Recognizing Delirium in the PICU: An Evidence-based Practice Improvement Project

Introduction: Pediatric delirium is underrecognized in the pediatric population and can lead to increased length of stay, hospital costs, and post-traumatic stress disorder (PTSD). Using a standardized screening tool to assess for delirium is an easy way for bedside nurses to evaluate patients and intervene as necessary. This quality improvement project aimed to implement the Cornell Assessment of Pediatric Delirium (CAPD) and complete a delirium screening on applicable patients once a shift \u3e 85% over four months. Methods: Between January 2020 to May 2020, bedside nurses completed a delirium screening assessment on applicable patients, first on paper and then through the electronic medical record (EMR). A retrospective chart review was conducted every two weeks to assess compliance and demographic data such as hospital length of stay, length of mechanical ventilation, Midazolam usage, and CAPD scores. Results: By the fourth week of implementation, 85% of nurses were compliant with screening. The aim was met and continued above 85% throughout the project. A positive delirium screen of more than 48 hours statistically increased length of stay (P \u3c .001). The average CAPD score pre-intervention to post-intervention and during and after intubation was significantly lower (P = .016 and P = .001, respectively). Conclusions: Providing the delirium screening tool in the Electronic Medical Record (EMR) increases compliance and ensures that the providers acknowledge the positive delirium screens. While the screen’s implementation was successful, additional measures are needed to manage and prevent delirium and improve patient care

Factor V Leiden and thrombosis in patients with systemic lupus erythematosus: a meta-analysis.

The aim of this study was to perform a meta-analysis of the association between the factor V Leiden polymorphism (FVL) and thrombosis among patients with systemic lupus erythematosus (SLE) and/or antiphospholipid antibody (aPL) positivity. Included studies recruited patients based on SLE or aPL-positive status, confirmed subjects' SLE diagnosis as defined by the American College of Rheumatology, and documented thrombotic events. Excluded studies were non-English or considered only arterial thrombosis. Individual patient data, available from 5 studies, together with unpublished data from 1210 European-American SLE patients from the UCSF Lupus Genetics Collection genotyped for FVL, were further analyzed. Seventeen studies (n=2090 subjects) were included in the initial meta-analysis. Unadjusted odds ratios (OR) were calculated to assess association of FVL with thrombosis. The OR for association of thrombosis with FVL was 2.88 (95% confidence interval (CI) 1.98-4.20). In the secondary analysis with our individual patient dataset (n=1447 European-derived individuals), SLE subjects with the FVL polymorphism still had more than two times the odds of thrombosis compared to subjects without this polymorphism, even when adjusting for covariates such as gender, age and aPL status. SLE and/or aPL-positive patients with the FVL variant have more than two times the odds of thrombosis compared to those without this polymorphism

Real time leak detection and isolation in pipelines: a comparison between Sliding Mode Observer and algebraic steady state method

The purpose of this paper is to compare two different algorithms used to detect and isolate water leaks in a pipeline. One method is based on a Sliding Mode Observer and the second method is an Algebraic method obtained from the pipeline model in steady state. Because of the simplicity of both methods, they can be easily implemented. The methods were tested offline with real time data and the Algebraic method was also implemented online. Satisfactory results are shown through some experiments.Consejo Nacional de Ciencia y Tecnologí

Conserved metabolite regulation of stress granule assembly via AdoMet

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Begovich, K., Vu, A. Q., Yeo, G., & Wilhelm, J. E. Conserved metabolite regulation of stress granule assembly via AdoMet. Journal of Cell Biology, 219(8), (2020): e201904141, doi:10.1083/jcb.201904141.Stress granules (SGs) are evolutionarily conserved condensates of ribonucleoproteins that assemble in response to metabolic stresses. Because aberrant SG formation is associated with amyotrophic lateral sclerosis (ALS), understanding the connection between metabolic activity and SG composition can provide therapeutic insights into neurodegeneration. Here, we identify 17 metabolic enzymes recruited to yeast SGs in response to physiological growth stress. Furthermore, the product of one of these enzymes, AdoMet, is a regulator of SG assembly and composition. Decreases in AdoMet levels increase SG formation, while chronic elevation of AdoMet produces SG remnants lacking proteins associated with the 5′ end of transcripts. Interestingly, acute elevation of AdoMet blocks SG formation in yeast and motor neurons. Treatment of ALS-derived motor neurons with AdoMet also suppresses the formation of TDP-43–positive SGs, a hallmark of ALS. Together, these results argue that AdoMet is an evolutionarily conserved regulator of SG composition and assembly with therapeutic potential in neurodegeneration.Work from the Wilhelm laboratory was supported by a grant to J.E. Wilhelm from the Collaborative Innovation Awards program of Howard Hughes Medical Institute and the James Wilhelm Memorial Fund. K. Begovich is a Howard Hughes Medical Institute Gilliam Fellow. Work from the Yeo laboratory was supported by grants to G. Yeo from the National Institutes of Health (HG004659), Target ALS (20193440), and the ALS Association (272 and 438)

An algebraic observer for leak detection and isolation in plastic pipelines

In the continuation of authors' studies on leak diagnosis in pipelines, a new model-based Leak Detection and Isolation (LDI) algorithm is designed. This system only uses measures of flow and pressure coming from sensors placed at the ends of a pipeline. The present approach is based on a finite nonlinear pipeline model, and extended with variables related to the leak. On this basis, the purpose here is to investigate the use of a so-called algebraic observer to estimate the leak position and its magnitude. The corresponding observer design is thus presented, and its performances are illustrated both with simulation results, and experimental ones, with data taken from a real pipeline prototype.Consejo Nacional de Ciencia y TecnologíaInstitut Universitaire de FranceUniversidad Nacional de Colombi

