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Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial
A Daniel Martin, Barbara K Smith, Paul D Davenport, Eloise Harman, Ricardo J Gonzalez-Rothi, Maher Baz, A Joseph Layon, Michael J Banner, Lawrence J Caruso, Harsha Deoghare, Tseng-Tien Huang, Andrea Gabrielli
Critical Care , 2011, DOI: 10.1186/cc10081
Abstract: We conducted a single center, single-blind, randomized controlled trial to test whether inspiratory muscle strength training (IMST) would improve weaning outcome in FTW patients. Of 129 patients evaluated for participation, 69 were enrolled and studied. 35 subjects were randomly assigned to the IMST condition and 34 to the SHAM treatment. IMST was performed with a threshold inspiratory device, set at the highest pressure tolerated and progressed daily. SHAM training provided a constant, low inspiratory pressure load. Subjects completed 4 sets of 6-10 training breaths, 5 days per week. Subjects also performed progressively longer breathing trials daily per protocol. The weaning criterion was 72 consecutive hours without MV support. Subjects were blinded to group assignment, and were treated until weaned or 28 days.Groups were comparable on demographic and clinical variables at baseline. The IMST and SHAM groups respectively received 41.9 ± 25.5 vs. 47.3 ± 33.0 days of MV support prior to starting intervention, P = 0.36. The IMST and SHAM groups participated in 9.7 ± 4.0 and 11.0 ± 4.8 training sessions, respectively, P = 0.09. The SHAM group's pre to post-training maximal inspiratory pressure (MIP) change was not significant (-43.5 ± 17.8 vs. -45.1 ± 19.5 cm H2O, P = 0.39), while the IMST group's MIP increased (-44.4 ± 18.4 vs. -54.1 ± 17.8 cm H2O, P < 0.0001). There were no adverse events observed during IMST or SHAM treatments. Twenty-five of 35 IMST subjects weaned (71%, 95% confidence interval (CI) = 55% to 84%), while 16 of 34 (47%, 95% CI = 31% to 63%) SHAM subjects weaned, P = .039. The number of patients needed to be treated for effect was 4 (95% CI = 2 to 80).An IMST program can lead to increased MIP and improved weaning outcome in FTW patients compared to SHAM treatment.ClinicalTrials.gov: NCT00419458Failure to wean (FTW) from mechanical ventilation (MV) is a significant clinical and economic problem. In 2003, approximately 300,00 patients required MV suppo
High reward makes items easier to remember, but harder to bind to a new temporal context  [PDF]
Christopher R. Madan,Esther Fujiwara,Bridgette C. Gerson,Jeremy B. Caplan
Frontiers in Integrative Neuroscience , 2012, DOI: 10.3389/fnint.2012.00061
Abstract: Learning through reward is central to adaptive behavior. Indeed, items are remembered better if they are experienced while participants expect a reward, and people can deliberately prioritize memory for high- over low-valued items. Do memory advantages for high-valued items only emerge after deliberate prioritization in encoding? Or, do reward-based memory enhancements also apply to unrewarded memory tests and to implicit memory? First, we tested for a high-value memory advantage in unrewarded implicit- and explicit-tests (Experiment 1). Participants first learned high or low-reward values of 36 words, followed by unrewarded lexical decision and free-recall tests. High-value words were judged faster in lexical decision, and more often recalled in free recall. These two memory advantages for high-value words were negatively correlated suggesting at least two mechanisms by which reward value can influence later item-memorability. The ease with which the values were originally acquired explained the negative correlation: people who learned values earlier showed reward effects in implicit memory whereas people who learned values later showed reward effects in explicit memory. We then asked whether a high-value advantage would persist if trained items were linked to a new context (Experiments 2a and 2b). Following the same value training as in Experiment 1, participants learned lists composed of previously trained words mixed with new words, each followed by free recall. Thus, participants had to retrieve words only from the most recent list, irrespective of their values. High- and low-value words were recalled equally, but low-value words were recalled earlier than high-value words and high-value words were more often intruded (proactive interference). Thus, the high-value advantage holds for implicit- and explicit-memory, but comes with a side effect: High-value items are more difficult to relearn in a new context. Similar to emotional arousal, reward value can both enhance and impair memory.
