Abstract Aim Optimal depth (50–60 mm) and rate (100–120 min−1 ) of chest compressions (CC) is the prerequisite of effective cardiopulmonary resuscitation (CPR). However, insufficient CC during CPR ...are common even among health care professionals. We sought to evaluate if CC are more effective with the use of a novel feedback device compared to standard CC. Primary endpoints were absolute percentage of correct CC of all CC (correct rate and correct depth, classified as “optimal” CC), and the percentage of CC in target rate and percentage of CC in target depth. Methods 63 healthcare professionals performed CC on a manikin with the use of a novel feedback device. The device provides audio–visual information about compression depth and rate. Each participant performed two minutes of CC with and without feedback. Participants were randomized into two groups that performed either CC with feedback first, followed by a trial without feedback, or vice versa. All participants answered a short questionnaire on self-estimation of CC performance. Results The absolute percentage of optimal compressions of all compressions has increased from 27.9 ± 28.8% to 47.6 ± 33.5% ( p < 0.001) with use of the device. Furthermore, a significant increase of the percentage of CC in target depth (35.9 ± 30.6% without vs. 54.8 ± 33.5% with the device, p = 0.003) and in target rate (70.5 ± 37.7% without vs. 82.7 ± 27.8 with the device, p = 0.039) were observed. Conclusion This novel feedback device significantly improved the quality of CC in health care professionals.
The Harlequin syndrome may occur in patients treated with venoarterial extracorporal membrane oxygenation (VA-ECMO), in whom blood from the left ventricle and the ECMO system supply different parts ...of the body with different paCO2-levels. The purpose of this study was to compare two variants of paCO2-analysis to account for the Harlequin syndrome during apnea testing (AT) in brain death (BD) determination.
Twenty-seven patients (median age 48 years, 26–76 years; male n = 19) with VA-ECMO treatment were included who underwent BD determination. In variant 1, simultaneous arterial blood gas (ABG) samples were drawn from the right and the left radial artery. In variant 2, simultaneous ABG samples were drawn from the right radial artery and the postoxygenator ECMO circuit. Differences in paCO2-levels were analysed for both variants.
At the start of AT, median paCO2-difference between right and left radial artery (variant 1) was 0.90 mmHg (95%-confidence intervall CI: 0.7–1.3 mmHg). Median paCO2-difference between right radial artery and postoxygenator ECMO circuit (variant 2) was 3.3 mmHg (95%-CI: 1.5–6.0 mmHg) and thereby significantly higher compared to variant 1 (p = 0.001). At the end of AT, paCO2-difference according to variant 1 remained unchanged with 1.1 mmHg (95%-CI: 0.9–1.8 mmHg). In contrast, paCO2-difference according to variant 2 increased to 9.9 mmHg (95%-CI: 3.5–19.2 mmHg; p = 0.002).
Simultaneous paCO2-analysis from right and left distal arterial lines is the method of choice to reduce the risk of adverse effects (e.g. severe respiratory acidosis) while performing AT in VA-ECMO patients during BD determination.
Biocompatibility and buffers: Effect of bicarbonate-buffered peritoneal dialysis fluids on peritoneal cell function.
Conventional peritoneal dialysis fluids (PDF) have been shown to compromise the ...function of both leukocytes and human peritoneal mesothelial cells (HPMC). Various in vitro studies have identified the low initial pH in combination with high lactate content, as well as the hyperosmolality and high glucose concentration present in currently used solutions as the primary determinants of their bioincompatibility. Bicarbonate buffered PDF (at neutral pH) display improved in vitro biocompatibility as compared to conventional, lactate buffered PDF. However, little information is currently available regarding the potential impact of PDF on the function of human peritoneal fibroblasts (HPFB), the major cell population present in peritoneal interstitium.
The current study compares the effect of bicarbonate and lactate buffered PDF in a model system of resting peritoneal mesothelial cells and fibroblasts cultured from human omentum. Interleukin-1β-stimulated IL-6 release from HPMC and HPFB was used as the cell functional parameter.
While short (30min) pre-exposure to lactate buffered PDF significantly reduced the IL-1β-stimulated IL-6 release from HPMC during a subsequent recovery period (24 hr), a significant decrease in HPMC IL-6 secretion with bicarbonate buffered PDF was only observed after prolonged (≥60min) exposure. In contrast, no significant IL-6 inhibition was detected with HPFB pre-exposed to PDF for up to 90minutes. A significant suppression of HPFB IL-6 secretion was only observed in coincubation experiments (24 hr) with dilutions of both types of PDF.
