Changes In Compliance Research Articles

Effect of community based nutritional education on knowledge, attitude and compliance to IFA supplementation among pregnant women in rural areas of southwest Ethiopia: a quasi experimental study

BackgroundCompliance with the iron folic acid supplementation is low and not at the required level to prevent anaemia during pregnancy in many countries, including Ethiopia, even though an iron-folic acid supplementation program is being implemented. The aims of this study were to determine the effect of community-based nutritional education on knowledge, attitude, and compliance to IFA supplementation in Ilu Aba Bor zone of southwest Ethiopia.MethodA pretest–posttest quasi-experimental study design consisting of intervention and control group was conducted among pregnant women. The total sample size of 472, therefore, 236 pregnant women for each interventional and control group from 16 kebeles were randomly selected in two districts. A multi-stage sampling technique was used to select the study participants. Then, individual study units were selected using a simple random sampling technique and followed until the end of the study period. Effect of community-based nutritional education on knowledge, attitude, and compliance to IFA supplementation among pregnant women in rural areas were measured.ResultsA total of 472 pregnant women participated in the study during the baseline and 437 (92.6%) were in the study until the end. The majority (49.2%) of respondents were 21–25 years of age, with a mean age of 23.4 (SD = 3.7) years. Community-based nutrition has resulted in a statistically significant increase in levels of maternal knowledge of IFAS by 15.2% in the intervention group compared to 5.1% in the control group. Similarly, the intervention group had odds of developing a positive attitude toward IFA 5.6 (4.01, 7.85) times higher than the control group. Moreover, in this study, the odds of compliance towards IFA supplementation were 3.9 (2.67, 5.57) times higher among those who received nutrition education than those women who did not.ConclusionThis study revealed that community-based nutritional education can result in a significant change in knowledge, attitude, and compliance towards IFA supplementation and supports the literature suggesting the importance of the intervention to overcome the problem of poor compliance and its associated consequences.

Pronation Reveals a Heterogeneous Response of Global and Regional Respiratory Mechanics in Patients With Acute Hypoxemic Respiratory Failure.

Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory compliance. However, this response still needs confirmation on humans. Therefore, this study aimed to assess the changes in global and regional respiratory mechanics in supine and prone positions over a range of PEEP levels in acute respiratory distress syndrome (ARDS) patients. A prospective cohort study. Twenty-two intubated patients with ARDS caused by COVID-19 pneumonia. Electrical impedance tomography and esophageal manometry were applied during PEEP titrations from 20 cm H2O to 6 cm H2O in supine and prone positions. Global respiratory system compliance (Crs), chest wall compliance, regional lung compliance, ventilation distribution in supine and prone positions. Compared with supine position, the maximum level of Crs changed after prone position in 59% of ARDS patients (n = 13), of which the Crs decreased in 32% (n = 7) and increased in 27% (n = 6). To reach maximum Crs after pronation, PEEP was changed in 45% of the patients by at least 4 cm H2O. After pronation, the ventilation and compliance of the dorsal region did not consistently change in the entire sample of patients, increasing specifically in a subgroup of patients who showed a positive change in Crs when transitioning from supine to prone position. These combined changes in ventilation and compliance suggest dorsal recruitment postpronation. In addition, the subgroup with increased Crs postpronation demonstrated the most pronounced difference between dorsal and ventral ventilation distribution from supine to prone position (p = 0.01), indicating heterogeneous ventilation distribution in prone position. Prone position modifies global respiratory compliance in most patients with ARDS. Only a subgroup of patients with a positive change in Crs postpronation presented a consistent improvement in dorsal ventilation and compliance. These data suggest that the response to pronation on global and regional mechanics can vary among ARDS patients, with some patients presenting more dorsal lung recruitment than others.

