1,903 research outputs found
Feasibility studies for quarkonium production at a fixed-target experiment using the LHC proton and lead beams (AFTER@LHC)
Used in the fixed-target mode, the multi-TeV LHC proton and lead beams allow
for studies of heavy-flavour hadroproduction with unprecedented precision at
backward rapidities - far negative Feyman-x - using conventional detection
techniques. At the nominal LHC energies, quarkonia can be studies in detail in
p+p, p+d and p+A collisions at sqrt(s_NN) ~ 115 GeV as well as in Pb+p and Pb+A
collisions at sqrt(s_NN) ~ 72 GeV with luminosities roughly equivalent to that
of the collider mode, i.e. up to 20 fb-1 yr-1 in p+p and p+d collisions, up to
0.6 fb-1 yr-1 in p+A collisions and up to 10 nb-1 yr-1 in Pb+A collisions. In
this paper, we assess the feasibility of such studies by performing fast
simulations using the performance of a LHCb-like detector.Comment: 12 pages, 14 figure
HAEMODYNAMIC RESPONSE DURING EXERCISE TESTING IN PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING A CARDIAC REHABILITATION PROGRAMME
Haemodynamic monitoring during exercise testing is seldom used during cardiac rehabilitation. The aim was to evaluate haemodynamic changes using the cardiac impedance method during exercise testing in patients after percutaneous coronary interventions and coronary artery bypass grafting during cardiac rehabilitation. Thirty (25 M; 5 F) patients were included in the programme. The group was divided according to ejection fraction (EF): low – below 50% normal – equal to or above 50%. The exercise test was performed simultaneously with a four-electrode impedance cardiogram before and after rehabilitation. ECG, blood pressure, thoracic impedance, first derivative dz/dt, stroke volume (SV) and cardiac output were recorded. Contractility index (Heather index – HI) and vascular peripheral resistance were calculated. The pattern of haemodynamic changes was normal in 24 patients. The deflection points for HI and SV trend patterns were observed among patients with low EF. The contractility index decreased 90 s before maximal exercise and after the next 30-60 s a deflection point was observed in SV curve trends. In 24 patients with normal EF the contractility index trends did not decrease and SV trends increased until the end of exercise or a deflection point was not noted. The deflection points of the contractility index and SV curves were observed before the clinical indications for exercise test termination appeared in patients with a low ejection fraction. Impedance cardiography may indicate the threshold of the workload during real-time exercise testing
A gestão do conhecimento como ferrammenta para potencializar o desenvolvimento de equipes na geração e execução de projetos de P&D.
Breve apreciação da gestão do conhecimento na Embrapa; Um modelo de maturidade da gestão do conhecimento como ferramenta de análise de uma instituição; Suporte e referencial teórico para implantação de um programa de GC; Ambiente de conhecimento; Inteligência competitiva; Redes de relacionamento; Apoio à pesquisa; Uma perspectiva de gestão do conhecimento para unidades de pesquisa; Aspectos gerais de um programa para unidades de pesquisa; Aspectos gerais de um programa para gestão do conhecimento aplicada a projetos de PD&I; Ações e efeitosda gestão do conhecimento no âmbito de um projeto de P&D.bitstream/item/58221/1/doc118.pd
Whole blood lactate kinetics in patients undergoing quantitative resuscitation for septic shock
Introduction We sought to compare the association of whole blood lactate kinetics with survival in patients with septic shock undergoing early quantitative resuscitation. Methods Preplanned analysis of a multicenter emergency department (ED)-based randomized control trial of early sepsis resuscitation targeting three physiological variables: central venous pressure, mean arterial pressure, and either central venous oxygen saturation or lactate clearance. Inclusion criteria: suspected infection, two or more systemic inflammatory response syndrome criteria, and either SBP 4 mmol/l. All patients had a lactate measured initially and subsequently at two hours. Normalization of lactate was defined as a lactate decline to 2.0 mmol/l was seen in 187/272 (69%), and 68/187 (36%) patients normalized their lactate. Overall mortality was 19.7%. AUCs for initial lactate, relative lactate clearance, and absolute lactate clearance were 0.70, 0.69, and 0.58, respectively. Lactate normalization best predicted survival (OR = 6.1, 95% CI = 2.2 to 21), followed by lactate clearance of 50% (OR = 4.3, 95% CI = 1.8 to 10.3), initial lactate of <2 mmol/l (OR = 3.4, 95% CI = 1.5 to 7.8), and initial lactate <4 mmol/l (OR = 2.3, 95% CI = 1.3 to 4.3), with lactate clearance of 10% not reaching significance (OR = 2.3, 95% CI = 0.96 to 5.6).
