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INTRODUCTION. Clinical, biochemical and haemodynamic variables are used to diagnose circulatory shock and guide treatment in the critically ill. Literature is inconsistent which clinical signs have the best prognostic value on top of well-validated prognostic scores such as the simplified acute physiology score (SAPS II). OBJECTIVES. The objective of the Simple Intensive Care Studies-I (SICS-I: NCT02912624) was to evaluate the association of clinical, biochemical and haemodynamic variables with 90-day mortality in a large, consecutive, cohort of critically ill patients [1]. METHODS. This prospective cohort study included all consecutive adults who were acutely admitted with an intensive care unit (ICU) stay expected to last beyond 24 hours. We conducted a protocolised clinical examination and critical care ultrasonography (CCUS) within 24 hours of ICU admission. Our primary outcome was 90-day mortality. Our secondary outcomes were 7-and 30-day mortality, and 90-day mortality by type of circulatory shock and clinical subgroups. We used multivariable Cox regression analyses to identify independent predictors of mortality. RESULTS. From 27 March 2015 until 22 July 2017, 1104 patients were included. A total of 298 patients (28%) died at 90-day follow-up. Patients who died were older, more often ventilated, unconscious and dependent on noradrenalin, had lower blood pressures and urine output, and more often had an impaired microcirculation (tables 1-3). Multivariable Cox regression adjusted for age and SAPS-II score showed that respiratory rate (HR 1.02; 95% CI 1.00-1.04), unrespon-siveness (HR 1.53; 95% CI 1.08-2.16) and serum lactate (HR 1.08; 95% CI 1.03-1.13) were independently associated with 90-day mortality. In patients with septic shock independent predictors were mottling rate (HR 1.27; 95% CI 1.02-1.58) and serum lactate (HR 1.11; 95% CI 1.02-1.22), whereas diuresis

INTRODUCTION. Clinical, biochemical and haemodynamic variables are used to diagnose circulatory shock and guide treatment in the critically ill. Literature is inconsistent which clinical signs have the best prognostic value on top of well-validated prognostic scores such as the simplified acute physiology score (SAPS II). OBJECTIVES. The objective of the Simple Intensive Care Studies-I (SICS-I: NCT02912624) was to evaluate the association of clinical, biochemical and haemodynamic variables with 90-day mortality in a large, consecutive, cohort of critically ill patients [1]. METHODS. This prospective cohort study included all consecutive adults who were acutely admitted with an intensive care unit (ICU) stay expected to last beyond 24 hours. We conducted a protocolised clinical examination and critical care ultrasonography (CCUS) within 24 hours of ICU admission. Our primary outcome was 90-day mortality. Our secondary outcomes were 7-and 30-day mortality, and 90-day mortality by type of circulatory shock and clinical subgroups. We used multivariable Cox regression analyses to identify independent predictors of mortality. RESULTS. From 27 March 2015 until 22 July 2017, 1104 patients were included. A total of 298 patients (28%) died at 90-day follow-up. Patients who died were older, more often ventilated, unconscious and dependent on noradrenalin, had lower blood pressures and urine output, and more often had an impaired microcirculation (tables 1-3). Multivariable Cox regression adjusted for age and SAPS-II score showed that respiratory rate (HR 1.02; 95% CI 1.00-1.04), unrespon-siveness (HR 1.53; 95% CI 1.08-2.16) and serum lactate (HR 1.08; 95% CI 1.03-1.13) were independently associated with 90-day mortality. In patients with septic shock independent predictors were mottling rate (HR 1.27; 95% CI 1.02-1.58) and serum lactate (HR 1.11; 95% CI 1.02-1.22), whereas diuresis

