Seven unconfirmed ideas to improve future ICU practice

With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by the results of the next trial. On the other hand, insights that stem from the intuitions of experienced clinicians, scientists and educators-while often neglected-help place current thinking into proper perspective and occasionally point the way toward formulating novel hypotheses that direct future research. Both streams of information and opinion contribute to progress. In this paper we present a wide-ranging set of unproven 'out of the mainstream' ideas of our FCCM faculty, each with a defensible rationale and holding clear implications for altering bedside management. Each proposition was designed deliberately to be provocative so as to raise awareness, stimulate new thinking and initiate lively dialog.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Cold-water coral growth under extreme environmental conditions, the Cape Lookout area, NW Atlantic

The Cape Lookout cold-water coral area off thecoast of North Carolina forms the shallowest and northernmostcold-water coral mound area on the Blake Plateau inthe NW Atlantic. Cold-water coral habitats near Cape Lookoutare occasionally bathed in the Gulf Stream, which is characterisedby oligotrophic warm water and strong surface currents.Here, we present the first insights into the mound distributionand morphology, sedimentary environment and coralcover and near-bed environmental conditions as recordedby bottom landers from this coral area. The mounds occurbetween 320 and 550m water depth and are characterisedby high acoustic backscatter indicating the presenceof hard structure. Three distinct mound morphologies wereobserved: (1) a mound with a flattened top at 320 m, (2)multi-summited mounds with a teardrop shape in the middlepart of the area and (3) a single mound at 540m water depth.Echosounder profiles show the presence of a strong reflectorunderneath all mound structures that forms the base of themounds. This reflector cropped out at the downstream side ofthe single mound and consists of carbonate slabs. Video analysisrevealed that all mounds are covered by Lophelia pertusaand that living colonies only occur close to the summitsof the SSW side of the mounds, which is the side that facesthe strongest currents. Off-mound areas were characterisedby low backscatter and sediment ripples, indicating the presenceof relatively strong bottom currents. Two bottom landerswere deployed amidst the coral mounds between December2009 and May 2010. Both landers recorded prominentevents, characterised by large fluctuations in environmentalconditions near the seabed as well as in the overlyingwater column. The period between December and April wascharacterised by several events of increasing temperature andsalinity, coinciding with increased flow and near-bed acousticbackscatter. During these events temperature fluctuatedby up to 9 ?C within a day, which is the largest temperaturevariability as measured so far in a cold-water coral habitat.Warm events, related to Gulf Stream meanders, had the durationof roughly 1 week and the current during these eventswas directed to the NNE. The consequences of such eventsmust be significant given the strong effects of temperature on the metabolism of cold-water corals. Furthermore, elevatedacoustic backscatter values and high mass fluxes werealso recorded during these events, indicating a second stressorthat may affect the corals. The abrasive nature of sand incombination with strong currents might sand blast the corals.We conclude that cold-water corals near Cape Lookout liveunder extreme conditions that limit mound growth at present

Acoustic and optical variations during rapid downward motion episodes in the deep north-western Mediterranean Sea

An Acoustic Doppler Current Profiler (ADCP) was moored at the deep-sea site of the ANTARES neutrino telescope near Toulon, France, thus providing a unique opportunity to compare high-resolution acoustic and optical observations between 70 and 170 m above the sea bed at 2475 m. The ADCP measured downward vertical currents of magnitudes up to 0.03 m s-1 in late winter and early spring 2006. In the same period, observations were made of enhanced levels of acoustic reflection, interpreted as suspended particles including zooplankton, by a factor of about 10 and of horizontal currents reaching 0.35 m s-1. These observations coincided with high light levels detected by the telescope, interpreted as increased bioluminescence. During winter 2006 deep dense-water formation occurred in the Ligurian subbasin, thus providing a possible explanation for these observations. However, the 10-20 days quasi-periodic episodes of high levels of acoustic reflection, light and large vertical currents continuing into the summer are not direct evidence of this process. It is hypothesized that the main process allowing for suspended material to be moved vertically later in the year is local advection, linked with topographic boundary current instabilities along the rim of the 'Northern Current'.Comment: 30 pages, 7 figure

Гераклиты – карбонатные образования газовых источников и грязевых вулканов миоцена

