Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial

Background: Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant. Research question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study design and methods: We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated by PSV plus sigh (increase of airway pressure to 30 cmH2Ofor 3 seconds once per minute) until day 28 or death or successful spontaneous breathing trial. The primary endpoint of the study was feasibility, assessed as non-inferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiological parameters in the first week from randomization, 28-day mortality and ventilator-free days. Results: Two-hundred fifty-eight patients (31% women; median age 65 [54-75] years) were enrolled. In the Sigh group, 23% of patients failed to remain on assisted ventilation vs. 30% in the No Sigh group (absolute difference -7%, 95%CI -18% to 4%; p=0.015 for non-inferiority). Adverse events occurred in 12% vs. 13% in Sigh vs. No Sigh (p=0.852). Oxygenation was improved while tidal volume, respiratory rate and corrected minute ventilation were lower over the first 7 days from randomization in Sigh vs. No Sigh. There was no significant difference in terms of mortality (16% vs. 21%, p=0.342) and ventilator-free days (22 [7-26] vs. 22 [3-25] days, p=0.300) for Sigh vs. No Sigh. Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk

Synthesis and characterization of PGM-free catalysts for the ORR in PEMFCs

Low-temperature proton-exchange-membrane fuel cells (PEMFCs) are promising energy conversion devices that, in recent years, have been successfully deployed in several vehicles. Besides the numerous advantages, however, they are still too expensive for mass commercialization. To build a fuel cell stack, in fact, a considerable amount of Pt is required, especially at the cathode electrode, where the oxygen reduction reaction (ORR) takes place. Thus, considerable research effort is focused on reducing or completely eliminating noble metal content. One approach is to use cheap and abundant materials, the so-called platinum-group-metal-free (PGM-free) catalysts. Although they are less active than platinum, their price allow to use higher loading, so that the ORR is facilitated. The most promising candidates demonstrated so far employ N-coordinated Fe as active species, embedded in a matrix of carbon (Fe-N-C catalysts). Aiming at a higher stability in acidic electrolyte than Fe-N-C based compounds, the purpose of this thesis work was to prepare and characterize PGM-free catalysts for the ORR based on carbon-supported ZrO2 nanoparticles. These metal oxide species are stable in acid solution and their discrete ORR activity was already reported from Ken-ichiro Ota research group, which is studying group IV and V metal-oxide-based compounds since past 10 years. The active sites for the reaction are not completely understood yet, but there is the hypothesis that they are correlated to the presence of oxygen vacancies or uncoordinated metal sites on the surface of the oxide. Literature reports the creation of oxygen vacancies in the oxide when either iron or copper are incorporated in ZrO2. For this reason, during this work, Fe- and Cu-doped zirconia has been synthetized starting from soluble metal (Zr, Fe and Cu) phthalocyanines as organometallic precursors. After impregnation on carbon black, the samples were heat treated to form the oxide nanoparticles. A series of samples were synthesized with different heat treatment conditions and doping-metal loadings. Structural characterization of the samples was primarily done by X-ray diffraction technique and secondly by transmission electron microscopy. For the Fe-doped ZrO2, the samples were analyzed by 57Fe-Mössbauer spectroscopy to monitor the Fe phases and the Fe incorporation

Frameworks and Pattern Languages: an Intriguing Relationship

The goal of this paper is the comparison between Application Frameworks and Pattern Languages. Frameworks and pattern languages are concepts proposed in the Object-Oriented literature to capture aspects which unify software development and raise reusability from the basic level of components to the higher level of complete architectures. Our experienc

The Framework Life Span: a Case Study for Flexible Manufacturing Systems

Frameworks are sets of reusable and customizable software components for specific application domains. The development of a framework usually follows a process, the framework life span, where the basic architectural elements, which are specific application independent, are designed first. These basic elements represent the stable parts of the framework and are used as "white box" components. When the framework becomes mature, an increasing number of concrete high level components are provided, which represent the variable parts of the framework and are reused as "black boxes". This paper presents the G++ application framework for computer integrated manufacturing (CIM) and illustrates how its design is derived from the G++ pattern language, highlighting the relationships between application frameworks, patterns, and pattern languages. Keywords : Frameworks, Pattern Languages, Computer Integrated Manufacturing. 1. INTRODUCTION A framework indicates, in the software community, an integ..

Patterns for Cooperation

Collaborating autonomous agents are becoming increasingly attractive for systems where problem solving and decision making must be distributed. Unfortunately, they are not yet practical for industrial application. Selected aspects of agent theory, however, can be very useful to software development. In this paper, we give three patterns which can form a base for this. The patterns are the result of a process improvement project for the textile industry, which we will use as an example. INTRODUCTION In recent years, the field of autonomous collaborating agents have received increased interest. This is due to some fundamental requirements encountered in industrial systems which are difficult to meet using traditional centralized control architectures; the most significant being robustness, scalability, reconfigurability, and reusability. Furthermore, industrial applications are usually complex, and complexity demands decomposition. The term "agent" is currently used in many different wa..

Patterns for Cooperation

Collaborating autonomous agents are becoming increasingly attractive for systems where problem solving and decision making must be distributed. Unfortunately, they are not yet practical for industrial application. Selected aspects of agent theory, however, can be very useful to software development. In this paper, we give three patterns which can form a base for this. The patterns are the result of a process improvement project for the textile industry, which we will use as an example. INTRODUCTION In recent years, the field of autonomous collaborating agents have received increased interest. This is due to some fundamental requirements encountered in industrial systems which are difficult to meet using traditional centralized control architectures; the most significant being robustness, scalability, reconfigurability, and reusability. Furthermore, industrial applications are usually complex, and complexity demands decomposition. The term "agent" is currently used in many different wa..

Patterns for Three-Tier Client/Server Applications

Database Interface, makes the application portable to different database platforms. Pattern 4, ORB Proxy for Database Object, deals with the integration of the often incompatible worlds of object brokers and object databases. Pattern 5, Automatic Object Locks, liberates developers from the tedious and error-prone work of manually locking and unlocking database objects. Pattern 6, Shared DB Connections, applies to the cases where it is necessary to have more simultaneous users than the number of connections the database servers will accept. This leads to pattern 7, Thread-Based Figure 1: Three-tier architecture. Application Server Database Server Concurrency Management, which shows how concurrency control can be implemented in application servers when database locks can no longer be used to36217-673 the clients. While pattern 5 is fairly C++-specific, the other patterns should apply to most object-oriented threetier application development projects. Pattern 1: Three-Tier Architecture..