2nd International Neuroergonomics Conference, PHILADELPHIE, ETATS-UNIS, 27-/06/2018 - 29/06/2018; Research works on operator monitoring underline the benefit of taking into consideration several signal modalities to improve accuracy for an objective mental state diagnosis. Heart rate (HR) is one of the most utilized systemic measures to assess cognitive workload (CW), whereas respiration parameters are hardly utilized. This study aims at verifying the contribution of analyzing respiratory signals to extract features to evaluate driver's activity and CW variations in driving with regard to cardiac activity. Eighteen subjects participated in the study. The participants carried out two different cognitive tasks requiring different CW demands, a single task as well as a competing cognitive task realized while driving in a simulator. Our results confirm that both HR and breathing rate (BR) increase in driving and are sensitive to CW. However, HR and BR are differently modulated by the CW variations in driving. Specifically, BR is suitable to evidence a variation of CW when driving is not required. On the other hand, spectral features characterizing respiratory signal could be also used similarly to HR variability indices to detect high CW episodes. These results hint the use of respiration to monitor the driver mental state in autonomic vehicles in order to predict the available cognitive resources if the user has to take over the vehicle.

This paper addresses the application of physiological status monitoring (PSM) for assessing the impact of harsh weather conditions on sports activities in universities in Saudi Arabia. Real sports measurement was conducted during sports activities such that the physiological status (HR and BR) of five students were continuously monitored by using Zephyr BioHarnessTM 3.0 sensors in order to identify the physiological bonds and zones. These bonds and zones were employed as indicators of the associated physiological risks of the performed sports activities. Furthermore, a short yes/no questionnaire was applied to collect information on participants’ health conditions and opinions of the applied PSM sensors. The results show the absence of a warning system as a protective aid for the hazardous levels of extremely hot and humid weather conditions that may cause dangerous and fatal circumstances. The applied formulas for estimating maximum HR provides accurate estimations for Maximum Heart Rate (HRmax). The physiological results reveal that the performed activities by the participants are considered the highest category (90–100%) in terms of activity intensity. This category is associated with higher HR, BR and physiological risks including losing the ability to control human body behaviors. Therefore, there is a need for immediate intervention actions to reduce the intensity of the performed activities to safer zones. The outcomes of this study assist the safety improvement of sports activities inside universities and athletes performing their sports activities. To the best of our knowledge, this is the first paper to represent a special case of the application of PSM technology for assessing sports activities in universities considering the impacts of harsh weather conditions on students’ health and safety., {"references":["Atrash, A., Mower, E., Shams, K., & Mataric, M. J. 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Background: Paediatric Early Warning Scores (PEWS) are increasingly being used for early identification and management of clinical deterioration in paediatric patients. A PEWS system includes scores, cut-off points and appropriate early intervention. In 2011, The Dutch Ministry of Health advised hospitals to implement a PEWS system in order to improve patient safety in paediatric wards. The objective of this study was to examine the results of implementation of PEWS systems and to gain insight into the attitudes of professionals towards using a PEWS system in Dutch non-university hospitals. Methods: Quantitative data were gathered at start, midway and at the end of the implementation period through retrospective patient record review (n= 554). Semi-structured interviews with professionals (n= 8) were used to gain insight in the implementation process and experiences. The interviews were transcribed and analysed using an inductive approach. Results: Looking at PEWS systems of the five participating hospitals, different parameters and policies were found. While all hospitals included heart rate and respiratory rate, other variables differed among hospitals. At baseline, none of the hospitals used a PEWS system. After 1 year, PEWS were recorded in 69.2% of the patient records and elevated PEWS resulted in appropriate action in 49.1%. Three themes emerged from the interviews: 1) while the importance of using a PEWS system was acknowledged, professionals voiced some doubts about the effectiveness and validity of their PEWS system 2) registering PEWS required little extra effort and was facilitated by PEWS being integrated into the electronic patient record 3) Without a national PEWS system or guidelines, hospitals found it difficult to identify a suitable PEWS system for their setting. Existing systems were not always considered applic able in a non-university setting. Conclusions: After 1 year, hospitals showed improvements in the use of their PEWS system, although some were decidedly more successful than others. Doubts among staff about validity, effectiveness and communication with other hospitals during transfer to higher level care hospital might hinder sustainable implementation. For these purposes the development of a national PEWS system is recommended, consisting of a “core set” of PEWS, cut-off points and associated early intervention.

