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This study aimed at evaluating the efficacy and safety of high-dose (> 0.2 L/kg of treated plasma per day) coupled plasma filtration-adsorption (CPFA) in treating patients with septic shock. Multicentre, randomised, adaptive trial, performed in 12 Italian intensive care units (ICUs). Patients aged 14 or more, admitted to the ICU with septic shock, or had developed it during the stay were eligible. The final outcome was mortality at discharge from the last hospital at which the patient received care. Between May 2015, and October 2017, 115 patients were randomised. The first interim analysis revealed a number of early deaths, prompting an unplanned analysis. Last hospital mortality was non-significantly higher in the CPFA (55.6%) than in the control group (46.2%, p = 0.35). The 90-day survival curves diverged in favour of the controls early after randomisation and remained separated afterwards (p = 0.100). An unplanned analysis showed higher mortality in CPFA compared to controls among patients without severe renal failure (p = 0.025); a dose–response relationship was observed between treated plasma volume and mortality (p = 0.010). The COMPACT-2 trial was stopped due to the possible harmful effect of CPFA in patients with septic shock. The harmful effect, if present, was particularly marked in the early phase of septic shock. Patients not requiring renal replacement therapy seemed most exposed to the possible harm, with evidence of a dose–response effect. Until the mechanisms behind these results are fully understood, the use of CPFA for the treatment of patients with septic shock is not recommended.

Background: As the global outbreak of COVID-19 continues to ravage the world, it is important to understand how frontline clinicians manage ventilatory support and the various limiting factors. / Methods: An online survey composed of 32 questions was developed and validated by an international expert panel. / Results: Overall, 502 respondents from 40 countries across six continents completed the survey. The mean number (±SD) of ICU beds was 64 ± 84. The most popular initial diagnostic tools used for treatment initiation were arterial blood gas (48%) and clinical presentation (37.5%), while the national COVID-19 guidelines were the most used (61.2%). High flow nasal cannula (HFNC) (53.8%), non-invasive ventilation (NIV) (47%), and invasive mechanical ventilation (IMV) (92%) were mostly used for mild, moderate, and severe COVID-19 cases, respectively. However, only 38.8%, 56.6% and 82.9% of the respondents had standard protocols for HFNC, NIV, and IMV, respectively. The most frequently used modes of IMV and NIV were volume control (VC) (36.1%) and continuous positive airway pressure/pressure support (CPAP/PS) (40.6%). About 54% of the respondents did not adhere to the recommended, regular ventilator check interval. The majority of the respondents (85.7%) used proning with IMV, with 48.4% using it for 12– 16 hours, and 46.2% had tried awake proning in combination with HFNC or NIV. Increased staff workload (45.02%), lack of trained staff (44.22%) and shortage of personal protective equipment (PPE) (42.63%) were the main barriers to COVID-19 management. / Conclusion: Our results show that general clinical practices involving ventilatory support were highly heterogeneous, with limited use of standard protocols and most frontline clinicians depending on isolated and varied management guidelines. We found increased staff workload, lack of trained staff and shortage of PPE to be the main limiting factors affecting global COVID-19 ventilatory support management.

(1) Methods for checking the condition of monumental masonry structures can still be considered understudied. Among the different approaches available in the literature, the graphical ones have a special role, due to their simplicity and effectiveness. (2) In this work, a 2D method (Thrust Line Analysis (TLA)), the Modified Thrust Line Method (MTLM), and the 3D Membrane Equilibrium Analysis (MEA) method are compared. All methods have the same starting concept: no tensile strength, no sliding between the stone blocks, infinite compressive strength. (3) The methods are compared in terms of stress distribution (for the same—or similar—thrust line), and in terms of the Geometrical Safety Factor ensured. (4) The work shows that these theories, if properly conveyed in a scientific methodology (as many authors are doing currently and have done in the past) demonstrate the effectiveness and the advantages of graphical methods for simple structures.

PURPOSE: Severe coronavirus disease 2019 (COVID-19) is strongly related to interstitial pneumonia with frequent development of acute respiratory distress syndrome (ARDS). The role of corticosteroids (CS) treatment in these patients is still controversial. Some studies evidenced a possible role of an early short-term course of CS treatment in the treatment of severe pneumonia. PATIENTS AND METHODS: This is a single-center, retrospective study considering the patients with confirmed COVID-19 pneumonia admitted to our hospital between 9th March and 15th June 2020. Two groups were considered: early high-dose of methyl-prednisolone (eHDM; n ​= ​31) and the control group (n ​= ​52). Patients in the eHDM group received the dose of 5-8 ​mg/kg/day of methyl-prednisolone for 2 consecutive days. Primary outcome was the mortality evaluation; secondary outcomes were clinical improvement, side-effects and laboratory/radiographic changes. RESULTS: Significant differences between the two groups were: length of hospitalization (21.5 vs 28.4 days, p ​= ​0.026), length of non-invasive ventilation (NIV) or mechanical ventilation (11.5 vs 14.5 days, p ​= ​0.031), death (5 vs 12, p ​= ​0.006) and clinical improvement (16 vs 11, p=0.018). The following factors were related to in-hospital mortality in the multivariate analysis: comorbidities (OR ​= ​2.919; 95%CI ​= ​1.515-16.705; p

