Cervical ultrasound for endotracheal intubation confirmation in dogs by veterinary students: a cadaveric study.

Although endotracheal intubation is usually a simple and fast procedure in dogs, some situations can be challenging and lead to the risk of tube misplacement in the esophagus-a life-threatening complication. Hence, confirming intubation is a cornerstone whenever this procedure is performed. Methods such as direct visualization or capnography present limitations insofar as they may be unreliable or unavailable under some circumstances. Ultrasound has emerged as a promising tool to confirm intubation in medicine. However, so far little research has been done on the subject in veterinary medicine. This study's main goal was to investigate ultrasound performed by veterinary students as a confirmation method for intubation in canine cadavers after a brief training session (25 minutes). A total of 160 exams were performed with a microconvex probe by 20 students in 11 different cadavers on left and right recumbencies. Overall accuracy was 70.6% with a median success rate of 75% and a median time to diagnosis of 25 seconds. The number of correct diagnoses was statistically higher than the wrong ones (p<0.05) without difference between recumbencies. Sensitivity, specificity, and positive and negative predictive values were 72.5%, 68.8%, 69.9%, and 71.4%, respectively. The fastest diagnosis was performed in just 4 seconds, and among the top-performers, one student had 100% accuracy with a mean time to diagnosis of 16.8 seconds, and four students had approximately 88% accuracy. This study showed for the first time that even inexperienced veterinary students can have acceptable accuracy in confirming endotracheal intubation in dogs after a brief training session.

Apesar de a intubação endotraqueal em cães ser frequentemente um procedimento simples e rápido, algumas situações podem ser desafiadoras e levar ao risco de posicionamento da sonda no esôfago - uma grave complicação. Portanto, a confirmação da intubação é uma etapa crucial sempre que o procedimento for realizado. Métodos como visualização direta ou capnografia apresentam limitações e podem ser pouco confiáveis ou indisponíveis sob certas circunstâncias. A ultrassonografia surgiu como uma ferramenta promissora para confirmação da intubação na medicina. Contudo, até o momento pouco foi estudado na veterinária. O objetivo deste estudo foi investigar a ultrassonografia realizada por estudantes de veterinária como método de confirmação para a intubação em cadáveres caninos após um breve treinamento (25 minutos). Foram realizados 160 exames com transdutor microconvexo por 20 estudantes em 11 cadáveres nos decúbitos direito e esquerdo. A acurácia geral foi 70.6% com medianas de taxa de sucesso de 75% e de tempo para diagnóstico de 25 segundos. O número de diagnósticos corretos foi estatisticamente superior aos errados (p<0.05) sem diferença entre decúbitos. Sensibilidade, especificidade, valor preditivo positivo e negativo foram, respectivamente: 72.5%; 68.8%; 69.9% e 71.4%. O diagnóstico mais rápido se deu em 4 segundos e entre os estudantes com melhor performance, um se destacou com 100% de acurácia e tempo médio para diagnóstico de 16.8 segundos enquanto quatro outros obtiveram 88% de acurácia. Este estudo demonstrou pela primeira vez que mesmo estudantes de veterinária inexperientes podem atingir uma acurácia aceitável na confirmação da intubação endotraqueal em cães após um breve treinamento.

Anaerobic degradation of digestate based hydrothermal carbonization products in a continuous hybrid fixed bed anaerobic filter.

This study investigates the suitability of continuous hybrid fixed bed anaerobic filter reactor for treating sewage and agro-industrial digestate hydrothermal carbonization (HTC) products; hydrochar and HTC liquor (HTCL). The reactor was operated for 300 days under mesophilic conditions at different organic loading rates (OLR); maximum OLRs of 7.4 and 10 gCOD/L/d were reached while treating HTC liquor and slurry, respectively. 15 g/L hydrochar were added to the reactor as a supplement while treating HTCL solely thus increasing the biogas production up to 153%. The reactor was fed with HTCL and hydrochar with an increasing mixing ratio, and the co-digestion impact was dependent on hydrochar concentrations. The results of the study indicate that the hybrid fixed bed anaerobic filter reactor is a promising anaerobic digestion configuration for treating HTCL and overcoming the HTC upscaling challenges, and the suitability of digestate hydrochar utilization as supplement material for anaerobic digestion.

Statistical Laws of Protein Motion in Neuronal Dendritic Trees.

Across their dendritic trees, neurons distribute thousands of protein species that are necessary for maintaining synaptic function and plasticity and that need to be produced continuously and trafficked to their final destination. As each dendritic branchpoint splits the protein flow, increasing branchpoints decreases the total protein number downstream. Consequently, a neuron needs to produce more proteins to maintain a minimal protein number at distal synapses. Combining in vitro experiments and a theoretical framework, we show that proteins that diffuse within the cell plasma membrane are, on average, 35% more effective at reaching downstream locations than proteins that diffuse in the cytoplasm. This advantage emerges from a bias for forward motion at branchpoints when proteins diffuse within the plasma membrane. Using 3D electron microscopy (EM) data, we show that pyramidal branching statistics and the diffusion lengths of common proteins fall into a region that minimizes the overall protein need.

An API for Wearable Environments Development and Its Application to mHealth Field †.

Wearable technologies are transforming research in traditional paradigms of software and knowledge engineering. Among them, expert systems have the opportunity to deal with knowledge bases dynamically varying according to real-time data collected by position sensors, movement sensors, etc. However, it is necessary to design and implement opportune architectural solutions to avoid expert systems are responsible for data acquisition and representation. These solutions should be able to collect and store data according to expert systems desiderata, building a homogeneous framework where data reliability and interoperability among data acquisition, data representation and data use levels are guaranteed. To this aim, the wearable environment notion has been introduced to treat all those information sources as components of a larger platform; a middleware has been designed and implemented, namely WEAR-IT, which allows considering each sensor as a source of information that can be dynamically tied to an expert system application running on a smartphone. As an application example, the mHealth domain is considered.

How mRNA Localization and Protein Synthesis Sites Influence Dendritic Protein Distribution and Dynamics.

Proteins drive the function of neuronal synapses. The synapses are distributed throughout the dendritic arbor, often hundreds of micrometers away from the soma. It is still unclear how somatic and dendritic sources of proteins shape protein distribution and respectively contribute to local protein changes during synaptic plasticity. Here, we present a unique computational framework describing for a given protein species the dendritic distribution of the mRNA and the corresponding protein in a dendrite. Using CaMKIIα as a test case, our model reveals the key role active transport plays in the maintenance of dendritic mRNA and protein levels and predicts the short and long timescales of protein dynamics. Our model reveals the fundamental role of mRNA localization and dendritic mRNA translation in synaptic maintenance and plasticity in distal compartments. We developed a web application for neuroscientists to explore the dynamics of the mRNA or protein of interest.

Modeling variation in 1,3-dichloropropene emissions due to soil conditions and applicator practices.

The fumigant 1,3-dichloropropene (1,3-D) is widely used for control of soil-borne pests and pathogens, but post-application emissions may lead to off-site transport and possible human exposure. The fraction of applied material emitted into the atmosphere and the magnitude of peak emissions are two quantities used by regulators to protect public health and are typically based on field estimates. However, the current body of field studies covers only a narrow subset of the broad range of application practices and soil conditions under which applications are performed and is subject to an unknown level of estimation error. Here we use the HYDRUS model to estimate cumulative and peak emissions of 1,3-D for 17 application methods used in California. The simulations are parameterized with soils data from 16 fields sampled immediately prior to fumigation in order to establish a representative distribution of initial soil conditions. The results demonstrate a wide range in cumulative emissions, with mean losses of initial applied mass between 10 and 58% over two weeks depending on application method. Emissions are highly variable in response to soil conditions, with coefficients of variation ranging from 16 to 54% for cumulative flux and 26 to 67% for peak three-hour flux depending on application method. The simulated distributions show similarities to the available field study estimates in terms of the mean and spread of distributions, particularly in the case of cumulative emissions, indicating that the modeling approach could be a useful tool to support regulatory decision-making in cases where field data is limited.