Background: Paediatric Early Warning Scores (PEWS) are increasingly being used for early identification and management of clinical deterioration in paediatric patients. A PEWS system includes scores, cut-off points and appropriate early intervention. In 2011, The Dutch Ministry of Health advised hospitals to implement a PEWS system in order to improve patient safety in paediatric wards. The objective of this study was to examine the results of implementation of PEWS systems and to gain insight into the attitudes of professionals towards using a PEWS system in Dutch non-university hospitals. Methods: Quantitative data were gathered at start, midway and at the end of the implementation period through retrospective patient record review (n= 554). Semi-structured interviews with professionals (n= 8) were used to gain insight in the implementation process and experiences. The interviews were transcribed and analysed using an inductive approach. Results: Looking at PEWS systems of the five participating hospitals, different parameters and policies were found. While all hospitals included heart rate and respiratory rate, other variables differed among hospitals. At baseline, none of the hospitals used a PEWS system. After 1 year, PEWS were recorded in 69.2% of the patient records and elevated PEWS resulted in appropriate action in 49.1%. Three themes emerged from the interviews: 1) while the importance of using a PEWS system was acknowledged, professionals voiced some doubts about the effectiveness and validity of their PEWS system 2) registering PEWS required little extra effort and was facilitated by PEWS being integrated into the electronic patient record 3) Without a national PEWS system or guidelines, hospitals found it difficult to identify a suitable PEWS system for their setting. Existing systems were not always considered applic able in a non-university setting. Conclusions: After 1 year, hospitals showed improvements in the use of their PEWS system, although some were decidedly more successful than others. Doubts among staff about validity, effectiveness and communication with other hospitals during transfer to higher level care hospital might hinder sustainable implementation. For these purposes the development of a national PEWS system is recommended, consisting of a “core set” of PEWS, cut-off points and associated early intervention.

This paper investigates the use of heart rate (HR) and breathing rate (BR) signals for the automatic recognition of car driver stress. The problem is defined as a binary classification problem, that is stress vs no-stress, and it is tackled by using the Support Vector Machines classification strategy. We propose the use of a combination of traditional state of the art features and raw values of the acquired signals as data representation. Experimentation is carried out on a subset of data belonging to a publicly available dataset of simulated driving. The HR and BR signals are acquired with an adrenergic sensor connected to a chest strap that is worn underneath the driver’s clothing. The experiments are made considering the leave-one-subject-out configuration, that is the subject under test is not included in the training set. The goodness of HR and BR is tested separately and then a combination of them. The results obtained are very encouraging, especially considering that the leave-one-subject-out configuration is adopted. The results reach a mean average accuracy of about 70% in the case where the combination of HR and BR is adopted.

Made available in DSpace on 2018-11-26T16:17:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-12-01 Natural Sciences and Engineering Research Council of Canada Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Fundação para o Desenvolvimento da UNESP (FUNDUNESP) The present study determined whether EEG and/or EMG recordings could be used to reliably define activity states in the Brazilian black and white tegu lizard (Tupinambis merianae) and then examined the interactive effects of temperature and activity states on strategies for matching O-2 supply and demand. In a first series of experiments, the rate of oxygen consumption (), breathing frequency (f (R)), heart rate (f (H)), and EEG and EMG (neck muscle) activity were measured in different sleep/wake states (sleeping, awake but quiet, alert, or moving). In general, metabolic and cardio-respiratory changes were better indictors of the transition from sleep to wake than were changes in the EEG and EMG. In a second series of experiments, the interactive effects of temperature (17, 27 and 37 A degrees C) and activity states on f (R), tidal volume (V (T)), the fraction of oxygen extracted from the lung per breath (FIO2-FEO2), f (H), and the cardiac O-2 pulse were quantified to determine the relative roles of each of these variables in accommodating changes in . The increases in oxygen supply to meet temperature- and activity-induced increases in oxygen demand were produced almost exclusively by increases in f (H) and f (R). Regression analysis showed that the effects of temperature and activity state on the relationships between f (H), f (R) and was to extend a common relationship along a single curve, rather than separate relationships for each metabolic state. For these lizards, the predictive powers of f (R) and f (H) were maximized when the effects of changes in temperature, digestive state and activity were pooled. However, the best r (2) values obtained were 0.63 and 0.74 using f (R) and f (H) as predictors of met abolic rate, respectively. Univ British Columbia, Dept Zool, Vancouver, BC V6T 1Z4, Canada Univ Estadual Paulista Rio Claro, Inst Nacl Ciencia & Tecnol Fisiol, Dept Zool, Rio Claro, SP, Brazil Brock Univ, Dept Biol Sci, St Catharines, ON L2S 3A1, Canada Univ Estadual Paulista Rio Claro, Inst Nacl Ciencia & Tecnol Fisiol, Dept Zool, Rio Claro, SP, Brazil