In many seismically active regions of the world there are large numbers of masonry buildings. Most of these buildings have not been designed for seismic loads. Recent earthquakes have shown that many of these buildings are seismically vulnerable and should be considered for retrofitting. Different conventional and unconventional retrofitting techniques are available to increase the strength and/or ductility of unreinforced masonry (URM) walls. This paper reviews and discusses seismic retrofitting of masonry walls with emphasis on the conventional techniques. Retrofitting procedures are discussed with regard to a case study: a stone masonry building in Irpinia region, damaged by the 1980 earthquake. The interventions are evaluated by means of finite elements with a macroelement obtained with an homogenization technique. Linear and nonlinear procedures are compared, and peculiarities of each procedure are shown

An accurate monitoring of power system behavior is a hot-topic for modern grid operation. Low-frequency oscillations (LFO), such as inter-area electromechanical oscillations, are detrimental phenomena impairing the development of the grid itself and also the integration of renewable sources. An interesting countermeasure to prevent the occurrence of such oscillations is to continuously identify their characteristic electromechanical mode parameters, possibly realizing an online monitoring system. In this paper an attempt to develop an online modal parameters identification system is done using machine learning techniques. An approach based on the development of a proper artificial neural network exploiting the frequency measurements coming from actual PMU devices is presented. The specifically developed offline training stage is fully detailed. The output results from the dynamic mode decomposition method are considered as reference in order to validate the machine learning approach. Some results are presented in order to validate the effectiveness of the proposed approach on data coming from recordings of real grid events. The main key points affecting the performance of the proposed technique are discussed by means of proper validation scenarios. This contribution is the first step of a more extended project whose final aim is the development of an artificial neural networks (ANN) architecture able to predict the system behavior (in a given time span) in terms of LFO modal parameters, and to classify the contingencies/disturbances based on an online training that has memory of the passed training samples.

Background As delayed intubation may worsen the outcome of coronavirus disease 2019 (COVID-19) patients treated with continuous positive airway pressure (CPAP), we sought to determine COVID-specific early predictors of CPAP failure. Methods In this observational retrospective multicentre study, we included all COVID-19 patients treated with out-of-ICU CPAP, candidates for intubation in case of CPAP failure. From these patients, we collected demographic and clinical data. Results A total of 397 COVID-19 patients were treated with CPAP for respiratory failure, with the therapeutic goal of providing intubation in case of CPAP failure. Univariable analysis showed that, age, lactate dehydrogenase (LDH) and white cell counts were all significantly lower in patients with successful CPAP treatment compared to those failing it and undergoing subsequent intubation. The percentage changes between baseline and CPAP application in the ratio of partial pressure arterial oxygen (PaO2) and fraction of inspired oxygen (FiO2), PaO2, respiratory rate and ROX index were higher in patients experiencing successful CPAP compared to those failing it. FiO2 and male gender were also significantly associated with intubation. Multivariable analysis adjusting for age, gender, Charlson comorbidity index, percentage change in PaO2/FiO2 or PaO2 and FiO2 separately, lactate, white blood cell count, LDH and C-reactive protein levels led to an area under the curve of 0.818 and confirmed that age, LDH and percentage increase in PaO2/FiO2 are predictors of intubation. Conclusions In COVID-19 patients requiring CPAP, age, LDH and percentage change in PaO2/FiO2 after starting CPAP are predictors of intubation.

AimWe aimed to characterise a large population of coronavirus disease 2019 (COVID-19) patients with moderate-to-severe hypoxaemic acute respiratory failure (ARF) receiving continuous positive airway pressure (CPAP) outside the intensive care unit (ICU), and to ascertain whether the duration of CPAP application increased the risk of mortality for patients requiring intubation.MethodsIn this retrospective, multicentre cohort study, we included adult COVID-19 patients, treated with CPAP outside ICU for hypoxaemic ARF from 1 March to 15 April, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay and 60-day in-hospital mortality.ResultsThe study included 537 patients with a median (interquartile range (IQR) age of 69 (60–76) years. 391 (73%) were male. According to the pre-defined CPAP therapeutic goal, 397 (74%) patients were included in the full treatment subgroup, and 140 (26%) in the do not intubate (DNI) subgroup. Median (IQR) CPAP duration was 4 (1–8) days, while hospital length of stay was 16 (9–27) days. 60-day in-hospital mortality was 34% (95% CI 0.304–0.384%) overall, and 21% (95% CI 0.169–0.249%) and 73% (95% CI 0.648–0.787%) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95% CI 0.345–0.488%) for 180 (45%) CPAP failures requiring intubation, and 2% (95% CI 0.008–0.035%) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality (hazard ratio 1.093, 95% CI 1.010–1.184).ConclusionsWe described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.

The aim of this contribution is to develop a procedure in order to identify and to model the intrinsic electric discontinuities in high-voltage overhead transmission lines to better design power line communications applications. The modeling is based on the results of a rigorous campaign of measurement carried out in collaboration with the Italian Transmission System Operator TERNA. The high-frequency model of the line also takes into account the conductors transpositions and other stray effects that can have an impact on the propagation of the high-frequency signals.

