Alternative Modes Research Articles

Structural insight into selectivity of amylin and calcitonin receptor agonists.

Amylin receptors (AMYRs), heterodimers of the calcitonin receptor (CTR) and one of three receptor activity-modifying proteins, are promising obesity targets. A hallmark of AMYR activation by Amy is the formation of a 'bypass' secondary structural motif (residues S19-P25). This study explored potential tuning of peptide selectivity through modification to residues 19-22, resulting in a selective AMYR agonist, San385, as well as nonselective dual amylin and calcitonin receptor agonists (DACRAs), with San45 being an exemplar. We determined the structure and dynamics of San385-bound AMY3R, and San45 bound to AMY3R or CTR. San45, via its conjugated lipid at position 21, was anchored at the edge of the receptor bundle, enabling a stable, alternative binding mode when bound to the CTR, in addition to the bypass mode of binding to AMY3R. Targeted lipid modification may provide a single intervention strategy for design of long-acting, nonselective, Amy-based DACRAs with potential anti-obesity effects.

Data-Driven Approach for Measuring and Managing Physical Distancing in Subways during Pandemic Conditions

Physical distancing was considered one of the key strategies for controlling the transmission of COVID-19. Its importance is particularly emphasized with regard to public transportation, on which passengers gather in confined spaces and create a high population density. Public transportation, although integral to the functioning of urban systems, possesses the potential to facilitate disease transmission. Its dual nature has motivated researchers and policymakers to propose transportation policies aimed at minimizing COVID-19 transmission. Nevertheless, quantitative assessments of physical distancing in relation to public transportation to support informed decision-making remain scarce. This study highlights the importance of data-driven analytics for understanding and assessing physical distancing when using public transportation. By applying a stochastic approach to smart card and train log data collected in Seoul, we estimated the routes traveled by subway passengers. We then calculated physical distances using the unit of links, which represents the flow of passengers between two consecutive stations, to obtain the spatiotemporal distribution of physical distances across the subway network. Using percentile ranks of these physical distances, we identified sections in which close physical distancing persisted after the pandemic. Additionally, we conducted an analysis comparing the travel time using subways with alternative modes of transportation such as buses and automobiles. Our data-driven analysis yields insights into areas within the public transportation system that require intervention and provides valuable information to policymakers for devising strategies for a safer and more sustainable public transportation system considering COVID-19 and potential future epidemics.

The antimicrobial peptide chensinin-1b alleviates the inflammatory response by targeting the TLR4/NF-κB signaling pathway and inhibits Pseudomonas aeruginosa infection and LPS-mediated sepsis

Excessive inflammatory responses are a major contributor to the high mortality associated with sepsis, a prevalent global complication. Therefore, the potential therapeutic strategy for sepsis involves targeting macrophages and reducing proinflammatory cytokine release. Chensinin-1b, an analog of the natural antimicrobial peptide derived from Rana chensinensis skin secretion, exhibits broad-spectrum antibacterial activity and adopts a random coil conformation in both PBS and membrane solution. By efficiently neutralizing LPS, chensinin-1b holds promise in alleviating LPS-induced inflammatory responses. In this study, we established a mouse septic shock model by exposing mice to multiple-drug-resistant Pseudomonas aeruginosa, as well as an endotoxin-mediated sepsis model induced by LPS. Administering chensinin-1b significantly prolonged the survival of the experimental mice, concurrently mitigating inflammatory responses and reducing organ damage. Additionally, we investigated the anti-inflammatory mechanism of chensinin-1b using a constructed LPS-induced mouse macrophage RAW264.7 inflammatory model. Our findings demonstrated that chensinin-1b effectively mitigated the excessive activation of the TLR4/NF-κB signaling pathway by directly neutralizing extracellular LPS, thus ameliorating the inflammatory response. Moreover, upon blocking the TLR4 signaling pathway, chensinin-1b further reduced the release of proinflammatory cytokines induced by LPS, indicating alternative modes of regulation. Notably, chensinin-1b rapidly entered RAW264.7 cells within 30 min via endocytosis, diffusing into the cytoplasm while retaining its anti-inflammatory properties intracellularly. Although further investigations are warranted to comprehensively elucidate the intracellular anti-inflammatory mechanism of chensinin-1b, our findings substantiate its possession of anti-inflammatory properties both intracellularly and extracellularly. Thus, chensinin-1b emerges as a promising candidate for mitigating excessive inflammatory responses associated with sepsis.