INTRODUCTION. The latest consensus on circulatory shock advocates clinical examination and ultrasonography for diagnosing circulatory shock. Propagation of daily clinical examination contrasts with available studies, which are of limited quality and quantity so that its level of evidence is considered 'best practice'. We hypothesize that clinical estimation of circulatory shock, should be based on multiple variables including combinations of clinical, laboratory and ultrasonography variables. OBJECTIVES. To evaluate the value of clinical examination, biochemical and ultrasonography variables in the critically ill, specifically for estimation which combinations of variables are associated with cardiac output. METHODS. We initiated the Simple Intensive Care Studies-I (SICS-I) which was designed as a prospective cohort study to include all patients acutely admitted to the intensive care unit. Clinical examination was performed in a standardized fashion in all patients according to predefined criteria including variables of heart rate, blood pressures, central venous pressure, mental state, auscultation of heart and lungs, respiratory rate, urine output, capillary refill times, central to peripheral temperatures gradients, skin mottling; biochemical variables including lactate; and ultrasonography of heart and lungs. These clinical, biochemical, and ultrasonography variables were recorded following a published protocol (NCT02912624). Circulatory shock was defined by the requirement of vasopressors and/or inotropes and measured by cardiac output using transthoracic ultrasonography. All researchers, including medical students, underwent focused training for recording of all variables, including obtaining specific ultrasonography images. Cardiac function was clinically estimated as well before being measured by ultrasonography. RESULTS. Between March 2015 and December 2016 a total of 704 out of 791 eligible patients were included. An independent Core laboratory assessed that ultrasonography images from 632 patients (90%) were of sufficient quality. Vasopressors and/or inotropes were used upon admission in 363 cases (52%). 173 patients (25%) had died at 90-day follow-up. The data of all patients included until July 1st, 2017 will be analysed to identify combinations of variables independently associated with cardiac output. At the congress, these results will be presented and these variables will inform the second phase of the on-going registry. CONCLUSIONS. Standardized clinical examination and ultrasonography in critically ill patients by novices is feasible. We will be able to answer whether clinical assessment of the presence of shock can reliably be established and if so, which combinations of variables are most informative for estimation of the patients' cardiac output.

INTRODUCTION. The latest consensus on circulatory shock advocates clinical examination and ultrasonography for diagnosing circulatory shock. Propagation of daily clinical examination contrasts with available studies, which are of limited quality and quantity so that its level of evidence is considered 'best practice'. We hypothesize that clinical estimation of circulatory shock, should be based on multiple variables including combinations of clinical, laboratory and ultrasonography variables. OBJECTIVES. To evaluate the value of clinical examination, biochemical and ultrasonography variables in the critically ill, specifically for estimation which combinations of variables are associated with cardiac output. METHODS. We initiated the Simple Intensive Care Studies-I (SICS-I) which was designed as a prospective cohort study to include all patients acutely admitted to the intensive care unit. Clinical examination was performed in a standardized fashion in all patients according to predefined criteria including variables of heart rate, blood pressures, central venous pressure, mental state, auscultation of heart and lungs, respiratory rate, urine output, capillary refill times, central to peripheral temperatures gradients, skin mottling; biochemical variables including lactate; and ultrasonography of heart and lungs. These clinical, biochemical, and ultrasonography variables were recorded following a published protocol (NCT02912624). Circulatory shock was defined by the requirement of vasopressors and/or inotropes and measured by cardiac output using transthoracic ultrasonography. All researchers, including medical students, underwent focused training for recording of all variables, including obtaining specific ultrasonography images. Cardiac function was clinically estimated as well before being measured by ultrasonography. RESULTS. Between March 2015 and December 2016 a total of 704 out of 791 eligible patients were included. An independent Core laboratory assessed that ultrasonography images from 632 patients (90%) were of sufficient quality. Vasopressors and/or inotropes were used upon admission in 363 cases (52%). 173 patients (25%) had died at 90-day follow-up. The data of all patients included until July 1st, 2017 will be analysed to identify combinations of variables independently associated with cardiac output. At the congress, these results will be presented and these variables will inform the second phase of the on-going registry. CONCLUSIONS. Standardized clinical examination and ultrasonography in critically ill patients by novices is feasible. We will be able to answer whether clinical assessment of the presence of shock can reliably be established and if so, which combinations of variables are most informative for estimation of the patients' cardiac output.

