Long-term noninvasive ventilation in COPD:current evidence and future directions

Introduction: Long-term noninvasive ventilation (NIV) is an established treatment for end-stage COPD patients suffering from chronic hypercapnic respiratory failure. This is reflected by its prominent position in national and international medical guidelines. Areas covered: In recent years, novel developments in technology such as auto-titrating machines and hybrid modes have emerged, and when combined with advances in information and communication technologies, these developments have served to improve the level of NIV-based care. Such progress has largely been instigated by the fact that healthcare systems are now confronted with an increase in the number of patients, which has led to the need for a change in current infrastructures. This article discusses the current practices and recent trends, and offers a glimpse into the future possibilities and requirements associated with this form of ventilation therapy. Expert opinion: Noninvasive ventilation is an established and increasingly used treatment option for patients with chronic hypercapnic COPD and those with persistent hypercapnia following acute hypercapnic lung failure. The main target is to augment alveolar hypoventilation by reducing PaCO2 to relieve symptoms. Nevertheless, when dealing with severely impaired patients, it appears necessary to switch the focus to patient-related outcomes such as health-related quality of life

Home noninvasive ventilatory support for patients with chronic obstructive pulmonary disease:patient selection and perspectives

Long-term or home mechanical noninvasive ventilation (Home-NIV) has become a well-established form of therapy over the last few decades for chronic hypercapnic COPD patients in European countries. However, meta-analyses and clinical guidelines do not recommend Home-NIV for COPD patients on a routine basis. In particular, there is ongoing debate about Home-NIV in chronic hypercapnic COPD regarding the overall effects, the most favorable treatment strategy, the selection of eligible patients, and the time point at which it is prescribed. The current review focuses on specific aspects of patient selection and discusses the various scientific as well as clinical-guided perspectives on Home-NIV in patients suffering from chronic hypercapnic COPD. In addition, special attention will be given to the topic of ventilator settings and interfaces

Obesity hypoventilation syndrome treated with non-invasive ventilation:Is a switch to CPAP therapy feasible?

Background and objective: Obesity hypoventilation syndrome (OHS) can be treated with either continuous positive airway pressure (CPAP) or non-invasive ventilation (NIV) therapy; the device choice has important economic and operational implications. Methods: This multicentre interventional trial investigated the safety and short-term efficacy of switching stable OHS patients who were on successful NIV therapy for ≥3 months to CPAP therapy. Patients underwent an autotitrating CPAP night under polysomnography (PSG); if the ensuing parameters were acceptable, they were sent home on a fixed CPAP for a 4–6-week period. It was hypothesized that blood gas analysis, PSG parameters and lung function tests would remain unchanged. Results: A total of 42 OHS patients were recruited, of whom 37 patients were switched to CPAP therapy. All patients had a history of severe obstructive sleep apnoea syndrome; chronic obstructive pulmonary disease (COPD) (Global Initiative for Obstructive Lung Disease (GOLD) I/II) was present in 52%. Regarding the primary outcome, 30 of 42 patients (71%, 95% CI: 55–84%) maintained daytime partial pressure of carbon dioxide (PaCO2) levels ≤45 mm Hg after the home CPAP period. There was no further impairment in quality of life, sleep parameters or lung function. Interestingly, 24 patients (65%) preferred CPAP as their long-term therapy, despite the high pressure levels used (mean: 13.8 ± 1.8 mbar). After the CPAP period, 7 of 37 patients were categorized as CPAP failure, albeit only due to mild hypercapnia (mean: 47.9 ± 2.7 mm Hg). Conclusion: It is feasible to switch most stable OHS patients from NIV to CPAP therapy, a step that could significantly reduce health-related costs. The auto-adjusted CPAP device, used in combination with the analysis of the PSG and capnometry, is a valid titration method in OHS patients

Integrated Disposal Facility FY2011 Glass Testing Summary Report

Pacific Northwest National Laboratory was contracted by Washington River Protection Solutions, LLC to provide the technical basis for estimating radionuclide release from the engineered portion of the disposal facility (e.g., source term). Vitrifying the low-activity waste at Hanford is expected to generate over 1.6 x 10{sup 5} m{sup 3} of glass (Certa and Wells 2010). The volume of immobilized low-activity waste (ILAW) at Hanford is the largest in the DOE complex and is one of the largest inventories (approximately 8.9 x 10{sup 14} Bq total activity) of long-lived radionuclides, principally {sup 99}Tc (t{sub 1/2} = 2.1 x 10{sup 5}), planned for disposal in a low-level waste (LLW) facility. Before the ILAW can be disposed, DOE must conduct a performance assessment (PA) for the Integrated Disposal Facility (IDF) that describes the long-term impacts of the disposal facility on public health and environmental resources. As part of the ILAW glass testing program PNNL is implementing a strategy, consisting of experimentation and modeling, in order to provide the technical basis for estimating radionuclide release from the glass waste form in support of future IDF PAs. The purpose of this report is to summarize the progress made in fiscal year (FY) 2011 toward implementing the strategy with the goal of developing an understanding of the long-term corrosion behavior of low-activity waste glasses

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

OSTRALE'O16: Katalog

Diese Publikation erscheint anlässlich der 10. Internationalen Ausstellung zeitgenössischer Künste in Dresden, error:x OSTRALE'O16. Wendebuch. OSTRALE weht ODER : Artyści z Drezna we Wrocławiu, 13.05.-31.07.2016, Browar Mieszczański Wrocła

A multigrid method for elasto-hydrodynamic contact simulations of radial slider bearing. ETNA - Electronic Transactions on Numerical Analysis

The well-known Reynolds equation is typically used to compute the pressure distribution for elasto-hydrodynamic contacts of parts, as, for instance, in radial slider bearings. In order to resolve local pressure phenomena like edge loading, a higher spatial resolution is needed. This causes problems for stationary solvers, like Gauss-Seidel iteration, which are well suited for the occurring nonlinearities. These problems can be overcome by applying multigrid methods. Since the Reynolds equation is nonlinear, expensive nonlinear multigrid methods are expected to be required. This paper introduces an approach to combine a linear multigrid method with a Gauss-Seidel solver on the finest level, which yields a similar convergence behavior as a nonlinear multigrid method but at much lower computational cost. The formulations are general so that analogous applications of the Reynolds equation, as, for instance, for axial slider bearings or hydrodynamic piston-liner contacts, are straightforward

OSTRALE'O16: Katalog

Diese Publikation erscheint anlässlich der 10. Internationalen Ausstellung zeitgenössischer Künste in Dresden, error:x OSTRALE'O16. Wendebuch. OSTRALE weht ODER : Artyści z Drezna we Wrocławiu, 13.05.-31.07.2016, Browar Mieszczański Wrocła

OSTRALE'O16: Katalog

Diese Publikation erscheint anlässlich der 10. Internationalen Ausstellung zeitgenössischer Künste in Dresden, error:x OSTRALE'O16. Wendebuch. OSTRALE weht ODER : Artyści z Drezna we Wrocławiu, 13.05.-31.07.2016, Browar Mieszczański Wrocła