Conclusions In ED sepsis patients undergoing early quantitative resuscitation, normalization of serum lactate during resuscitation was more strongly associated with survival than any absolute value or absolute/ relative change in lactate. Further studies should address whether strategies targeting lactate normalization leads to improved outcomes
Effect of Glucose–Insulin–Potassium Infusion on Mortality in Critical Care Settings: A Systematic Review and Meta-Analysis
This study seeks to measure the treatment effect of glucose—insulin—potassium (GIK) infusion on mortality in critically ill patients. A systematic review of randomized controlled trials is conducted, comparing GIK treatment with standard care or placebo in critically ill adult patients. The primary outcome variable is mortality. Two authors independently extract data and assess study quality. The primary analysis is based on the random effects model to produce pooled odds ratios (ORs) with 95% confidence intervals (CIs). The search yields 1720 potential publications; 23 studies are included in the final analysis, providing a sample of 22 525 patients. The combined results demonstrate no heterogeneity (P = .57, I2 = 0%) and no effect on mortality (OR = 1.02; 95% CI, 0.93–1.11) with GIK treatment. No experimental studies of shock or sepsis populations are identified. This meta-analysis finds that there is no mortality benefit to GIK infusion in critically ill patients; however, study populations are limited to acute myocardial infarction and cardiovascular surgery patients. No studies are identified using GIK in patients with septic shock or other forms of circulatory shock, providing an absence of evidence regarding the effect of GIK as a therapy in patients with shock
Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study
BACKGROUND:
Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome.
METHODS:
This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao2) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao2 >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao2 and poor neurological outcome. To assess whether there was an association between other supranormal Pao2 levels and poor neurological outcome, we used other Pao2 cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg).
RESULTS:
Of the 280 patients included, 105 (38%) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70% of patients in the entire cohort and in 77% versus 65% among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12%; 95% confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23; 95% confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3% increase in risk of poor neurological outcome (relative risk, 1.03; 95% confidence interval, 1.02-1.05). We found that the association with poor neurological outcome began at ≥300 mm Hg.
CONCLUSIONS:
Early hyperoxia exposure after resuscitation from cardiac arrest was independently associated with poor neurological function at hospital discharge
The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: A meta-analysis
Objective
Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis.
Data Sources
We conducted a systematic review of the Cochrane Library, MEDLINE, EMBASE, CINAHL, conference proceedings, clinical practice guidelines, and other sources using a comprehensive strategy.
Study Selection
We identified randomized control trials comparing quantitative resuscitation with standard resuscitation in adult patients who were diagnosed with sepsis using standard criteria. The primary outcome variable was mortality.
Data Abstraction
Three authors independently extracted data and assessed study quality using standardized instruments; consensus was reached by conference. Preplanned subgroup analysis required studies to be categorized based on early (at the time of diagnosis) vs. late resuscitation implementation. We used the chi-square test and I2 to assess for statistical heterogeneity (p 25%). The primary analysis was based on the random effects model to produce pooled odds ratios with 95% confidence intervals.
Results
The search yielded 29 potential publications; nine studies were included in the final analysis, providing a sample of 1001 patients. The combined results demonstrate a decrease in mortality (odds ratio 0.64, 95% confidence interval 0.43–0.96); however, there was statistically significant heterogeneity (p = 0.07, I2 = 45%). Among the early quantitative resuscitation studies (n = 6) there was minimal heterogeneity (p = 0.40, I2 = 2.4%) and a significant decrease in mortality (odds ratio 0.50, 95% confidence interval 0.37–0.69). The late quantitative resuscitation studies (n = 3) demonstrated no significant effect on mortality (odds ratio 1.16, 95% confidence interval 0.60–2.22).
Conclusion
This meta-analysis found that applying an early quantitative resuscitation strategy to patients with sepsis imparts a significant reduction in mortality
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