Physiological modeling, tight glycemic control, and the ICU clinician: what are models and how can they affect practice?

Critically ill patients are highly variable in their response to care and treatment. This variability and the search for improved outcomes have led to a significant increase in the use of protocolized care to reduce variability in care. However, protocolized care does not address the variability of outcome due to inter- and intra-patient variability, both in physiological state, and the response to disease and treatment. This lack of patient-specificity defines the opportunity for patient-specific approaches to diagnosis, care, and patient management, which are complementary to, and fit within, protocolized approaches

Risk of human exposure to arsenic and other toxic elements from geophagy : trace element analysis of baked clay using inductively coupled plasma spectrometry

Geophagy or earth-eating is common amongst some Bangladeshi women, especially those who are pregnant, both in Bangladesh and in the United Kingdom. A large proportion of the population in Bangladesh is already exposed to high concentrations of arsenic (As) and other toxic elements from drinking contaminated groundwater. Additional exposure to As and other toxic elements from non-food sources has not been adequately addressed and here we present the first study to monitor As levels in baked clay (known as sikor). Methods: Sikor samples originating from Bangladesh were digested using a microwave digester and analysed for their As, Pb, Cd, Mn, Fe and Zn levels using ICP-MS. Detailed As speciation analysis was performed using HPLC-ICPMS. Results: Of particular concern were the levels of As (3.8-13.1 mg kg-1), Cd (0.09-0.4 mg kg-1) and Pb (21-26.7 mg kg-1) present in the sikor samples and their possible impact on human health. Speciation analysis revealed that sikor samples contained mainly inorganic As. Modest consumption of 50 g of sikor is equivalent to ingesting 370 μg of As and 1235 μg of Pb per day, based on median concentration values. This level of sikor consumption exceeds the permitted maximum tolerable daily intake (PMTDI) of inorganic As by almost 2-fold. Conclusion: We conclude that sikor can be a significant source of As, Cd and Pb exposure for the Bangladeshi population consuming large quantities of this material. Of particular concern in this regard is geophagy practiced by pregnant women concurrently exposed to As contaminated drinking water. Future studies needs to evaluate the bioavailability of As and other elements from sikor and their impact on human health