Maternal heat stress during late gestation affects calf function during postnatal life. The objective of the present study was to evaluate whether calves that experience heat stress in utero have altered thermoregulatory responses to acute heat stress later in life. Specifically, the hypothesis was that heat stress in utero would improve the response to acute heat stress at maturity. Females were born to dams exposed to heat stress or cooled during late gestation preceding their birth. All animals were raised postnatally under identical management. Twelve lactating Holstein cows that were exposed to in utero heat stress (HT) and 12 that were exposed to in utero control (CON) were used. A heat stress challenge was conducted in 3 blocks using 4 HT and 4 CON cows matched according to milk yield, stage of lactation, and parity. Each challenge consisted of transfer from a barn with shade and evaporative cooling to one with shade but no additional cooling for 48 h. The challenge was replicated twice for each block. Sweating rate, respiration rate, rectal temperature (RT), and skin temperature were measured on each cow at 0900, 1100, 1300, 1500, and 1700 h for 2 consecutive days. Mean ambient temperature across 6 challenge days was 26.15 +/- 4.75 degrees C. Tendencies for differences at 1700 h were observed between treatments for RT (HT: 39.5 +/- 0.1; CON: 39.6 +/- 0.1 degrees C; P = 0.065), however, there was no difference in respiration rate (HT: 77.6 +/- 1.6; CON: 79.5 +/- 1.6 bpm; P = 0.85). Sweating rate for shaved skin (HT: 29.4 +/- 2.0; CON: 36.0 +/- 2.0 g/m(2)h; P = 0.057) and for non-shaved skin (HT: 22.5 +/- 1.5; CON: 29.2 +/- 1.2 g/m(2)h; P = 0.01) differed between groups. However, there was no effect on skin temperature at the shaved location (HT: 36.2 +/- 0.2; CON: 36.0 +/- 0.2 degrees C; P = 0.81), but there was a tendency for differences for the non-shaved area (HT: 35.4 +/- 0.2; CON: 34.9 +/- 0.2 degrees C; P = 0.097). Cows that underwent in utero heat stress had greater skin temperature at 1700 h vs. in utero control cows, which may be because HT cows increased skin perfusion, and consequently greater cooling via conduction. In utero HT cows would then have higher heat loss and reduced core body temperature, which results in lower rectal temperature and lower sweating rate when exposed to heat stress. These results support the hypothesis that heat stress in utero in late gestation increases heat tolerance at maturity by increasing capacity to dissipate heat to maintain core body temperature.

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Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse.Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful.Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome.Measurements and Main Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159–1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a PaO2/FiO2 lower than 150 mm Hg.Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg.

BACKGROUND: The purpose of this study is to detect the mortality predictive power of new Glasgow coma scale, age, and arterial pressure (GAP) scoring system in major trauma patients admitted to the emergency department (ED). METHODS: A total of 100 major trauma patients admitted to Uludag University Faculty of Medicine ED who were 18 years of age or more were included in the study. In this prospective study, revised trauma score (RTS), injury severity score (ISS), trauma-related ISS (TRISS), Mechanism, GAP (MGAP) and GAP scores of the patients were calculated. RESULTS: A significant positive correlation was established between ISS, TRISS, MGAP, and GAP in predicting in-hospital mortality (p

