Differential contractile response of critically ill patients to neuromuscular electrical stimulation

BACKGROUND: Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. METHODS: This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. RESULTS: One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). CONCLUSION: Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. TRIAL REGISTRATION: ISRCTN ISRCTN19392591 , registered 17 February 201

Asymptotic normality of the Parzen-Rosenblatt density estimator for strongly mixing random fields

We prove the asymptotic normality of the kernel density estimator (introduced by Rosenblatt (1956) and Parzen (1962)) in the context of stationary strongly mixing random fields. Our approach is based on the Lindeberg's method rather than on Bernstein's small-block-large-block technique and coupling arguments widely used in previous works on nonparametric estimation for spatial processes. Our method allows us to consider only minimal conditions on the bandwidth parameter and provides a simple criterion on the (non-uniform) strong mixing coefficients which do not depend on the bandwith.Comment: 16 page

In the blink of an eye: reading mental states from briefly presented eye regions

Faces provide not only cues to an individual’s identity, age, gender, and ethnicity but also insight into their mental states. The aim was to investigate the temporal aspects of processing of facial expressions of complex mental states for very short presentation times ranging from 12.5 to 100 ms in a four-alternative forced choice paradigm based on Reading the Mind in the Eyes test. Results show that participants are able to recognise very subtle differences between facial expressions; performance is better than chance, even for the shortest presentation time. Importantly, we show for the first time that observers can recognise these expressions based on information contained in the eye region only. These results support the hypothesis that the eye region plays a particularly important role in social interactions and that the expressions in the eyes are a rich source of information about other peoples’ mental states. When asked to what extent the observers guessed during the task, they significantly underestimated their ability to make correct decisions, yet perform better than chance, even for very brief presentation times. These results are particularly relevant in the light of the current COVID-19 pandemic and the associated wearing of face coverings. </jats:p

Interpretation of High Energy String Scattering in terms of String Configurations

High energy string scattering at fixed momentum transfer, known to be dominated by Regge trajectory exchange, is interpreted by identifying families of string states which induce each type of trajectory exchange. These include the usual leading trajectory $\alpha(t)=\alpha^\prime t+1$ and its daughters as well as the ``sister'' trajectories $\alpha_m(t)=\alpha(t)/m-(m-1)/2$ and their daughters. The contribution of the sister $\alpha_m$ to high energy scattering is dominated by string excitations in the $m^{th}$ mode. Thus, at large $-t$, string scattering is dominated by wee partons, consistently with a picture of string as an infinitely composite system of ``constituents'' which carry zero energy and momentum.Comment: 14 pages, phyzzx, psfig required, Florida Preprint UFIFT-94-

Overcoming the risk of inaction from emissions uncertainty in smallholder agriculture

The potential for improving productivity and increasing the resilience of smallholder agriculture, while also contributing to climate change mitigation, has recently received considerable political attention (Beddington et al 2012). Financial support for improving smallholder agriculture could come from performance-based funding including sale of carbon credits or certified commodities, payments for ecosystem services, and nationally appropriate mitigation action (NAMA) budgets, as well as more traditional sources of development and environment finance. Monitoring the greenhouse gas fluxes associated with changes to agricultural practice is needed for performance-based mitigation funding, and efforts are underway to develop tools to quantify mitigation achieved and assess trade-offs and synergies between mitigation and other livelihood and environmental priorities (Olander 2012)

Carbon regulation and pathways for institutional transition in market-led housing systems : a case study of English housebuilders and zero carbon housing policy

In this paper, we argue that current research on carbon regulation neglects the complex interactions of institutional norms and market behaviour that characterise responses to regulatory change. We draw on empirical research undertaken with English housebuilders and housing market stakeholders to examine how transitional pathways towards a low-carbon housing future might be advanced and consider the implications of such for carbon regulation and low-carbon economies. Our core proposition is that carbon regulation research can no longer ignore the impact of institutionally constituted market behaviour in shaping pathways and transitions towards low-carbon futures