A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety

Patients in intensive care units (ICUs) often receive sedation for prolonged periods. In order to better understand the impact of sub-optimal sedation practice on outcomes, we performed a systematic review, including observational studies and controlled trials which were conducted in sedated patients in the ICU and which compared the impact of changes in or different protocols for sedation management on economic and patient safety outcomes

The incidence of sub-optimal sedation in the ICU: a systematic review

Patients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs

Buried Black Hole Growth in IR-selected Mergers: New Results from Chandra

Observations and theoretical simulations suggest that a significant fraction of merger-triggered accretion onto supermassive black holes is highly obscured, particularly in late-stage galaxy mergers, when the black hole is expected to grow most rapidly. Starting with the Wide-Field Infrared Survey Explorer all-sky survey, we identified a population of galaxies whose morphologies suggest ongoing interaction and which exhibit red mid-infrared colors often associated with powerful active galactic nuclei (AGNs). In a follow-up to our pilot study, we now present Chandra/ACIS and XMM-Newton X-ray observations for the full sample of the brightest 15 IR-preselected mergers. All mergers reveal at least one nuclear X-ray source, with 8 out of 15 systems exhibiting dual nuclear X-ray sources, highly suggestive of single and dual AGNs. Combining these X-ray results with optical line ratios and with near-IR coronal emission line diagnostics, obtained with the near-IR spectrographs on the Large Binocular Telescope, we confirm that 13 out of the 15 mergers host AGNs, two of which host dual AGNs. Several of these AGNs are not detected in the optical. All X-ray sources appear X-ray weak relative to their mid-infrared continuum, and of the nine X-ray sources with sufficient counts for spectral analysis, eight reveal strong evidence of high absorption with column densities of $N_\mathrm{H} \gtrsim 10^{23}$~cm$^{-2}$. These observations demonstrate that a significant population of single and dual AGNs are missed by optical studies, due to high absorption, adding to the growing body of evidence that the epoch of peak black hole growth in mergers occurs in a highly obscured phase.Comment: 29 pages, 22 figures; (Main text: 17 pages, 4 figures

Flow-driven transition and associated velocity profiles in a nematic liquid-crystal cell

S. A. Jewell, S. L. Cornford, F. Yang, P. S. Cann, and J. R. Sambles, Physical Review E, Vol. 80, article 041706 (2009) "Copyright © 2009 by the American Physical Society."The alignment properties and distribution of flow speed during Poiseuille flow through a microchannel of a nematic liquid crystal in a cell with homeotropic surface alignment has been measured using a combination of conoscopy, fluorescence confocal polarizing microscopy, and time-lapse imaging. Two topologically distinct director profiles, with associated fluid velocity fields, are found to exist with the preferred state dictated by the volumetric flow rate of the liquid crystal. The results show excellent agreement with model data produced using the Ericksen-Leslie nematodynamics theory

Effect of Particle Size on Droplet Infiltration into Hydrophobic Porous Media As a Model of Water Repellent Soil

The wettability of soil is of great importance for plants and soil biota, and in determining the risk for preferential flow, surface runoff, flooding,and soil erosion. The molarity of ethanol droplet (MED) test is widely used for quantifying the severity of water repellency in soils that show reduced wettability and is assumed to be independent of soil particle size. The minimum ethanol concentration at which droplet penetration occurs within a short time (≤10 s) provides an estimate of the initial advancing contact angle at which spontaneous wetting is expected. In this study, we test the assumption of particle size independence using a simple model of soil, represented by layers of small (0.2–2 mm) diameter beads that predict the effect of changing bead radius in the top layer on capillary driven imbibition. Experimental results using a three-layer bead system show broad agreement with the model and demonstrate a dependence of the MED test on particle size. The results show that the critical initial advancing contact angle for penetration can be considerably less than 90° and varies with particle size, demonstrating that a key assumption currently used in the MED testing of soil is not necessarily valid

Hydrous Carbonatitic Liquids Drive CO2 Recycling From Subducted Marls and Limestones

