Long-term survival in elderly patients with a do-not-intubate order treated with noninvasive mechanical ventilation

Paolo Scarpazza1, Cristoforo Incorvaia2, Paolo Amboni3, Giuseppe di Franco1, Stefania Raschi1, Pierfranco Usai1, Monica Bernareggi1, Cristiano Bonacina1, Chiara Melacini1, Roberta Cattaneo1, Serena Bencini1, Chiara Pravettoni2, Gian Galeazzo Riario-Sforza2, Gianni Passalacqua4, Walter Casali11Divisione di Broncopneumotisiologia, Ospedale Civile, Vimercate, Italy; 2Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 3Clinical Chemistry Laboratory, Ospedali Riuniti, Bergamo, Italy; 4Allergy and Respiratory Diseases, University Of Genoa, Genoa, ItalyBackground: Noninvasive mechanical ventilation (NIMV) is an effective tool in treating patients with acute respiratory failure (ARF), since it reduces both the need for endotracheal intubation and the mortality in comparison with nonventilated patients. A particular issue is represented by the outcome of NIMV in patients referred to the emergency department for ARF and with a do-not-intubate (DNI) status because of advanced age or excessively critical conditions. This study evaluated long-term survival in a group of elderly patients with acute hypercapnic ARF who had a DNI order and who were successfully treated by NIMV.Methods: The population consisted of 54 patients with a favorable outcome after NIMV for ARF. They were followed up for 3 years by regular control visits, with at least one visit every 4 months, or as needed according to the patient’s condition. Of these, 31 continued NIMV at home and 23 were on long-term oxygen therapy (LTOT) alone.Results: A total of 16 of the 52 patients had not survived at the 1-year follow-up, and another eight patients died during the 3-year observation, with an overall mortality rate of 30.8% after 1 year and 46.2% after 3 years. Comparing patients who continued NIMV at home with those who were on LTOT alone, 9 of the 29 patients on home NIMV died (6 after 1 year and 3 after 3 years) and 15 of the 23 patients on LTOT alone died (10 after 1 year and 5 after 3 years).Conclusion: These results show that elderly patients with ARF successfully treated by NIMV following a DNI order have a satisfactory long-term survival.Keywords: COPD, acute respiratory failure, mortality rate, respiratory failur

3D seismic imaging through reverse-time migration on homogeneous and heterogeneous multi-core processors

Abstract. Reverse-Time Migration (RTM) is a state-of-the-art technique in seismic acoustic imaging, because of the quality and integrity of the images it provides. Oil and gas companies trust RTM with crucial decisions on multi-million-dollar drilling investments. But RTM requires vastly more computational power than its predecessor techniques, and this has somewhat hindered its practical success. On the other hand, despite multi-core architectures promise to deliver unprecedented computational power, little attention has been devoted to mapping efficiently RTM to multi-cores. In this paper, we present a mapping of the RTM computational kernel to the IBM Cell/B.E. processor that reaches close-tooptimal performance. The kernel proves to be memory-bound and it achieves a 98% utilization of the peak memory bandwidth. Our Cell/B.E. implementation outperforms a traditional processor (PowerPC 970MP) in terms of performance (with an 15.0× speedup) and energy-efficiency (with a 10.0× increase in the GFlops/W delivered). Also, it is the fastest RTM implementation available to the best of our knowledge. These results increase the practical usability of RTM. Also, the RTM-Cell/B.E. combination proves to be a strong competitor in the seismic arena

Abstract A Parsing Technique for Tile Rewriting Picture Grammars

Recently, a novel model, called Tile Rewriting Grammar (TRG), has been introduced to apply the generative grammar approach to picture languages, or 2D languages. In many respects, the TRGs can be considered the equivalent of context-free (CF) grammars for 2D languages. However, the possibility to investigate applications was precluded so far by the lack of a good parsing algorithm. We propose a parsing algorithm for TRGs, which can be described as an extension to 2D of Cocke, Kasami and Younger’s classical parsing technique for 1D context-free grammars.