Abstract Background Use of Extracorporeal Membrane Oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being deployed as an adjunct to conventional CPR. It is unknown if this has ...been associated with improved outcomes. Aims To describe trends in survival and patient demographics for ECPR patients in the international Extracorporeal Life Support Organisation (ELSO) database over the past 12 years and identify factors associated with changes in survival. Methods Patients greater than 16 years of age who received ECPR between January 2003 and December 2014 were extracted from the ELSO registry and were divided into three 4-year cohorts (Cohort 1: 2003–2006, Cohort 2: 2007–2010, Cohort 3: 2011–2014). Univariable analysis was performed to compare demographics and outcomes of patients across the three cohorts. Univariable and multivariable analyses were then performed to identify factors independently associated with survival. Results 1796 patients treated with ECPR were extracted from the registry, aged 50 (±18.5) years. Annual ECPR episodes increased over 10-fold, from 35 to over 400 per year. Survival to hospital discharge was 29% overall (27% cohort 1, 28% cohort 2, 30% cohort 3 (p = 0.71)). Age, body weight and documented comorbidities increased over time. There was a reduction in complications associated with ECMO usage. After adjusting for confounders there was no change in the odds of survival over the time period examined. Interpretation Over the period 2003–2014, survival to hospital discharge was 29% for patients who require ECPR. Despite advances in provision of ECMO care and increasing co-morbidities of patients, there has been no change in risk-adjusted survival over time.
Language plays an essential role in how we portray our personalities. Through social interaction, others develop a picture of us based on our linguistic cues. However, when we interact in a foreign ...language and in a new country, limitations in linguistic and cultural knowledge can make self-presentation a more difficult task. This book explores the problems faced by language students embarking on 'study abroad' programmes, spending time in a foreign country and having to interact - and express their personalities - in a second language. Drawing on her extensive work with students, Valerie Pellegrino Aveni explores the factors that complicate self-presentation and the strategies students use for overcoming these, looking in particular at issues of anxiety, control, age, gender, risk-taking and self-esteem. Offering rich insights into the study abroad experience, this book will be an invaluable resource for professionals in second language acquisition, and for teachers and students preparing for study abroad.
Es responsabilidad de los actuales sistemas de salud universales brindar servicios respetando los siguientesprincipios:Integralidad: porque abarca todos los niveles de organización, desde lo ...molecular a lo social y ambiental,mediante acciones intersectoriales.Continuidad: acompaña a lo largo de toda la vida promoviendo, protegiendo y previniendo y en casoatendiendo los problemas de salud.Descentralización: las acciones de salud se desarrollan en los lugares en los cuales las personas hacen suvida cotidiana, el sistema de salud se acerca a las personas, familias y comunidades para brindar unaatención “in situ”.Coordinación: En el cual la atención primaria es el eje mismo de la atención, prevención, protección ypromoción, y marca las necesidades y ritmos de dichos requerimientos.Proactivo: Anticipa riesgos y/o los maneja en tiempo real.Centrado en las necesidades de las personas, familias y comunidades: por cuanto tiene por eje afrontarretos y resolver problemas en muy diversos entornos adecuándose a ellos de manera dinámica.Accesible: capaz de responder a las necesidades de salud de manera anticipada, con latencias mínimas ysin generar barreras al acceso.Evolutivo: es capaz de cambiar en función de la transformación del conocimiento y de los resultadosobtenidos por la investigación propia y el trabajo en redes académicas.Viable y factible: que utilice el conocimiento para reducir costos, que no sea onerosa y sea eficaz, efectivo,eficiente y equitativo.Las facultades y escuelas de medicina deben concebirse como centros intelectivos para el desarrollo de losnuevos sistemas de salud, capaces de identificar retos, articular y generar conocimientos, con un enfoqueinter y transdisciplinar, creando tecnología y evaluando resultados, impulsando la mejora continua de lacobertura y calidad del sistema de salud.
