Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial.

BACKGROUND: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. METHODS: This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. FINDINGS: Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. INTERPRETATION: Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. FUNDING: Instituto de Salud Carlos III and the European Regional Development Funds.

Corticosteroids in sepsis and community-acquired pneumonia.

Sepsis and septic shock, which are often caused by pneumonia, impact millions of people every year. Despite adequate antibiotic therapy, mortality remains high, up to 45% in septic shock, which is characterized by an inappropriate, excessive immune response of the host. Moreover, critical illness-related corticosteroid insufficiency often coexists. Against this background, several trials and meta-analyses evaluated corticosteroid therapy as adjuvant therapy with heterogeneous results. Indeed, before 2000, high-dosage, short courses of corticosteroid treatment resulted in no benefit on mortality and a higher rate of adverse events. After 2000, thanks to a deeper understanding of the pathophysiology, low-dosage with longer courses of treatment were tested. With this regimen, a faster decrease in inflammation and faster resolution of shock, with a low rate of mild adverse events, was demonstrated although no clear effect on mortality was shown. To date, guidelines on sepsis and septic shock and guidelines on severe community-acquired pneumonia suggest corticosteroid use in selected patients. Furthermore, by utilizing latent class analysis, phenotypes of sepsis patients who benefit the most from corticosteroid treatment were recently identified. Future research should be guided by a precision medicine approach to identify adequate dosage and duration of corticosteroid treatment for appropriate patients. This article is freely available.

Modeling intrinsic factors of inclusive engagement in citizen science: Insights from the participants' survey analysis of CSI-COP.

Inclusive citizen science, an emerging field, has seen extensive research. Prior studies primarily concentrated on creating theoretical models and practical strategies for diversifying citizen science (CS) projects. These studies relied on ethical frameworks or post-project empirical observations. Few examined active participants' socio-demographic and behavioral data. Notably, none, to our knowledge, explored prospective citizen scientists' traits as intrinsic factors to enhance diversity and engagement in CS. This paper presents a new inclusive CS engagement model based on quantitative analysis of surveys administered to 540 participants of the dedicated free informal education MOOC (Massive Open Online Course) 'Your Right to Privacy Online' from eight countries in the EU funded project, CSI-COP (Citizen Scientists Investigating Cookies and App GDPR compliance). The surveys were filled out just after completing the training stage and before joining the project as active CSs. Out of the 540 participants who completed the surveys analyzed in this study, only 170 (32%) individuals actively participated as CSs in the project. Therefore, the study attempted to understand what characterizes these participants compared to those who decided to refrain from joining the project after the training stage. The study employed descriptive analysis and advanced statistical tests to explore the correlations among different research variables. The findings revealed several important relationships and predictors for becoming a citizen scientist based on the surveys analysis, such as age, gender, culture, education, Internet accessibility and apps usage, as well as the satisfaction with the MOOC, the mode of training and initial intentions for becoming a CS. These findings lead to the development of the empirical model for inclusive engagement in CS and enhance the understanding of the internal factors that influence individuals' intention and actual participation as CSs. The devised model offers valuable insights and key implications for future CS initiatives. It emphasizes the necessity of targeted recruitment strategies, focusing on underrepresented groups and overcoming accessibility barriers. Positive learning experiences, especially through MOOCs, are crucial; enhancing training programs and making educational materials accessible and culturally diverse can boost participant motivation. Acknowledging varying technological proficiency and providing necessary resources enhances active engagement. Addressing the intention-engagement gap is vital; understanding underlying factors and creating supportive environments can transform intentions into active involvement. Embracing cultural diversity through language-specific strategies ensures an inclusive environment for effective contributions.

Hormonal computing: a conceptual approach.

This paper provides a conceptual roadmap for the use of hormonal bioinspired models in a broad range of AI, neuroengineering, or computational systems. The functional signaling nature of hormones provides an example of a reliable multidimensional information management system that can solve parallel multitasks. Two existing examples of hormonal computing bioinspired possibilities are shortly reviewed, and two novel approaches are introduced, with a special emphasis on what researchers propose as hormonal computing for neurorehabilitation in patients with complete spinal cord injuries. They extend the use of epidural electrical stimulation (EES) by applying sequential stimulations to limbs through prostheses. The prostheses include various limb models and are connected to a neurostimulation bus called the central pattern generator (CPG). The CPG bus utilizes hormonal computing principles to coordinate the stimulation of the spinal cord and muscles.

Open Dialogue in Spain: an initial survey of knowledge and perspectives.