Морфологические признаки, минералогия, геохимия и состав газовой фракции гераклитов подтвердили их генетическую общность с современными карбонатными образованиями метановых источников и грязевых вулканов Черного моря. Присутствие в гераклитах битумов, метана и этана может служить индикатором наличия нефти и газа на Гераклейском полуострове и прилегающему к нему шельфе.Морфологічні ознаки, мінералогія, геох!мія i склад газової фракцїї гераклитів підтвердили їх генетичну спільність із сучасними карбонатними утвореннями метанових джерел i грязьових вулканів Чорного моря. Присутність у гераклітах бітумів, метану i етану може слугувати як індикатор наявності нафти й газу на Гераклейськом niвocтpoвi i прилеглому до нього шельфі.Morphological attributes, mineralogy, geochemistry and structure of gas fraction Geraklit have confirmed their proximity to modern carbonate formations of methane sources and mud volcanoes in the Black sea. Presence of bitumen, methane and ethane in Geraklites serves as indicator of occurence of oil fields and gas on the Geraklejskij peninsula and adjoining to them a shelf

The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment:A systematic review and meta-analysis

Background: Aerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments. Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia. Aim: The purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia. Methods: Using a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on ‘MoCA’, ‘MMSE’, ‘Mini-Cog’ (measures) and ‘cognition’, ‘cognitive function’, ‘cognitive’, ‘cognitive performance’, ‘executive function’, ‘executive process’, ‘attention’, ‘memory’, ‘memory performance’ (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants’ age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale. Results: Overall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28–0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12–1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22–0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05–0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21–1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12–1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04–2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20–1,18], p = 0.01). Conclusion: Our systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment

The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment:A systematic review and meta-analysis

Background: Aerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments.Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia.Aim: The purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia.Methods: Using a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on ‘MoCA’, ‘MMSE’, ‘Mini-Cog’ (measures) and ‘cognition’, ‘cognitive function’, ‘cognitive’, ‘cognitive performance’, ‘executive function’, ‘executive process’, ‘attention’, ‘memory’, ‘memory performance’ (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants’ age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale.Results: Overall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28–0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12–1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22–0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05–0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21–1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12–1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04–2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20–1,18], p = 0.01).Conclusion: Our systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment.</p

Individual scatterers as microscopic origin of equilibration between spin- polarized edge channels in the quantum Hall regime

The equilibration length between spin-polarized edge states in the Quantum Hall regime is measured as a function of a gate voltage applied to an electrode on top of the edge channels. Reproducible fluctuations in the coupling are observed and interpreted as a mesoscopic fingerprint of single spin-flip scatterers which are turned on and off. A model to analyze macroscopic edge state coupling in terms of individual scatterers is developed, and characteristic values for these scatterers in our samples are extracted. For all samples investigated, the distance between spin-flip scatterers lies between the Drude and the quantum scattering length.Comment: 4 pages, 2 figure

An ovine model of hyperdynamic endotoxemia and vital organ metabolism

BACKGROUND: Animal models of endotoxemia are frequently used to understand the pathophysiology of sepsis and test new therapies. However, important differences exist between commonly used experimental models of endotoxemia and clinical sepsis. Animal models of endotoxemia frequently produce hypodynamic shock in contrast to clinical hyperdynamic shock. This difference may exaggerate the importance of hypoperfusion as a causative factor in organ dysfunction. This study sought to develop an ovine model of hyperdynamic endotoxemia and assess if there is evidence of impaired oxidative metabolism in the vital organs. METHODS: Eight sheep had microdialysis catheters implanted into the brain, heart, liver, kidney and arterial circulation. Shock was induced with a 4hr escalating dose infusion of endotoxin. After 3hrs vasopressor support was initiated with noradrenaline and vasopressin. Animals were monitored for 12hrs after endotoxemia. Blood samples were recovered for haemoglobin, white blood cell count, creatinine and proinflammatory cytokines (IL-1Beta, IL-6 & IL-8). RESULTS: The endotoxin infusion was successful in producing distributive shock with the mean arterial pressure decreasing from 84.5 ± 12.8 mmHg to 49 ± 8.03 mmHg (p < 0.001). Cardiac index remained within the normal range decreasing from 3.33 ± 0.56 l/min/m to 2.89l ± 0.36 l/min/m (p = 0.0845). Lactate/pyruvate ratios were not significantly abnormal in the heart, brain, kidney or arterial circulation. Liver microdialysis samples demonstrated persistently high lactate/pyruvate ratios (mean 37.9 ± 3.3). CONCLUSIONS: An escalating dose endotoxin infusion was successful in producing hyperdynamic shock. There was evidence of impaired oxidative metabolism in the liver suggesting impaired splanchnic perfusion. This may be a modifiable factor in the progression to multiple organ dysfunction and death