Monitoring for Delirium in the Intensive Care Unit Following the Introduction of the Confusion Assessment Method for the Intensive Care Unit

PURPOSE: The goals of this study were to: improve delirium recognition by implementing the Confusion Assessment Method for the ICU (CAM-ICU), evaluate adherence to routine delirium monitoring, measure the incidence of CAM-positive patients, and measure the use of analgesic and sedative medications in ICU patients. METHODS: This study was a single-center post-implementation retrospective medical record review examining the adherence and incidence of delirium after the introduction of the CAM-ICU assessment on the surgical ICU. Prior to the beginning of the study the surgical ICU nurses were educated on how to assess for delirium using the CAM-ICU instrument. During the six week study the following data were collected: adherence to delirium monitoring through documentation, incidence of CAM-positive patients, and sedation and analgesic medication usage. The sample consisted of seventy-six patients that were admitted to the surgical ICU between September 6, 2016 and October 18, 2016. RESULTS: Thirty-two (58.1%) patients had the CAM-ICU assessment completed once a shift at the 48-hour evaluation and twenty-two (81.4%) patients during the 96-hour evaluation. Five (9%) patients were CAM-positive at the 48-hour and one (3.7%) at the 96-hour evaluation. The 48-hour time interval had the highest average number of dosages for analgesic medications at 2.3 (29.4%) for CAM-negative patients. CAM-positive analgesic medications usage increased progressively, peaking at the 72-hour interval with the average dose at 3.6 (32.1%). With regards to sedative medications, CAM-negative patients had the highest average number of dosages, 1.9 (30.2%), at the 48-hour interval. For CAM-positive patients the use of sedative medications peaked at the 24-hour interval and then decreased at the 48-hour time frame; after which sedative medication usage rose steadily from the 48 through 96-hour interval. CONCLUSION: Required routine delirium monitoring should occur per evidence-based practice guidelines for all ICU patients. The incidence of delirium in this study was found to be low, at 9%, when compared to previous studies on delirium. No statistically significant conclusions could be drawn from this study. Factors that could have contributed to this low incidence of delirium in these specific patients could have been the relative young age of the patients (mean age of 53.2) and the possible lower severity of illness, both of these factors influence the risk of delirium development. In conclusion, this single study may have found a low incidence of delirium among these specific ICU patients but many previous studies have determined that the incidence of delirium is much higher

An inactivated vaccine made from a U.S. field isolate of porcine epidemic disease virus is immunogenic in pigs as demonstrated by a dose-titration

Citation: Collin, E. A., Anbalagan, S., Okda, F., Batman, R., Nelson, E., & Hause, B. M. (2015). An inactivated vaccine made from a U.S. field isolate of porcine epidemic disease virus is immunogenic in pigs as demonstrated by a dose-titration. BMC Veterinary Research, 11(1). doi:10.1186/s12917-015-0357-1Background: Porcine epidemic diarrhea virus (PEDV), a highly pathogenic and transmissible virus in swine, was first detected in the U.S. in May, 2013, and has caused tremendous losses to the swine industry. Due to the difficulty in isolating and growing this virus in cell culture, few vaccine studies using cell culture propagated PEDV have been performed on U.S. strains in pigs. Therefore, the objective of this study was to evaluate the humoral immune response to the selected inactivated PEDV vaccine candidate in a dose-titration manner. Results: PEDV was isolated from a pig with diarrhea and complete genome sequencing found >99% nucleotide identity to other U.S. PEDV. Inactivated adjuvanted monovalent vaccines were administered intramuscularly to five week old pigs in a dose titration experimental design, ranging from 6.0-8.0 log10 tissue culture infective dose (TCID50/mL), to evaluate immunogenicity using a fluorescent foci neutralization assay (FFN), fluorescent microsphere immunoassay (FMIA), and enzyme-linked immunosorbent assay (ELISA) on sera. Pigs vaccinated with 8.0 log10 TCID50/mL inactivated virus showed significantly higher FFN titers as well as FMIA and ELISA values than 6.0 log10 TCID50/mL vaccinates and the negative controls. Conclusions: These results demonstrate the immunogenicity of a PEDV inactivated viral vaccine with a U.S. strain via dose-titration. A future vaccination-challenge study would illustrate the efficacy of an inactivated vaccine and help evaluate protective FFN titers and ELISA and FMIA responses. © Collin et al; licensee BioMed Central

A Single-Arm, Proof-Of-Concept Trial of Lopimune (Lopinavir/Ritonavir) as a Treatment for HPV-Related Pre-Invasive Cervical Disease

BACKGROUND: Cervical cancer is the most common female malignancy in the developing nations and the third most common cancer in women globally. An effective, inexpensive and self-applied topical treatment would be an ideal solution for treatment of screen-detected, pre-invasive cervical disease in low resource settings. METHODS: Between 01/03/2013 and 01/08/2013, women attending Kenyatta National Hospital's Family Planning and Gynaecology Outpatients clinics were tested for HIV, HPV (Cervista®) and liquid based cervical cytology (LBC -ThinPrep®). HIV negative women diagnosed as high-risk HPV positive with high grade squamous intraepithelial lesions (HSIL) were examined by colposcopy and given a 2 week course of 1 capsule of Lopimune (CIPLA) twice daily, to be self-applied as a vaginal pessary. Colposcopy, HPV testing and LBC were repeated at 4 and 12 weeks post-start of treatment with a final punch biopsy at 3 months for histology. Primary outcome measures were acceptability of treatment with efficacy as a secondary consideration. RESULTS: A total of 23 women with HSIL were treated with Lopimune during which time no adverse reactions were reported. A maximum concentration of 10 ng/ml of lopinavir was detected in patient plasma 1 week after starting treatment. HPV was no longer detected in 12/23 (52.2%, 95%CI: 30.6-73.2%). Post-treatment cytology at 12 weeks on women with HSIL, showed 14/22 (63.6%, 95%CI: 40.6-82.8%) had no dysplasia and 4/22 (18.2%, 95%CI: 9.9-65.1%) were now low grade demonstrating a combined positive response in 81.8% of women of which 77.8% was confirmed by histology. These data are supported by colposcopic images, which show regression of cervical lesions. CONCLUSIONS: These results demonstrate the potential of Lopimune as a self-applied therapy for HPV infection and related cervical lesions. Since there were no serious adverse events or detectable post-treatment morbidity, this study indicates that further trials are clearly justified to define optimal regimes and the overall benefit of this therapy. TRIAL REGISTRATION: ISRCTN Registry 48776874

КЛІНІКО-ДІАГНОСТИЧНІ МАРКЕРИ РАННЬОЇ ДІАГНОСТИКИ ВНУТРІШНЬОУТРОБНИХ ІНФЕКЦІЙ У НЕДОНОШЕНИХ НОВОНАРОДЖЕНИХ.

Prenatal infection at the present stage are one of the major problems of obstetrics and perinatology. Issues of diagnosis, treatment and prevention of prenatal infections to date have not been studied sufficiently, and still remain part of the modern perinatology, which requires in-depth study. Therefore, the aim of our study was to investigate clinical and laboratory markers for early diagnosis of prenatal infection in premature newborns. In the course of the study were examined 43 premature newborn child at the age of 1 day and again on the 15th day, conducted a retrospective analysis of medical and obstetric history of the mothers of these newborns. Studies have shown a role of maternal infection not only in the formation of a complicated pregnancy, premature birth, and in the development of prenatal infection, intrauterine development of the fetus, but also in reducing the adaptive capacity of the newborn in the early neonatal period. To improve the effectiveness of early diagnosis of prenatal infection in premature newborns born to mothers with risk factors, it is recommended to take cord blood at birth and venous blood at birth and again at 15th day to identify the etiology of prenatal infections by polymerase chain reaction.Внутриутробные инфекции (ВУИ) на современном этапе являются одной из важнейших проблем акушерства и перинатологии. Вопросы диагностики, лечения и профилактики ВУИ до настоящего времени не изучены в достаточной мере и по-прежнему остаются той частью современной перинатологии, которая требует всестороннего изучения. Поэтому целью нашего исследования было изучить клинико-лабораторные маркеры ранней диагностики внутриутробных инфекций у недоношенных детей. В процессе исследования было обследовано 43 недоношенных новорожденных ребенка в возрасте 1-х суток и повторно на 15-е сутки, проведен ретроспективный анализ соматического и акушерско-гинекологического анамнеза матерей этих новорожденных. Проведенные исследования свидетельствуют о роли материнской инфекции не только в формировании осложненной беременности, преждевременных родов, в развитии внутриутробного инфицирования, задержки внутриутробного развития плода, но и в снижении адаптивных возможностей новорожденного в раннем неонатальном периоде. С целью повышения эффективности ранней диагностики ВУИ недоношенным детям, родившимся от матерей с факторами риска, рекомендуется взятие пуповинной крови на момент рождения и венозной крови на момент рождения и повторно на 15-е сутки на предмет выявления этиологии ВУИ методом полимеразной цепной реакции.Внутрішньоутробні інфекції (ВУІ) на сучасному етапі є однією з найважливіших проблем акушерства та перинатології. Питання діагностики, лікування та профілактики ВУІ досі не вивчені достатньою мірою та, як і раніше, залишаються тією частиною сучасної перинатології, яка потребує всебічного вивчення. Тому метою нашого дослідження було вивчити клініко-лабораторні маркери ранньої діагностики внутрішньоутробних інфекцій у недоношених дітей. У процесі дослідження було обстежено 43 недоношених новонароджених дитини віком 1-х діб і повторно на 15-ту добу, проведено ретроспективний аналіз соматичного та акушерсько-гінекологічного анамнезу матерів цих новонароджених. Проведені дослідження свідчать про роль материнської інфекції не тільки у формуванні ускладненої вагітності, передчасних пологів, у розвитку внутрішньоутробного інфікування, затримки внутрішньоутробного розвитку плода, але і в зниженні адаптивних можливостей новонародженого в ранньому неонатальному періоді. З метою підвищення ефективності ранньої діагностики ВУІ недоношеним дітям, які народилися від матерів з факторами ризику, рекомендується взяття пуповинної крові на момент народження та венозної крові на момент народження і повторно на 15-ту добу на предмет виявлення етіології ВУІ методом полімеразної ланцюгової реакції

Technical assessment of the Office of Industrial Programs' Advanced Heat Exchanger Program

The DOE's AHX Program is an integral part of the OIP's Waste Heat Recovery Program whose goals are to increase the end-use energy efficiency of industry and agricultural operations, and to expand the energy options for manufacturing processes by providing technologies which use various fuels including coal, renewables, oil, and natural gas. The OIP and PNL convened a panel of industry experts to conduct a technical assessment of OIP's AHX program. This report documents the results of the panel's assessment

Degradation of Spacesuit Fabrics in Low Earth Orbit

Six samples of pristine and dust-abraded outer layer spacesuit fabrics were included in the Materials International Space Station Experiment-7, in which they were exposed to the wake-side low Earth orbit environment on the International Space Station (ISS) for 18 months in order to determine whether abrasion by lunar dust increases radiation degradation. The fabric samples were characterized using optical microscopy, optical spectroscopy, field emission scanning electron microscopy, atomic force microscopy, and tensile testing before and after exposure on the ISS. Comparison of pre- and post-flight characterizations showed that the environment darkened and reddened all six fabrics, increasing their integrated solar absorptance by 7 to 38 percent. There was a decrease in the ultimate tensile strength and elongation to failure of lunar dust abraded Apollo spacesuit fibers by a factor of four and an increase in the elastic modulus by a factor of two

Neurochemical Metabolomics Reveals Disruption to Sphingolipid Metabolism Following Chronic Haloperidol Administration

