The Facility for Antiproton and Ion Research (FAIR) will be the accelerator-based flagship research facility in many basic sciences and their applications in Europe for the coming decades. FAIR will ...open up unprecedented research opportunities in hadron and nuclear physics, in atomic physics and nuclear astrophysics as well as in applied sciences like materials research, plasma physics and radiation biophysics with applications towards novel medical treatments and space science. FAIR is currently under construction as an international facility at the campus of the GSI Helmholtzzentrum for Heavy-Ion Research in Darmstadt, Germany. While the full science potential of FAIR can only be harvested once the new suite of accelerators and storage rings is completed and operational, some of the experimental detectors and instrumentation are already available and will be used starting in summer 2018 in a dedicated research program at GSI, exploiting also the significantly upgraded GSI accelerator chain. The current manuscript summarizes how FAIR will advance our knowledge in various research fields ranging from a deeper understanding of the fundamental interactions and symmetries in nature to a better understanding of the evolution of the Universe and the objects within.
BACKGROUND:The anesthetic conserving device (ACD) reduces consumption of volatile anesthetic drug by a conserving medium adsorbing exhaled drug during expiration and releasing it during inspiration. ...Elevated arterial CO2 tension (PaCO2) has been observed in patients using the ACD, despite tidal volume increase to compensate for larger apparatus dead space. In a test lung using room temperature dry gas, this was shown to be due to adsorption of CO2 in the ACD during expiration and release of CO2 during the following inspiration. The effect in the test lung was higher than in patients. We tested the hypothesis that a lesser dead space effect in patients is due to higher temperature and/or moisture attenuating rebreathing of CO2.
METHODS:The lungs of 6 postoperative cardiac surgery patients were ventilated using a conventional heat and moisture exchanger (HME) or an ACD. The ACD was studied with a test lung at varying temperatures and moistures. Infrared spectrometry was used to measure apparent dead space by the single-breath test for CO2 as well as rebreathing of CO2.
RESULTS:In patients, the median apparent dead space was 136 mL (95% confidence interval CI, 120–167) larger using the ACD compared with an HME (after correction for difference in internal volume 100 and 50 mL, respectively). Median rebreathing of CO2 using the ACD was 53% (range 48–58) of exhaled CO2 compared with 29% (range 27–32) with an HME. The median difference in CO2 rebreathing was 23% (95% CI, 18–27). In the test lung apparent dead space using ACD was unaffected by body temperature but decreased from 360 to 260 mL when moisture was added. This decreased rebreathing of CO2 from 62% to 48%.
CONCLUSIONS:The use of an ACD increases apparent dead space to a greater extent than can be explained by its internal volume. This is caused by adsorption of CO2 in the ACD during expiration and release of CO2 during inspiration. Rebreathing of CO2 was attenuated by moisture. The dead space effect of the ACD could be clinically relevant in acute respiratory distress syndrome and other diseases associated with ventilation difficulties, but investigations with larger sample sizes would be needed to determine the clinical importance.
V/PSPECT has the potential to become a first hand tool for diagnosis of pulmonary embolism based on standardized technology and new holistic interpretation criteria. Pretest probability helps ...clinicians choose the most appropriate objective test for diagnosis or exclusion of PE. Interpretation should also take into account all ventilation and perfusion patterns allowing diagnosis of other cardiopulmonary diseases than PE. In such contexts, V/PSPECT has excellent sensitivity and specificity. Nondiagnostic reports are ≤3%. V/PSPECT has no contraindication; it is noninvasive and has very low radiation exposure. Moreover, acquisition time for V/PSPECT is only 20 minutes. It allows quantification of PE extension which has an impact on individual treatment. It is uniquely useful for followup and research.
Quasifree one-proton knockout reactions have been employed in inverse kinematics for a systematic study of the structure of stable and exotic oxygen isotopes at the R^{3}B/LAND setup with incident ...beam energies in the range of 300-450 MeV/u. The oxygen isotopic chain offers a large variation of separation energies that allows for a quantitative understanding of single-particle strength with changing isospin asymmetry. Quasifree knockout reactions provide a complementary approach to intermediate-energy one-nucleon removal reactions. Inclusive cross sections for quasifree knockout reactions of the type ^{A}O(p,2p)^{A-1}N have been determined and compared to calculations based on the eikonal reaction theory. The reduction factors for the single-particle strength with respect to the independent-particle model were obtained and compared to state-of-the-art ab initio predictions. The results do not show any significant dependence on proton-neutron asymmetry.
Background
Limiting tidal volume (
V
T
), plateau pressure, and driving pressure is essential during the acute respiratory distress syndrome (ARDS), but may be challenging when brain injury coexists ...due to the risk of hypercapnia. Because lowering dead space enhances CO
2
clearance, we conducted a study to determine whether and to what extent replacing heat and moisture exchangers (HME) with heated humidifiers (HH) facilitate safe
V
T
lowering in brain-injured patients with ARDS.
Methods
Brain-injured patients (head trauma or spontaneous cerebral hemorrhage with Glasgow Coma Scale at admission < 9) with mild and moderate ARDS received three ventilatory strategies in a sequential order during continuous paralysis: (1) HME with
V
T
to obtain a PaCO
2
within 30–35 mmHg (HME1); (2) HH with
V
T
titrated to obtain the same PaCO
2
(HH); and (3) HME1 settings resumed (HME2). Arterial blood gases, static and quasi-static respiratory mechanics, alveolar recruitment by multiple pressure–volume curves, intracranial pressure, cerebral perfusion pressure, mean arterial pressure, and mean flow velocity in the middle cerebral artery by transcranial Doppler were recorded. Dead space was measured and partitioned by volumetric capnography.
Results
Eighteen brain-injured patients were studied: 7 (39%) had mild and 11 (61%) had moderate ARDS. At inclusion, median interquartile range PaO
2
/FiO
2
was 173 146–213 and median PEEP was 8 cmH
2
O 5–9. HH allowed to reduce
V
T
by 120 ml 95% CI: 98–144,
V
T
/kg predicted body weight by 1.8 ml/kg 95% CI: 1.5–2.1, plateau pressure and driving pressure by 3.7 cmH
2
O 2.9–4.3, without affecting PaCO
2
, alveolar recruitment, and oxygenation. This was permitted by lower airway (− 84 ml 95% CI: − 79 to − 89) and total dead space (− 86 ml 95% CI: − 73 to − 98). Sixteen patients (89%) showed driving pressure equal or lower than 14 cmH
2
O while on HH, as compared to 7 (39%) and 8 (44%) during HME1 and HME2 (
p
< 0.001). No changes in mean arterial pressure, cerebral perfusion pressure, intracranial pressure, and middle cerebral artery mean flow velocity were documented during HH.
Conclusion
The dead space reduction provided by HH allows to safely reduce
V
T
without modifying PaCO
2
nor cerebral perfusion. This permits to provide a wider proportion of brain-injured ARDS patients with less injurious ventilation.
Alveolar dead space reflects phenomena that render arterial partial pressure of carbon dioxide higher than that of mixed alveolar gas, disturbing carbon dioxide exchange. Right-to-left shunt fraction ...(Qs/Qt) leads to an alveolar dead space fraction (VdAS/VtA; where VtA is alveolar tidal volume). In acute respiratory distress syndrome, ancillary physiological disturbances may include low cardiac output, high metabolic rate, anaemia and acid-base instability. The purpose of the present study was to analyze the extent to which shunt contributes to alveolar dead space and perturbs carbon dioxide exchange in ancillary physiological disturbances.
A comprehensive model of pulmonary gas exchange was based upon known equations and iterative mathematics.
The alveolar dead space fraction caused by shunt increased nonlinearly with Qs/Qt and, under 'basal conditions', reached 0.21 at a Qs/Qt of 0.6. At a Qs/Qt of 0.4, reduction in cardiac output from 5 l/minute to 3 l/minute increased VdAS/VtA from 0.11 to 0.16. Metabolic acidosis further augmented the effects of shunt on VdAS/VtA, particularly with hyperventilation. A Qs/Qt of 0.5 may increase arterial carbon dioxide tension by about 15% to 30% if ventilation is not increased.
In acute respiratory distress syndrome, perturbation of carbon dioxide exchange caused by shunt is enhanced by ancillary disturbances such as low cardiac output, anaemia, metabolic acidosis and hyperventilation. Maintained homeostasis mitigates the effects of shunt.
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