This research was supported by the Italian Ministry of Education, University, and Research (MIUR) program PRIN2017 and by the Deep Carbon Observatory (DCO). We are greatly indebted to Andrea Risplendente for careful examination of run charges at the Electron Microprobe.Pelagic limestones are subducted in a variety of subduction zones worldwide. Despite the geochemical relevance of systems enriched in CaCO3, previous experimental investigations mostly focused on carbonated pelites, with low Ca/(Ca+Mg+Fe) ratio. We present the compositions and the formation conditions of liquids in the model system CaO‐Al2O3‐SiO2‐H2O‐CO2 (CASHC), building on phase relationships in the subsystems CHC and CSHC, where a second critical endpoint was suggested at temperatures as low as 515 °C, and 3.2 GPa. Multianvil experiments were performed at 4.2 and 6.0 GPa on five bulk compositions at variable Ca/Si/Al ratios. H2O contents vary from 5.6 to 21 wt%. Aragonite + kyanite + vapor and minor lawsonite form at 700 °C, replaced by zoisite/grossular at 800 °C. Between 850 °C and 950 °C, a complex sequence of textural features is observed upon quenching of a single volatile‐rich liquid phase formed at run conditions. Precipitates include dendritic CaCO3, silicate glass, and Al‐rich whiskers. The bulk composition of such hydrous carbonatitic liquids is retrieved by image analysis on X‐ray maps, showing Ca/Si ratio increasing with pressure and temperature. Hydrous Ca‐carbonatitic liquids are efficient media for scavenging volatiles from subducted crustal material and for metasomatizing the mantle wedge.Ministry of Education, Universities and Research (MIUR)Deep Carbon Observatory (DCO

Doubly charged silicon vacancy center, Si-N complexes, and photochromism in N and Si codoped diamond

Diamond samples containing silicon and nitrogen are shown to be heavily photochromic, with the dominant visible changes due to simultaneous change in total SiV0/− concentration. The photochromism treatment is not capable of creating or destroying SiV defects, and thus we infer the presence of the optically inactive SiV2− . We measure spectroscopic signatures we attribute to substitutional silicon in diamond, and identify a silicon-vacancy complex decorated with a nearest-neighbor nitrogen SiVN, supported by theoretical calculations

Matrix-assisted laser desorption ionization hydrogen/deuterium exchange studies to probe peptide conformational changes

AbstractHydrogen/deuterium (H/D) exchange chemistry monitored by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry is used to study solution phase conformational changes of bradykinin, α-melanocyte stimulating hormone, and melittin as water is added to methanol-d4, acetonitrile, and isopropanol-d8 solutions. The results are interpreted in terms of a preference for the peptides to acquire more compact conformations in organic solvents as compared to the random conformations. Our interpretation is supported by circular dichroism spectra of the peptides in the same solvent systems and by previously published structural data for the peptides. These results demonstrate the utility of MALDI-TOF as a method to monitor the H/D exchange chemistry of peptides and investigations of solution-phase conformations of biomolecules

Recombination dynamics of a human Y-chromosomal palindrome:rapid GC-biased gene conversion, multi-kilobase conversion tracts, and rare inversions

The male-specific region of the human Y chromosome (MSY) includes eight large inverted repeats (palindromes) in which arm-to-arm similarity exceeds 99.9%, due to gene conversion activity. Here, we studied one of these palindromes, P6, in order to illuminate the dynamics of the gene conversion process. We genotyped ten paralogous sequence variants (PSVs) within the arms of P6 in 378 Y chromosomes whose evolutionary relationships within the SNP-defined Y phylogeny are known. This allowed the identification of 146 historical gene conversion events involving individual PSVs, occurring at a rate of 2.9-8.4×10(-4) events per generation. A consideration of the nature of nucleotide change and the ancestral state of each PSV showed that the conversion process was significantly biased towards the fixation of G or C nucleotides (GC-biased), and also towards the ancestral state. Determination of haplotypes by long-PCR allowed likely co-conversion of PSVs to be identified, and suggested that conversion tract lengths are large, with a mean of 2068 bp, and a maximum in excess of 9 kb. Despite the frequent formation of recombination intermediates implied by the rapid observed gene conversion activity, resolution via crossover is rare: only three inversions within P6 were detected in the sample. An analysis of chimpanzee and gorilla P6 orthologs showed that the ancestral state bias has existed in all three species, and comparison of human and chimpanzee sequences with the gorilla outgroup confirmed that GC bias of the conversion process has apparently been active in both the human and chimpanzee lineages