Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.
Human-induced land-use changes have resulted in loss and degradation of intertidal environments worldwide. Saltmarsh ecosystem dynamics in Portugal are greatly influenced by historic uses and consequent habitat degradation. This study uses an original approach combining vegetation surveys and spatial analysis of historic maps and aerial photographs to assess the effects of land use changes on saltmarshes in two areas in the Algarve, southern Portugal. Historical maps from c. 1800 and aerial photographs from 1958 to 2010 were analysed to map saltmarsh ecosystems and quantify land-use changes in the Alvor estuary and Arade River. Between c. 1800 and 2010 more than half of saltmarshes were lost due to dyke building and saltmarsh reclamation for agriculture. In mid-1960s, the abandonment of reclaimed agricultural areas resulted in the recolonization of saltmarsh vegetation, which developed physically separated from natural marshes. In the study area, these saltmarshes naturally evolved into two distinct typologies: (1) enclosed mixed marshes, formed by patches of brackish, freshwater and some invasive species developing due to saline intrusion in areas where dykes have not been breached; and (2) tidally-restored saltmarshes, formed in areas where dyke breaching allows incursion of tides and development of a vegetation structure similar to natural saltmarshes. In Europe, passive (without human intervention) and active (artificially planned) saltmarsh restoration are important mechanisms for voluntary or statutory re-creation of intertidal habitats. Improved understanding of the factors influencing the development of distinct saltmarsh typologies through passive ecosystem recovery can provide new insights to support decision-making concerning intertidal habitat restoration.
This paper describes a general framework alternative to the traditional surveys that are commonly performed to estimate, for statistical purposes, the areal extent of predefined land cover classes across Europe. The framework has been funded by Eurostat and relies on annual land cover mapping and updating from remotely sensed and national GIS-based data followed by area estimation. Map production follows a series of steps, namely data collection, change detection, supervised image classification, rule-based image classification, and map updating/generalization. Land cover area estimation is based on mapping but compensated for mapping error as estimated through thematic accuracy assessment. This general structure was applied to continental Portugal, successively updating a map of 2010 for the following years until 2015. The estimated land cover change was smaller than expected but the proposed framework was proved as a potential for statistics production at the national and European levels. Contextual and structural methodological challenges and bottlenecks are discussed, especially regarding mapping, accuracy assessment, and area estimation.
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