20 cmH(2)O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamic, CO(2 )gap (gastric minus arterial partial pressures), and ventilatory measurements were performed. RESULTS: PEEP had no effect on CO(2 )gap (median [range], baseline: 19 [2–30] mmHg; PEEP 10: 19 [0–40] mmHg; PEEP 15: 18 [0–39] mmHg; PEEP 20: 17 [4–39] mmHg; ideal PEEP: 19 [9–39] mmHg; P = 0.18). Cardiac index also remained unchanged (baseline: 4.6 [2.5–6.3] l min(-1 )m(-2); PEEP 10: 4.5 [2.5–6.9] l min(-1 )m(-2); PEEP 15: 4.3 [2–6.8] l min(-1 )m(-2); PEEP 20: 4.7 [2.4–6.2] l min(-1 )m(-2); ideal PEEP: 5.1 [2.1–6.3] l min(-1 )m(-2); P = 0.08). One patient did not complete the protocol because of hypotension. CONCLUSION: PEEP of 10–20 cmH(2)O does not affect gastric mucosal perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving adrenergic drugs

Decoupling Reinforcement Learning From 16 Bit Architectures in Suffix Trees

Recent advances in empathic archetypes and large- scale methodologies are based entirely on the assumption that Moore's Law and context-free grammar are not in conflict with the location-identity split. In our research, we verify the synthesis of congestion control. We explore a novel application for the typical unification of the World Wide Web and jour- naling file systems, which we call STIFLE

An integrated INS/GPS navigation system for small AUVs using an asynchronous Kalman filter

A Small AUV Navigation System (SANS) is being developed at the Naval Postgraduate School. The SANS is an integrated INS/GPS navigation system composed of low-cost, small-size components. It is designed to demonstrate the feasibility of using a low-cost Inertial Measurement Unit (IMU) to navigate between intermittent GPS fixes. This thesis presents recent improvements to the SANS hardware and software. The 486-based ESP computer used in the previous version of SANS is now replaced by an AMD 586DX133 based PC/104 computer to provide more computing power, reliability and compatibility with PC/104 industrial standards. The previous SANS navigation filter consisting of a complementary constant gain filter is now aided by an asynchronous Kalman filter. This navigation filter has six states for orientation estimation (constant gain) and eight states for position estimation (Kalman filtered). Low- frequency DGPS noise is explicitly modeled based on an experimentally obtained autocorrelation function. Ocean currents are also modeled as a low-frequency random process. The asynchronous nature of GPS measurements resulting from AUV submergence or wave splash on the DGPS antennas is also taken into account by adopting an asynchronous Kalman filter as the basis for the SANS software. Matlab simulation studies of the asynchronous filter have been conducted and results documented in this thesis.http://www.archive.org/details/integratedinsgps00hernLieutenant, United States Coast GuardApproved for public release; distribution is unlimited

Lactate-guided resuscitation saves lives: we are not sure

SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Twentieth century warming of the tropical Atlantic captured by Sr-U paleothermometry

Author Posting. © American Geophysical Union, 2017. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 32 (2017): 146–160, doi:10.1002/2016PA002976.Coral skeletons are valuable archives of past ocean conditions. However, interpretation of coral paleotemperature records is confounded by uncertainties associated with single-element ratio thermometers, including Sr/Ca. A new approach, Sr-U, uses U/Ca to constrain the influence of Rayleigh fractionation on Sr/Ca. Here we build on the initial Pacific Porites Sr-U calibration to include multiple Atlantic and Pacific coral genera from multiple coral reef locations spanning a temperature range of 23.15–30.12°C. Accounting for the wintertime growth cessation of one Bermuda coral, we show that Sr-U is strongly correlated with the average water temperature at each location (r2 = 0.91, P < 0.001, n = 19). We applied the multispecies spatial calibration between Sr-U and temperature to reconstruct a 96 year long temperature record at Mona Island, Puerto Rico, using a coral not included in the calibration. Average Sr-U derived temperature for the period 1900–1996 is within 0.12°C of the average instrumental temperature at this site and captures the twentieth century warming trend of 0.06°C per decade. Sr-U also captures the timing of multiyear variability but with higher amplitude than implied by the instrumental data. Mean Sr-U temperatures and patterns of multiyear variability were replicated in a second coral in the same grid box. Conversely, Sr/Ca records from the same two corals were inconsistent with each other and failed to capture absolute sea temperatures, timing of multiyear variability, or the twentieth century warming trend. Our results suggest that coral Sr-U paleothermometry is a promising new tool for reconstruction of past ocean temperatures.NSF Graduate Research Fellowships Grant Numbers: NSF-OCE-1338320, NSF-OCE-1031971, NSF-OCE-0926986; WHOI Access to the Sea Grant Numbers: 27500056, 0734826; NSF HRD; UPR Central Administration to EAHD through the Center for Applied Tropical Ecology and Conservation of UPR2017-08-1