Risk factors for delirium in ICU: a double-centre trial

Risk factors for delirium in ICU Background Delirium is a syndrome characterized by acute brain dysfunction. This syndrome is under-recognized in the intensive care unit (ICU) with not fully elucidated causing mechanisms. The identification of risk factors associated with delirium may prevent the onset of delirium and help in the management. Aim of this study is to estimate the incidence of delirium in ICU and to identify related risk factors in two different ICU. Methods This study was carried out in collaboration with the Intensive Care Unit of Santa Chiara Hospital, Pisa University, Italy, and the Intensive Care Unit of South Egypt Cancer Institute, Assiut University, Egypt. During a 3 months research period patients admitted to the referred ICU were enrolled. The Confusion Assessment Method for ICU was used as methodology for diagnosing delirium. Patients were assessed twice a day. Haemodynamic parameters, arterial blood gas values, electrolytes, presence of sepsis, type of ventilation and type of sedation were assessed at the same intervals. We also recorded daily laboratory investigations, age, diagnosis, length of ICU stay, incidence of complications and general condition at discharge. Data were statistically analyzed with Mann-Whitney test, Wilcoxon test and the Chi-square test. Results 111 patients in the first ICU and 51 patients in the second ICU were enrolled. ICU delirium was found to be significantly related to sepsis, mechanical ventilation and sedation (P-value <0,05). Conclusion We believe that the early identification of risk factors that may lead to the occurrence of delirium in ICU, associated with the appropriate treatment may reduce the incidence of delirium in ICU and delirium related complications

Factores que afectan la productividad en la construcción de un edificio en el Centro Cívico de Santiago.

Tesis (Ingeniero Constructor)RESUMEN: En la presente tesis se analiza la problemática que se tiene al construir la obra gruesa de una edificación en altura ubicada en el centro cívico de la comuna de Santiago, cuáles son las limitantes y factores que en la realidad pueden modificar y alterar de forma positiva o negativa el estudio previo de un proyecto ya que es una de las etapas más incidentes tanto en la programación como en los costos. Para el estudio se tomará una edificación de referencia la cual está ubicada en Moneda 1375 esquina con Hermanos Amunátegui, la cual posee en un terreno de 500 m2, 5 subterráneos y 14 plantas sobre cota 0 con un metraje de 480 m2 cada una. El plazo que se estableció para dicha construcción es de 19 meses y medio. Los datos recolectados y resultados obtenidos pretenden mostrar la cantidad de factores que al momento de presupuestar, planificar y programar una obra no se tienen en consideración o simplemente son factores que al momento de los estudios previos no son visibles a simple vista. En los siguientes capítulos se verá reflejado cómo la teoría no es siempre lo acertado y cómo diferentes factores, situaciones, imprevistos y sobre todo la información previa y detallada de donde se va a construir, las cual normalmente no se conoce en un 100 % pueden afectar de sobre manera un presupuesto, plazos y el estudio de recursos humanos que se requiere para la realización de un proyecto en una zona determinada.ABSTRACT: In this thesis the problem you have when building structural works a tall building located in the civic center of the municipality of Santiago, what are the limiting factors that can change reality and alter positively or analyzed negative prior study of a project as it is one of the steps further incidents both in programming and costs. For the study, a reference building which is located at the corner of Brothers 1375 Currency Amunátegui be taken, which has an area of 500 m2, 5 floors underground and 14 on level 0 with footage of 480 m2 each. The deadline that was set for this construction is 19 months and half. The data collected and results are intended to show the number of factors at the time of budget, plan and schedule work are not taken into consideration or just are factors when previous studies are not visible to the naked eye. Will see in the following chapters reflected how the theory is not always successful and how different factors, situations, unforeseen and especially prior and detailed information which is to be built, the which usually is not known 100% can affect way of on a budget, deadlines and the study of human resources required to carry out a project in a particular area

Estudio comparativo de la remoción del hidróxido de calcio, entre irrigación ultrasónica y limas XP-ENDO en raíces con dos conductos