Objective
To quantitatively synthesize extant literature on perceived triggers of primary headache disorders.
Methods
A meta-analytic review of headache trigger survey studies was conducted. ...Endorsement rates, assessment method, and headache and sample characteristics were extracted from included articles. Separate random-effects models were used to assess trigger endorsement rates and post-hoc meta-regressions examined potential moderator variables.
Results
85 articles from 1958 to 2015 were included, involving 27,122 participants and querying 420 unique triggers (collapsed into 15 categories). Four-fifths (0.81; 95% CI .75 to .86) of individuals with migraine or tension-type headache endorsed at least one trigger. Rates increased with the number of categories queried (OR: 1.18, 1.08–1.30) and year of publication (OR: 1.04, 1.00–1.08). The triggers most commonly endorsed were stress (.58, .53–.63) and sleep (.41, .36–.47).
Conclusions
Extreme heterogeneity characterizes the headache trigger literature. Most individuals with a primary headache disorder perceive their attacks to be triggered by one or more precipitants, the most common of which are stress and sleep. However, trigger endorsement is influenced by method of assessment. Enhancing methodological consistency and prioritizing experimental studies would improve our understanding of headache triggers.
Background
Advanced testing methodologies and measurement techniques to identify complex deformation and failure at high strain rates have drawn increasing attention in recent years.
Objective
The ...objective of the current study is the development of a novel combined tension–torsion split Hopkinson bar (TTHB) conceived to generate a combination of tensile and torsional stress waves in a single loading case, and to measure material data representative of real case impact scenarios.
Methods
An energy store and release mechanism was employed to generate both the longitudinal and shear waves via the rapid release of a bespoke clamp assembly. A parametric study of the material and geometry of the clamp was implemented via numerical simulations to optimise critical aspects of the wave generation. Thin-walled tube specimens made of two metallic materials were utilised to examine the capability of the developed TTHB system by comparing the experimental measurements with those obtained from conventional split Hopkinson tension and torsion bars.
Results
The experimental results demonstrate that the synchronisation of the longitudinal and torsional waves was achieved within 15 microseconds. Different wave rise time were obtained via the controlled release of the clamp using fracture pins of various materials. The analysis indicates that the developed TTHB is capable of characterising the dynamic behaviour of materials under tension, torsion, as well as under a wide range of complex stress states.
Conclusions
The presented apparatus, testing and analysis methods allow for the direct population of the dynamic failure stress envelopes of engineering materials and for the accurate evaluation of existing and novel constitutive models.
Building automation and control systems (BACs) allow plants in buildings to be controlled and managed, thus increasing the users' comfort and reducing the operation and maintenance costs. As far as ...the lighting services are concerned, control systems offer an important opportunity of managing lighting systems and reducing energy consumption, due to the use of integration strategies between daylight and electric lighting and strategies based on the occupancy of spaces. The results of an experimental case study of ten offices in Torino (Italy), in which a custom-design building automation and control system has been designed to control both the lighting plants and the air conditioning system, are presented in this paper. The study was carried out in order to evaluate the energy efficiency of the lighting control system and to analyse the environmental luminous conditions obtained through the application of this technology to a real case. The environmental and energy performances, together with the degree of users' satisfaction and acceptance of this control system, were analysed after a year of activity to verify the potentiality and operation of this lighting control system. The obtained results regarding the potential energy savings (from 17% to 32%) were evaluated taking into account both the monitored annual electric energy consumption (for operation) and the parasitic energy consumption due to the installed devices (luminaire ballasts, sensors and controllers), and were compared with the estimated energy consumption calculated applying the method proposed in the European standard EN 15193:2007.
•We presented an experimental case study with the use of a lighting control system.•We analysed environmental and energy performances of the lighting control system.•We verified users' satisfaction referred to the lighting control system.•We calculated the potential energy savings due to the use of lighting control system.•We verified the weight of the parasitic energy consumption due to the system.