Haloperidol is an effective antipsychotic drug for treatment of schizophrenia, but prolonged use can lead to debilitating side effects. To better understand the effects of long-term administration, we measured global metabolic changes in mouse brain following 3 mg/kg/day haloperidol for 28 days. These conditions lead to movement-related side effects in mice akin to those observed in patients after prolonged use. Brain tissue was collected following microwave tissue fixation to arrest metabolism and extracted metabolites were assessed using both liquid and gas chromatography mass spectrometry (MS). Over 300 unique compounds were identified across MS platforms. Haloperidol was found to be present in all test samples and not in controls, indicating experimental validity. Twenty-one compounds differed significantly between test and control groups at the p < 0.05 level. Top compounds were robust to analytical method, also being identified via partial least squares discriminant analysis. Four compounds (sphinganine, N-acetylornithine, leucine and adenosine diphosphate) survived correction for multiple testing in a non-parametric analysis using false discovery rate threshold < 0.1. Pathway analysis of nominally significant compounds (p < 0.05) revealed significant findings for sphingolipid metabolism (p = 0.02) and protein biosynthesis (p = 0.03). Altered sphingolipid metabolism is suggestive of disruptions to myelin. This interpretation is supported by our observation of elevated N-acetylaspartylglutamate in the haloperidol-treated mice (p = 0.004), a marker previously associated with demyelination. This study further demonstrates the utility of murine neurochemical metabolomics as a method to advance understanding of CNS drug effects

Behavioral metabolomics analysis identifies novel neurochemical signatures in methamphetamine sensitization: Methamphetamine sensitization metabolomics

Behavioral sensitization has been widely studied in animal models and is theorized to reflect neural modifications associated with human psychostimulant addiction. While the mesolimbic dopaminergic pathway is known to play a role, the neurochemical mechanisms underlying behavioral sensitization remain incompletely understood. In the present study, we conducted the first metabolomics analysis to globally characterize neurochemical differences associated with behavioral sensitization. Methamphetamine-induced sensitization measures were generated by statistically modeling longitudinal activity data for eight inbred strains of mice. Subsequent to behavioral testing, nontargeted liquid and gas chromatography-mass spectrometry profiling was performed on 48 brain samples, yielding 301 metabolite levels per sample after quality control. Association testing between metabolite levels and three primary dimensions of behavioral sensitization (total distance, stereotypy and margin time) showed four robust, significant associations at a stringent metabolome-wide significance threshold (false discovery rate < 0.05). Results implicated homocarnosine, a dipeptide of GABA and histidine, in total distance sensitization, GABA metabolite 4-guanidinobutanoate and pantothenate in stereotypy sensitization, and myo-inositol in margin time sensitization. Secondary analyses indicated that these associations were independent of concurrent methamphetamine levels and, with the exception of the myo-inositol association, suggest a mechanism whereby strain-based genetic variation produces specific baseline neurochemical differences that substantially influence the magnitude of MA-induced sensitization. These findings demonstrate the utility of mouse metabolomics for identifying novel biomarkers, and developing more comprehensive neurochemical models, of psychostimulant sensitization

Addressing Cervical Cancer Disparities in Texas: Expansion of a Community-Based Prevention initiative For Medically Underserved Populations

Although cervical cancer is preventable, significant disparities exist in access to screening and prevention services. In medically underserved areas (MUAs) of Texas, these rates are 55% higher compared to the remainder of the US. In 2019, we expanded a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. Hands-on training courses to learn these skills are coupled with biweekly telementoring conferences using Project ECHO® (Extension for Community Healthcare Outcomes). This program was implemented in 2015 and expanded to other MUAs in Texas in 2019. From March 2019 to August 2022, 75,842 individuals were educated about cervical cancer screening and HPV vaccination. A total of 44,781 women underwent screening for cervical cancer, and 2,216 underwent colposcopy and 264 underwent LEEP. High-grade cervical dysplasia was diagnosed in 658 individuals and invasive cervical cancer in 33 individuals. We trained 22 providers to perform colposcopy and/or LEEP. In addition, 78 Project ECHO telementoring sessions were held with an average of 42 attendees per session, with 72 individual patient cases discussed. Our comprehensive community-based prevention initiative for medically underserved populations has led to a significant number of individuals undergoing cervical cancer screening in MUAs, as well as improved access to colposcopy and LEEP services