Feasibility of a randomised controlled trial of financial incentives to promote alternative travel modes to the car

IntroductionAlternatives to the car, such as walking, cycling and public transport can integrate physical activity into everyday life. Interventions promoting alternatives to the car targeting individual behaviour have shown modest effects, and supportive environments appear important. MethodsThis mixed-method study assesses the scientific and operational feasibility of conducting a randomised controlled trial (RCT) of individual financial incentives within a supportive physical environment. We invited residents of Northstowe, Cambridgeshire, UK who had not previously claimed financial incentives to complete a baseline questionnaire assessing socio-demographic characteristics and travel behaviour. On completion, households were randomly assigned to (1) control – claimed incentives online; (2) intervention - received incentives via email; and (3) intervention plus - received greater value incentives via email. We assessed incentive use via questionnaires at three and six months. Longitudinal qualitative interviews at baseline, three months and six months elicited views of incentives and factors influencing use. Results99 residents from 88 households (household response rate: 88/475 (19%)) completed the baseline questionnaire and were randomised at household level. The local authority delivered all incentives. Compared to the control group, incentive use was higher in the intervention and intervention plus groups at six months, but there was little difference between intervention and intervention plus group. Qualitative data suggests that incentives worked by prompting existing intentions, raising awareness of alternative travel modes and to a lesser degree by reducing travel cost. This resulted in some new leisure travel behaviour, but most often to subsidise existing travel. Qualitative data suggests that existing travel preferences and environmental conditions influenced incentive use. ConclusionIt is feasible to deliver an RCT in collaboration with a local authority and future trials should account for recruitment challenges. Reducing the effort required to obtain incentives increased their use, but future research should investigate the surrounding enabling environmental contexts.

Emerging Issues and Problems of Teacher Education

Teacher Education is a program related with Teacher Proficiency and Competence that would make them competent enough to face new challenges in the Education. Now a days the field of Education is not only limited with books but has broadened in various new horizons. Teacher Education can be considered in three phases: there are Pre-service, Induction and In-service. The three phases are considered as parts of a continuous process. The scope of Teacher Education can be divided into three ways; there are Teacher Education at different levels of Education, Triangular basis of Teacher Education and Aspects of Teacher Education. Major issues in Teacher Education concern may be Proliferation of Colleges of Education, Isolation of Colleges of Education, Regional imbalances, Alternative modes of Teacher Education and etc… Emerging problems of Teacher Education may be Economic, Social, Cultural, Political, Moral, Ecological and Educational. Some suggestions here for improving the condition of Teacher Education are given below. It also discusses the need of Teacher Education program to be innovative and various practices that can be included. It has been recognized that Teacher Education Program should be structured and modified in a way that enables them to respond dynamically to the new problems and challenges in the field of Education, then only Teacher can help in National Development.

Access and Uses of ICTs: Can Virtual Learning Be an Alternative Mode of Education in India?

This study analyses household access and persons’ uses of information and communication technologies (ICTs) in India by using the latest National Sample Survey Organization’s (NSSO) Education survey (2017–2018) datasets. Accordingly, an ICT Index is computed, and a logistic model is applied to examine the pattern and likelihood of digital technology usage and access. The result shows that access to ICTs is lower in rural areas and access increases with the level of education. The study also observes that factors like education, income and regional variations are significant aspects of the disproportionate uses and access of ICTs at the household and individual levels. This study also observed that the low level of access to ICTs will be a huge challenge for the Government to ensure alternate online or virtual modes of education.

Contribution of Agama Arbitration Council as an Alternative Mode for Conflict Resolution Adopted By Shari’ah Courts in South Central Mindanao

Issuing the Code of Muslim Personal Laws of the Philippines was a constitutional justification for the free exercise of Religion and cultural communities. This study aimed to ascertain the relationship between the contribution of the Agama Arbitration Council as an alternative mode for conflict resolution adopted by the Shari'ah Courts in South Central Mindanao. The study utilized a descriptive correlation to the 100 respondents composed of judges, clerks of courts, counselors, staff, and asatidz in the cities of Cotabato and Kidapawan, including provinces of Maguindanao, Sultan Kudarat, and North Cotabato. The researcher-made survey questionnaire was used and validated by experts, and its reliability was tested on alpha Cronbach. The Pearson r was used to analyze the data. The results found a high positive correlation between the Agama Arbitration Council as an Alternative Mode for Conflict Resolution adopted by the Shari'ah Courts in terms of divorce (talaq), subsequent marriage, and offense against customary law and its attainment of objectives on the proper conduct of arbitration procedure and the speedy disposition of cases. Hence, the Agama Arbitration Council served as a viable process instead of litigation in the regular courts. It is recommended to incorporate them as essential in the legal system of Muslims in the Philippines.

How to use Zoom to collect data in mathematics educational research: A case study in assessing students’ online mathematics learning

During the COVID-19 pandemic, researchers faced challenges conducting data collection. However, emerging communication technologies, such as web-conferencing platforms, provided an alternative mode of data collection. Among these platforms, Zoom stands out for its functional affordances and unique features that support data collection methods, including screen-capturing, digital photography, drawing, polling, and artifact-based interviews, which attempt to reveal a child's viewpoint and ability. In this article, we explore the feasibility of using Zoom to conduct educational research by investigating the mathematical learning experience among 26 primary 1 and 2 students in Hong Kong on two topics—understanding time and addition and subtraction. Five mathematics teachers were recruited to participate in 2-month online workshops with assessments among three groups of students to understand the suitability for data collection. Based on teachers’ observations and students’ responses, our findings suggest that Zoom is a viable and effective tool for qualitative data collection. It offers a cost-effective method for researchers and educators to examine students’ mathematical performance in an online environment. We also investigate students’ perceptions of online assessment strategies, perceived usefulness of various Zoom functions, and explore the benefits and challenges teachers and students perceived throughout mathematical education using Zoom. However, several technical difficulties were encountered, such as the digital literacy gap and privacy concerns. Therefore, improving students’ digital literacy for remote learning and triangulation is important for online mathematical data collection and assessments.

Schools and students’ preparedness on reopening and adaptation during and after the pandemic: A cross-sectional review of schools of a city in Eastern India

BackgroundCOVID-19pandemic led to closure of schools as a precautionary measure and later the reopening of the schools was a gruesome task for the stake-holders.This needed earnest imposition of measures of prevention to manage disease. AimsThis study aims at observing the preparations and other health safety measures being taken by different secondary level high schools of Bhubaneswar, stratified for its ownership categories (government and private); it would also try and measure the student's perception of the newer methods of imparting education-their advantages and disadvantages besides their personal safety. MethodsA cross-sectional observational study was planned in Bhubaneswar for 900 students; surveyed after Multistage random sampling technique approaches. ResultThe overall basic knowledge about COVID-19 was appropriate, irrespective of the category of the schools.The practice of COVID-appropriate behaviour was better in private school students; this can be related to the finding that Government school (around 28%) students were more affected by COVID-19 than private school students (around 22%). The students of both strata significantly agreed that Lockdown had hampered their education (68.7% in Government and 53.9% in Private schools) and they were under stress due to the pandemic. ConclusionThe pandemic definitely has breathed an air of fresh life into the age-old institution of schools, whose handling and functioning were dealt with unacceptable complacency towards student's health and safety. The alternate mode of teaching has definitely come up as a plausible alternative, but would never replace face-face classes.

Building Sustainable Funding for Teacher Residency Programs

Schools across the U.S. are facing substantial challenges filling positions ( Bleiberg & Kraft, 2022 ) and are considering solutions to address potential teacher shortages. As of 2022, almost half of the States in the U.S. create or support teacher residency programs (TRPs) through statute or regulation ( Education Commission of the States, 2022 ). TRPs are a structured, alternative mode of entry into the education profession that combines coursework in education with extensive on-the-job training, modeled after medical residencies ( Guha et al. 2016 ; Silva et al. 2014 ). To fulfill its promise, TRPs need to be organized and funded to offer living stipends to attract high-quality candidates with diverse backgrounds and experiences while providing them with intensive preparation. In this commentary article, we discuss “4 Rs” of sustainable funding: Reallocation, Reduction, Reinvestment, and Realignment. The literature suggests that most of the needed resources are already in the system, but they need to be realigned and reapplied. This transition can occur through cooperation and collaboration among state policymakers, EPPs, and local school districts.

Overview of Stability and Coordination Control for MVDC Traction Power Supply System

The traditional 25KV electric railways have various problems such as power quality issues, passing neutral sections, complex storage, and utilization of regenerative braking energy, the medium‐voltage direct current (MVDC) traction power supply system (TPSS) may be a potential alternative electric railway mode and can be freely accessed to the renewable energy and energy storage systems, which is an important development direction of the future low‐carbon RES. This paper first describes the structure and characteristics of the current Railway Electrification System (RES), and then analyzes and summarizes the current research status of the MVDC TPSS topology structure, modeling method, stability criterion, and analysis method and coordination control strategy. Finally, combined with the research status, the development direction of the MVDC TPSS has prospected. © 2023 Institute of Electrical Engineer of Japan and Wiley Periodicals LLC.

Premotor function in interpersonal bimanual coordination: Neural responses to varying frequencies and spatio–temporal relationships

BackgroundInterpersonal movement coordination is an important aspect of daily life. Behavioral studies have found that rhythmic bimanual coordination of movement is mainly influenced by two factors, spatio–temporal relationship and frequency of movements. How these factors affect action coordination at the neural level needs further exploration. The current study used a factor design to investigate the brain basis of movement coordination under various spatiotemporal relationships and frequencies, as well as their intricate interaction. MethodsParticipants were asked to perform symmetric or alternating hand movements under conditions of different spatio–temporal relationships (symmetric, alternating) and frequencies. A multi–channel, continuous wave, functional near–infrared spectral (fNIRS) imaging instrument was used to monitor hemodynamic activity while 16 pairs of volunteers performed the task. ResultsBehaviorally, as indexed by phase locking value, movements were more stable in symmetric mode than in alternate mode. With increasing frequency, symmetric mode became more unstable; in contrast, alternating mode became more stable at higher frequencies, suggesting phase transition. Activation in brain regions of interest was much stronger in symmetric mode as compared with alternate mode. In alternate mode, but not symmetric mode, [HbO] varied with frequency. ConclusionInterpersonal bimanual coordination involves activity in premotor areas (premotor cortex, supplementary motor area, and frontal eye fields). More oxygen is consumed in these regions in alternating mode than in symmetric mode.

Diverse modes of H3K36me3-guided nucleosomal deacetylation by Rpd3S

Context-dependent dynamic histone modifications constitute a key epigenetic mechanism in gene regulation1–4. The Rpd3 small (Rpd3S) complex recognizes histone H3 trimethylation on lysine 36 (H3K36me3) and deacetylates histones H3 and H4 at multiple sites across transcribed regions5–7. Here we solved the cryo-electron microscopy structures of Saccharomyces cerevisiae Rpd3S in its free and H3K36me3 nucleosome-bound states. We demonstrated a unique architecture of Rpd3S, in which two copies of Eaf3–Rco1 heterodimers are asymmetrically assembled with Rpd3 and Sin3 to form a catalytic core complex. Multivalent recognition of two H3K36me3 marks, nucleosomal DNA and linker DNAs by Eaf3, Sin3 and Rco1 positions the catalytic centre of Rpd3 next to the histone H4 N-terminal tail for deacetylation. In an alternative catalytic mode, combinatorial readout of unmethylated histone H3 lysine 4 and H3K36me3 by Rco1 and Eaf3 directs histone H3-specific deacetylation except for the registered histone H3 acetylated lysine 9. Collectively, our work illustrates dynamic and diverse modes of multivalent nucleosomal engagement and methylation-guided deacetylation by Rpd3S, highlighting the exquisite complexity of epigenetic regulation with delicately designed multi-subunit enzymatic machineries in transcription and beyond.

Enabling Broader Adoption of Biocatalysis in Organic Chemistry.

Biocatalysis is becoming an increasingly impactful method in contemporary synthetic chemistry for target molecule synthesis. The selectivity imparted by enzymes has been leveraged to complete previously intractable chemical transformations and improve synthetic routes toward complex molecules. However, the implementation of biocatalysis in mainstream organic chemistry has been gradual to this point. This is partly due to a set of historical and technological barriers that have prevented chemists from using biocatalysis as a synthetic tool with utility that parallels alternative modes of catalysis. In this Perspective, we discuss these barriers and how they have hindered the adoption of enzyme catalysts into synthetic strategies. We also summarize tools and resources that already enable organic chemists to use biocatalysts. Furthermore, we discuss ways to further lower the barriers for the adoption of biocatalysis by the broader synthetic organic chemistry community through the dissemination of resources, demystifying biocatalytic reactions, and increasing collaboration across the field.

Leveraging Learning Collectives: How Novice Outsiders Break into an Occupation

Existing research depicts occupational learning as predominantly happening through formal education, situated learning, or a combination of the two. How career switchers might develop occupational skills outside of these established learning pathways is understudied. This paper examines how novice outsiders break into a skilled occupation by looking at the case of aspiring software developers attending coding bootcamps. Drawing on 17 months of fieldwork in the San Francisco Bay area, I find that bootcamps did not resemble either schools or workplaces, the two institutions that facilitate occupational learning. Instead, bootcamps scaffolded learning collectives—groups composed of peers and near peers who learn collaboratively and purposefully to reach a shared goal. Within learning collectives, aspirants progressed from novice outsiders to hirable software developers, despite limited access to proximate experts to learn from or legitimate peripheral participation opportunities. Three scaffoldings facilitated learning at bootcamps. First, peer team structures turned what is normally a solitary activity—writing code—into a collaborative endeavor and facilitated peer-to-peer knowledge exchange. Second, near-peer role structures engaged recent graduates in teaching and mentorship relationships with novices so that aspirants could access knowledge quickly and easily. Third, bootcamps encouraged aspirants to self-learn by reaching out to the expertise of the broader occupational community. This third scaffolding prepared aspirants for learning beyond the bootcamp curriculum and socialized them for an occupation with high learning demands. The outcome of this process was that novices pursuing an alternative mode of occupational entry developed both occupational skills and new self-conceptions as software developers. Funding: This work was supported by a grant from Stanford Cyber Initiative.

Why the Car Is Not Always King in Global South Cities: Evidence From Ulaanbaatar

Access to a private car has established itself as a critical control on mobility and access to opportunities for residents living in a diverse range of settings, globally. Across cities of the Global South, the benefits of private car access are often intensified by the absence of viable alternative modes of travel. This article explores the influence of private car access and mobility in relation to residents living in “ger district” areas of Ulaanbaatar, Mongolia’s capital city. These peri-urban areas are informally created when rural migrants set up home on the edge of the city, initially using mobile felt dwellings called “ger” that become augmented or replaced by permanent structures over time. An absence of forward planning as well as unmade roads and hilly topography mean that the ger districts are often poorly served by public transport, while the low density of the built environment also means that informal transport services can be limited in coverage and relatively expensive. This article utilises a database of household questionnaires collected in 2020 to compare mobility patterns and accessibility between car-owning and non-car-owning households in three case study ger districts, capturing seasonal differences between the extreme cold of the wintertime and warmer summer conditions. The findings not only reveal stark mobility and access differences in relation to car ownership but also discrepancies between car ownership and actual car use for important and routine journeys. This indicates that despite a lack of public transport available, many households opt to use what public transport they can. This pattern provides a potentially important basis for future policies that aim to limit car use in order to reduce traffic congestion and broaden access to the city for non-car-owning households by providing more accessible public transport.

