Confusion assessment method to analyze delirium in intensive care unit: literature review

Delirium is frequently observed in intensive care unit patients and its occurrence is related to increased morbidity and mortality, length of stay, functional decline and high costs. The Confusion Assessment Method for Intensive Care Unit is a tool that facilitates early identification and occurrence of delirium among intubated patients. Objective: To verify the aspects of delirium studied by means of the Confusion Assessment Method for Intensive Care Unit. A literature review was conducted in the LILACS, MedLine, PubMed and CINAHL databases, from 2001, when the Confusion Assessment Method for Intensive Care Unit was validated, to 2008. Descriptors used for LILACS, MedLine and PubMed were delirium and intensive care unit, while for the CINAHL database, delirium and intensive care were used. From 293 articles, 35 were selected. The aspects analyzed disclosed, different types of delirium in different intensive care units. Variation in sensitivity was of 93% to 100% and variation in specificity, 89% to 100% of the Confusion Assessment Method for Intensive Care Unit, an important tool for detection, characterization and control of delirium and its impact. The aspects of delirium studied by means of the Confusion Assessment Method for Intensive Care Unit were: the performance index, identification, management, cost of treatment, morbidity and mortality due to delirium.O delirium é freqüentemente observado em pacientes internados em unidades de terapia intensiva e a sua ocorrência relaciona-se com o aumento da morbimortalidade, do período de internação, declínio funcional e custos elevados. O Confusion Assessment Method for Intensive Care Unit é um instrumento que facilita a identificação precoce e a ocorrência de delirium em pacientes intubados. Este trabalho tem como objetivo verificar aspectos já estudados sobre o delirium utilizando o Confusion Assessment Method for Intensive Care Unit. Foi realizada uma revisão narrativa nas bases de dados LILACS, MedLine, PubMed e CINAHL que compreendeu desde o ano de validação do Confusion Assessment Method for Intensive Care Unit (2001) até março de 2008. Os descritores utilizados nas bases de dados LILACS, MedLine, PubMed foram delirium e intensive care unit e na CINAHAL foram delirium e intensive care. Do total de 293 artigos encontrados foram selecionados 35. Em relação aos aspectos estudados constatou-se incidência variável dos tipos de delirium em diferentes tipos de unidades de terapia intensiva. Quanto a sensibilidade do Confusion Assessment Method for Intensive Care Unit este apresentou uma variação de 93 a 100% e a especificidade foi de 89 a 100% sendo considerado um instrumento valioso na detecção, caracterização e controle do delirium e suas repercussões. Além disso, sua utilização permite o controle mais eficaz dos pacientes graves que apresentam o distúrbio ou riscos para desenvolvê-lo.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de EnfermagemServiço de Atendimento Móvel de UrgênciaHospital Nove de Julho Unidade de Terapia Intensiva AdultoUNIFESP, EPESciEL

A Massive Galaxy in its Core Formation Phase Three Billion Years After the Big Bang

Most massive galaxies are thought to have formed their dense stellar cores at early cosmic epochs. However, cores in their formation phase have not yet been observed. Previous studies have found galaxies with high gas velocity dispersions or small apparent sizes but so far no objects have been identified with both the stellar structure and the gas dynamics of a forming core. Here we present a candidate core in formation 11 billion years ago, at z=2.3. GOODS-N-774 has a stellar mass of 1.0x10^11 Msun, a half-light radius of 1.0 kpc, and a star formation rate of 90[+45-20]Msun/yr. The star forming gas has a velocity dispersion 317+-30 km/s, amongst the highest ever measured. It is similar to the stellar velocity dispersions of the putative descendants of GOODS-N-774, compact quiescent galaxies at z~2 and giant elliptical galaxies in the nearby Universe. Galaxies such as GOODS-N-774 appear to be rare; however, from the star formation rate and size of the galaxy we infer that many star forming cores may be heavily obscured, and could be missed in optical and near-infrared surveys.Comment: To appear in Natur

