Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19∗

OBJECTIVE: High-flow nasal oxygen (HFNO) therapy is frequently applied outside ICU setting in hypoxemic patients with COVID-19. However, safety concerns limit more widespread use. We aimed to assess the safety and clinical outcomes of initiation of HFNO therapy in COVID-19 on non-ICU wards. DESIGN: Prospective observational multicenter pragmatic study. SETTING: Respiratory wards and ICUs of 10 hospitals in The Netherlands. PATIENTS: Adult patients treated with HFNO for COVID-19-associated hypoxemia between December 2020 and July 2021 were included. Patients with treatment limitations were excluded from this analysis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Outcomes included intubation and mortality rate, duration of hospital and ICU stay, severity of respiratory failure, and complications. Using propensity-matched analysis, we compared patients who initiated HFNO on the wards versus those in ICU. Six hundred eight patients were included, of whom 379 started HFNO on the ward and 229 in the ICU. The intubation rate in the matched cohort (n = 214 patients) was 53% and 60% in ward and ICU starters, respectively (p = 0.41). Mortality rates were comparable between groups (28-d [8% vs 13%], p = 0.28). ICU-free days were significantly higher in ward starters (21 vs 17 d, p &lt; 0.001). No patient died before endotracheal intubation, and the severity of respiratory failure surrounding invasive ventilation and clinical outcomes did not differ between intubated ward and ICU starters (respiratory rate-oxygenation index 3.20 vs 3.38; Pao2:Fio2ratio 65 vs 64 mm Hg; prone positioning after intubation 81 vs 78%; mortality rate 17 vs 25% and ventilator-free days at 28 d 15 vs 13 d, all p values &gt; 0.05). CONCLUSIONS: In this large cohort of hypoxemic patients with COVID-19, initiation of HFNO outside the ICU was safe, and clinical outcomes were similar to initiation in the ICU. Furthermore, the initiation of HFNO on wards saved time in ICU without excess mortality or complicated course. Our results indicate that HFNO initiation outside ICU should be further explored in other hypoxemic diseases and clinical settings aiming to preserve ICU capacity and healthcare costs.</p

How to detect fluctuating order in the high-temperature superconductors

We discuss fluctuating order in a quantum disordered phase proximate to a quantum critical point, with particular emphasis on fluctuating stripe order. Optimal strategies for extracting information concerning such local order from experiments are derived with emphasis on neutron scattering and scanning tunneling microscopy. These ideas are tested by application to two model systems - the exactly solvable one dimensional electron gas with an impurity, and a weakly-interacting 2D electron gas. We extensively review experiments on the cuprate high-temperature superconductors which can be analyzed using these strategies. We adduce evidence that stripe correlations are widespread in the cuprates. Finally, we compare and contrast the advantages of two limiting perspectives on the high-temperature superconductor: weak coupling, in which correlation effects are treated as a perturbation on an underlying metallic (although renormalized) Fermi liquid state, and strong coupling, in which the magnetism is associated with well defined localized spins, and stripes are viewed as a form of micro-phase separation. We present quantitative indicators that the latter view better accounts for the observed stripe phenomena in the cuprates.Comment: 43 pages, 11 figures, submitted to RMP; extensively revised and greatly improved text; one new figure, one new section, two new appendices and more reference

On the use of posture verbs by French-speaking learners of Dutch : A corpus-based study

This article presents the results of a quantitative and qualitative corpus study of the use of the Dutch posture verbs staan ('stand'), liggen ('lie') and zitten ('sit') by French-speaking learners of Dutch. In addition to providing a quantified insight into which uses of these verbs prove most problematic to the L2 learners, the study has also revealed three important tendencies. Firstly, in line with the typological differences between French and Dutch (where these verbs behave like noun classifiers), our analysis confirms the French-driven tendency of the learners for underusing these verbs. Secondly, seemingly paradoxical to the previous point, is that these learners occasionally overuse these posture verbs in contexts where no such verb is allowed. Thirdly, our qualitative analysis of errors reveals that the learners operate on grammaticised semantic distinctions drawn from the target language. Even if the categories used by L2 speakers may not be the same as those exploited by native speakers, our analysis suggests that the L2 speakers are thus aware of the patterns in the input and exploit them in a fashion that may not differ all that much in kind from those in L1 acquisition. © 2010 Walter de Gruyter

Flow-controlled ventilation decreases mechanical power in postoperative ICU patients

Background: Mechanical power (MP) is the energy delivered by the ventilator to the respiratory system and combines factors related to the development of ventilator-induced lung injury (VILI). Flow-controlled ventilation (FCV) is a new ventilation mode using a constant low flow during both inspiration and expiration, which is hypothesized to lower the MP and to improve ventilation homogeneity. Data demonstrating these effects are scarce, since previous studies comparing FCV with conventional controlled ventilation modes in ICU patients suffer from important methodological concerns. Objectives: This study aims to assess the difference in MP between FCV and pressure-controlled ventilation (PCV). Secondary aims were to explore the effect of FCV in terms of minute volume, ventilation distribution and homogeneity, and gas exchange. Methods: This is a physiological study in post-cardiothoracic surgery patients requiring mechanical ventilation in the ICU. During PCV at baseline and 90 min of FCV, intratracheal pressure, airway flow and electrical impedance tomography (EIT) were measured continuously, and hemodynamics and venous and arterial blood gases were obtained repeatedly. Pressure–volume loops were constructed for the calculation of the MP. Results: In 10 patients, optimized FCV versus PCV resulted in a lower MP (7.7 vs. 11.0 J/min; p = 0.004). Although FCV did not increase overall ventilation homogeneity, it did lead to an improved ventilation of the dependent lung regions. A stable gas exchange at lower minute volumes was obtained. Conclusions: FCV resulted in a lower MP and improved ventilation of the dependent lung regions in post-cardiothoracic surgery patients on the ICU. Trial registration Clinicaltrials.gov identifier: NCT05644418. Registered 1 December 2022, retrospectively registered.</p

Vitamin K Antagonists Compared to Low-Molecular-Weight Heparins for Treatment of Cancer-Associated Venous Thromboembolism: An Observational Study in Routine Clinical Practice

Thrombosis and Hemostasi

Synthesis and supramolecular organization of chiral poly(thiophene) -magnetite hybrid nanoparticles

© 2018 The Royal Society of Chemistry. In this study, poly((S)-3-(3′,7′-dimethyloctyl)thiophene) is synthesized via KCTCP, using a catechol-based external Ni-initiator. After characterization, the polymer's catechol functionality is deprotected and coupled with magnetite nanoparticles and the supramolecular organization is studied using UV/Vis, CD, AFM and Faraday measurements. We conclude that no long range supramolecular ordering is present in the hybrid material and that only interchain interactions between polymer chains attached on different nanoparticles are present. Also the effect of the new initiator and the branched monomer side chain on the controlled character of the KCTCP is investigated. It is found that a methyl group on the 3-position of the monomer sidechain already affects the controlled character of the polymerization. Also, a mechanism for the observed effects of the branched monomer and the new catechol-based initiator on the controlled character of the polymerization is proposed.status: publishe