These results indicate that (i) bicarbonate buffered PDF are less inhibitory to peritoneal cell function as compared to conventional, lactate buffered PDF; and (ii) HPFB may be more resistant than HPMC to bioincompatible PDF.
The human genome contains approximately 20 thousand protein-coding genes
, but the size of the collection of antigen receptors of the adaptive immune system that is generated by the recombination of ...gene segments with non-templated junctional additions (on B cells) is unknown-although it is certainly orders of magnitude larger. It has not been established whether individuals possess unique (or private) repertoires or substantial components of shared (or public) repertoires. Here we sequence recombined and expressed B cell receptor genes in several individuals to determine the size of their B cell receptor repertoires, and the extent to which these are shared between individuals. Our experiments revealed that the circulating repertoire of each individual contained between 9 and 17 million B cell clonotypes. The three individuals that we studied shared many clonotypes, including between 1 and 6% of B cell heavy-chain clonotypes shared between two subjects (0.3% of clonotypes shared by all three) and 20 to 34% of λ or κ light chains shared between two subjects (16 or 22% of λ or κ light chains, respectively, were shared by all three). Some of the B cell clonotypes had thousands of clones, or somatic variants, within the clonotype lineage. Although some of these shared lineages might be driven by exposure to common antigens, previous exposure to foreign antigens was not the only force that shaped the shared repertoires, as we also identified shared clonotypes in umbilical cord blood samples and all adult repertoires. The unexpectedly high prevalence of shared clonotypes in B cell repertoires, and identification of the sequences of these shared clonotypes, should enable better understanding of the role of B cell immune repertoires in health and disease.
Maintenance routines on ships today follow either a reactive maintenance (RM) or preventive maintenance (PvM) approach. RM can be regarded as post-failure repair, which might create large costs. PvM ...uses predetermined maintenance intervals, which often involves unnecessary maintenance. Recently, prognostics and health management (PHM) has emerged as a potential way to develop an ideal maintenance policy. PHM aims to provide optimal maintenance schedule through the use of sensor measurement for fault detection and fault prognostics, among which fault detection is the first and fundamental action. In this paper, a long-short term memory based variational autoencoder (LSTM-VAE) is proposed for fault detection of maritime components onboard. It is a semi-supervised approach that requires only fault-free data for training. Therefore, it is widely applicable in the maritime industry since operational data in normal conditions already exists. Real-world operation data collected from a diesel engine on the research vessel (RV) Gunnerus is used to validate the method. Results show that the LSTM-VAE can detect the fault accurately.
Via 16S rRNA gene amplicon sequencing, this study explores whether the gut mucus microbiota of rainbow trout is affected by the interaction of a plant-protein-based diet and a daily handling stressor ...(chasing with a fishing net) across two genetic lines (A, B). Initial body weights of fish from lines A and B were 124.7 g and 147.2 g, respectively. Fish were fed 1.5% of body weight per day for 59 days either of two experimental diets, differing in their fish meal fishmeal-based diet (F): 35%, plant-based diet (V): 7% and plant-based protein content (diet F: 47%, diet V: 73%). No diet- or stress-related effect on fish performance was observed at the end of the trial. However, we found significantly increased observed ASVs in the intestinal mucus of fish fed diet F compared to diet V. No significant differences in Shannon diversity could be observed between treatments. The autochthonous microbiota in fish fed with diet V was dominated by representatives of the genera Mycoplasma, Cetobacterium, and Ruminococcaceae, whereas Enterobacteriaceae and Photobacterium were significantly associated with diet F. The mucus bacteria in both genetic lines were significantly separated by diet, but neither by stress nor an interaction, as obtained via PERMANOVA. However, pairwise comparisons revealed that the diet effect was only significant in stressed fish. Therefore, our findings indicate that the mucus-associated microbiota is primarily modulated by the protein source, but this modulation is mediated by the stress status of the fish.
The arms race between phages and their hosts has led to the development of phage anti-defence systems (ADSs) to combat bacterial defence systems.Following the growth in the number of discovered ...bacterial defence systems, the number of new phage ADSs is now beginning to parallel this rate of discovery.We describe the known repertoire of phage ADSs and group them based on molecular mechanisms of action.Computational approaches can harness large-scale sequencing and phage–host interaction data to expedite the discovery of new ADSs.
