Conceptual design of a functional electrical stimulation cycling platform as a rehabilitation therapy for spinal cord injury or stroke

Stroke and spinal cord injuries (SCI) are leading causes of disability worldwide, involving problems in mobility, balance and coordination, among others. While aerobic exercise is associated with a greater plasticity in the motor cortex of healthy individuals, its effect on neuroplasticity after suffer- ing a stroke or a SCI is still unknown. Besides, there is no methodology to promote both cardiovascular and neuroplastic recovery in patients suffering from neurological injuries. Up to now, it has been demonstrated that physical exercise is a therapeutic intervention in many rehabilitation programs that, apart from providing clear benefits related to the phys- ical conditioning, functionality, mood and cardiovascular health, it could also promote neuroplasticity. The literature suggests that stronger neuroplastic responses are elicited in mid-to-high intensity training programs, but the lack of homogeneity in the dose-response and the non-uniform eval- uations of the neuroplasticity seem to be a limitation to gen- eralise the obtained results. The combination of functional electrical stimulation (FES) with the benefits of cardiovas- cular exercise makes cycling assisted by FES a promising approach to target both the aerobic capacity and the neu- romotor function. The objective of this project is to prove that aerobic exercise during personalized FES-cycling could contribute to enhance the process of neuroplasticity, and to maintain locomotor and cardiovascular function in patients with stroke or spinal cord injury.This work is partially developed within the Research Network FUSION “Red Tem´atica Sobre Fusi´on de Tec- nolog´ıas Rob´oticas y Estimulaci´on El´ectrica Neuro- muscular para Neurorrehabilitaci´on de Trastornos del Movimiento”, grant by Agencia Estatal de Investigaci´on (RED2022-134319-T)

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

A live fuel moisture content product from landsat TM satellite time series for implementation in fire behavior models

Live Fuel Moisture Content (LFMC) contributes to fire danger and behavior, as it affects fire ignition and propagation. This paper presents a two layered Landsat LFMC product based on topographically corrected relative Spectral Indices (SI) over a 2000–2011 time series, which can be integrated into fire behavior simulation models. Nine chaparral sampling sites across three Landsat-5 Thematic Mapper (TM) scenes were used to validate the product over the Western USA. The relations between field-measured LFMC and Landsat-derived SIs were strong for each individual site but worsened when pooled together. The Enhanced Vegetation Index (EVI) presented the strongest correlations (r) and the least Root Mean Square Error (RMSE), followed by the Normalized Difference Infrared Index (NDII), Normalized Difference Vegetation Index (NDVI) and Visible Atmospherically Resistant Index (VARI). The relations between LFMC and the SIs for all sites improved after using their relative values and relative LFMC, increasing r from 0.44 up to 0.69 for relative EVI (relEVI), the best predictive variable. This relEVI served to estimate the herbaceous and woody LFMC based on minimum and maximum seasonal LFMC values. The understory herbaceous LFMC on the woody pixels was extrapolated from the surrounding pixels where the herbaceous vegetation is the top layer. Running simulations on the Wildfire Analyst (WFA) fire behavior model demonstrated that this LFMC product alone impacts significantly the fire spatial distribution in terms of burned probability, with average burned area differences over 21% after 8 h burning since ignition, compared to commonly carried out simulations based on constant values for each fuel model. The method could be applied to Landsat-7 and -8 and Sentinel-2A and -2B after proper sensor inter-calibration and topographic correctionNASA NNX11AF93G: The European Union SENSORVEG (FP7-PEOPLE-2009-IRSES-246666); and the Spanish Ministry of Economy and Competitiveness SynerTGE (CGL2015-G9095-R-MINECO/FEDER, EU) funded this research. In addition, a CONICYT Doctoral Fellowship from the Chilean Government supported J.G.Peer reviewe

Assessment of the worldwide burden of critical illness: The Intensive Care Over Nations (ICON) audit

Background Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality.Methods 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country.Findings 10 069 patients were included from ICUs in Europe (5445 patients; 54.1%), Asia (1928; 19.2%), the Americas (1723; 17.1%), Oceania (439; 4.4%), the Middle East (393; 3.9%), and Africa (141; 1.4%). Overall, 2973 patients (29.5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16.2% (95% CI 15.5-16.9) across the whole population and 25.8% (24.2-27.4) in patients with sepsis. Hospital mortality rates were 22.4% (21.6-23.2) in the whole population and 35.3% (33.5-37.1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0.19, p=0.002) and between-hospital variations (var=0.43, p<0.0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income.Interpretation This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death

Higher Fluid Balance Increases the Risk of Death from Sepsis: Results from a Large International Audit∗

Objectives: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. Design: Observational cohort study. Setting: Seven hundred and thirty ICUs in 84 countries. Patients: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. Measurements and Main Results: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. Conclusions: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death

Correction to collaborators in acknowledgments in: Decision-making on withholding or withdrawing life support in the ICU: A worldwide perspective

The authors have reported to CHEST that the collaborators from the ICON Investigators were omitted from the Acknowledgments in “Decision-Making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective” (Chest. 2017;152(2):321-329). https://doi.org/10.1016/j.chest.2017.04.17

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology