Anticholinergic drug burden tools/scales and adverse outcomes in different clinical settings: a systematic review of reviews

Background: Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed. Objective: This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them. Methods: A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. The final selection of reviews was critically appraised using the ROBIS tool and pre-defined data were extracted; the primary data of interest were the anticholinergic burden scales or tools used. Results: Five reviews were identified for analysis containing a total of 62 original articles. Eighteen anticholinergic burden scales or tools were identified with variation in their derivation, content and how they quantified the anticholinergic activity of medications. The Drug Burden Index was the most commonly used scale or tool in community and database studies, while the Anticholinergic Risk Scale was used more frequently in care homes and hospital settings. The association between anticholinergic burden and clinical outcomes varied by index and study. Falls and hospitalisation were consistently found to be associated with anticholinergic burden. Mortality, delirium, physical function and cognition were not consistently associated. Conclusions: Anticholinergic burden scales vary in their rationale, use and association with outcomes. This review showed that the concept of anticholinergic burden has been variably defined and inconsistently described using a number of indices with different content and scoring. The association between adverse outcomes and anticholinergic burden varies between scores and has not been conclusively established

Ride analysis tools for passenger cars: objective and subjective evaluation techniques and correlation processes–a review

In passenger cars, the ride characteristics are fundamental to the driver and passenger engagement, as they define the comfort and road holding performance. Therefore, the methods and tools to assess ride quality are of significant interest to the vehicle dynamics specialists, and are an important part of the internal know-how of each car maker and Tier 1 supplier, which is often kept confidential. Unfortunately, the available literature does not include a comprehensive survey on the evaluation of the objective and subjective aspects related to ride, and their correlation. This review targets the gap, and deals with: (i) the available tools and techniques to objectively assess primary and secondary ride, including typical manoeuvres, road profiles, required vehicle instrumentation, and key performance indicators (KPIs); (ii) the subjective attributes and their categorisation; (iii) the approaches and mathematical models to correlate the objective KPIs with the subjective evaluation; and (iv) future trends. The know-how of the authors on the ride assessment of high-performance passenger cars will also be used to cover the aspects that are currently overlooked by the available literature and standards. In summary, the manuscript provides the interested reader with useful guidance on the procedures to perform ride quality analyses

Effect of n-acetylcysteine administration on 30-day mortality in critically ill patients with septic shock caused by carbapenem-resistant klebsiella pneumoniae and acinetobacter baumannii. A retrospective case-control study

Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) and Acinetobacter baumannii (CR-Ab) represent important cause of severe infections in intensive care unit (ICU) patients. N-Acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties, showing also in-vitro antibacterial activity. Aim was to evaluate the effect on 30-day mortality of the addition of intravenous NAC to antibiotics in ICU patients with CR-Kp or CR-Ab septic shock. A retrospective, observational case:control study (1:2) in patients with septic shock caused by CR-Kp or CR-Ab hospitalized in two different ICUs was conducted. Cases included patients receiving NAC plus antimicrobials, controls included patients not receiving NAC. Cases and controls were matched for age, SAPS II, causative agent and source of infection. No differences in age, sex, SAPS II score or time to initiate definitive therapy were observed between cases and controls. Pneumonia and bacteremia were the leading infections. Overall, mortality was 48.9% (33.3% vs. 56.7% in cases and controls, p = 0.05). Independent risk factors for mortality were not receiving NAC (p = 0.002) and CR-Ab (p = 0.034) whereas therapy with two in-vitro active antibiotics (p = 0.014) and time to initial definite therapy (p = 0.026) were protective. NAC plus antibiotics might reduce the 30-day mortality rate in ICU patients with CR-Kp and CR-Ab septic shock

Operation of a 250μm-thick SiC detector with DT neutrons at high temperatures

The Silicon Carbide detector (SiC) is an object of research as an alternative to diamond detectors for fast neutron detection and spectrometry where harsh environments are an issue, like in Tokamaks. Since future breeding blankets mock-ups will feature temperatures up to 550 °C, diamond detectors were characterized in the past, finding limitations in their functionality at high temperatures. This paper expands on the previous work by proving the detection of fast neutrons with good detection parameters of a 250 μm-thick 4 H-SiC detector prototype at temperatures up to 250 °C, highlighting the detector's excellent resilience to temperature. The experiment is conducted with instrumentation similar to the one used in the past with diamond detectors, using as source of irradiation the Frascati Neutron Generator (FNG) in ENEA, which is accelerator driven neutron source based on deuterium-tritium (DT) fusion reaction

Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset

The sound source of a voice is produced by the self-excited oscillation of the vocal folds. In modal voice production, a drastic increase in transglottal pressure after vocal fold closure works as a driving force that develops self-excitation. Another type of vocal fold oscillation with less pronounced glottal closure observed in falsetto voice production has been accounted for by the mucosal wave theory. The classical theory assumes a quasi-steady flow, and the expected driving force onto the vocal folds under wavelike motion is derived from the Bernoulli effect. However, wavelike motion is not always observed during falsetto voice production. More importantly, the application of the quasi-steady assumption to a falsetto voice with a fundamental frequency of several hundred hertz is unsupported by experiments. These considerations suggested that the mechanism of falsetto voice onset may be essentially different from that explained by the mucosal wave theory. In this paper, an alternative mechanism is submitted that explains how self-excitation reminiscent of the falsetto voice could be produced independent of the glottal closure and wavelike motion. This new explanation is derived through analytical procedures by employing only general unsteady equations of motion for flow and solids. The analysis demonstrated that a convective acceleration of a flow induced by rapid wall movement functions as a negative damping force, leading to the self-excitation of the vocal folds. The critical subglottal pressure and volume flow are expressed as functions of vocal fold biomechanical properties, geometry, and voice fundamental frequency. The analytically derived conditions are qualitatively and quantitatively reasonable in view of reported measurement data of the thresholds required for falsetto voice onset. Understanding of the voice onset mechanism and the explicit mathematical descriptions of thresholds would be beneficial for the diagnosis and treatment of voice diseases and the development of artificial vocal folds

Characterization of the I-phase regime at TCV

The I-phase is an H-mode confinement regime of tokamaks characterized by limit cycle oscillations, the so-called LCOs or bursts. These bursts are the manifestation of a periodic flattening of the plasma edge pressure profile. The profile flattening is caused by increased radial transport, driven by a high-frequency plasma edge mode that periodically appears. This short-living mode is intrinsically connected to each burst. It vanishes once the profiles are fully flattened, and it reestablishes during profile recovery once critical gradients are reached and a new cycle begins. In this paper, we describe for the first time the unambiguous presence of the I-phase at the tokamak `a configuration variable (TCV). As the I-phase confinement regime is found in the parameter regime between the L-mode and the fully developed H-mode, it is often confused with dithers between H-mode and L-mode. Therefore, we are highlighting the differences between these two phenomena. Furthermore, we show the two-dimensional dynamics of the I-phase mode and bursts and the associated filamentary transport, enabled by the outstanding capabilities of the 2D TCV Gas Puff Imaging diagnostics

Le collezioni museali naturalistiche come fondamentale risorsa nella ricerca scientifica: distribuzione spazio-temporale dei reperti di grandi vertebrati marini nei musei italiani

Il patrimonio culturale marino italiano ha per tradizione e storia un’imponente ricchezza di collezioni museali naturalistiche, con migliaia di reperti ossei e tassidermizzati di vertebrati marini, costruite in oltre due secoli di attività. I reperti museali rappresentano la conoscenza primaria ed unica della biodiversità organismica ed ecosistemica storica del Mediterraneo e costituiscono un ampio archivio di tessuti e dati scientifici potenzialmente sfruttabile grazie alle nuove tecnologie biomolecolari per comprendere pattern, processi e possibili cause della perdita di biodiversità, degrado degli ecosistemi e declino delle popolazioni. Con l’obiettivo di ricostruire le traiettorie evolutive ed ecologiche di specie e popolazioni di grandi predatori marini del Mediterraneo (cetacei ed elasmobranchi) abbiamo costituito un network di 25 collezioni osteologiche museali (universitarie e civiche) e private italiane, da cui abbiamo ottenuto oltre 500 campioni (fotografie geometriche e tessuti biologici di crani, rostri, mascelle, vertebre e denti) di individui storici di Delphinus delphis, Stenella coeruleoalba, Tursiops truncatus, Carcharodon carcharias, quattro specie di pesce sega dei generi Pristis e Anoxypristis, otto specie di cetacei mediterranei e la foca monaca (Monachus monachus). Il presente lavoro descrive i risultati, in termini di numero e di distribuzione, dei reperti di alcune specie di grandi predatori marini e mette in evidenza il valore storico, culturale e scientifico delle collezioni museali, in particolar modo per gruppi di organismi di particolare interesse conservazionistico