This paper considers stone or brick staircases that appear to cantilever from an exterior wall as they spiral upward. A new equilibrium solution is proposed that does not rely on cantilevering from the wall. Unlike previously proposed membrane solutions, the proposed new analytical solution, called Linear Arch Static Analysis (LASA), is based on a 1D no-tension filament, or a set of such 1D filaments (that -by following Rankine’s definition- we call space linear arches), and is therefore particularly efficient. Each space linear arch represents a compressive element that spirals down the staircase, simulating a compressive force that is transferred through and between each stair. In addition, the equilibrium of each filament requires the contribution of horizontal uniaxial compressive forces which are provided by the exterior wall support and transmitted horizontally through each stair. The lines of action of such uniaxial compressive stresses are entirely contained inside the masonry. The new solution is applied to both circular and elliptical stairs to demonstrate the new equilibrium solutions, but also to quantify and highlight the magnitude of resulting forces and the efficiency of the solution. The effect of geometric variations on internal forces are also explored to evaluate the efficiency and feasibility of various potential stair geometries.

This work studies the possible reduction of the direct near-field radiation from electromagnetic bandgap-based comm-on-mode filters on printed circuit boards by using lossy dielectric and magnetic materials. Different combinations of materials are considered and numerically simulated. The comparisons of their performances are reported and discussed.

The objective of the present work is to develop an automated numerical method for the analysis of thin masonry shells. The material model for masonry that we adopt is the so-called "normal rigid no-tension" (NRNT) material; and for such a material, the kinematical and the safe theorems of limit analysis are valid. The present study focuses on the application of the second theorem to masonry vaults and domes, being devoted to the determination of a class of purely compressive stress regimes, which are balanced with the load. The mere existence of such a class is a proof that the structure is safe, and members of this class may be used to assess the geometric degree of safety of the structure and to estimate bounds on the thrust forces exerted by the structure on its boundary. The problem is reduced to the equilibrium of a membrane S and can be formulated in terms of projected stresses defined on the planform Ω of S. The search of the stress reduces to the solution of a second-order pde, in terms of the stress potential F. In order that the membrane stress on S be compressive, the potential F must be concave. As for the thrust line in an arch, the surface S is not fixed and may be changed, given that it remains inside the masonry. Under these simplifying assumptions, the whole class of equilibrated stress regimes for a masonry shell is obtained by moving and deforming S inside the masonry, and also, for any fixed shape, by changing the boundary data for F, that is the distribution of thrust forces along the boundary. The search for a feasible stress state on a convenient membrane surface, to be chosen with a trial and error procedure, requires a substantial effort and may be unrewarded. Then, the main object of the present work, is to produce a computer code that can handle numerically the interplay of the shape controlled by a function f, and of the stress potential F, by developing a convergent optimization scheme able to give a safe state under the given material and geometrical constraints, namely the concavity of F and the inclusion of f within the masonry. Two simple cases, are exposed in detail to illustrate the method.

The assessment of the equilibrium and the safety of masonry vaults is of high relevance for the conservation and restoration of historical heritage. In the literature many approaches have been proposed for this tasks, starting from the 17th century. In this work we focus on the Membrane Equilibrium Analysis, developed under the Heyman’s theory of Limit Analysis. Within this theory, the equilibrium of a vault is assessed if it is possible to find at least one membrane surface, between the volume of the vaults, being in equilibrium under the given loads through a purely compressive stress field. The equilibrium of membranes is described by a second order partial differential equation, which is definitely elliptic only when a negative semidefinite stress is assigned, and the shape is the unknown of the problem. The proposed algorithm aims at finding membrane shapes, entirely comprised between the geometry of the vault, in equilibrium with admissible stress fields, through the minimization of an error function with respect to shape parameters of the stress potential, and then, with respect to the boundary values of the membrane shape. The application to two test cases shows the viability of this tool for the assessment of the equilibrium of existing masonry vaults.

Masonry railways bridges were built and are still in use all over Europe and in many other countries all over the world. Limit analysis is widely adopted to assess the equilibrium of these structur...

In this work preliminary yet comprehensive considerations are reported on the possibility for remote monitoring of degraded compression and bolted joints on high voltage overhead power lines. Measurements are performed on new, naturally aged, and artificially degraded joints to quantify the impedance discontinuity introduced along typical HV overhead lines. Numerical simulations, a preliminary time domain reflectometry (TDR) measurement campaign, and circuit simulations are performed on a real power line to study the TDR-based capabilities for the identification of the investigated joint impedances. This study sets the basic concepts to the development of a remote monitoring system for quantifying and locating degraded joints.

Common-mode (CM) noise on differential signals can be suppressed by planar electromagnetic bandgap (EBG) technologies. In this study, two new CM filter structures were designed, fabricated, and measured. The filters are based on a previously proposed geometry, a “sandwich-type” EBG structure that resonates at the desired filter frequency; however, the new filters are placed on the top of the PCB as a surface-mount component, instead of being implemented within the PCB stackup. Stripline and microstrip versions of the surface-mount filter are considered. The filters can be easily removed and substituted with another one that is designed to filter a different frequency but maintains the same footprint and external dimensions. In addition, the surface-mount filter allows us to incorporate dc blocking capacitors into the microstrip version of the filter, thus providing two functions in one package. The total radiated power (TRP) of the implemented filter is investigated and discussed. RF absorbing material and traditional shielding are considered to reduce the TRP.