Muscle weakness is common in patients requiring extracorporeal membrane oxygenation (ECMO), but early identification is challenging. This study aimed to 1) quantify the change in quadriceps size and ...quality (echogenicity) from baseline to day 10 using ultrasound in patients requiring ECMO, 2) determine the relationship between ultrasound measures, muscle strength and highest mobility level.
Prospective cohort study involving ultrasound measurement of quadriceps at baseline, days 10 and 20. Muscle strength and highest mobility level were assessed at days 10 and 20 using the Medical Research Council sum-score (MRC), hand-held dynamometry (HHD) and the ICU mobility scale (IMS).
25 patients (age 49 ± 14 years, 44% male) received ECMO. There was a significant reduction (−19%, p < .001) in rectus femoris cross-sectional area by day 10. Echogenicity did not change over time. There was a negative correlation between echogenicity and MRC at day 10 (r = −0.66) and HHD at day 20 (r = −0.81). At day 20, there was a moderate correlation between total muscle thickness and IMS (rho = 0.59) and MRC (rho = 0.56).
In patients requiring ECMO there was marked wasting of the quadriceps over the first 10 days. Ultrasound measures were related to muscle strength and highest mobility level.
•There was marked wasting of the quadriceps muscle from day 1 to day 10, and this continued to day 20.•Quadriceps muscle size and echogenicity were associated with measures of muscle strength and highest mobility level.•Premorbid frailty was associated with quadriceps size at day 1, however by day 10 and 20 there was little correlation.
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•The developed approach includes urban overheating KPI to assist stakeholders.•Overheating exposure is studied through local monitoring for a coastal city.•The modelled nighttime ...indicators were consistent with the measurements.•The analysis of different KPIs shows various sensitivity for same strategies.
In response to urbanization and global warming, which amplify heatwave effects and might lead to urban heat stress, this paper proposes a practical approach to characterize the local microclimate at the neighborhood scale. In this approach, the local urban climate is described using suitable indicators, to support the ecodistrict design process or refurbishment. Experimental and numerical results illustrate the approach in a case study of a French coastal city, La Rochelle. In the first step, we set up urban and rural weather stations to characterize the local urban climate over a summer period and to identify local temperature differences. The measurements highlighted a daytime urban cooling effect due to the local sea breeze. While the Urban Weather Generator (UWG) simulation tool used for this study does not capture coastal effects, the results were consistent with the urban heat island (UHI) measurements. We proposed two indicators to quantify the local climate modifications: local UHI and overheating intensity. The parameters of the adaptation strategies were assessed through a sensitivity analysis for these two indicators. For this case-study, we identified vegetation cover, building height and road albedo as key parameters that can be used to mitigate local overheating.
Quasi-static and dynamic experiments are conducted to characterise the mechanical response of a syntactic foam comprising hollow glass microballoons in a polyurethane matrix. Stress versus strain ...histories are measured in uniaxial tension and compression as well as in pure shear, at strain rates ranging from 10−4 to 103 s−1, via non-standard experimental techniques; quasi-static in-situ tests are conducted to visualise the deformation mechanisms in tension and compression. The material displays a pronounced sensitivity to the imposed strain rate and relatively high tensile and shear ductility at both low and high strain rates. A tension/compression asymmetry is displayed in quasi-static tests but is lost at high rates of strain.
•Response of a PU syntactic foam measured in compression, tension and shear.•Response measured at quasi-static and high strain rates.•The syntactic foam displays strain rate sensitivity superior to that of solid PU.•The foam displays high tensile and shear ductility at low and high strain rates.•The foam displays tension/compression asymmetry in the quasi-static regime.
Pellegrino A. Luciano analyzes how people in Machu Picchu, Peru mobilized against neoliberal reforms. Luciano describes how they resisted and accommodated large capital investments and conservation ...efforts to protect their local tourism economy.
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