Long-term Outcomes of a Telementoring Program for Distant Teaching of Endovascular Aneurysm Repair.

PURPOSE: To prospectively evaluate the long-term outcomes after a telementoring program for distant teaching of endovascular aneurysm repair (EVAR) and the degree of EVAR procedure assimilation into routine practice. METHODS: A telementoring protocol using stepwise introduction of EVAR was implemented between a university care center and a remote vascular health care site; from March 1999 to October 2003, 49 EVAR patients (mean age 72 years; 48 men) were treated during telementoring at the remote center. After the telementoring period, 86 patients (mean age 71 years; 77 men) underwent EVAR procedures carried out at the secondary care center from November 2003 to July 2011. The long-term outcomes were compared between the EVAR procedures performed during telementoring with the procedures performed independently thereafter. RESULTS: No significant difference was appreciated between telementored and not telementored procedures either in 30-day mortality (4.1% vs 2.3%, p=0.621) or in the initial technical success (93.9% vs 97.7%, p=0.353). The telementored group showed no significant difference in overall aneurysm-related mortality (6.1% vs 2.3%, p=0.353) or in the overall complication rates (p=0.985). The reintervention rate was significantly lower among the unmentored procedures (11.6% vs 32.7%, p=0.004). In particular, significantly fewer patients underwent late endovascular procedures (1.2% vs 12.2%, p=0.009) and late percutaneous interventions (7.0% vs 20.4%, p=0.027) after telementoring ceased. CONCLUSION: The telementoring program followed here allowed excellent EVAR skill assimilation into the routine practice of a remote health care site. Telementoring is a feasible strategy to support skill introduction in remote medical facilities.

Universal transition from unstructured to structured neural maps.

Neurons sharing similar features are often selectively connected with a higher probability and should be located in close vicinity to save wiring. Selective connectivity has, therefore, been proposed to be the cause for spatial organization in cortical maps. Interestingly, orientation preference (OP) maps in the visual cortex are found in carnivores, ungulates, and primates but are not found in rodents, indicating fundamental differences in selective connectivity that seem unexpected for closely related species. Here, we investigate this finding by using multidimensional scaling to predict the locations of neurons based on minimizing wiring costs for any given connectivity. Our model shows a transition from an unstructured salt-and-pepper organization to a pinwheel arrangement when increasing the number of neurons, even without changing the selectivity of the connections. Increasing neuronal numbers also leads to the emergence of layers, retinotopy, or ocular dominance columns for the selective connectivity corresponding to each arrangement. We further show that neuron numbers impact overall interconnectivity as the primary reason for the appearance of neural maps, which we link to a known phase transition in an Ising-like model from statistical mechanics. Finally, we curated biological data from the literature to show that neural maps appear as the number of neurons in visual cortex increases over a wide range of mammalian species. Our results provide a simple explanation for the existence of salt-and-pepper arrangements in rodents and pinwheel arrangements in the visual cortex of primates, carnivores, and ungulates without assuming differences in the general visual cortex architecture and connectivity.

Two-particle problem in comblike structures.

Encounters between walkers performing a random motion on an appropriate structure can describe a wide variety of natural phenomena ranging from pharmacokinetics to foraging. On homogeneous structures the asymptotic encounter probability between two walkers is (qualitatively) independent of whether both walkers are moving or one is kept fixed. On infinite comblike structures this is no longer the case and here we deepen the mechanisms underlying the emergence of a finite probability that two random walkers will never meet, while one single random walker is certain to visit any site. In particular, we introduce an analytical approach to address this problem and even more general problems such as the case of two walkers with different diffusivity, particles walking on a finite comb and on arbitrary bundled structures, possibly in the presence of loops. Our investigations are both analytical and numerical and highlight that, in general, the outcome of a reaction involving two reactants on a comblike architecture can strongly differ according to whether both reactants are moving (no matter their relative diffusivities) or only one is moving and according to the density of shortcuts among the branches.

Lévy flights with power-law absorption.

We consider a particle performing a stochastic motion on a one-dimensional lattice with jump lengths distributed according to a power law with exponent µ+1. Assuming that the walker moves in the presence of a distribution a(x) of targets (traps) depending on the spatial coordinate x, we study the probability that the walker will eventually find any target (will eventually be trapped). We focus on the case of power-law distributions a(x)∼x(-α) and we find that, as long as µ<α, there is a finite probability that the walker will never be trapped, no matter how long the process is. This result is shown via analytical arguments and numerical simulations which also evidence the emergence of slow searching (trapping) times in finite-size system. The extension of this finding to higher-dimensional structures is also discussed.

Hitting and trapping times on branched structures.

In this work we consider a simple random walk embedded in a generic branched structure and we find a close-form formula to calculate the hitting time H(i,f) between two arbitrary nodes i and j. We then use this formula to obtain the set of hitting times {H(i,f)} for combs and their expectation values, namely, the mean first-passage time, where the average is performed over the initial node while the final node f is given, and the global mean first-passage time, where the average is performed over both the initial and the final node. Finally, we discuss applications in the context of reaction-diffusion problems.

Endovascular abdominal aneurysm repair and impact of systematic preoperative embolization of collateral arteries: endoleak analysis and long-term follow-up.

PURPOSE: To report our results of endovascular aneurysm repair (EVAR) over a 10-year period using systematic preoperative collateral artery embolization. METHODS: From 1999 until 2009, 124 patients (117 men; mean age 70.8 years) with abdominal aortic aneurysm (AAA) underwent embolization of patent lumbar and/or inferior mesenteric arteries prior to elective EVAR procedures. Embolization was systematically attempted and, whenever possible, performed using microcoils and a coaxial technique. Follow-up included computed tomography and/or magnetic resonance imaging and abdominal radiography. RESULTS: The technical success for EVAR was 96% (119/124), with 4 patients dying within 30 days (3.2% perioperative mortality) and 1 type III endoleak accounting for the failures. Collateral arteries were occluded spontaneously or by embolization in 60 (48%) of 124 patients. The endoleak rate was 50.9% (74 in 61 patients), most of which were type II (19%). Over a mean clinical follow-up of 60.5±34.1 months (range 1-144), aneurysm sac dimensions decreased in 66 patients, increased in 19 patients, and were stable in 35. The endoleak rate was significantly higher in the patients with increasing sac diameter (p<0.001). Among the patients with patent collateral arteries, 38/64 (59.3%) developed 46 leaks, while 28 leaks appeared in 23 (41%) of 56 patients with collateral artery occlusion (p=0.069). The type II endoleak rate significantly differed between these two groups (47.8% vs. 3.6%, p<0.001). CONCLUSION: Preoperative collateral embolization seems to be a valid method of reducing the incidence of type II endoleak, improving the long-term outcome.

Polycyclic aromatic hydrocarbons in soil of the Canadian river floodplain in Oklahoma.