In Spain, the introduction of the Open Dialogue framework is relatively recent. This study takes a closer look at Open Dialogue training, interest and research in this region. To this end, a survey has been conducted through a convenience sample of professionals, people with their own experiences in mental health, family members, relatives, university professors and students. The results showed that a significant number of participants had no training in OD, and their exposure to relevant literature and congress attendance was limited. Amongst the different profiles, professionals reported the highest level of training. These findings highlight the urgent need for further research and training initiatives to improve the understanding and application of the OD framework in Spain. Efforts should be directed towards broadening the knowledge base, increasing access to training programmes and fostering interest amongst different stakeholders. By addressing these gaps, the implementation and use of OD can be expanded to meet the growing demand and interest in this approach in the Spanish context.

Slime mould: The fundamental mechanisms of biological cognition.

The slime mould Physarum polycephalum has been used in developing unconventional computing devices for in which the slime mould played a role of a sensing, actuating, and computing device. These devices treated the slime mould as an active living substrate, yet it is a self-consistent living creature which evolved over millions of years and occupied most parts of the world, but in any case, that living entity did not own true cognition, just automated biochemical mechanisms. To "rehabilitate" slime mould from the rank of a purely living electronics element to a "creature of thoughts" we are analyzing the cognitive potential of P. polycephalum. We base our theory of minimal cognition of the slime mould on a bottom-up approach, from the biological and biophysical nature of the slime mould and its regulatory systems using frameworks such as Lyon's biogenic cognition, Muller, di Primio-Lengelers modifiable pathways, Bateson's "patterns that connect" framework, Maturana's autopoietic network, or proto-consciousness and Morgan's Canon.

Lessons from culturally contrasted alternative methods of inquiry and styles of comprehension for the new foundations in the study of life.

Contemporary scientific approaches to Biology are the result of some cultural ideas considered as universal by Western reductionist traditions. The study of the cultural, symbolic and historical approaches to reality and Life provides us important lessons about the necessity of integrating Eastern holistic views into the study of Life. This is both an epistemological and ontological enhancement which provides more powerful and insightful ways to deal with Life and its understanding.

Brains, language and the argumentative mind in Western and Eastern societies. The fertile differences between Western-Eastern argumentative traditions.

The philosophical differences between Western and Eastern philosophy not only derive from general cultural ideas about reality, but as Nisbet writes (2003), are also methodological, ontological, and cognitively driven. Thus, we can see that strategies of thought and theory-generation are constrained and enabled by conceptual levels, and that the existence of differences and within these levels may be pragmatically combined in fruitful ways. At this point, I remark that there is not a single way to connect biology and culture, but at least we need to admit that brains allow the existence of minds and that these create languages, which also organize the world symbolically following a long set of (sometimes interconnected) heuristics. Throughout the paper we will see how fundamental, geographically located cultural perspectives have affected reasoning strategies and discourses, determining the main Western and Eastern Traditions. At the same time, we can conclude that different traditional perspectives allow more diversity for knowledge acquisition.

The Best Model of a Cat Is Several Cats.

Modern biotechnology is emerging at the intersection of engineering, biology, physics, and computer science. As such it carries with it history from several disparate fields of research including a strong tradition in deductive reasoning primarily derived from discovery focused molecular biology and physics. Engineering biological systems is a complex undertaking requiring a broader set of epistemic tools and methods than what is usually applied in today's discovery based research. Inductive reasoning as commonly used in computer science has proven to be a very efficient approach to build knowledge about complex megadimensional datasets, including synthetic biology applications. The authors conclude that the multi-heuristic nature of modern biotechnology makes it an engineering field primed for inductive reasoning to complement the dominating deductive tradition.

Situated phenomenology and biological systems: Eastern and Western synthesis.

Phenomenology was born with the mission to give foundations for science of experience and to open consciousness to scientific study. The influence of phenomenology initiated in the works of Husserl and continued in a wide range of works of others was immense, but mainly within the confines of philosophy and the humanities. The actual attempts to develop a scientific discipline of the study of consciousness and to carry out research on cognition and consciousness were always based on the methods of traditional science in which elimination of the subjective has been always a primary tenet. Thus, focus was mainly on neurological correlates of conscious phenomena. The present paper is an attempt to initiate an extension and revision of phenomenological methodology with the use of philosophical and scientific experience and knowledge accumulated in a century of inquiry and research in relevant disciplines. The question which disciplines are relevant is crucial and our answer is innovative. The range of disciplines involved here is from information science and studies of computation, up to cultural psychology and the studies of philosophical traditions of the East. Concepts related to information and computation studies provide a general conceptual framework free from the limitations of particular languages and of linguistic analysis. This conceptual framework is extending the original perspective of phenomenology to issues of modern technology and science. Cultural psychology gives us tools to root out what in phenomenology was considered universal for humanity, but was a result of European ethnocentrism. Most important here is the contrast between individualistic and collectivistic cultural determinants of consciousness. Finally, philosophical tradition of the East gives alternatives in seeking solutions for fundamental problems. This general outline of the research methodology is illustrated by an example of its use when phenomenology is studied within the conceptual framework of information.