The biological interplay between phages and bacteria has driven the evolution of phage anti-defence systems (ADSs), which evade bacterial defence mechanisms. These ADSs bind and inhibit host defence proteins, add covalent modifications and deactivate defence proteins, degrade or sequester signalling molecules utilised by host defence systems, synthesise and restore essential molecules depleted by bacterial defences, or add covalent modifications to phage molecules to avoid recognition. Overall, 145 phage ADSs have been characterised to date. These ADSs counteract 27 of the 152 different bacterial defence families, and we hypothesise that many more ADSs are yet to be discovered. We discuss high-throughput approaches (computational and experimental) which are indispensable for discovering new ADSs and the limitations of these approaches. A comprehensive characterisation of phage ADSs is critical for understanding phage–host interplay and developing clinical applications, such as treatment for multidrug-resistant bacterial infections.
The biological interplay between phages and bacteria has driven the evolution of phage anti-defence systems (ADSs), which evade bacterial defence mechanisms. These ADSs bind and inhibit host defence proteins, add covalent modifications and deactivate defence proteins, degrade or sequester signalling molecules utilised by host defence systems, synthesise and restore essential molecules depleted by bacterial defences, or add covalent modifications to phage molecules to avoid recognition. Overall, 145 phage ADSs have been characterised to date. These ADSs counteract 27 of the 152 different bacterial defence families, and we hypothesise that many more ADSs are yet to be discovered. We discuss high-throughput approaches (computational and experimental) which are indispensable for discovering new ADSs and the limitations of these approaches. A comprehensive characterisation of phage ADSs is critical for understanding phage–host interplay and developing clinical applications, such as treatment for multidrug-resistant bacterial infections.
Enthusiasm for ship autonomy is flourishing in the maritime industry. In this context, data-driven prognostics and health management (PHM) systems have emerged as the optimal way to improve ...operational reliability and system safety. However, further research is needed to enhance the essential actions relating to such a system. Fault detection is the first and most crucial action of any data-driven PHM system. In this article, we propose a fault-type independent spectral anomaly detection algorithm for marine diesel engine degradation in autonomous ferries. The benefits of the algorithm are verified on three fault types where the nature of degradation differs. Both normal operation data and faulty degradation data have been collected from a marine diesel engine using two different engine load profiles. These profiles aim to replicate real autonomous ferry crossing operations, environmental conditions that the ferry may encounter. First, the data are subjected to a feature selection process to remove irrelevant and redundant features. Then, a multiregime normalization method is performed on the data to merge the engine loads into one context. Finally, a variational autoencoder is trained to estimate velocity and acceleration calculations of the anomaly score. Generic and dynamic threshold limits are simultaneously established to detect the fault time step online. The algorithm achieved an accuracy of 97.66% in the final test when the acceleration was used as the fault detector. The results suggest that the algorithm is independent of fault types with different nature of degradation related to the marine diesel engine.
Modification of drug delivery materials with beta‐cyclodextrins (β‐CyD) is known to increase solubility of poorly water‐soluble drugs, protect drugs from degradation and sustain release. In this ...study, we developed a hydrogel drug delivery system for local paclitaxel delivery using the natural polysaccharide alginate functionalized with β‐CyD‐moieties. Paclitaxel was chosen due to its ability to form inclusion complexes with cyclodextrins. The rheological and mechanical properties of the prepared hydrogels were characterized, as well as in vitro release of the paclitaxel and in vitro activity on PC‐3 prostate cancer cells. Introduction of β‐CyD‐moieties into the hydrogel reduces the mechanical properties of the gels compared to nonmodified gels. However, gelation kinetics were not markedly different. Furthermore, the β‐CyD‐modified alginate helped to reduce undesired crystallization of the paclitaxel in the gel and facilitated paclitaxel diffusion out of the gel network. Remarkably, the β‐CyD grafted alginate showed increased capacity to complex paclitaxel compared to free HPβ‐CyD. Release of both paclitaxel and degradation products were measured from the gels and were shown to have cytotoxic effects on the PC‐3 cells. The results indicate that functionalized alginate with β‐CyDs has potential as a material for drug delivery systems.
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