The Effect of an algorithm based sedation guideline on the duration of mechanical ventilation for intensive care patients in an Australian intensive care unit

Patients who are cared for in intensive care units (ICUs) have life threatening illnesses and require intrusive interventions and monitoring, which may cause discomfort. They often require analgesic medications to relieve pain and sedative medications to reduce anxiety. Agitation and accidental self-harm may result from providing too little medication and the administration of too much may lead to the prolongation of mechanical ventilation. Sedation guidelines offer the potential to reduce these problems. The aim of this study was to examine the effect of an algorithm based sedation guideline on the duration of mechanical ventilation of patients in an Australian ICU. Secondary aims included the effect of the guideline on the: patients’ perspective of their recovery; length of stay in ICU; number of tracheostomies; number of self-extubations and reintubations; and the cost of intravenous sedative medications. The rate of adoption of the guideline and sedation scale was examined. The intervention was tested in a quasi-experimental preintervention and postintervention study (n= 322). The sample comprised 58% men and the median age was 61.1 years (range 19.7 to 91.8 years). Mean Acute Physiology and Chronic Health Evaluation II score was 21.8 points (range 3 to 45 points). Nineteen percent of patients were admitted post operatively and 81% were admitted for non-operative medical diagnoses. Mechanical ventilation was instigated for 225 (70%) patients prior to admission to the study ICU. There was a 22% mortality rate. The groups were equivalent at baseline. The mean duration of mechanical ventilation was 4.33 days for the preintervention group and 5.64 days for the postintervention group (p=0.02). There was no difference in the patients’ perspective of their recovery. There was no difference in length of stay in ICU and the number of tracheostomies. The number of self-extubations and reintubations were similar. The overall cost of intravenous sedative medications increased slightly in the postintervention phase. Sedation scale adoption was poor in the preintervention phase but increased in the postintervention phase. The sedation guideline was gradually adopted in the postintervention phase. Adoption data suggests that patients were more deeply sedated during the postintervention phase. In conclusion, the sedation scale and sedation guideline were well adopted by the nurses. Patients were more deeply sedated when the guideline was used and there was a mean increase in duration of ventilation of 1.31 days. Other secondary patient outcomes were not affected. The successful implementation of a clinical guideline was demonstrated but was not associated with improvements in patient outcomes in this setting

Does pregnancy affect the metabolic equivalent at rest and during low intensity exercise?

Background: One metabolic equivalent (MET) is the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2·kg-1·min-1. METs are often used to provide simple, practical, and easily understood values that reflect the energy cost of physical activity. It is plausible that the increase in body mass and absolute submaximal oxygen uptake during gestation has the potential to affect the MET of pregnant women. Objective: The aim of this study was to measure the MET during the second trimester of pregnancy and to compare this with non-pregnant women. In addition, the measured MET values were compared to those proposed by the Compendium of Physical Activities (CPA). Design: Ten pregnant and ten non-pregnant women participated in this study. Ventilatory variables and heart rate (HR) were measured during four conditions on two different days: Condition 1 - sitting, Condition 2 - lying, Condition 3 - treadmill walking and Condition 4 - cycling. The women performed two conditions on each testing day; one resting condition followed by one exercising condition. The data were analysed using a two-way ANOVA with repeated measures. Bonferroni’s tests were used when significant differences were detected. Results: The MET was not significantly different between pregnant and non-pregnant women either at rest or during exercise (p > 0.05). While cycling, the MET obtained by indirect calorimetry (IC) was significantly higher than the CPA predicted MET, regardless of group (pregnant cycling p = 0.002 and non-pregnant cycling p 0.05). In general, (combined pregnant and non-pregnant data), VE and HR were significantly higher during seated rest, when compared with supine rest and all ventilatory variables, HR and ratings of perceived exertion (RPE) were significantly higher during cycling, when compared with walking (p > 0.05). Conclusion: METs were unaffected by pregnancy at rest or when undertaking either walking or cycling exercise during the second trimester of pregnancy. The MET of cycling was significantly underestimated by the CPA, when compared to IC, in both groups

The antiviral RNAi response in vector and non-vector cells against orthobunya viruses

Background: Vector arthropods control arbovirus replication and spread through antiviral innate immune responses including RNA interference (RNAi) pathways. Arbovirus infections have been shown to induce the exogenous small interfering RNA (siRNA) and Piwi-interacting RNA (piRNA) pathways, but direct antiviral activity by these host responses in mosquito cells has only been demonstrated against a limited number of positive-strand RNA arboviruses. For bunyaviruses in general, the relative contribution of small RNA pathways in antiviral defences is unknown. Methodology/Principal Findings: The genus Orthobunyavirus in the Bunyaviridae family harbours a diverse range of mosquito-, midge- and tick-borne arboviruses. We hypothesized that differences in the antiviral RNAi response in vector versus non-vector cells may exist and that could influence viral host range. Using Aedes aegypti-derived mosquito cells, mosquito-borne orthobunyaviruses and midge-borne orthobunyaviruses we showed that bunyavirus infection commonly induced the production of small RNAs and the effects of the small RNA pathways on individual viruses differ in specific vector-arbovirus interactions. Conclusions/Significance: These findings have important implications for our understanding of antiviral RNAi pathways and orthobunyavirus-vector interactions and tropism

n-type chalcogenides by ion implantation.

Carrier-type reversal to enable the formation of semiconductor p-n junctions is a prerequisite for many electronic applications. Chalcogenide glasses are p-type semiconductors and their applications have been limited by the extraordinary difficulty in obtaining n-type conductivity. The ability to form chalcogenide glass p-n junctions could improve the performance of phase-change memory and thermoelectric devices and allow the direct electronic control of nonlinear optical devices. Previously, carrier-type reversal has been restricted to the GeCh (Ch=S, Se, Te) family of glasses, with very high Bi or Pb 'doping' concentrations (~5-11 at.%), incorporated during high-temperature glass melting. Here we report the first n-type doping of chalcogenide glasses by ion implantation of Bi into GeTe and GaLaSO amorphous films, demonstrating rectification and photocurrent in a Bi-implanted GaLaSO device. The electrical doping effect of Bi is observed at a 100 times lower concentration than for Bi melt-doped GeCh glasses.This work was supported by the UK EPSRC grants EP/I018417/1, EP/I019065/1 and EP/I018050/1.This is the author accepted manuscript. The final version is available from NPG via http://dx.doi.org/10.1038/ncomms634

Effect of maternal Schistosoma mansoni infection and praziquantel treatment during pregnancy on Schistosoma mansoni infection and immune responsiveness among offspring at age five years.

INTRODUCTION: Offspring of Schistosoma mansoni-infected women in schistosomiasis-endemic areas may be sensitised in-utero. This may influence their immune responsiveness to schistosome infection and schistosomiasis-associated morbidity. Effects of praziquantel treatment of S. mansoni during pregnancy on risk of S. mansoni infection among offspring, and on their immune responsiveness when they become exposed to S. mansoni, are unknown. Here we examined effects of praziquantel treatment of S. mansoni during pregnancy on prevalence of S. mansoni and immune responsiveness among offspring at age five years. METHODS: In a trial in Uganda (ISRCTN32849447, http://www.controlled-trials.com/ISRCTN32849447/elliott), offspring of women treated with praziquantel or placebo during pregnancy were examined for S. mansoni infection and for cytokine and antibody responses to SWA and SEA, as well as for T cell expression of FoxP3, at age five years. RESULTS: Of the 1343 children examined, 32 (2.4%) had S. mansoni infection at age five years based on a single stool sample. Infection prevalence did not differ between children of treated or untreated mothers. Cytokine (IFNγ, IL-5, IL-10 and IL-13) and antibody (IgG1, Ig4 and IgE) responses to SWA and SEA, and FoxP3 expression, were higher among infected than uninfected children. Praziquantel treatment of S. mansoni during pregnancy had no effect on immune responses, with the exception of IL-10 responses to SWA, which was higher in offspring of women that received praziquantel during pregnancy than those who did not. CONCLUSION: We found no evidence that maternal S. mansoni infection and its treatment during pregnancy influence prevalence and intensity of S. mansoni infection or effector immune response to S. mansoni infection among offspring at age five years, but the observed effects on IL-10 responses to SWA suggest that maternal S. mansoni and its treatment during pregnancy may affect immunoregulatory responsiveness in childhood schistosomiasis. This might have implications for pathogenesis of the disease