Measurements of elastic properties and their dependencies within a damage mechanics workflow

Experimental rock mechanics testing provides a controlled and effective method for measuring physical properties, their dependencies, and their evolution due to the addition of localized microcracks. To understand the contributions of microcracks to first order changes in compliance, the behavior of initial undamaged properties of a material should be comprehensively investigated as a function of stress, load path, and load history. We perform a comprehensive study of elastic properties and their dependence on a variety of materials exhibiting nonlinearity, and varying levels of anisotropy in elastic stiffnesses. We programmatically perturb the testing environment of the specimens under triaxial stresses. Elastic moduli are measured within each test, and along multiple discrete loading paths for multistage tests as a function of stress, focusing on a set launch point. Four single stage triaxial tests per rock type are performed to calculate Mohr-Coulomb failure criteria, and ultrasonic velocities are captured during compression for establishing the upper bound of elastic behavior. Shear wave velocity for granite experiences a maximum value at a lower differential stress than maximum volumetric strain. Sandstone displays a similar trend at the highest confining pressure, while these two maxima converge under the lowest confining pressure.

Quality Review Committee Audit Improves Thoracic Enhanced Recovery After Surgery Protocol Compliance

IntroductionCompliance with thoracic Enhanced Recovery After Surgery (ERAS) protocols is critical to achieving their maximum benefits. We sought to examine utilization of quality review meetings as a method to improve protocol compliance through identification and resolution of barriers with compliance. MethodsA multidisciplinary committee implemented a thoracic ERAS protocol for anatomic lung resections across five hospitals within our health system. Compliance data at one institution were tracked for 4 mo after initiation of the ERAS protocol; a quality review meeting was held at one hospital, and two additional months of compliance data were recorded. Outcomes of interest were compliance changes to five protocol elements. Pathway elements deferred due to “mindful deviation” were excluded. Chi-square and Fisher’s exact tests were used to compare compliance differences. ResultsWe included 81 patients: 53 patients before the quality review meeting and 28 after. There were 405 compliance opportunities; 68 (17%) were excluded for mindful deviation, leaving 337 (83%) for inclusion. Overall compliance improved from 53% before to 84% after the quality review meeting. Compliance to avoiding intraoperative urinary catheters, placing chest tubes to water seal in postanesthesia care unit, liberal chest tube removal, and postoperative multimodal pain regimen use improved after the quality review meeting (P values <0.05). Use of preoperative pain bundles was not significantly different (87% versus 96%, P = 0.25). ConclusionsConducting a quality review meeting significantly improved ERAS protocol element use at our intervention healthcare region. This methodology should be considered at other institutions implementing surgical protocols.

Sensitivity of shear wave splitting to fracture connectivity

SUMMARY Shear wave splitting (SWS) is currently considered to be the most robust seismic attribute to characterize fractures in geological formations. Despite its importance, the influence of fluid pressure communication between connected fractures on SWS remains largely unexplored. Using a 3-D numerical upscaling procedure based on the theory of poroelasticity, we show that fracture connectivity has a significant impact on SWS magnitude and can produce a 90° rotation in the polarization of the fast quasi-shear wave. The simulations also indicate that SWS can become insensitive to the type of fluid located within connected fractures. These effects are due to changes of fracture compliance in response to wave-induced fluid pressure diffusion. Our results improve the understanding of SWS in fractured formations and have important implications for the detection and monitoring of fracture connectivity in hydrocarbon and geothermal reservoirs as well as for the use of SWS as a forecasting tool for earthquakes and volcanic eruptions.

Reinventing How We Teach Venous Return.

We propose a simple, intuitive model to progressively explain the principles underlying venous return. At stop-flow, mean circulatory filling pressure (MCFP) can be defined by the filling of the cardiovascular system from internal and external environments, blood vessel compliance, and oncotic pressure. The dynamic distribution of blood within a regular cardiac system and the establishment of central venous pressure (CVP) and mean arterial pressure (MAP) can then be explained by cardiac output and factors controlling distribution. Lastly, control of the cardiovascular system can be explained by changes in resistances and compliances of the blood vessels and their effect on CVP and cardiac output while briefly considering how these are controlled.

Out of Site, Out of Mind? The Role of the Government‐Appointed Corporate Monitor

ABSTRACTWe study the role of a relatively new type of external firm monitor, an on‐site government‐appointed Corporate Monitor, and assess whether such appointments reduce firms' propensity to violate laws. Using a sample of deferred and nonprosecution agreements, we first document the determinants of Monitor appointment. We find firms that voluntarily disclose wrongdoing and have more independent directors are less likely to have Corporate Monitors, whereas those with more severe infractions, mandated board changes, and increased cooperation requirements are more likely to have Monitors. We find such appointments are associated with an 18%–25% reduction in violations while the Monitor is on site, however, the effect does not persist after the Monitorship ends. Using a semisupervised machine learning method to measure changes in firms' ethics and compliance norms, we find that the reduction in violations is associated with changes in ethics and compliance that also do not persist. Finally, we document that firms under Monitorship experience a persistent reduction in innovation, highlighting a previously unexplored cost of these interventions. Overall, our results suggest that, although Corporate Monitors on site are associated with fewer violations, firms revert to previous levels of violations following Monitors' departure.

Fluid-structure interactions of peripheral arteries using a coupled in silico and in vitro approach

Vascular compliance is considered both a cause and a consequence of cardiovascular disease and a significant factor in the mid- and long-term patency of vascular grafts. However, the biomechanical effects of localised changes in compliance cannot be satisfactorily studied with the available medical imaging technologies or surgical simulation materials. To address this unmet need, we developed a coupled silico-vitro platform which allows for the validation of numerical fluid-structure interaction results as a numerical model and physical prototype. This numerical one-way and two-way fluid-structure interaction study is based on a three-dimensional computer model of an idealised femoral artery which is validated against patient measurements derived from the literature. The numerical results are then compared with experimental values collected from compliant arterial phantoms via direct pressurisation and ring tensile testing. Phantoms within a compliance range of 1.4–68.0%/100 mmHg were fabricated via additive manufacturing and silicone casting, then mechanically characterised via ring tensile testing and optical analysis under direct pressurisation with moderately statistically significant differences in measured compliance ranging between 10 and 20% for the two methods. One-way fluid-structure interaction coupling underestimated arterial wall compliance by up to 14.7% compared with two-way coupled models. Overall, Solaris™ (Smooth-On) matched the compliance range of the numerical and in vivo patient models most closely out of the tested silicone materials. Our approach is promising for vascular applications where mechanical compliance is especially important, such as the study of diseases which commonly affect arterial wall stiffness, such as atherosclerosis, and the model-based design, surgical training, and optimisation of vascular prostheses.

Vascular Aging Is Accelerated in Hematological Cancer Survivors Who Undergo Allogeneic Stem Cell Transplant.

Survivors of allogeneic stem cell transplant (SCT) receive intensive cancer treatments that are associated with cardiovascular dysfunction. Markers of vascular age can indicate early signs of adverse (cardio)vascular changes; however, the impact of SCT on these makers is unknown. We aimed to determine the short (3 months) and longer-term (≥2 years) effect of SCT on markers of vascular age in hematologic cancer survivors compared with an age-matched noncancer control group. The short-term effects of SCT, markers of vascular age (aortic compliance, arterial elastance, and ventricular-vascular coupling) were assessed via cardiac magnetic resonance imaging (cardiac and aortic volumes) before and ≈3 months post-SCT in 13 short-term survivors and compared with 11 controls. The longer-term impact was assessed by comparing 14 long-term survivors (6.5 [2-20] years post-SCT) to the short-term survivors (post-SCT) and controls (n=16). The groups were similar for age and body mass index. In the short-term survivors, no significant group-by-time interactions were observed for any markers of vascular aging from pretransplant to posttransplant (net difference for change in compliance between groups -0.07 [95% CI, -1.49 to 1.35]). For the time-course analysis, aortic compliance was significantly lower in both SCT groups (overall P=0.007) compared with controls, whereas ventricular-vascular coupling was higher in both survivor groups as was arterial elastance in long-term SCT survivors (ie, worse; P<0.01 for all). This study provides evidence of an accelerated vascular aging phenotype in allogeneic SCT survivors and provides insight into the increased burden of cardiovascular disease among hematologic cancer survivors.

