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Reverse triggering (RT) occurs when respiratory effort begins after a mandatory breath is initiated by the ventilator. RT may exacerbate ventilator-induced lung injury and lead to breath stacking.

We sought to describe the frequency and risk factors for RT amongst ARDS patients and identify risk factors for breath-stacking.

Secondary analysis of physiologic data from children on Synchronized Intermittent Mandatory pressure control ventilation enrolled in a single center RCT for ARDS. When children had a spontaneous effort on esophageal manometry, waveforms were recorded and independently analyzed by two investigators to identify RT.

We included 81,990 breaths from 100 patient-days and 36 patients. Overall, 2.46% of breaths were RTs, occurring in 15/36 patients (41.6%). Higher tidal volume and a minimal difference between neural respiratory rate and set ventilator rate were independently associated with RT (p=0.001) in multivariable modeling. Breath stacking occurred in 534 (26.5%) of 2017 RT breaths, and 14 (93.3%) of 15 RT patients. In multivariable modeling, breath stacking was more likely to occur when total airway delta pressure (Peak Inspiratory Pressure-PEEP) at the time patient effort began, Peak Inspiratory Pressure, PEEP, and Delta Pressure were lower, and when patient effort started well after the ventilator initiated breath (higher phase angle) (all p<0.05). Together these parameters were highly predictive of breath stacking (AUC 0.979).

Patients with higher tidal volume and who have a set ventilator rate close to their spontaneous respiratory rate are more likely to have RT, which results in breath stacking over 25% of the time. Clinical trial registered with ClinicalTrials.gov (NCT03266016).
Patients with higher tidal volume and who have a set ventilator rate close to their spontaneous respiratory rate are more likely to have RT, which results in breath stacking over 25% of the time. Clinical trial registered with ClinicalTrials.gov (NCT03266016).Public health threats require effective communication. Evaluating effectiveness during a situation that requires emergency risk communication is difficult, however, because these events require an immediate response and collecting data may be secondary to more immediate needs. In this article, we draw on research analyzing the effectiveness of social media messages during times of imminent threat and research analyzing the emergency risk communication conceptual model in order to propose a method for evaluating emergency risk communication on social media. We demonstrate this method by evaluating 2,915 messages sent by local, state, and federal public health officials during the 2014 Ebola outbreak in the United States. The results provide empirical support for emergency risk communication and identify message strategies that have the potential to increase exposure to official communication on social media during future public health threats.Hurricanes can destroy or overwhelm communities and cause or exacerbate health conditions. Legal mechanisms and practices may aid or impede hurricane response. In the United States, where states have primary public health responsibility, state governors possess legal powers to address hurricanes. They often exercise these powers using executive orders and proclamations-legal mechanisms that direct public and private parties. Although executive orders and proclamations are critical for hurricane preparedness and response, how governors use them to respond to hurricanes is not fully understood. Using legal epidemiology, we systematically identified and analyzed hurricane-related executive orders and proclamations issued in the United States from January 1, 2006, through December 31, 2018. We found 468 relevant executive orders and proclamations, 14% of which were issued, at least in part, to benefit a jurisdiction other than the issuer's state. We observed variations in when and where such orders and proclamations were issued. Executive orders and proclamations were most commonly used to direct government response or recovery (32%), handle and administer government resources (31%), and suspend legal requirements perceived to inhibit response (27%). Fewer orders and proclamations regulated private parties (10%). Understanding how governors use executive orders and proclamations to respond to hurricanes can bolster future preparedness and response efforts.Human early visual cortex has long been suggested to play a crucial role in context-dependent visual size perception through either lateral interaction or feedback projections from higher to lower visual areas. We investigated the causal contribution of early visual cortex to context-dependent visual size perception using the technique of transcranial direct current stimulation and two well-known size illusions (i.e., the Ebbinghaus and Ponzo illusions) and further elucidated the underlying mechanism that mediates the effect of transcranial direct current stimulation over early visual cortex. The results showed that the magnitudes of both size illusions were significantly increased by anodal stimulation relative to sham stimulation but left unaltered by cathodal stimulation. Moreover, the anodal effect persisted even when the central target and surrounding inducers of the Ebbinghaus configuration were presented to different eyes, with the effect lasting no more than 15 min. These findings provide compelling evidence that anodal occipital stimulation enhances the perceived visual size illusions, which is possibly mediated by weakening the suppressive function of the feedback connections from higher to lower visual areas. Moreover, the current study provides further support for the causal role of early visual cortex in the neural processing of context-dependent visual size perception.Dating back to the 19th century, the discovery of processing stages has been of great interest to researchers in cognitive science. The goal of this paper is to demonstrate the validity of a recently developed method, hidden semi-Markov model multivariate pattern analysis (HsMM-MVPA), for discovering stages directly from EEG data, in contrast to classical reaction-time-based methods. To test the validity of stages discovered with the HsMM-MVPA method, we applied it to two relatively simple tasks where the interpretation of processing stages is straightforward. In these visual discrimination EEG data experiments, perceptual processing and decision difficulty were manipulated. Guadecitabine concentration The HsMM-MVPA revealed that participants progressed through five cognitive processing stages while performing these tasks. The brain activation of one of those stages was dependent on perceptual processing, whereas the brain activation and the duration of two other stages were dependent on decision difficulty. In addition, evidence accumulation models (EAMs) were used to assess to what extent the results of HsMM-MVPA are comparable to standard reaction-time-based methods.
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