Effect of n-3 fatty acids on cerebral markers and the inflammatory response in sepsis

Introduction ICM+ software encapsulates our 20 years' experience in brain monitoring. It collects data from a variety of bedside monitors and produces time trends of parameters defi ned using confi gurable mathematical formulae. To date it is being used in nearly 40 clinical research centres worldwide. We present its application for continuous monitoring of cerebral autoregulation using near-infrared spectroscopy (NIRS). Methods Data from multiple bedside monitors are processed by ICM+ in real time using a large selection of signal processing methods. These include various time and frequency domain analysis functions as well as fully customisable digital fi lters. The fi nal results are displayed in a variety of ways including simple time trends, as well as time window based histograms, cross histograms, correlations, and so forth. All this allows complex information from bedside monitors to be summarized in a concise fashion and presented to medical and nursing staff in a simple way that alerts them to the development of various pathological processes. Results One hundred and fi fty patients monitored continuously with NIRS, arterial blood pressure (ABP) and intracranial pressure (ICP), where available, were included in this study. There were 40 severely headinjured adult patients, 27 SAH patients (NCCU, Cambridge); 60 patients undergoing cardiopulmonary bypass (John Hopkins Hospital, Baltimore) and 23 patients with sepsis (University Hospital, Basel). In addition, MCA fl ow velocity (FV) was monitored intermittently using transcranial Doppler. FV-derived and ICP-derived pressure reactivity indices (PRx, Mx), as well as NIRS-derived reactivity indices (Cox, Tox, Thx) were calculated and showed signifi cant correlation with each other in all cohorts. Errorbar charts showing reactivity index PRx versus CPP (optimal CPP chart) as well as similar curves for NIRS indices versus CPP and ABP were also demonstrated. Conclusions ICM+ software is proving to be a very useful tool for enhancing the battery of available means for monitoring cerebral vasoreactivity and potentially facilitating autoregulation guided therapy. Complexity of data analysis is also hidden inside loadable profi les, thus allowing investigators to take full advantage of validated protocols including advanced processing formulas

Orographic and convective gravity waves above the Alps and Andes mountains during GPS radio occultation events – a case study

The significant distortions introduced in the measured atmospheric gravity wavelengths by soundings other than in vertical and horizontal directions, are discussed as a function of elevation angle of the sounding path and the gravity waves aspect ratio. Under- or overestimation of real vertical wavelengths during the measurement process depends basically on the value of these two parameters. The consequences of these distortions on the calculation of the energy and vertical flux of horizontal momentum are analyzed and discussed in the context of two experimental limb satellite setups: GPS-LEO radio occultations and TIMED/SABER measurements. Possible discrepancies previously found between the momentum flux calculated from satellite temperature profiles, on site and from model simulations, may, to a certain degree, be attributed to these distortions. A recalculation of previous momentum flux climatologies based on these considerations seems to be a difficult goal.Fil: Hierro, Rodrigo Federico. Universidad Austral. Facultad de Ingeniería. Departamento de Ciencias Básicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Steiner, Andrea K.. Universidad de Graz; AustriaFil: de la Torre, Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Austral. Facultad de Ingeniería. Departamento de Ciencias Básicas; ArgentinaFil: Alexander, Pedro Manfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Física de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Física de Buenos Aires; ArgentinaFil: Llamedo Soria, Pablo Martin. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Austral. Facultad de Ingeniería. Departamento de Ciencias Básicas; ArgentinaFil: Cremades, Pablo Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Exactas y Naturales; Argentin

Intumescences On Poplar Leaves. I. Structure And Development

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141211/1/ajb208869.pd

Structured headache services as the solution to the ill-health burden of headache. 2. Modelling effectiveness and cost-effectiveness of implementation in Europe: methodology