Trends in cow numbers and culling rate in the Irish cattle population, 2003 to 2006

Cows are the main economic production units of Ireland's cattle industry. Therefore, demographic information, including overall numbers and survival rates, are relevant to the Irish agricultural industry. However, few data are available on the demographics of cows within a national population, either in Ireland or elsewhere, despite the recent development of comprehensive national cattle databases in many EU Member States. This study has sought: to determine the rate of cow culling from the national herd; to determine the rate of culling by type (dairy, beef), age, method of exit, date of exit and interval between last calving and exit; to calculate the national cow on-farm mortality rate; and to compare the Irish rates with published data from other countries. This work was conducted using data recorded in the national Cattle Movement Monitoring System (CMMS). Culling refers to the exit of cows from the national herd, as a result of death but regardless of reason, and cow-culling rate was calculated as the number of cow exits (as defined above) each year divided by the number of calf births in the same year. Culling rate was determined by type (dairy or beef), date of birth, method of exit (slaughter or on-farm death), month of exit and interval between last calving and exit. The average cow-culling rate during 2003 to 2006 was 19.6% (21.3% for dairy, 18% for beef). While comparisons must be treated with caution, it concluded that the overall rates of culling in Ireland fell within published internationally accepted norms. The on-farm mortality rate of 3.2-4.1% was similar to that reported in comparable studies

A memória do jongo em bananal – SP:no encalço do ponto perdido

This paper presents data from an ethnographic research that tookplace in a small city called Bananal (a little over 11 000 inhabitants). Thereferred city is located at Vale do Paraíba in São Paulo State – Brazil.Historically, Bananal was enshrined as one of the main coffee producers inthe 19th century, in the eastern region of São Paulo State. At first theresearch investigated among the popular imagination of local studentsabout a characteristic of a character of the "folklore" in the country: theSaci. The researchers noticed that beyond the walls of the local school,there were memories, musics and dances that are characteristic of blackpopulation brought through the African diaspora. Bananal is located at theHistoric Valley of the Paraíba do Sul River, which until now preserves thetraditional cultural that remain in the memory of its inhabitants, such as:the Jongo – a music style that can be identified as the music of the diasporadue to the particularity of antifonia of the singing. This scenary of Bananalwas ideal to the part of the oral history, reconstruct the memories of thecommunity, the Jongo and the history of blacks in Brazil, without forgettingthe precarious condition of the public school system used for these socialgroups in their initial formation.Este trabalho apresenta dados de uma pesquisa etnográfica que teve como lócus a pequena cidade de Bananal (pouco mais de 11 mil habitantes), localizada no Vale do Paraíba no Estado de São Paulo – Brasil. Historicamente, Bananal se consagrou como uma das principais produtoras de café no século XIX, na região leste do Estado paulista. Inicialmente a pesquisa investigou entre os estudantes locais o imaginário popular sobre um personagem característico do "folclore" no país: o Saci. Os pesquisadores perceberam que para além dos muros da escola local, havia memórias, músicas e danças que são característicos de populações negras trazidas através da diáspora africana. Bananal está situada no Vale Histórico do Rio Paraíba do Sul, que ainda hoje preserva as marcas d acultura tradicional e permanece na memória de seus habitantes, tais como: o Jongo – um estilo musical que pode-se identificar como música da diáspora, devido a particularidade da antifonia do canto. Este cenário de Bananal foi ideal para partir da história oral, reconstruir as memórias da comunidade, do Jongo e da história dos negros no Brasil, sem esquecer a condição precária do sistema escolar público utilizado por estes grupos sociais em sua formação inicial