The accumulation of polycyclic aromatic hydrocarbons (PAH) in soil, plants, and water may impart negative effects on ecosystem and human health. We quantified the concentration and distribution of 41 PAH (n = 32), organic C, total N, and S (n = 140) and investigated PAH sources using a chronosequence of floodplain soils under a natural vegetation succession. Soil samples were collected between 0- and 260-cm depth in bare land (the control), wetland, forest, and grassland areas near a closed municipal landfill and an active asphalt plant (the contaminant sources) in the north bank of the Canadian River near Norman, OK. Principal component, cluster, and correlation analyses were used to investigate the spatial distribution of PAH, in combination with diagnostic ratios to distinguish pyrogenic vs. petrogenic PAH suites. Total PAH concentration (SigmaPAH) had a mean of 1300 ng g(-1), minimum of 16 ng g(-1), and maximum of 12,000 ng g(-1). At 0- to 20-cm depth, SigmaPAH was 3500 +/- 1600 ng g(-1) (mean +/- 1 SE) near the contaminant sources. The most common compounds were nonalkylated, high molecular weight PAH of pyrogenic origin, i.e., fluoranthene (17%), pyrene (14%), phenanthrene (9%), benzo(b)fluoranthene (7%), chrysene (6%), and benzo(a)anthracene (5%). SigmaPAH in the control (130 +/- 23 ng g(-1)) was comparable to reported concentrations for the rural Great Plains. Perylene had a unique distribution pattern suggesting biological inputs. The main PAH contamination mechanisms were likely atmospheric deposition due to asphalt production at the 0- to 20-cm depth and past landfill operations at deeper depths.

Telementoring during endovascular treatment of abdominal aortic aneurysms: a prospective study.

PURPOSE: To explore the use of telementoring for distant teaching and training in endovascular aortic aneurysm repair (EVAR). METHODS: According to a prospectively designed study protocol, 48 patients underwent EVAR: the first 12 patients (group A) were treated at a secondary care center by an experienced interventionist, who was training the local team; a further 12 patients (group B) were operated by the local team at their secondary center with telementoring by the experienced operator from an adjacent suite; and the last 24 patients (group C) were operated by the local team with remote telementoring support from the experienced interventionist at a tertiary care center. Telementoring was performed using 3 video sources; images were transmitted using 4 ISDN lines. EVAR was performed using intravascular ultrasound and simultaneous fluoroscopy to obtain road mapping of the abdominal aorta and its branches, as well as for identifying the origins of the renal arteries, assessing the aortic neck, and monitoring the attachment of the stent-graft proximally and distally. RESULTS: Average duration of telementoring was 2.1 hours during the first 12 patients (group B) and 1.2 hours for the remaining 24 patients (group C). There was no difference in procedural duration (127+/-59 minutes in group A, 120+/-4 minutes in group B, and 119+/-39 minutes in group C; p=0.94) or the mean time spent in the ICU (26+/-15 hours in group A, 22+/-2 hours in group B, and 22+/-11 hours for group C; p=0.95). The length of hospital stay (11+/-4 days in group A, 9+/-4 days in group B, and 7+/-1 days in group C; p=0.002) was significantly different only for group C versus A (p=0.002). Only 1 (8.3%) patient (in group A: EVAR performed by the experienced operator) required conversion to open surgery because of iliac artery rupture. This was the only conversion (and the only death) in the entire study group (1/12 in group A versus 0/36 in groups B + C, p=0.31). CONCLUSIONS: Telementoring for EVAR is feasible and shows promising results. It may serve as a model for development of similar projects for teaching other invasive procedures in cardiovascular medicine.

Thrombus aspiration as a bailout procedure during percutaneous renal angioplasty.

PURPOSE: To present a case in which thrombus aspiration, urokinase, and abciximab were used to recanalize a sudden acute thrombotic occlusion of the right renal artery during percutaneous renal angioplasty. CASE REPORT: A 72-year-old man with severe arterial hypertension, impaired renal function, and peripheral artery disease was referred for interventional renal revascularization of a proximal stenosis of the right renal artery. Predilation was unsuccessful, and stent placement was followed by immediate occlusion of the distal renal artery, probably due to dislocation of a mural thrombus. Since intra-arterial administration of urokinase (300,000 IU) was ineffective, thrombus aspiration was performed using the 7-F guiding catheter. After successful removal of the thrombus, abciximab was given intravenously. Control angiograms showed recanalization of the stented segment and patency of the distal renal arteries, an outcome confirmed 8 months later by duplex ultrasound. CONCLUSIONS: As demonstrated in our case, thromboembolic complications can be rapidly and successfully treated on the table by combined measures, such as catheter thrombus extraction and pharmacological strategies.