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:30:32Z No. of bitstreams: 0 Made available in DSpace on 2014-05-27T11:30:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-09-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) This study examined the distribution and orientation of gill O2 chemoreceptors in Oreochromis niloticus and their role in cardiorespiratory responses to graded hypoxia. Intact fish, and a group with the first gill arch excised (operated), were submitted to graded hypoxia and their cardiorespiratory responses (oxygen uptake - V̇O2, breathing frequency - fR, ventilatory stroke volume - VT, gill ventilation - V̇G, O2 extraction from the ventilatory current - EO2, and heart rate - fH) were compared. Their responses to bolus injections of NaCN into the bloodstream (internal) or ventilatory water stream (external) were also determined. The V̇O2 of operated fish was significantly lower at the deepest levels of hypoxia. Neither reflex bradycardia nor ventilatory responses were completely abolished by bilateral excision of the first gill arch. EO2 of the operated group was consistently lower than the intact group. The responses to internal and external NaCN included transient decreases in fH and increases in fR and Vamp (ventilation amplitude). These cardiorespiratory responses were attenuated but not abolished in the operated group, indicating that chemoreceptors are not restricted to the first gill arch, and are sensitive to oxygen levels in both blood and water. © 2013 Elsevier Inc. Department of Physiological Sciences Laboratory of Zoophysiology and Comparative Biochemistry Federal University of São Carlos (UFSCar), P.O. Box 676, Via Washington Luis, km 235, 13565-905 São Carlos, SP Department of Zoology and Botany São Paulo State University - UNESP/IBILCE, Rua Cristóvão Colombo, 2265, 15054-000 - São José do Rio Preto, SP National Institute of Science and Technology - Comparative Physiology (FAPESP/CNPq) Department of Zoology and Botany São Paulo State University - UNESP/IBILCE, Rua Cristóvão Colombo, 2265, 15054-000 - São José do Rio Preto, SP FAPESP: 10/03599-2

Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists.

Contains fulltext : 171220.pdf (Publisher’s version ) (Closed access) PURPOSE: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. METHODS: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1-2 who received invasive mechanical ventilation. RESULTS: 2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO2/FiO2 ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores. CONCLUSIONS: Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS. TRIAL REGISTRATION: ClinicalTrials.gov NCT02010073.

Arachidonic acid (AA) is a polyunsaturated fatty acid that is present in the phospholipids of the cell membranes of the body and is abundant in the brain. Exogenously administered AA has been shown to affect brain metabolism and to exhibit cardiovascular and neuroendocrine actions. However, little is known regarding its respiratory actions and/or central mechanism of its respiratory effects. Therefore, the present study was designed to investigate the possible effects of centrally injected AA on respiratory system and the mediation of the central cyclooxygenase (COX) to thromboxane A2 (TXA2) signaling pathway on AA-induced respiratory effects in anaesthetized rats. Intracerebroventricular (i.c.v.) administration of AA induced dose- and time-dependent increase in tidal volume, respiratory rates and respiratory minute ventilation and also caused an increase in partial oxygen pressure (pO2) and decrease in partial carbon dioxide pressure (pCO2) in male anaesthetized Sprague Dawley rats. I.c.v. pretreatment with ibuprofen, a non-selective COX inhibitor, completely blocked the hyperventilation and blood gases changes induced by AA. In addition, central pretreatment with different doses of furegrelate, a TXA2 synthesis inhibitor, also partially prevented AA-evoked hyperventilation and blood gases effects. These data explicitly show that centrally administered AA induces hyperventilation with increasing pO2 and decreasing pCO2 levels which are mediated by the activation of central COX to TXA(2) signaling pathway. (C) 2016 Elsevier B.V. All rights reserved.

Background: Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients. However, airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance. This study was to evaluate the Pawstress index on lung mechanics and the correlation between Pawstress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients. Methods: Twenty-four ARF patients with mechanical ventilation (MV) were consecutively recruited from July 2011 to April 2013 in Zhongda Hospital, Nanjing, China and Ospedale S. Giovanni Battista-Molinette Hospital, Turin, Italy. All patients underwent MV with volume control (tidal volume 6 ml/kg) for 20 min. PEEP was set according to the ARDSnet study protocol. The patients were divided into two groups according to the chest wall elastance/respiratory system elastance ratio. The high elastance group (H group, n = 14) had a ratio ≥30%, and the low elastance group (L group, n = 10) had a ratio