Real Time Leak Isolation in Pipelines Based on a Time Delay Neural Network

In this paper, the one leak isolation problem in a water pipeline is tackled using a Time Delay Neural Network. This scheme comes as an alternative to achieve better computing performance since the classical model-based methods usually have high workloads due to the pipe mathematical model complexity compared with the leak dynamics speed. The Neural Network structure could have better time performance exploiting the parallel architecture of some electronics devices like an FPGA. The authors propose a scheme where, due to the difficulty in obtaining training data from a real pipeline, a mathematical model is used to generate synthetic training data. Such training data is obtained using different leak magnitudes and leak positions and it is also corrupted by random noise in order to emulate real data pipe. Finally, to show the potentiality of this method, some results are presented by using real-noisy databases coming from a pipeline prototype.Following the classical leak diagnosis hypothesis, only flow and pressure sensor at both ends of the aqueducts are used for the treatment.ITESO, A.C

Inactivation of Eα and Eβ expression in inbred and wild mice by multiple distinct mutations, some of which predate speciation within Mus species

The H-2 MHC of mice encodes two functional class II heterodimeric proteins: AαAβ (A) and EαEβ (E). While failure to express the A protein has not been reported, a significant proportion of of H-2 haplotypes In both Inbred and wild mice do not express E proteins. We and others have previously characterized the molecular basis for defective E expression in haplotypes from Mus domestlcus (b, f, q, s, from inbred strains) and Af. castaneus (w17, wild-derived) species, identifying six distinct defects in the genes for Eα or Eβ. In this report we have extended these studies to other E- haplotypes, Including several from f-haplotype-bearlng M. domesticus mice (w29, w57, w302) and one derived from the Asian species M. bactrianus (w301). Analyses at the protein, RNA and DNA levels were employed to Identify the defects in the genes for Ea and Eb. At least one new defect was identified that prevents Eβ expression in a t-associated H-2 haplotypes (w57), bringing the number of distinct mutations causing the Eβ phenotype to seven. Another t-associated haplotype, w302, was found to share the same Eβ defect with mice of the inbred q haplotype and of the w17 haplotype from Af. castaneus, while its Ea gene contains the deletion carried also by the Inbred b and s haplotypes and by a number of wild haplotypes. The mutations in the Ea and Eb genes of the w301 haplotype from M. bactrianus were found to be Identical to those of the Inbred f haplotype. This indicates that the origin of the mutations in the Eb genes of the q, w17 and w302 haplotypes and in the Ea and Eb genes of the f and w301 haplotypes, predated speciation within Mus, thought to have occurred ∼0.35-1 million years ago. Their maintenance in mouse populations suggests that in certain conditions the failure to express EαEβ proteins may be advantageous and selected fo

A quantitative screen for metabolic enzyme structures reveals patterns of assembly across the yeast metabolic network

© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Noree, C., Begovich, K., Samilo, D., Broyer, R., Monfort, E., & Wilhelm, J. E. A quantitative screen for metabolic enzyme structures reveals patterns of assembly across the yeast metabolic network. Molecular Biology of the Cell, 30(21), (2019): 2721-2736, doi:10.1091/mbc.E19-04-0224.Despite the proliferation of proteins that can form filaments or phase-separated condensates, it remains unclear how this behavior is distributed over biological networks. We have found that 60 of the 440 yeast metabolic enzymes robustly form structures, including 10 that assemble within mitochondria. Additionally, the ability to assemble is enriched at branch points on several metabolic pathways. The assembly of enzymes at the first branch point in de novo purine biosynthesis is coordinated, hierarchical, and based on their position within the pathway, while the enzymes at the second branch point are recruited to RNA stress granules. Consistent with distinct classes of structures being deployed at different control points in a pathway, we find that the first enzyme in the pathway, PRPP synthetase, forms evolutionarily conserved filaments that are sequestered in the nucleus in higher eukaryotes. These findings provide a roadmap for identifying additional conserved features of metabolic regulation by condensates/filaments.We thank Douglass Forbes for comments on the manuscript, Susanne Rafelski for the gift of the pVTU-mito-dsRed plasmid, and Brian Zid for the gift of the pKT-mNeonGreen plasmid. Work at the Wilhelm lab was supported by a grant from the Hughes Collaborative Innovation Award program of the Howard Hughes Medical Institute and the James Wilhelm Memorial Fund. Kyle Begovich is a Howard Hughes Medical Institute Gilliam Fellow

Mathematical model for multicomponent separations on the continuous annular chromatograph

A model for multicomponent separations on ion exchange columns has been adapted for use in studying the performance of the continuous annular chromatograph. The model accurately predicts solute peak positions in the column effluent and qualitatively predicts trends in solute effluent resolution as a function of increasing bandwidth of the solute feed pulse. The major virtues of the model are its simplicity in terms of the calculations involved and the fact that it incorporates the nonlinear solute-resin binding isotherms common in many ion exchange separations. Because dispersion effects are not accounted for in the model, discrepancies exist between the shapes of the effluent peaks predicted by the model and those determined experimentally