The outcome of extubation failure in a community hospital intensive care unit: a cohort study

INTRODUCTION: Extubation failure has been associated with poor intensive care unit (ICU) and hospital outcomes in tertiary care medical centers. Given the large proportion of critical care delivered in the community setting, our purpose was to determine the impact of extubation failure on patient outcomes in a community hospital ICU. METHODS: A retrospective cohort study was performed using data gathered in a 16-bed medical/surgical ICU in a community hospital. During 30 months, all patients with acute respiratory failure admitted to the ICU were included in the source population if they were mechanically ventilated by endotracheal tube for more than 12 hours. Extubation failure was defined as reinstitution of mechanical ventilation within 72 hours (n = 60), and the control cohort included patients who were successfully extubated at 72 hours (n = 93). RESULTS: The primary outcome was total ICU length of stay after the initial extubation. Secondary outcomes were total hospital length of stay after the initial extubation, ICU mortality, hospital mortality, and total hospital cost. Patient groups were similar in terms of age, sex, and severity of illness, as assessed using admission Acute Physiology and Chronic Health Evaluation II score (P > 0.05). Both ICU (1.0 versus 10 days; P < 0.01) and hospital length of stay (6.0 versus 17 days; P < 0.01) after initial extubation were significantly longer in reintubated patients. ICU mortality was significantly higher in patients who failed extubation (odds ratio = 12.2, 95% confidence interval [CI] = 1.5–101; P < 0.05), but there was no significant difference in hospital mortality (odds ratio = 2.1, 95% CI = 0.8–5.4; P < 0.15). Total hospital costs (estimated from direct and indirect charges) were significantly increased by a mean of US$33,926 (95$22,573–45,280; P < 0.01). CONCLUSION: Extubation failure in a community hospital is univariately associated with prolonged inpatient care and significantly increased cost. Corroborating data from tertiary care centers, these adverse outcomes highlight the importance of accurate predictors of extubation outcome

Modeling the impediment of methane ebullition bubbles by seasonal lake ice

Microbial methane (CH4) ebullition (bubbling) from anoxic lake sediments comprises a globally significant flux to the atmosphere, but ebullition bubbles in temperate and polar lakes can be trapped by winter ice cover and later released during spring thaw. This "ice-bubble storage" (IBS) constitutes a novel mode of CH4 emission. Before bubbles are encapsulated by downward-growing ice, some of their CH4 dissolves into the lake water, where it may be subject to oxidation. We present field characterization and a model of the annual CH4 cycle in Goldstream Lake, a thermokarst (thaw) lake in interior Alaska. We find that summertime ebullition dominates annual CH4 emissions to the atmosphere. Eighty percent of CH4 in bubbles trapped by ice dissolves into the lake water column in winter, and about half of that is oxidized. The ice growth rate and the magnitude of the CH4 ebullition flux are important controlling factors of bubble dissolution. Seven percent of annual ebullition CH4 is trapped as IBS and later emitted as ice melts. In a future warmer climate, there will likely be less seasonal ice cover, less IBS, less CH4 dissolution from trapped bubbles, and greater CH4 emissions from northern lakes

Microsaccades reflect the dynamics of misdirected attention in magic

The methods of magicians provide powerful tools for enhancing the ecological validity of laboratory studies of attention. The current research borrows a technique from magic to explore the relationship between microsaccades and covert attention under near-natural viewing conditions. We monitored participants’ eye movements as they viewed a magic trick where a coin placed beneath a napkin vanishes and reappears beneath another napkin. Many participants fail to see the coin move from one location to the other the first time around, thanks to the magician’s misdirection. However, previous research was unable to distinguish whether or not participants were fooled based on their eye movements. Here, we set out to determine if microsaccades may provide a window into the efficacy of the magician’s misdirection. In a multi-trial setting, participants monitored the location of the coin (which changed positions in half of the trials), while engaging in a delayed match-to-sample task at a different spatial location. Microsaccades onset times varied with task difficulty, and microsaccade directions indexed the locus of covert attention. Our com-bined results indicate that microsaccades may be a useful metric of covert attentional processes in applied and ecologically valid settings

Responses of non-native earthworms to experimental eradication of garlic mustard and implications for native vegetation

Recent studies in invasion biology suggest that positive feedback among two or more introduced organisms facilitate establishment within a new range and drive changes in native plant communities. Here, we experimentally tested for relationships between native plants and two non‐native organisms invading forest habitats in North America: garlic mustard (Alliaria petiolata, Brassicaceae) and earthworms. In two forested sites, we compared understory vegetation and earthworm biomass in plots where garlic mustard was removed for three years, plots without garlic mustard invasion, and plots invaded by garlic mustard that was not removed. Earthworm biomass was highest in the plots with garlic mustard, and long‐term eradication of garlic mustard reduced earthworm biomass to levels similar to those observed in the uninvaded control plots. Invasion treatment, and the interactions between earthworm biomass and treatment, explained most of the variation in plant community composition and diversity—suggesting that earthworms alone do not necessarily drive forest understory floristic patterns. In contrast to broader geographic patterns indicating earthworms as the main driver of vegetation change in the presence of non‐native plants, we show that garlic mustard solely, or in conjunction with earthworm biomass, drives changes in native plant composition and diversity at the scale of individual forests. From a local management perspective, our data suggest that garlic mustard eradication can directly assist in the conservation of native plant communities and simultaneously reduce earthworm biomass

Hyperspectral microarray scanning: impact on the accuracy and reliability of gene expression data

BACKGROUND: Commercial microarray scanners and software cannot distinguish between spectrally overlapping emission sources, and hence cannot accurately identify or correct for emissions not originating from the labeled cDNA. We employed our hyperspectral microarray scanner coupled with multivariate data analysis algorithms that independently identify and quantitate emissions from all sources to investigate three artifacts that reduce the accuracy and reliability of microarray data: skew toward the green channel, dye separation, and variable background emissions. RESULTS: Here we demonstrate that several common microarray artifacts resulted from the presence of emission sources other than the labeled cDNA that can dramatically alter the accuracy and reliability of the array data. The microarrays utilized in this study were representative of a wide cross-section of the microarrays currently employed in genomic research. These findings reinforce the need for careful attention to detail to recognize and subsequently eliminate or quantify the presence of extraneous emissions in microarray images. CONCLUSION: Hyperspectral scanning together with multivariate analysis offers a unique and detailed understanding of the sources of microarray emissions after hybridization. This opportunity to simultaneously identify and quantitate contaminant and background emissions in microarrays markedly improves the reliability and accuracy of the data and permits a level of quality control of microarray emissions previously unachievable. Using these tools, we can not only quantify the extent and contribution of extraneous emission sources to the signal, but also determine the consequences of failing to account for them and gain the insight necessary to adjust preparation protocols to prevent such problems from occurring

Installation of a drum-out port in a nuclear facility

The Plutonium Facility at Los Alamos National Laboratory is constantly undergoing decommissioning of processing equipment to keep up with new technology and improving process equipment to accommodate customer needs. The old process equipment that is decommissioned has been exposed to radioactive materials and has to be disposed of a s TRU-waste. The bag-out process that was used for removing contaminated equipment pieces was very time consuming and exposed glovebox workers to hazardous radiation. This was due to a small size of the bag-out port, which limited the size of the pieces to fit through the port, and consequently increased the number of pieces and bag-outs that had to be performed

Role of Multimodal Cardiac Imaging in Diagnosing a Primary Intimal Sarcoma of the Left Atrial Appendage

Primary cardiac tumors are rare, and most are benign. Intimal sarcomas are among the rarest of the malignant cardiac tumors; they are aggressive and associated with a poor prognosis. Whereas transesophageal echocardiography has been instrumental in evaluating cardiac masses, other imaging methods, such as cardiac magnetic resonance, have proved invaluable in accurately characterizing these masses. We present the case of a 49-year-old woman in whom we diagnosed a primary intimal sarcoma of the left atrial appendage, and we discuss the importance of multimodal imaging in the evaluation and diagnosis of cardiac masses

Phase synchronization of a two-channel phase-sensitive amplifier based on optical injection-locking of InP quantum-dash mode-locked lasers

A synchronization scheme for a two-channel phase sensitive amplifier is implemented based on the injection-locking of single InP quantum-dash mode-locked laser. Error free performance with penalty <1 dB is demonstrated for both channels

An observational prospective study of topical acidified nitrite for killing methicillin-resistant Staphylococcus aureus (MRSA) in contaminated wounds

Background Endogenous nitric oxide (NO) kills bacteria and other organisms as part of the innate immune response. When nitrite is exposed to low pH, NO is generated and has been used as an NO delivery system to treat skin infections. We demonstrated eradication of MRSA carriage from wounds using a topical formulation of citric acid (4.5%) and sodium nitrite (3%) creams co-applied for 5 days to 15 wounds in an observational prospective pilot study of 8 patients. Findings Following treatment with topical citric acid and sodium nitrite, 9 of 15 wounds (60%) and 3 of 8 patients (37%) were cleared of infection. MRSA isolates from these patients were all sensitive to acidified nitrite in vitro compared to methicillin-sensitive S. aureus and a reference strain of MRSA. Conclusions Nitric oxide and acidified nitrite offer a novel therapy for control of MRSA in wounds. Wounds that were not cleared of infection may have been re-contaminated or the bioavailability of acidified nitrite impaired by local factors in the tissue