The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial

BackgroundThe Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic.MethodsParticipants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component.ResultsThe program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant’s adherence levels included virtual exercise sessions 81% (95% CI: 75–88%), home-based exercise 50% (95% CI: 38–62%), protein supplements consumption 68% (95% CI: 55–80%), and medication optimization 38% (95% CI: 21–59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms.ConclusionThe GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant’s intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change.Trial registrationClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366

IN VITRO PROPAGATION OF PLATELETS FROM EMBRYONIC STEM CELLS WITH C. PAPAYA LEAF EXTRACT

Objective: The depletion of platelets in patients under different clinical conditions like thrombocytopenia is often associated with a significant mortality factor. Alternative modes of platelet propagation from other resources, including stem cells, are evaluated under in vitro conditions. Embryonic stem (ES) cells can proliferate and differentiate into various cell types. This study evaluated the generation of functional platelets from embryonic stem cells with C. papaya leaf extract through a controlled sequential pathway to meet the clinical demand.
 Methods: In vitro culture of embryonic stem cells was carried out with the help of growth factors and a suitable medium. The differentiated megakaryocytes and platelets were analyzed by staining, flow cytometer and functional studies. The normal megakaryocytes were compared with the megakaryocytes differentiated from Embryonic Stem cells.
 Results: The platelets derived from embryonic stem cells are morphologically identical to normal platelets isolated from peripheral blood, and the number of viable cells was analyzed by flow cytometer. The distinctive two waves of platelet production represented normal primitive and definitive hematopoiesis.
 Conclusion: This study is a preliminary milestone in platelet propagation from embryonic stem cells with C. papaya leaf extract. The differentiation of ESCs into megakaryocyte-mediated platelets with C. papaya leaf extract has shown valuable information on the positive effects that embryonic stem cells can be used for large-scale platelet production.

A closed-loop ventilation mode that targets the lowest work and force of breathing reduces the transpulmonary driving pressure in patients with moderate-to-severe ARDS

IntroductionThe driving pressure (ΔP) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing.AimTo compare transpulmonary and respiratory system ΔP between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS.MethodsSingle-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary ΔP; secondary outcomes included respiratory system ΔP, and other key parameters of ventilation.ResultsThirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary ΔP with was lower (7.0 [5.0–10.0] vs. 10.0 [8.0–11.0] cmH2O, mean difference − 2.5 [95% CI − 2.6 to − 2.1] cmH2O; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients.ConclusionsIn this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary ΔP in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation.Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1.

Hypotensive Effects of Aquatic Exercise Training in Older Adults.

Although regular exercise can help reduce blood pressure, older adults often struggle with adhering to land-based exercise due to barriers such as arthritis pain, functional limitations, and fear of falling. Aquatic exercise is a good alternative mode of exercise that may reduce barriers and improve adherence. However, limited evidence is available on the effectiveness of aquatic exercise in reducing blood pressure in older adults with isolated systolic hypertension. This study aimed to determine the effects of an 8-week aquatic exercise program on arterial blood pressure in older adults. Twenty-five participants were randomized to a control (n=12, 81±8 years) or aquatic exercise group (n=13, 83±7 years). The exercise group received aquatic cognitive-motor training at a moderate-intensity for 45 minutes per session three times per week for eight weeks. The non-exercising control group received a one-hour fall prevention seminar and was asked to maintain their normal physical activity level. Baseline characteristics were not different between the groups. After eight weeks, the exercise group had reductions in systolic blood pressure (135±11 vs. 126±13 mmHg, p<0.01) and pulse pressure (68±8 vs. 60±8 mmHg, p<0.01) without significant change in diastolic blood pressure. There were no significant changes in the control group. Aquatic cognitive-motor training performed at a moderate-intensity was effective in inducing clinically meaningful reductions in systolic blood pressure and pulse pressure in older adults.