Development and Initial Characterisation of a Localised Elastin Degradation Ex Vivo Porcine Aortic Aneurysm Model

Aortic aneurysms (AA) occur in 4.8% of people causing 150,000 deaths annually. While endovascular aneurysm repairs reduce surgical morbidity, device-related failures (leak/displacement) are frequent highlighting the need for test models that better represent the mural geometry and compliance changes in human AAs. We aimed to develop and characterise an ex vivo porcine aortic model of AA. The optimal duration of tissue elastase exposure to emulate AA changes in elastin microstructure and content was determined using porcine aortic rings. Elastase-induced changes were quantified morphologically, and mechanical properties assessed via ring tensile testing. Subsequent experiments tested the potential for localised elastase treatment in a 1 cm segment of porcine aorta using a specially designed 3D printed rig. The effect on pressure-diameter behaviour was investigated via inflation-extension testing. Elastase treatment produced time dependent decreases in elastin, resulting in an increased tensile modulus and circumferential length in the ring samples in the final phase of the J-shaped tissue stress-strain curves. In whole aortic segments, localised elastase-induced luminal degradation was successfully limited to a central region. The degree of elastin degradation achieved was sufficient to cause localised dilation with respect to controls under physiological pressures. Localised elastin degradation in porcine aortic segments is feasible and emulates the changes seen clinically in aortic aneurysms.

FTP4.1 Compliance With Antimicrobial Prescribing Guideline Recommendations

Abstract Aims Due to concerns regarding the quality of antimicrobial prescribing in the General Surgery department at a District General Hospital, a prospective quality improvement project was undertaken to guide local antimicrobial stewardship. To assess the compliance of the General Surgery department with local antimicrobial prescribing guidelines and policies, and recommendations in the BNF and electronic medicines compendium (EMC). The aim was to evaluate the extent of change in compliance of the General Surgery junior doctors during after intervention. Methodology Prospectively collected data on the patients admitted and started on antimicrobial agents over two 3-week periods under the General Surgery department. Educational interventions were initiated in the interval between the periods of data collection. Results 91 patients were audited in Cycle 1 with a median age of 57 (9-93) years including 36 males and 55 females. Cycle 2 involved 89 patients with a median age of 60 (9-87) with 48 males and 41 females. After intervention, there was an increase in correct prescribing regime (51.6 to 56.2%), correct dose (91.2 to 98.9%), correct frequency (59.3 to 79.8%), and correct duration; when included (78.8 to 83.3%). There was a decrease in the duration being included on the prescription (36.3 to 33.7%). The increases in correct antimicrobial dosing and correct antimicrobial frequency prescriptions were statistically significant at p ≤ 0.05. Conclusion Areas for improvement in the compliance to prescribing guidelines in the department could be influenced successfully through appropriate intervention. The audit highlighted particular areas to be targeted by education.

Comorbidities and the occurrence of changes in Intracranial Compliance in elderly

Population aging is reality and indicates the need for a better quality of life. Aging brings loss of functions, neurological changes and comorbidities. Studies have sought to reduce the progression of diseases in the elderly and some suggest diseases may have their development related to high intracranial pressures (ICP). The aim of this study was to evaluate for the first time ICP morphology in residents of a Long-Term Institution for the Elderly, using a non-invasive technology. Of the 91 elderly people evaluated, 88% had ICP alterations, 58% are dependent to daily activities, 23% are wheelchair users and 79% have a mental state as compromised. As for comorbidities, frequently identified chronic-degenerative diseases were arterial hypertension (50%), depression (27%), diabetes (24%) and dementia (14%), in addition to polypharmacy. There was a significant difference in the prevalence of altered ICP for wheelchair users and for residents who do not walk . A high rate of altered ICP was observed in the population studied, highlighting the importance of assessing intracranial compliance in understanding the aging and future follow-up studies of the elderly at different stages of diseases, especially neurological ones.

Pengaruh Pengetahuan Wajib Pajak, Kesadaran Wajib Pajak, Dan Sanksi Pajak Terhadap Kepatuhan Wajib Pajak Kendaraan Bermotor Di Semarang

Motor vehicle tax consists of annual tax and tax once every five years. Taxpayer compliance is the fulfillment of their tax obligations through tax regulations. This study was conducted to obtain information and analyze several causes of changes in taxpayer compliance in Semarang, such as taxpayer knowledge and consciousness, as well as tax sanctions. Research sampling technique with accidental sampling technique. The use of this type of data in the study is primary data. The population in the study includes taxpayers who own and control motor vehicles included in the list at SAMSAT Semarang 1 in 2022. The results of taxpayer knowledge testing showed that it did not have a significant reaction on taxpayer compliance. For the moment, taxpayer consciousness testing and tax sanctions show a significant influence on taxpayer compliance.&#x0D; Keywords: knowledge, consciousness, sanctions, compliance

Characterization of cerebral macro- and microvascular hemodynamics during transient hypotension.

The aim of the current study was to establish the interplay between blood flow patterns within a large cerebral artery and a downstream microvascular segment under conditions of transiently reduced mean arterial pressure (MAP). We report data from nine young, healthy participants (5 women; 26 ± 4 yr) acquired during a 15-s bout of sudden-onset lower body negative pressure (LBNP; -80 mmHg). Simultaneous changes in microvascular cerebral blood flow (CBF) and middle cerebral artery blood velocity (MCAvmean) were captured using diffuse correlation spectroscopy (DCS) and transcranial Doppler ultrasound (TCD), respectively. Brachial blood pressure (finger photoplethysmography) and TCD waveforms were extracted at baseline and during the nadir blood pressure (BP) response to LBNP and analyzed using a modified Windkessel model to calculate indices of cerebrovascular resistance (Ri) and compliance (Ci). Compared with baseline, rapid-onset LBNP decreased MAP by 22 ± 16% and Ri by 14 ± 10% (both P ≤ 0.03). Ci increased (322 ± 298%; P < 0.01) but MCAvmean (-8 ± 16%; P = 0.09) and CBF (-2 ± 3%; P = 0.29) were preserved. The results provide evidence that changes in both vascular resistance and compliance preserve CBF, as indexed by no significant changes in MCAvmean or DCS microvascular flow, during transient hypotension.NEW & NOTEWORTHY To characterize the relationship between cerebrovascular patterns within the large middle cerebral artery (MCA) and a downstream microvascular segment, we used a novel combination of transcranial Doppler ultrasound of the MCA and optical monitoring of a downstream microvascular segment, respectively, under conditions of transiently reduced mean arterial pressure (i.e., lower body negative pressure, -80 mmHg). A rapid increase in vessel compliance accompanied the maintenance of MCA blood velocity and downstream microvascular flow.

THEORETICAL INSIGHTS INTO ACCOUNTING AND RECORD-KEEPING REQUIREMENTS UNDER THE GOODS AND SERVICES TAX ACT IN INDIA

In India, the implementation of the Goods and Services Tax has an effect on a wide range of businesses. Goods and Services Tax reform eliminated Indias major indirect taxes such as Excise, Service Tax, and VAT, among others. It has also led to a change in the system of finalisation of accounts. Accounting treatment of GST is simpler than that for the older regime, due to the lesser number of taxes to account for. However, institutions need to be wary of GST record-keeping and GST Accounting measures to maintain compliance. GST implementation will have profound and far-reaching effects on a companys operations, necessitating a complete overhaul of the companys business, finance, financial reporting, and accounting systems. As management teams continue to assess these changes, they will need to consider changes in financial reporting as well as indirect tax accounting. The purpose of this research is to discuss the various types of business transactions involving Goods and Services Tax and their accounting treatment in the books of accounts and their compliances. This article also examines some of the most significant GST accounting and compliance changes. KEYWORDS: GST, Accounting, Compliances, Accounts and records.