Background The helmet is a well-tolerated interface for noninvasive ventilation, although it is associated with poor patient–ventilator interaction. A new helmet (NH) has proven to attenuate this limitation of the standard helmet (SH) in both bench study and healthy volunteers. The authors compared a NH and a SH in intensive care unit patients receiving noninvasive ventilation for prevention of postextubation respiratory failure; both helmets were also compared with the endotracheal tube in place before extubation. Methods Fourteen patients underwent 30-min trials in pressure support during invasive ventilation and then with a SH and a NH in a random order. The authors measured comfort, triggering delays, rates of pressurization (airway pressure–time product [PTP] of the first 300 [PTP300-index] and 500 [PTP500-index] ms from the onset of effort, and the first 200 ms from the onset of insufflation [PTP200]), time of synchrony between effort and assistance (Timesynch/Tineu), respiratory drive and frequency, arterial blood gases (ABGs), and rate of asynchrony. Results Compared with SH, NH improved comfort (5.5 [5.0 to 6.0] vs. 8.0 [7.8 to 8.0]), respectively, P < 0.001), inspiratory trigger delay (0.31 [0.22 to 0.43] vs. 0.25 [0.18 to 0.31] s, P = 0.007), and pressurization (PTP300-index: 0.8 [0.1 to 1.8] vs. 2.7 [7.1 to 10.0]%; PTP500-index: 4.8 [2.5 to 9.9] vs. 27.3 [16.2 to 34.8]%; PTP200: 13.6 [10.1 to 19.6] vs. 30.4 [24.9 to 38.4] cm H2O/s, P < 0.01 for all comparisons) and Timesynch/Tineu (0.64 [0.48 to 0.72] vs. 0.71 [0.61 to 0.81], P = 0.007). Respiratory drive and frequency, ABGs, and rate of asynchrony were not different between helmets. Endotracheal tube outperformed both helmets with respect to all variables, except for respiratory rate, ABGs, and asynchronies. Conclusions Compared with a SH, a NH improved comfort and patient–ventilator interaction.

This paper deals with the filters based on EBG cavities employed for reducing common-mode currents along differential stripline traces. The crosstalk among differential interconnects routed in close proximity to EBG-based filters, and next to filtered pairs, is accurately quantified. The comparison between the experimental and simulation frequency-domain results validate the proposed filter's effectiveness and make the simulation model reliable for investigating the complex multichannel crosstalk problem. This paper focuses on the stripline environment, where crosstalk occurs among traces routed on adjacent layers, with the EBG cavity acting as a coupling path. Multichannel time-domain simulations complete the characterization of the filter, showing the limited effects of the filter on the intentional differential signal, and the beneficial impact on reducing the potentially radiating common-mode harmonics. The quantification of the common-mode spectrum shows that the filtered harmonics are reduced by 10–15 dB; thus, minimizing the corresponding electromagnetic interference. Design guidelines are defined for the filter layout according to the relative position of unfiltered differential traces, when constraints force them to be placed in close proximity to EBG cavities and filtered pairs. In particular, the best layout for unfiltered traces on adjacent layers is orthogonal with respect to the filtered pair, whereas the parallel routing should be carefully used taking into account the signal bandwidth on the victim pairs.

Background The renal assist device (RAD) is a blood purification system containing viable renal tubular epithelial cells (TECs) that has been proposed for the treatment of acute kidney injury (AKI) and multiple organ failure. Perfluorocarbons (PFCs) are oxygen carriers used for organ preservation in transplantation. The aim of this study was to investigate the effect of PFCs on hypoxia- and sepsis-induced TEC injury and on renal CD133+ progenitor differentiation in a microenvironment similar to the RAD. Methods TECs were seeded in a polysulphone hollow fibre under hypoxia or cultured with plasma from 10 patients with sepsis-associated AKI in the presence or absence of PFCs and were tested for cytotoxicity (XTT assay), apoptosis (terminal deoxynucleotidyl transferase dUTP nick end labeling assay, caspases, enzyme-linked immunosorbent assay, Fas/Fas Ligand pathway activation), mitochondrial activity, cell polarity [transepithelial electrical resistance (TEER)] and adenosine triphosphate production. The effect of PFCs on proliferation and differentiation of human CD133+ progenitors was also studied. Results In the presence of PFCs, TECs seeded into the polysulphone hollow fibre showed increased viability and expression of insulin-like growth factor 1, hepatocyte growth factor and macrophage-stimulating protein. Plasma from septic patients induced TEC apoptosis, disruption of oxidative metabolism, alteration of cell polarity and albumin uptake, down-regulation of the tight junction protein ZO-1 and the endocytic receptor megalin on the TEC surface. These detrimental effects were significantly reduced by PFCs. Moreover, PFCs induced CD133+ renal progenitor cell proliferation and differentiation towards an epithelial/tubular-like phenotype. Conclusions PFCs improved the viability and metabolic function of TECs seeded within a polysulphone hollow fibre and subjected to plasma from septic AKI patients. Additionally, PFCs promoted differentiation towards a tubular/epithelial phenotype of CD133+ renal progenitor cells.

This paper presents an improvement and extension of the removable Electromagnetic Bandgap (EBG) based common mode filters for signal bus structures such as the PCI Express bus. A filter component for four input and four output is designed and numerically validated. The reliability of the design procedure and the effectiveness of the EBG common mode filter are shown by means of frequency and time domain results.

Post-myocardial infarction ventricular septal rupture (VSR) is one of the most serious complications occurring in patients with ST elevation myocardial infarction. Although surgical repair with concurrent coronary artery bypass grafting (CABG) is considered the treatment of choice, it carries a very high morbidity and mortality rates. For this reason, surgical approach to all patients might not be reasonable, in particular when patients are critically ill or with multiple comorbidities. Percutaneous interventional approach appears to be safe and effective in patients with a chronic VSR or treated for a residual shunt after initial surgical closure. Immediate primary transcatheter closure in acute setting may also be considered an alternative and effective strategy in selected patients ensuring greater effectiveness and fewer complications compared to surgery. The timing of surgical or percutaneous intervention is critical: the presence of cardiogenic shock and closure in the acute phase after VSR diagnosis are important risk factors of mortality. Due to the high mortality rate, the use of percutaneous occluders has been investigated as an alternative approach. The treatment with dedicated device is in general successful with few procedure-related complications. This strategy is a less invasive alternative to surgical approach; however it needs to be applied on a case-by-case basis.

Purpose To describe the effect of renal sympathetic denervation (RDN) on renal arteries immediately after the procedure and at follow-up. Case report A 52-year-old woman with severe resistant hypertension underwent RDN. A transient spasm occurred in the left renal artery immediately after radiofrequency energy delivery, with subsequent complete resolution without any additional therapy. At 6-month follow-up, the blood pressure increased, and imaging revealed a tight stenosis in the left renal artery, which was successfully treated with a stent. In the next days, there was an immediate significant blood pressure reduction. Conclusion Renal denervation can be complicated by local tissue injury at the ablation sites that could be a possible trigger of late arterial disease.

Background Surgery in patients affected by amyotrophic lateral sclerosis (ALS) presents a particular anesthetic challenge because of the risk of post-operative pulmonary complications. Aims of the study We report on the use of non-invasive ventilation (NIV) to prevent post-operative pulmonary complications (PPCs) in nine patients affected by ALS enrolled in a phase-1 clinical trial with stem cell transplantation. Methods All patients were treated with autologous mesenchymal stem cells implanted into the spinal cord with a surgical procedure. Anesthesia was induced with propofol and maintained with remifentanil and sevoflurane. No muscle relaxant was used. After awakening and regain of spontaneous breathing, patients were tracheally extubated. Non-invasive ventilation through nasal mask was delivered and non-invasive positive pressure ventilation and continuous positive pressure ventilation were started. Results The average time on NIV after surgery was 3 h and 12 min. All patients regained stable spontaneous breathing after NIV discontinuation and had no episodes of respiratory failure until the following day. Conclusions Our case series suggest that the use of NIV after surgery can be a safe strategy to prevent PPCs in patients affected by ALS. The perioperative procedure we chose for these patients appeared safe even in patients with advanced functional stage of the disease.

To evaluate the performance of a new helmet (NH) recently introduced into clinical use relative to that of the standard helmet (SH) in terms of delivering non-invasive continuous positive airway pressure (nCPAP) and pressure support ventilation (nPSV).This was a bench study using a mannequin connected to an active lung simulator. The SH was fastened to the mannequin by armpit braces, which are not needed to secure the NH.The inspiratory and expiratory variations in nCPAP delivered with two different simulated efforts (Pmus), were determined relative to the preset CPAP level. nPSV was applied at two simulated respiratory rates (RR) and two cycling-off flow thresholds. We measured inspiratory trigger delay (Delay trinsp), expiratory trigger delay (Delay trexp), time of synchrony (Time sync), trigger pressure drop (ΔP trigger), airway pressure-time product during the triggering phase (PTPt), the initial 200 ms from the onset of the ventilator pressurization (PTP 200), and the initial 300 and 500 ms from the onset of the simulated effort; this two latter parameters were expressed as the percentage of the area of ideal pressurization (PTP 300-index and PTP 500-index, respectively).In nCPAP, at both Pmus, the differences between the two interfaces at both Pmus were small and clinically irrelevant. In nPSV, regardless of the setting, NH resulted in significantly smaller trigger delays, ΔP trigger, and PTPt. Time sync, PTP 200, PTP 300-index, and PTP 500-index were also significantly higher with the NH compared to the SH, irrespective of the setting.Compared to the SH, the NH is equally effective in delivering nCPAP and more effective in delivering nPSV, and it is used to avoid the need for armpit braces.

To develop usable EBG-based common mode fliters miniaturization is required. In this paper is introduced a quarter-wavelength resonant EBG-based common mode filter on LTCC substrate whose dimensions are miniaturized according a systematic stepped procedure. Results in terms of common mode attenuation and differential mode transmission are presented. Consideration is also given to the decreasing of the direct radiation.

Introduction Chemical, biological, radiological, and nuclear (CBRN) emergencies need particular hospital preparedness and resources availability. Also, specific skills and capabilities are required for efficient response to these types of events. The aim of this study was to develop an assessment tool to evaluate hospital preparedness and response performance with respect to CBRN emergencies. Methods An evaluation tool was developed using the Delphi technique. A panel of experts from 10 countries, both European and non-European, with more than 5 years of experience in research or practice in CBRN emergency management was involved in this study. The study was run online, and the experts were asked to evaluate a list of items on hospital preparedness and response in CBRN emergencies. A threshold of 85% agreement level was defined as the consensus of experts in this study. Results The first-round questionnaire was answered by 13 experts. Consensus on the preparedness section was reached for all 29 items during the first round and one item was also added by the experts. Consensus on the response performance indicators were reached in 51 out of the 59 items, during the first round, and eight items were modified and then approved in the second round by the experts. Conclusion Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The assessment tool, developed through experts' consensus in this study, provides a standardized method for the evaluation of hospital preparedness and response performance with respect to CBRN emergencies. The feasibility and reliability of this assessment tool could be evaluated before and during simulated exercises in a standardized manner.

The aim of this paper is to clarify some important aspects associated with the possibility to detect degraded compression and bolted joints in power transmission lines using a time-domain reflectometry (TDR)-based remote monitoring. The optimization of a TDR-based remote monitoring method is discussed, studying the effects of the source impedance, source-to-line connection, line characteristic impedance, and scope settings, providing useful guidelines for a future method and instrumentation refinement. The experimental results are presented consisting in the inclusion of lumped resistors of several values along a 130-kV power transmission line. The minimum detectable resistance is discussed based on the present available hardware. The TDR-based method is shown to be able to also identify the main features of the line layout such as phase transpositions and different heights of adjacent towers. This paper represents a preliminary base to keep developing the proposed method, with the aim to overcome the actual limitations (costs, reliability, etc.) in power line monitoring.

Electromagnetic bandgap structures have been shown to be effective in realizing simple and cheap common mode filters for differential interconnect applications in modern high-speed digital electronics. There are two major advantages offered by this technology. The first is that it relies on the standard planar layout methodology for filter design, applied to either a printed circuit board (PCB) or packaging materials and technology. The second advantage is easy analytical design procedure that requires full wave electromagnetic simulations only at a final stage for the filter geometry refinement to precisely meet given performance specifications. In this chapter, the latter aspect is enhanced by introducing an optimization stage that allows for automated adjustment of geometry parameters of the filter in order to improve its performance in terms of achieving the required central frequency, widening the bandwidth, and increasing the band-notch depth. The optimization approach proposed here combines fast response surface approximation modeling for initial design screening and local derivative-free design improvement using pattern search.

Neurally adjusted ventilatory assist (NAVA) has been shown to improve patient-ventilator interaction and reduce asynchronies in intubated patients, as opposed to pressure support ventilation (PSV). This is a short-term head-to-head physiologic comparison between PSV and NAVA in delivering noninvasive ventilation through a helmet (h-NIV), in patients with postextubation hypoxemic acute respiratory failure.Ten patients underwent three 20-min trials of h-NIV in PSV, NAVA, and PSV again. Arterial blood gases (ABGs) were assessed at the end of each trial. Diaphragm electrical activity (EAdi) and airway pressure (P (aw)) were recorded to derive neural and mechanical respiratory rate and timing, inspiratory (delay(TR-insp)) and expiratory trigger delays (delay(TR-exp)), time of synchrony between diaphragm contraction and ventilator assistance (time(synch)), and the asynchrony index (AI).ABGs, peak EAdi, peak P (aw), respiratory rate, either neural or mechanical, neural timing, and delay(TR-exp) were not different between trials. Compared with PSV, with NAVA the mechanical expiratory time was significantly shorter, while the inspiratory time and duty cycle were greater. Time(synch) was 0.79 ± 0.35 s in NAVA versus 0.60 ± 0.30 s and 0.55 ± 0.29 s during the PSV trials (p 0.01 for both). AI exceeded 10% during both PSV trials, while not in NAVA (p 0.001).Compared with PSV, NAVA improves patient-ventilator interaction and synchrony, with no difference in gas exchange, respiratory rate, and neural drive and timing.

In sepsis, dysregulation of the immune response leads to rapid multiorgan failure and death. Accurate and timely diagnosis is lifesaving and should discriminate sepsis from the systemic inflammatory response syndrome (SIRS) caused by non-infectious agents. Osteopontin acts as an extracellular matrix component or a soluble cytokine in inflamed tissues. Its exact role in immune response and sepsis remains to be elucidated. Therefore, we investigated the role of osteopontin in SIRS and sepsis.Prospective, observational study.Intensive care unit of a university hospital.Fifty-six patients with SIRS or sepsis and 56 healthy subjects were enrolled.We analyzed the serum levels of osteopontin and TH1-TH2 cytokines and investigated the role of osteopontin on interleukin 6 secretion by monocytes.Serum osteopontin levels were strikingly higher in patients than in controls and in sepsis than in SIRS, and decreased during the resolution of both the disorders. Receiver operating characteristic curves showed that osteopontin levels have discriminative power between SIRS and sepsis with an area under the curve of 0.796. Osteopontin levels directly correlated with those of interleukin 6 and in vitro, recombinant osteopontin increased interleukin 6 secretion by monocytes in both the absence and presence of high doses of lipopolysaccharide.These data suggest that osteopontin might be a mediator involved in the pathogenesis of SIRS and sepsis, possibly by supporting interleukin 6 secretion.45. SIRS/Sepsis: clinical studies.

This paper describes the effort to miniaturize common mode filters based on electromagnetic bandgap structures. It describes the proposed approach by means of a systematic analysis of different configurations. The typical 3-patch configuration proposed in the past is modified removing the central patch and the bridge dimensions are tuned for keeping the same target frequency. The analysis of the crosstalk is carried out for the relevant configurations in order to assess the possible implementation of these structures in high density printed circuit boards. The simulation results are discussed and compared to identify the best miniaturized geometry for a practical implementation.

The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs).Prospective, intention-to-treat.General ICU of a tertiary care, non-teaching, 400-bed, city hospital.Twelve consecutive mechanically ventilated septic shock patients, with or without concomitant acute renal failure (ARF).A median of 10 consecutive sessions (prescribed treatment time: 10 h/session; delivered duration: 8.43+/-1.37 h/min) of coupled plasmafiltration-adsorption for each patient.Mean arterial pressure (77.2+/-12.5 [CI 95%; 74.5-79.8] vs. 83.3+/-14.1 [CI 95%; 80.3-86.3] mm Hg; [ p0.001]), cardiac index (4.03+/-0.89 [CI 95%; 3.83-4.22] vs. 3.46+/-0.82 [CI 95%; 3.28-3.64] L/m(2)/min; [ p0.001]), systemic vascular resistance index (1,388+/-496 [CI 95%; 1,278-1,497] vs. 1,753+/-516 [CI 95%; 1,639-1,867] dynes x s/cm(5); [ p0.001]), PO2/FIO2 ratio (204+/-87 [CI 95%; 185-223] vs. 238+/-82 [CI 95%; 220-256]; [ p0.001]), significantly improved during 100 global treatments (pre- vs. post-treatment values). Intra-thoracic blood volume and extra-vascular lung water did not change across treatments. Vasopressor requirement was reduced: norepinephrine decrease from an infusion rate of 0.13+/-0.07 (CI 95%; 0.06-0.16) to 0 gamma/kg/min after a mean of 5.3+/-2.7 sessions. C reactive protein (CRP) significantly decreased (from 29.3+/-7.3 vs. 7.9+/-4.8; p0.0001) during treatment. Survival was 90% at day 28 and 70% at day 90.Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamics, the pulmonary function, and the outcome in septic shock patients with or without concomitant ARF.

The concept of reliability and safety is the foundation of every kind of system used in the aeronautical and aerospace applications and diagnostics contributes significantly to this goal. In the literature there are several methods (thermal, on test bench, etc...) that perform diagnostics of electric motors both in the production phase and in the test phase in the sample. These methods tend to test the electrical and mechanical parameters. Using a frequency analysis technique SFRA (Sweep Frequency Response Analysis), it's possible to have a "signature" in frequency of the electric motor. The reference standard IEC 60076-18 (still in the process of study and development), which regulates the diagnosis through SFRA technique for power transformers, does not contain any guidelines on the interpretation of the results. Almost all of the existing researches are addressed on oil insulated transformers. The research aims to investigate the measurement methodologies for the characterization of the stators and for the faults detection caused by the manufacturing process.

In this paper there will be presented basically two main subjects: the development procedure of a particular fault-adaptive multiphase sensorless strategy, based on Neural techniques, and the design issues involved by the fault-detection and isolation stages included in the proposed sensorless method. The proposed strategy is particularly suitable to be applied for the implementation of a cheap additional redundancy feature in order to augment the still existing fault-tolerant capabilities of some multiphase drives employed in safety-critical applications. In particular this unusual sensorless strategy is based on a back-EMF observer plus a proper set of coordinate transformations and possesses reconfiguration capabilities with respect to the occurrence of some certain classes of phase faults, gained through the use of a specific fault-adaptation mechanism. At first, the developmental steps of the fault-adaptive strategy will be described in detail after a preliminary motor modeling section, while, in a second step, the design issues linked with the fault-detection and remedial stages will be deeper investigated. Detailed simulation results will be shown at the end to validate the fault-adaptive properties of the proposed multiphase sensorless strategy.

This paper will present the development process of a multiphase observer-based sensorless strategy possessing also reconfiguration capabilities with respect to the occurrence of some phase faults. The presented strategy is particularly suitable to be applied for the implementation of a cheap additional redundancy feature in order to augment the still existing fault-tolerant capabilities of some multiphase drives employed in safety-critical applications. The developmental steps will be described in detail after a preliminary motor modeling section, in particular the core stage of the multiphase sensorless scheme, more related with the rotor position and speed detection, will be illustrated at first and then, in a second step, the reconfiguration strategy linked with a certain subset of faults, that is opening of the phases, will be introduced subsequently; the proposed remedial policy will mainly involve the proper switching of the linear transformation used to get the equivalent two-phase description of the machine and of the employed back-EMF observer in turn. Simulation and preliminary experimental results will be shown at the end to validate the fault-adaptive properties of the proposed multiphase sensorless strategy; in this last case a proper Real-Time Simulation platform will be used.

This paper presents an approach to rapid prototyping of digitally controlled electrical drives based on real-time simulation. The case study refers to an interior permanent magnet synchronous motor drive. A field oriented speed control algorithm is considered, arranged in the rotor fixed d-q frame, with optimization of the torque-to-current ratio and decoupling of the feeding voltages. The real-time simulation platform and the actual drive share the same control hardware, based on the TMS320F2812 digital signal controller. At simulation stage the controlled hardware (motor, converter and transducers) is replaced by proper models running on the digital controller, while the control algorithm is implemented using the same procedures and real-time architecture that will be adopted in the final application. When one backtracks to consider the actual hardware, time and efforts needed for the ultimate controller set-up will be drastically reduced. The case study demonstrates the accuracy, efficiency, and simplicity of the proposed approach which can be easily extended to the prototyping of any kind of control scheme.