Background: Health economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere). Our aim here, within the European Brain Council’s Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Methods: We developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, population size, income level and health-care systems and for which we had population-based data. Each model compared current (suboptimal) care vs target care (delivered in accordance with the structured headache services model). Epidemiological and economic data were drawn from studies conducted by the Global Campaign against Headache; data on efficacy of treatments were taken from published randomized controlled trials; assumptions on uptake of treatments, and those made for Healthy Life Year (HLY) calculations and target-care benefits, were agreed with experts. We made annual and 5-year cost estimates from health-care provider (main analyses) and societal (secondary analyses) perspectives (2020 figures, euros). Results: The analytical models were successfully developed and applied to each country setting. Headache-related costs (including use of health-care resources and lost productivity) and health outcomes (HLYs) were mapped across populations. The same calculations were repeated for each alternative (current vs target care). Analyses of the differences in costs and health outcomes between alternatives and the incremental cost-effectiveness ratios are presented elsewhere. Conclusions: This study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region. The models are robust, and can assist policy makers in allocating health budgets between interventions to maximize the health of populations

Vortices in simulations of solar surface convection

We report on the occurrence of small-scale vortices in simulations of the convective solar surface. Using an eigenanalysis of the velocity gradient tensor, we find the subset of high vorticity regions in which the plasma is swirling. The swirling regions form an unsteady, tangled network of filaments in the turbulent downflow lanes. Near-surface vertical vortices are underdense and cause a local depression of the optical surface. They are potentially observable as bright points in the dark intergranular lanes. Vortex features typically exist for a few minutes, during which they are moved and twisted by the motion of the ambient plasma. The bigger vortices found in the simulations are possibly, but not necessarily, related to observations of granular-scale spiraling pathlines in "cork animations" or feature tracking.Comment: 11 pages, 13 figures, accepted for publication in A&A, complementary movies at http://www.mps.mpg.de/homes/moll/strudel/papermovies

Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions

Background: There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. Methods: Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. Results: The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. Conclusions: This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe

Nuclear Astrophysics in Rare Isotope Facilities

Nuclear reactions in stars are difficult to measure directly in the laboratory at the small astrophysical energies. In recent years indirect methods with rare isotopes have been developed and applied to extract low-energy astrophysical cross sections.Comment: Invited talk (parallel section) at the Int. Conf. Nucleus-Nucleus Collisions (NN2009), Beijing, China, August 16-21, 2009. To appear in Nucl. Phys.

Orographic and convective gravity waves above the Alps and Andes Mountains during GPS radio occultation events – a case study

Gravity waves (GWs) and convective systems play a fundamental role in atmospheric circulation, weather, and climate. Two usual main sources of GWs are orographic effects triggering mountain waves and convective activity. In addition, GW generation by fronts and geostrophic adjustment must also be considered. The utility of Global Positioning System (GPS) radio occultation (RO) observations for the detection of convective systems is tested. A collocation database between RO events and convective systems over subtropical to midlatitude mountain regions close to the Alps and Andes is built. From the observation of large-amplitude GW structures in the absence of jets and fronts, subsets of RO profiles are sampled. A representative case study among those considered at each region is selected and analyzed. The case studies are investigated using mesoscale Weather Research and Forecasting (WRF) simulations, ERA-Interim reanalysis data, and measured RO temperature profiles. The absence of fronts or jets during both case studies reveals similar relevant GW features (main parameters, generation, and propagation). Orographic and convective activity generates the observed GWs. Mountain waves above the Alps reach higher altitudes than close to the Andes. In the Andes case, a critical layer prevents the propagation of GW packets up to stratospheric heights. The case studies are selected also because they illustrate how the observational window for GW observations through RO profiles admits a misleading interpretation of structures at different altitude ranges. From recent results, the distortion introduced in the measured atmospheric vertical wavelengths by one of the RO events is discussed as an illustration. In the analysis, both the elevation angle of the sounding path (line of tangent points) and the gravity wave aspect ratio estimated from the simulations and the line of sight are taken into account. In both case studies, a considerable distortion, over- and underestimation of the vertical wavelengths measured by RO, may be expected