Enterprise standardization and convergence of large-volume infusion pump drug libraries.

With the implementation of a new electronic health record (EHR) system across Mayo Clinic, a project was approved to standardize and converge 9 region-specific large-volume infusion pump (LVP) drug libraries for Baxter SIGMA Spectrum pumps. The objectives of the project were to (1) develop recommendations for identified variances in practice, (2) consolidate regional drug libraries into a converged enterprise library, (3) improve the drug library management process, and (4) maintain or exceed previous Dose Error Reduction System (DERS) compliance for infusions administered. Harmonization efforts with infusion pumps decreased the number of drug libraries maintained, reduced content maintenance time, and increased readiness for smart infusion pump-EHR interoperability. Seven of the 8 regions for which change in DERS compliance was assessed showed improved compliance relative to baseline in the 30-day postwashout period. Furthermore, when comparing pre- and postimplementation DERS compliance, the number of regions meeting the minimum compliance rate of 95% increased from 5 to 6 regions. The project improved the drug library management process, allowed for DERS compliance to be accurately compared across regions, and ensured that patients across the enterprise receive the same standard of care with the administration of intravenous medications.

Topology optimization of isotropic elastic materials in the two-dimensional design domain with changes in characteristic boundary conditions

Topology optimization (TO) has become increasingly popular as a useful tool for designers and engineers during the initial stages of design. TO aims to optimize the geometry of a design to achieve a specific objective, which can range from discrete grid-like structures to continuum structures. In essence, the geometry is parameterized pixel-by-pixel, with the material density of each element or mesh point serving as a design variable. After that, the optimization problem is addressed using mathematical programming and analytic gradient calculation-based optimization approaches. In this paper, we investigate the material distribution when performing topology optimization for an isotropic material with boundary conditions including fixed structures, supports, or external forces changing. In addition, we investigate more cases where there are material holes in the design domain, meaning that the density of the material is zero. In this study, the modified SIMP method and filter sensitivity are used for topology optimization. The results of the study are the optimized structural domains and the change in compliance according to the number of iterations. The results indicate that the compliance value of most structures reaches convergence after optimization up to the 20th iteration. Moreover, if the force applied to the design domain is symmetrical, the optimal structure also exhibits symmetry. Thus, the distribution of material is concentrated at the positions of the supports. Topology optimization produces designs that both meet boundary conditions while saving material and reducing their mass. The results obtained are important data for structural optimization design for isotropic elastomeric materials. From there, it can be applied to real objects with different requirements and conditions

Comparison of effects of peripheral vasculature on tonometric radial pulse and cuff-based brachial pulse waveform as used in estimation of central aortic pressures.

Aortic pressure estimation requires reliable peripheral pulse waveform acquisition. The peripheral waveform can change with local vascular effects that can be independent of aortic pressure. This study quantifies the effects of peripheral vasculature changes on radial and brachial waveforms. In 20 subjects (37± 15 years, 7 female), brachial volumetric displacement (cuff-based) and radial tonometry waveforms were simultaneously measured whilst a cuff around the hand on the same arm was inflated to induce transmural pressures of -60, -30, -15, 0, 15 and 30 mmHg, altering local peripheral resistance and compliance by graded arterial wall unloading. Aortic blood pressure (BP), augmentation index (AIx) and ejection duration were calculated from the measurements using a generalized transfer function. The parameters under unloaded conditions were compared to baseline measurements. Brachial systolic and diastolic BP did not change throughout the experiment. Altering peripheral resistance and compliance did not significantly change calculated aortic BP values, although changes were nominally greater for radial (maximum +8±1 mmHg) compared to brachial (maximum +2±1 mmHg) waveforms. AIx at 0 mmHg transmural pressure (maximum arterial wall unloading) was higher when derived from radial waveforms (+24±3%, p<0.001) but not when derived from brachial waveforms. Localized changes in peripheral resistance and compliance affect tonometer acquired radial waveforms but not volumetric displacement acquired brachial pressure waveforms, as judged by computed central aortic augmentation pressure parameters. This suggests aortic pressure estimation from the brachial cuff waveform is less sensitive to peripheral vasculature disturbances that alter the peripheral arterial pulse morphology.

Improvement in Infection Prevention and Control Compliance at the Three Tertiary Hospitals of Sierra Leone following an Operational Research Study.

Implementing infection prevention and control (IPC) programmes in line with the World Health Organization's (WHO) eight core components has been challenging in Sierra Leone. In 2021, a baseline study found that IPC compliance in three tertiary hospitals was sub-optimal. We aimed to measure the change in IPC compliance and describe recommended actions at these hospitals in 2023. This was a 'before and after' observational study using two routine cross-sectional assessments of IPC compliance using the WHO IPC Assessment Framework tool. IPC compliance was graded as inadequate (0-200), basic (201-400), intermediate (401-600), and advanced (601-800). The overall compliance scores for each hospital showed an improvement from 'Basic' in 2021 to 'Intermediate' in 2023, with a percentage increase in scores of 16.9%, 18.7%, and 26.9% in these hospitals. There was improved compliance in all core components, with the majority in the 'Intermediate' level for each hospital IPC programme. Recommended actions including the training of healthcare workers and revision of IPC guidelines were undertaken, but a dedicated IPC budget and healthcare-associated infection surveillance remained as gaps in 2023. Operational research is valuable in monitoring and improving IPC programme implementation. To reach the 'Advanced' level, these hospitals should establish a dedicated IPC budget and develop long-term implementation plans.

Airway and Transpulmonary Driving Pressure by End-Inspiratory Holds During Pressure Support Ventilation.

The precision of quasi-static airway driving pressure (ΔP) assessed in pressure support ventilation (PSV) as a surrogate of tidal lung stress is debatable because persistent muscular activity frequently alters the readability of end-inspiratory holds. In this study, we used strict criteria to discard excessive muscular activity during holds and assessed the accuracy of ΔP in predicting global lung stress in PSV. Additionally, we explored whether the physiological effects of high PEEP differed according to the response of respiratory system compliance (CRS). Adults with ARDS undergoing PSV were enrolled. An esophageal catheter was inserted to calculate lung stress through transpulmonary driving pressure (ΔPL). ΔP and ΔPL were assessed in PSV at PEEP 5, 10, and 15 cm H2O by end-inspiratory holds. CRS was calculated as tidal volume (VT)/ΔP. We analyzed the effects of high PEEP on pressure-time product per minute (PTPmin), airway pressure at 100 ms (P0.1), and VT over PTP per breath (VT/PTPbr) in subjects with increased versus decreased CRS at high PEEP. Eighteen subjects and 162 end-inspiratory holds were analyzed; 51/162 (31.5%) of the holds had ΔPL ≥ 12 cm H2O. Significant association between ΔP and ΔPL was found at all PEEP levels (P < .001). ΔP had excellent precision to predict ΔPL, with 15 cm H2O being identified as the best threshold for detecting ΔPL ≥ 12 cm H2O (area under the receiver operating characteristics 0.99 [95% CI 0.98-1.00]). CRS changes from low to high PEEP corresponded well with lung compliance changes (R2 0.91, P < .001) When CRS increased, a significant improvement of PTPmin and VT/PTPbr was found, without changes in P0.1. No benefits were observed when CRS decreased. In subjects with ARDS undergoing PSV, high ΔP assessed by readable end-inspiratory holds accurately detected potentially dangerous thresholds of ΔPL. Using ΔP to assess changes in CRS induced by PEEP during assisted ventilation may inform whether higher PEEP could be beneficial.