Because non-invasive mechanical ventilation (NIV) is increasingly used, new devices, both ventilators and interfaces, have been continuously proposed for clinical use in recent years. To provide the clinicians with valuable information about ventilators and interfaces for NIV, several bench studies evaluating and comparing the performance of NIV devices have been concomitantly published, which may influence the choice in equipment acquisition. As these comparisons, however, may be problematic and sometimes lacking in consistency, in the present article we review and discuss those technical aspects that may explain discrepancies. Studies concerning bench evaluations of devices for NIV were reviewed, focusing on some specific technical aspects: lung models and simulation of inspiratory demand and effort, mechanical properties of the virtual respiratory system, generation and quantification of air leaks, ventilator modes and settings, assessment of the interface-ventilator unit performance. The impact of the use of different test lung models is not clear and warrants elucidation; standard references for simulated demand and effort, mode of generation and extent of air leaks, resistance and compliance of the virtual respiratory system, and ventilator settings are lacking; the criteria for assessment of inspiratory trigger function, inspiration-to-expiration (I:E) cycling, and pressurization rate vary among studies; finally, the terminology utilized is inconsistent, which may also lead to confusion. Consistent experimental settings, uniform terminology, and standard measurement criteria are deemed to be useful to enhance bench assessment of characteristics and comparison of performance of ventilators and interfaces for NIV.

This work presents a rapid motor control prototyping technique based on the development of a real-time simulation environment structured on a DSP architecture. The considered case study refers to an Interior Permanent Magnet synchronous motor (IPM) drive arranging a field oriented speed control with the optimization of the torque-to-current ratio and the decoupling of the feeding voltages. The main topics of this work are related with the construction of the real-time simulation platform and with the implementation issues coming from the use of a hardware DSP-based setup. In particular it will be shown how such a kind of simulation architecture can model very closely the real behaviour of a controlled IPM drive and consequently how it can be used to properly tune the control algorithm without the needing of using the real motor drive saving this way a lot of deployment time.

The work developed in this paper presents a comparison between three different phase detection algorithms in order to study the benefits of using each of them when they are applied inside a sensorless rotor position estimation technique. In particular we will analyse the various aspects related to the use of each single algorithm when it is applied into a specific model-based sensorless strategy and when we also take into account the typical impairments affecting the implementation of the real setup, such as unwanted harmonic components and measurement offsets. As a first step a short overview on each phase-detection algorithm under consideration will be given and subsequently the proposed model-based estimation technique will be presented. As a second step the three algorithms are analyzed in detail highlighting their dynamical performances and their robustness properties against implementative knots, in particular through the use of software simulations and real-time simulations reproducing the specific test case of a five-phase motor.

Patients who fail noninvasive ventilation are generally intubated and are then subjected to complications of invasive mechanical ventilation. With transtracheal open ventilation, ventilator support is delivered through an uncuffed small bore minitracheostomy tube, which eliminates pooling of secretions above the cuff and thus reduces the risk of tracheobronchial microbial colonization.To compare transtracheal open ventilation (treatment group) with conventional invasive ventilation (control group) in patients with exacerbation of chronic obstructive pulmonary disease who initially failed noninvasive ventilation.Patients were randomized to receive trans-tracheal open ventilation (n=19) or conventional invasive ventilation (n=20).There was no difference in arterial blood gases after 1 and 30 h between the two groups. Two patients receiving transtracheal open ventilation and 13 undergoing conventional ventilation had complications (p0.0001). Compared with conventional ventilation, transtracheal open ventilation significantly decreased both the duration of mechanical ventilation (7.6+/-4.7 vs. 18.6+/-10.6 d, p0.0001) and length of stay in the intensive care unit (10.2+/-4.5 vs. 21.3+/-9.7 d, p0.0001).Transtracheal open ventilation was as effective as conventional ventilation in maintaining adequate gas exchange and reducing complications, duration of mechanical ventilation, and intensive care unit length of stay.

Traumatic injury and trauma deaths have been worldwide considered a major health problem [1]. The World Health Organization estimates that 16 000 people die everyday from trauma injuries, and for every person who dies, several thousands more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease [2].

Objective: To evaluate the efficacy of mechanical ventilation administered through a small-bore, uncuffed tracheotomy tube, so-called transtracheal open ventilation (TOV), in comparison with conventional mechanical ventilation via a cuffed tracheal tube (endotracheal invasive ventilation, EIV). Design: Physiologic study. Setting: Intensive care unit of a referral trauma center. Patients: Ten acute quadriplegic patients. Interventions: In acute quadriplegic patients receiving EIV, TOV was subsequently applied via an uncuffed, small-bore tube (internal diameter of 4 or 5 mm). Measurements and Main Results: Compared with EIV, arterial blood gases were not significantly different after 1 hr of TOV (PaO 2 /FIO 2 , 222.8 ± 60.9 vs. 218.5 ± 60.3; PacO 2 , 37.8 ± 7.1 torr [5.04 ± 0.95 kPa] vs. 35.5 ± 6.8 torr [4.73 ± 0.91 kPa], for EIV and TOV, respectively). Respiratory rate (19.5 ± 4.7 vs. 19.6 ± 5 breaths/min) and inspiratory effort (pressure-time product of esophageal pressure during a 1-min period, 125.9 ± 48.4 vs. 112.8 ± 36.4 cm H 2 O.sec -1 .min -1 ) were also no different between the two modes. After 24 hrs of TOV, compared with EIV and TOV after 1 hr, respiratory rate and arterial blood gases remained stable, and the pressure-time product of esophageal pressure during a 1-min period was slightly, but significantly, reduced (83.5 ± 16.6 cm H 2 O.sec -1 .min -1 , p