Tesis (Cirujano Dentista)Introducción: En la actualidad existen muchos métodos para remover el hidróxido de calcio de los conductos. Objetivo: Comparar el uso de las limas Xp-Endo Finisher ®, y la irrigación ultrasónica para remover el hidróxido de calcio de las paredes de los conductos, específicamente en dientes que tengan dos conductos en una raíz. Materiales y métodos: Se utilizaron 20 dientes humanos, (específicamente primeros y segundos molares inferiores) que tenían como requisito principal presentar dos conductos radiculares en una misma raíz. Se procedió a la limpieza y sellado de las muestras; a continuación, se llevó a cabo un análisis radiográfico, la preparación de los conductos y posterior medicación. Para luego remover la medicación con dos métodos distintos, 10 dientes (20 conductos) con Xp-Endo Finisher ®, y otros 10, con irrigación ultrasónica pasiva. Luego se procedió a cortar los dientes en sentido vestíbulo-lingual, o coronal, para después analizarlos en un microscopio Olympus CX31 con videocámara ocular conectada al software Micrometrics ®, para hacer la valoración del remanente de hidróxido de calcio en las paredes de los conductos. El análisis estadístico se realizó con el Test Shapiro-Wilk y Test U deMann-Whitney. Resultados: En el tercio cervical no hay evidencia estadísticamente significativa, pero sí en el tercio medio, y especialmente en apical, en los cuales el método de remoción de hidróxido de calcio mediante irrigación ultrasónica pasiva fue más efectivo. 9 Conclusión: Existe diferencia entre ambos métodos de remoción de Ca(OH)2 de las paredes de los conductos.Introduction: There are currently many methods for removing calcium hydroxide from the root canals. Objective: To compare the use of Xp-Endo Finisher ® and passive ultrasonic irrigation (PUI) to remove calcium hydroxide from the surfaces of the root canals, specifically on teeth having two root canals in one root. Materials and methods: Twenty human teeth (specifically first and second lower molars) were used, which had as main requirement to present two root canals in the same root. The samples were cleaned and sealed; a radiographic analysis was done; the preparation of the ducts and subsequent medication were realized. Then, the medication was removed with two different methods, 10 teeth (20 root canals) with Xp-Endo Finisher ®, and another 10, with PUI. Then the teeth were cut in a lingual-vestibular or coronal direction and then analyzed on an Olympus CX31 microscope with an eye-catcher connected to the Micrometrics ® software to evaluate the calcium hydroxide remnant on the surfaces of the root canals. Statistical analysis was performed using the Shapiro-Wilk Test and the U deMann-Whitney Test. Results: In the cervical third there is no statistically significant evidence, but it was significant in the middle third, and especially in the apical, where the method of removal of calcium hydroxide by PUI was more effective. Conclusion: There is a difference between the two methods of removing CA (OH)2 from the surfaces of the root canal

Fluid inclusion study of the Boccassuolo VMS-related stockwork deposit (Northern-Apennine ophiolites, Italy)

Several Cyprus-type volcanogenic massive sulphide (VMS) deposits are found in the Jurassic ophiolitic series of the Northern Apennines. Stratabound, stratiform and stockwork deposits were formed in the western limb of the Neotethys (Ligurian Ocean) and are found today in basalt, gabbro and serpentinised peridotite host rocks. The studied stockwork deposit at Boccassuolo is found in basalt and basalt breccia. Detailed petrography, fluid inclusion study, Raman spectroscopy analyses and chlorite thermometry calculations were used to determine the P, T, X conditions of the fluid circulation system. The veins contain three quartz generations, calcite, chlorite, epidote and sericite as gangue minerals and pyrite, chalcopyrite, sphalerite, pyrrhotite and galena as ore minerals. Based on the fluid inclusion study, the earlier defined three vein types (1., 2. and 3.) precipitated from the same type of evolving fluid, though at slightly different stratigraphical positions. The determined ranges of temperature (370 60°C), salinity (6.2 11.4 NaCl equiv. wt%), pressure (30-44 MPa) ranges and methane content (average 0.28 mol/kg) suggest an evolved seawater origin for the hydrothermal fluid, modified by fluid-rock interaction and possibly by mixing of magmatic volatile. The fluid characteristics and the mineralogical observations have proven a slightly distal position in relation to the centre of the fluid flow for all studied locations, but less and more distal blocks were also recognised. The temporal evolution of the system developed into a low temperature event, occurring after the main mineral stage, but still participating to the same process as a whole.</p

Galois covers of the open p-adic disc

This paper investigates Galois branched covers of the open $p$-adic disc and their reductions to characteristic $p$. Using the field of norms functor of Fontaine and Wintenberger, we show that the special fiber of a Galois cover is determined by arithmetic and geometric properties of the generic fiber and its characteristic zero specializations. As applications, we derive a criterion for good reduction in the abelian case, and give an arithmetic reformulation of the local Oort Conjecture concerning the liftability of cyclic covers of germs of curves.Comment: 19 pages; substantial organizational and expository changes; this is the final version corresponding to the official publication in Manuscripta Mathematica; abstract update

Extention of Finite Solvable Torsors over a Curve

Let $R$ be a discrete valuation ring with fraction field $K$ and with algebraically closed residue field of positive characteristic $p$. Let $X$ be a smooth fibered surface over $R$ with geometrically connected fibers endowed with a section $x\in X(R)$. Let $G$ be a finite solvable $K$-group scheme and assume that either $|G|=p^n$ or $G$ has a normal series of length 2. We prove that every quotient pointed $G$-torsor over the generic fiber $X_{\eta}$ of $X$ can be extended to a torsor over $X$ after eventually extending scalars and after eventually blowing up $X$ at a closed subscheme of its special fiber $X_s$.Comment: 16 page

The Stillwater Complex chromitites : the response of chromite crystal chemistry to magma injection

Nineteen chromite crystals from the A, B, E, G, H, J and K chromitite layers of the Peridotite Zone of the Stillwater Complex (Montana, USA) have been studied by means of X-ray single crystal diffraction and microprobe analyses. The results show that samples from the basal A layer are quite different from the others showing very high oxygen positional parameter u (0.2633-0.2635) and Ti- contents (0.059-0.067apfu). Mg# values are within the range 0.21-0.23 while for the other chromites it is in the range 0.45-0.47. Moreover, for the other samples, according to the structural parameters, two groups have been identified. The first one comprises samples of layers B, E and G, the second includes H, J and K layer samples. It is supposed that high Fe2+ and Ti contents of A layer samples are due to the post-crystallization reaction with interstitial liquid. This fact allowed a very slow cooling rate as evidenced by the high u values. The fractionation of evolved magma from within the intrusion and pulse of a new magma bringing more chromium into the chamber lead to Cr- and Fe3+ -rich compositions and consequently to the increase of the cell edges. The decrease of u values seems to be related to the Cr+Fe3+ and/or Al contents

Mindfulness-based stress reduction in patients with interstitial lung diseases: a pilot, single-centre observational study on safety and efficacy

open11siBackground Chronic, progressive respiratory symptoms are associated with great psychological and emotional impact in patients suffering from interstitial lung disease (ILD). This single-centre pilot study evaluated for the first time the safety, feasibility and efficacy of a Mindfulness Based Stress Reduction Program (MBSR) in a group of patients with ILD. Methods Prospective observational study set in a university hospital ILD outpatient clinic. Nineteen patients with different ILDs were recruited 2 months prior to the start of the 8-week MBSR program and followed up for 12 months. Primary outcomes were program safety and feasibility, while secondary outcomes were changes in moods and stress (assessed by Profile Of Mood State (POMS) and Perceived Stress Scale (PSS) questionnaires), symptoms (Shortness Of Breath (SOB) and Cough And Sputum Assessment (CASA-Q) questionnaires), lung function and exercise tolerance at 12 months. Results Two patients (10.5%) dropped out in the observational period before the start of the MBSR intervention because of non-respiratory causes. All 17 patients who entered the 8-week MBSR program managed to complete it with an adherence average of eight sessions of nine. No adverse events related to the mindfulness training were reported. Statistically significant improvements in the POMS total score and in several individual items of POMS and PSS were observed throughout the study. However, respiratory questionnaire scores, lung function and exercise tolerance did not show a significant difference over time. Conclusions An MBSR program appears to be safe and feasible in patients with ILD, and might affect perceived moods and stress producing a positive and lasting improvement in several stress-related negative domains. These findings pave the way to larger (possibly multicentre), randomised, controlled confirmatory trials.openSgalla, Giacomo; Cerri, Stefania; Ferrari, Roberto; Ricchieri, Maria Pia; Poletti, Stefano; Ori, Margherita; Garuti, Martina; Montanari, Gloria; Luppi, Fabrizio; Petropulacos, Kyriakoula; Richeldi, LucaSgalla, Giacomo; Cerri, Stefania; Ferrari, Roberto; Ricchieri, Maria Pia; Poletti, Stefano; Ori, Margherita; Garuti, Martina; Montanari, Gloria; Luppi, Fabrizio; Petropulacos, Kyriakoula; Richeldi, Luc

Exotic accessory minerals in layered chromitites of the Campo Formoso complex (Brazil)

The Campo Formoso stratiform intrusive complex, in Bahia State, Brazil, considered to be of Paleoproterozoic age, consists of a tabular body of ultramafic rocks about 40 km long and 100-1100 m wide. Thick horizons of chromitite are exploited and the deposits are the richest in Brazil. The complex was intruded by the Campo Formoso calc-alkaline batholith, emplaced by the result of the Transamazonian collision-related orogeny. The peridotite was firstly thoroughly serpentinized, then affected by a renewed cycle of hydrothermal alteration as the batholith cooled, leading in the roof zone to emerald mineralization around roof pendants. An even later influx of fluid led to the formation of talc, silica and carbonates, such that the ultramafic rocks were locally converted to listwanite. The chromitite sequences are highly unusual in containing rather exotic minerals, such as monazite-(La), monazite-(Ce), apatite, galena, bismuthinite, antimony, and three unknown minerals of stoichiometry PbSb2, Pb Sb and PbSb4, all associated with the clinochlore. The latter phases may have formed during hydrothermal activity in the system Pb-Sb. The presence of these exotic minerals in chromitite, which makes this occurrence unique in the world, strongly support the hypothesis that the La, Ce, P, Pb, Bi and Sb were metasomatically added to the Campo Formoso chromitite horizons by hydrothermal fluids emanating from the nearby Campo Formoso calc-alkaline batholith as it cooled