The Spatial Extent and Distribution of Star Formation in 3D-HST Mergers at z~1.5

We present an analysis of the spatial distribution of star formation in a sample of 60 visually identified galaxy merger candidates at z>1. Our sample, drawn from the 3D-HST survey, is flux-limited and was selected to have high star formation rates based on fits of their broad-band, low spatial resolution spectral energy distributions. It includes plausible pre-merger (close pairs) and post-merger (single objects with tidal features) systems, with total stellar masses and star formation rates derived from multi-wavelength photometry. Here we use near-infrared slitless spectra from 3D-HST which produce Halpha or [OIII] emission line maps as proxies for star-formation maps. This provides a first comprehensive high-resolution, empirical picture of where star formation occurred in galaxy mergers at the epoch of peak cosmic star formation rate. We find that detectable star formation can occur in one or both galaxy centres, or in tidal tails. The most common case (58%) is that star formation is largely concentrated in a single, compact region, coincident with the centre of (one of) the merger components. No correlations between star formation morphology and redshift, total stellar mass, or star formation rate are found. A restricted set of hydrodynamical merger simulations between similarly massive and gas-rich objects implies that star formation should be detectable in both merger components, when the gas fractions of the individual components are the same. This suggests that z~1.5 mergers typically occur between galaxies whose gas fractions, masses, and/or star formation rates are distinctly different from one another.Comment: Accepted for publication in MNRAS, 16 pages, 10 figure

The association of smoking and socioeconomic status on cutaneous melanoma: a population‐based, data‐linkage, case–control study

BACKGROUND: Previous studies have identified an inverse association between melanoma and smoking; however, data from population-based studies are scarce. OBJECTIVES: To determine the association between smoking and socioeconomic (SES) on the risk of development of melanoma. Furthermore, we sought to determine the implications of smoking and SES on survival. METHODS: We conducted a population-based case-control study. Cases were identified from the Welsh Cancer Intelligence and Surveillance Unit (WCISU) during 2000-2015 and controls from the general population. Smoking and SES were obtained from data linkage with other national databases. The association of smoking status and SES on the incidence of melanoma were assessed using binary logistic regression. Multivariate survival analysis was performed on a melanoma cohort using a Cox proportional hazard model using survival as the outcome. RESULTS: During 2000-2015, 9636 patients developed melanoma. Smoking data were obtained for 7124 (73·9%) of these patients. There were 26 408 controls identified from the general population. Smoking was inversely associated with melanoma incidence [odds ratio (OR) 0·70, 95% confidence interval (CI) 0·65-0·76]. Smoking was associated with an increased overall mortality [hazard ratio (HR) 1·30, 95% CI 1·09-1·55], but not associated with melanoma-specific mortality. Patients with higher SES had an increased association with melanoma incidence (OR 1·58, 95% CI 1·44-1·73). Higher SES was associated with an increased chance of both overall (HR 0·67, 95% CI 0·56-0·81) and disease-specific survival (HR 0·69, 95% CI 0·53-0·90). CONCLUSIONS: Our study has demonstrated that smoking appeared to be associated with reduced incidence of melanoma. Although smoking increases overall mortality, no association was observed with melanoma-specific mortality. Further work is required to determine if there is a biological mechanism underlying this relationship or an alternative explanation, such as survival bias. What's already known about this topic? Previous studies have been contradictory with both negative and positive associations between smoking and the incidence of melanoma reported. Previous studies have either been limited by publication bias because of selective reporting or underpowered. What does this study add? Our large study identified an inverse association between smoking status and melanoma incidence. Although smoking status was negatively associated with overall disease survival, no significant association was noted in melanoma-specific survival. Socioeconomic status remains closely associated with melanoma. Although higher socioeconomic populations are more likely to develop the disease, patients with lower socioeconomic status continue to have a worse prognosis

7/7: A reflexive re-evaluation of journalistic practice

The suicide bombings of 7 July 2005 remain the most serious terror attacks in the United Kingdom to date in the so-called ‘war on terror’. Much has been published on the war on terror but few journalists have reflected on their practice post 9/11 and none on their domestic coverage of the 7/7 attacks. This article is written by a journalist who covered the London bombings for a UK national newspaper and more recently is a practitioner-academic. Using academic texts focusing on the domestic reporting of the war on terror as stimuli for scholarly reflection, this article reviews the author’s own coverage using reflexive practice and content analysis. This article places 7/7 in the continuum of reporting subsequent to 11 September 2001 (9/11) and issues discussed. Some 63 authored articles were considered from the period. Scholarly texts have proposed a range of concepts to analyse coverage from including political ritual, trauma, national wound and hegemony. This article concludes by noting that while many academic texts see coverage of terrorism as an elite discourse, dominated by political economy drivers and responding to events in a homogeneous reactivity, in practice, news organisations can have complex responses and journalists, agency in their coverage of major terrorism events

3D-HST: A wide-field grism spectroscopic survey with the Hubble Space Telescope

We present 3D-HST, a near-infrared spectroscopic Treasury program with the Hubble Space Telescope for studying the processes that shape galaxies in the distant Universe. 3D-HST provides rest-frame optical spectra for a sample of ~7000 galaxies at 1<z<3.5, the epoch when 60% of all star formation took place, the number density of quasars peaked, the first galaxies stopped forming stars, and the structural regularity that we see in galaxies today must have emerged. 3D-HST will cover 3/4 (625 sq.arcmin) of the CANDELS survey area with two orbits of primary WFC3/G141 grism coverage and two to four parallel orbits with the ACS/G800L grism. In the IR these exposure times yield a continuum signal-to-noise of ~5 per resolution element at H~23.1 and a 5sigma emission line sensitivity of 5x10-17 erg/s/cm2 for typical objects, improving by a factor of ~2 for compact sources in images with low sky background levels. The WFC3/G141 spectra provide continuous wavelength coverage from 1.1-1.6 um at a spatial resolution of ~0."13, which, combined with their depth, makes them a unique resource for studying galaxy evolution. We present the preliminary reduction and analysis of the grism observations, including emission line and redshift measurements from combined fits to the extracted grism spectra and photometry from ancillary multi-wavelength catalogs. The present analysis yields redshift estimates with a precision of sigma(z)=0.0034(1+z), or sigma(v)~1000 km/s. We illustrate how the generalized nature of the survey yields near-infrared spectra of remarkable quality for many different types of objects, including a quasar at z=4.7, quiescent galaxies at z~2, and the most distant T-type brown dwarf star known. The CANDELS and 3D-HST surveys combined will provide the definitive imaging and spectroscopic dataset for studies of the 1<z<3.5 Universe until the launch of the James Webb Space Telescope.Comment: Replacement reflects version now accepted by ApJS. A preliminary data release intended to provide a general illustration of the WFC3 grism data is available at http://3dhst.research.yale.edu

Fatores associados a gravidade do trauma de vítimas de acidentes de trânsito de uma capital da Amazônia Legal / Factors associated with the severity of trauma to traffic accident victims in a capital of the Legal Amazon

Objetivo: Identificar os fatores associados à gravidade dos traumas ocasionados por acidentes de trânsito. Métodos: Estudo transversal com vítimas internadas por acidente de trânsito no ano de 2010. Consulta aos prontuários hospitalares e entrevistas nos domicílios constituíram as fontes de dados. As lesões foram analisadas segundo localização e gravidade. Regressão logística hierárquica foi realizada para os fatores associados à gravidade do trauma. Resultados: Maior parte das 405 vítimas estudadas correspondeu a motociclistas (68,6%), sexo masculino de 20 e 39. Presença de lesão cerebrocraniana e de tórax/abdome/múltipla apresentaram-se significativamente associadas a gravidade (OR7,32; IC95% 3,47;15,46 e OR5,76; IC 95% 2,54;13,06, respectivamente). Conclusão/ Considerações finais:   A amostra estudada representa a realidade constatada nos acidentes de trânsito, jovens do sexo masculino nos quais a gravidade do trauma associou-se às lesões cerebrocranianas, de tórax e múltiplas.