Relativisation makes contradictions harder for Resolution  [PDF]
Stefan Dantchev,Barnaby Martin
Computer Science , 2013,
Abstract: We provide a number of simplified and improved separations between pairs of Resolution-with-bounded-conjunction refutation systems, Res(d), as well as their tree-like versions, Res*(d). The contradictions we use are natural combinatorial principles: the Least number principle, LNP_n and an ordered variant thereof, the Induction principle, IP_n. LNP_n is known to be easy for Resolution. We prove that its relativisation is hard for Resolution, and more generally, the relativisation of LNP_n iterated d times provides a separation between Res(d) and Res(d+1). We prove the same result for the iterated relativisation of IP_n, where the tree-like variant Res*(d) is considered instead of Res(d). We go on to provide separations between the parameterized versions of Res(1) and Res(2). Here we are able again to use the relativisation of the LNP_n, but the classical proof breaks down and we are forced to use an alternative. Finally, we separate the parameterized versions of Res*(1) and Res*(2). Here, the relativisation of IP_n will not work as it is, and so we make a vectorising amendment to it in order to address this shortcoming
Harder-Narasimhan categories  [PDF]
Huayi Chen
Mathematics , 2007,
Abstract: We propose a generalization of Quillen's exact category -- arithmetic exact category and we discuss conditions on such categories under which one can establish the notion of Harder-Narasimhan filtrations and Harder-Narsimhan polygons. Furthermore, we show the functoriality of Harder-Narasimhan filtrations (indexed by $\mathbb R$), which can not be stated in the classical setting of Harder and Narasimhan's formalism.
Convergence of Harder-Narasimhan polygons  [PDF]
Huayi Chen
Mathematics , 2007,
Abstract: We establish in this article convergence results of normalized Harder-Narasimhan polygons both in geometric and in arithmetic frameworks by introducing the Harder-Narasimhan filtration indexed by $\mathbb R$ and the associated Borel probability measure.
Schematic Harder-Narasimhan Stratification  [PDF]
Nitin Nitsure
Mathematics , 2009,
Abstract: For any flat family of pure-dimensional coherent sheaves on a family of projective schemes, the Harder-Narasimhan type (in the sense of Gieseker semistability) of its restriction to each fiber is known to vary semicontinuously on the parameter scheme of the family. This defines a stratification of the parameter scheme by locally closed subsets, known as the Harder-Narasimhan stratification. In this note, we show how to endow each Harder-Narasimhan stratum with the structure of a locally closed subscheme of the parameter scheme, which enjoys the universal property that under any base change the pullback family admits a relative Harder-Narasimhan filtration with a given Harder-Narasimhan type if and only if the base change factors through the schematic stratum corresponding to that Harder-Narasimhan type. The above schematic stratification induces a stacky stratification on the algebraic stack of pure-dimensional coherent sheaves. We deduce that coherent sheaves of a fixed Harder-Narasimhan type form an algebraic stack in the sense of Artin.
Manipulation is Harder with Incomplete Votes  [PDF]
Palash Dey,Neeldhara Misra,Y. Narahari
Computer Science , 2015,
Abstract: The Coalitional Manipulation (CM) problem has been studied extensively in the literature for many voting rules. The CM problem, however, has been studied only in the complete information setting, that is, when the manipulators know the votes of the non-manipulators. A more realistic scenario is an incomplete information setting where the manipulators do not know the exact votes of the non- manipulators but may have some partial knowledge of the votes. In this paper, we study a setting where the manipulators know a partial order for each voter that is consistent with the vote of that voter. In this setting, we introduce and study two natural computational problems - (1) Weak Manipulation (WM) problem where the manipulators wish to vote in a way that makes their preferred candidate win in at least one extension of the partial votes of the non-manipulators; (2) Strong Manipulation (SM) problem where the manipulators wish to vote in a way that makes their preferred candidate win in all possible extensions of the partial votes of the non-manipulators. We study the computational complexity of the WM and the SM problems for commonly used voting rules such as plurality, veto, k-approval, k-veto, maximin, Copeland, and Bucklin. Our key finding is that, barring a few exceptions, manipulation becomes a significantly harder problem in the setting of incomplete votes.
Wean Earlier and Automatically with New technology (the WEAN study): a protocol of a multicentre, pilot randomized controlled trial
Karen EA Burns, Maureen O Meade, Martin R Lessard, Sean P Keenan, Francois Lellouche
Trials , 2009, DOI: 10.1186/1745-6215-10-81
Abstract: A pilot weaning randomized controlled trial (RCT) is underway in the ICUs of 8 Canadian hospitals. We will randomize 90 critically ill adults requiring invasive ventilation for at least 24 hours and identified at an early stage of the weaning process to either Automated Weaning (SmartCare?) or Protocolized Weaning. The results of a National Weaning Survey informed the design of the Protocolized Weaning arm. Both weaning protocols are operationalized in Pressure Support mode, include opportunities for Spontaneous Breathing Trials, and share a common sedation protocol, oxygen titration parameters, and extubation and reintubation criteria. The primary outcome of the WEAN study is to evaluate compliance with the proposed weaning and sedation protocols. A key secondary outcome of the pilot RCT is to evaluate clinician acceptance of the weaning and sedation protocols. Prior to initiating the WEAN Study, we conducted a run-in phase, involving two patients per centre (randomizing the first participant to either weaning strategy and assigning the second patient to the alternate strategy) to ensure that participating centres could implement the weaning and sedation protocols and complete the detailed case report forms.Mechanical ventilation studies are difficult to implement; requiring protocols to be operationalized continuously and entailing detailed daily data collection. As the first multicentre weaning RCT in Canada, the WEAN Study seeks to determine the feasibility of conducting a large scale future weaning trial and to establish a collaborative network of ICU clinicians dedicated to advancing the science of weaning.ISRCTN43760151Weaning is the process during which mechanical ventilation is gradually or abruptly withdrawn. In addition, it is the time during which work of breathing is transferred from the ventilator back to the patient until fully autonomous breathing is resumed. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation [1,
Factors associated with failure to wean children from mechanical ventilators
Dyah Kanya Wati,Antonius Pudjiadi,Abdul Latief
Paediatrica Indonesiana , 2013,
Abstract: Background Patients with failure to wean from mechanical ventilators in 48 hours have increased risk of morbidity, however only a few protocols can be used for children.Objective To assess possible factors associated with failure to wean from mechanical ventilators in the pediatric intensive care unit (PICU).Methods This cross sectional study performed from June 2011 to June 2012 had 124 subjects with 79 patients who were successfully weaned and 45 patients who fail to be weaned from mechanical ventilators. Data was analyzed by 2x2 contingency tables. Rresults with P value <0.05 were further analysis by logistic regression multivariate analysis.Results Factors associated with failure to wean from mechanical ventilators were abnormal electrolyte (P=0.001) and acid base status (P<0.001), lower ratio between tidal volume (TV)/inspiration time (IT) (P<0.001), lower mechanical load (P<0.001), and longer duration of mechanical ventilator use (P<0.001). Multivariate analyses revealed that the significant risk factors for failure to wean were TV/IT (OR 6.0; 95%CI 3.5 to 7.5; P=0.001), mechanical load (OR 11.5, 95%CI 10.3 to 15.5; P=0.002), and duration of mechanical ventilator use (OR 12.5; 95%CI 8.5 to 14.9; P=0.026).Conclusions Lower ratio of TV/IT and mechanical load, as well as longer duration of ventilator use are factors associated with failure to wean from a mechanical ventilator.
General and Stronger Uncertainty Relation  [PDF]
Vishnu M. Bannur
Physics , 2015,
Abstract: Recently, Maccone and Pati [Phys. Rev. Lett. {\bf 113}, 260401 (2014)] derived few inequalities among variances of incompatible operators which they called stronger uncertainty relations, stronger than Heisenberg-Robertson or Schrodinger uncertainty relations. Here we generalize their study to get infinite number of such inequalities and propose that only one of them may be the correct uncertainty relation between incompatible operators. We get back well known uncertainty relations of Heisenberg-Robertson and Schrodinger under certain limits. We also reexamine the conclusions of Maccone and Pati and comment on their work.
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