A precision study of the fine tuning in the DiracNMSSM

Recently the DiracNMSSM has been proposed as a possible solution to reduce the fine tuning in supersymmetry. We determine the degree of fine tuning needed in the DiracNMSSM with and without non-universal gaugino masses and compare it with the fine tuning in the GNMSSM. To apply reasonable cuts on the allowed parameter regions we perform a precise calculation of the Higgs mass. In addition, we include the limits from direct SUSY searches and dark matter abundance. We find that both models are comparable in terms of fine tuning, with the minimal fine tuning in the GNMSSM slightly smaller.Comment: 20 pages + appendices, 10 figure

On Horava-Lifshitz "Black Holes"

The most general spherically symmetric solution with zero shift is found in the non-projectable Horava-Lifshitz class of theories with general coupling constants. It contains as special cases, spherically symmetric solutions found by other authors earlier. It is found that the generic solution has conventional (AdS, dS or flat) asymptotics with a universal 1/r tail. There are several special cases where the asymptotics differ, including the detailed balance choice of couplings. The conventional thermodynamics of this general class of solutions is established by calculating the energy, temperature and entropy. Although several of the solutions have conventional horizons, for particles with ultra-luminal dispersion relations such solutions appear to be horizonless.Comment: Latex 41 pages, 5 figure

A pilot study of sound levels in an Australian adult general intensive care unit

High technology and activity levels in the intensive care unit (ICU) lead to elevated and disturbing sound levels. As noise has been shown to affect the ability of patients to rest and sleep, continuous sound levels are required during sleep investigations. The aim of this pilot study was to develop a robust protocol to measure continuous sound levels for a larger more substantive future study to improve sleep for the ICU patient. A review of published studies of sound levels in intensive care settings revealed sufficient information to develop a study protocol. The study protocol resulted in 10 usable recordings out of 11 attempts to collect pilot data. The mean recording time was 17.49 ± 4.5 h. Sound levels exceeded recommendations made by the World Health Organization (WHO) for hospitals. The mean equivalent sound level (LAeq) was 56.22 ± 1.65 dB and LA90 was 46.8 ± 2.46 dB. The data reveal the requirement for a noise reduction program within this ICU

Emergency department presentations by older people for mental health or drug and alcohol conditions: A multicentre retrospective audit

© 2017 College of Emergency Nursing Australasia Purpose Emergency department presentations by older people associated with mental health and drug and alcohol related conditions are increasing. However, the characteristics of presentations by older people in Australia are largely unknown. The aim of this research was to explore the characteristics of older people presenting with mental health and drug and alcohol conditions. Procedures We used a retrospective electronic medical record audit to explore all emergency department presentations by older people 65 years and over for mental health and drug and alcohol related conditions over a 12 month period. Data were described using descriptive statistics. Finidngs There were 40,093 presentations; 2% (n = 900) were related to mental health or drug and alcohol related conditions. Presentations were mainly associated with primary mental or medical symptoms. The majority were female (n = 471; 53%). Predominate conditions were cognitive impairment (n = 234; 26%) and affective disorders (n = 233; 26.0%). Sixty-three percent of patients were admitted to a hospital ward. Over the study period 106 patients (242 episodes of care) represented. Principle conclusions Given the ageing population and increasing prevalence for mental health and drug and alcohol conditions, strategies are required to better recognise these conditions to reduce the burden on the health care system and improve health for older people

The effectiveness of public health interventions to reduce the health impact of climate change:a systematic review of systematic reviews

Climate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases