Delirium in hospitalised adults with acute burns – A systematic review

Introduction: Delirium is a potentially modifiable, acutely altered mental state, commonly characterised as a hospital-acquired complication. Studies of adult inpatients with acute burns with and without delirium identify causative risks related to the injury or treatment and outcomes related to the patient and healthcare system. We compare patients with and without delirium, providing a high-level quantitative synthesis of delirium risks and outcomes to inform guidelines and future research. Methods: A systematic review, meta-analysis and GRADE evaluation of risks and outcomes associated with delirium in adults with acute burns was conducted using PRISMA guidelines and PROSPERO protocol CRD42021283055. The Newcastle-Ottawa Scale was used to assess quality. Results: Investigators reviewed ten studies. ASA score ≥ 3, Total Body Surface Area Percentage (TBSA) \u3e 10%, surgery done, ICU admission, hospital and also Intensive Care Unit (ICU) lengths of stay all had statistically significant associations with delirium, with low-very low certainty on GRADE evaluation. Limitations were heterogeneous studies, review methodology and study bias. Conclusion: Delirium represents a significant risk to comorbid patients with burns that are hospitalised, receive ICU care, and surgery. Further research is indicated to precisely categorise delirium along the clinical journey to identify modifiable factors, prevention, and proactive therapy

Water deficit and nitrogen nutrition of crops. A review

Among the environmental factors that can be modified by farmers, water and nitrogen are the main ones controlling plant growth. Irrigation and fertilizer application overcome this effect, if adequately used. Agriculture thus consumes about 85% of the total fresh water used worldwide. While only 18% of the world’s cultivated areas are devoted to irrigated agriculture, this total surface represents more than 45% of total agricultural production. These data highlight the importance of irrigated agriculture in a framework where the growing population demands greater food production. In addition, tighter water restrictions and competition with other sectors of society is increasing pressure to diminish the share of fresh water for irrigation, thus resulting in the decrease in water diverted for agriculture.The effect of water and nutrient application on yield has led to the overuse of these practices in the last decades. This misuse of irrigation and fertilizers is no longer sustainable, given the economic and environmental costs. Sustainable agriculture requires a correct balance between the agronomic, economic and environmental aspects of nutrient management. The major advances shown in this review are the following: (1) the measurement of the intensity of drought and N deficiency is a prerequisite for quantitative assessment of crop needs and management of both irrigation and fertilizer application. The N concentration of leaves exposed to direct irradiance allows both a reliable and high-resolution measurement of the status and the assessment of N nutrition at the plant level. (2) Two experiments on sunflower and on tall fescue are used to relate the changes in time and irrigation intensity to the crop N status, and to introduce the complex relationships between N demand and supply in crops. (3) Effects of water deficits on N demand are reviewed, pointing out the high sensitivity of N-rich organs versus the relative lesser sensitivity of organs that are poorer in N compounds. (4) The generally equal sensitivities of nitrifying and denitrifying microbes are likely to explain many conflicting results on the impact of water deficits on soil mineral N availability for crops. (5) The transpiration stream largely determines the availability of mineral N in the rhizosphere. This makes our poor estimate of root densities a major obstacle to any precise assessment of N availability in fertilized crops. (6) The mineral N fluxes in the xylem are generally reduced under water deficit and assimilation is generally known to be more sensitive to water scarcity. (7) High osmotic pressures are maintained during grain filling, which enables the plant to recycle large amounts of previously assimilated N. Its part in the total grain N yield is therefore generally higher under water deficits. (8) Most crop models currently used in agronomy use N and water efficiently but exhibit different views on their interaction

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

10.1371/journal.pone.0139981PLoS ONE1010e013998

Multi-messenger Observations of a Binary Neutron Star Merger

International audienceOn 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of $\sim 1.7\,{\rm{s}}$ with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg(2) at a luminosity distance of ${40}_{-8}^{+8}$ Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 $\,{M}_{\odot }$. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at $\sim 40\,{\rm{Mpc}}$) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ∼10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position $\sim 9$ and $\sim 16$ days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC 4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta