Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness

BACKGROUND: There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU). METHODS: In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge. Safety end points included extrapyramidal symptoms and excessive sedation. RESULTS: Written informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differences with respect to the secondary end points or the frequency of extrapyramidal symptoms. CONCLUSIONS: The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium. (Funded by the National Institutes of Health and the VA Geriatric Research Education and Clinical Center; MIND-USA ClinicalTrials.gov number, NCT01211522 .)

The Influence of Free Quintessence on Gravitational Frequency Shift and Deflection of Light with 4D momentum

Based on the 4D momentum, the influence of quintessence on the gravitational frequency shift and the deflection of light are examined in modified Schwarzschild space. We find that the frequency of photon depends on the state parameter of quintessence $w_q$: the frequency increases for $-1<w_q<-1/3$ and decreases for $-1/3<w_q<0$. Meanwhile, we adopt an integral power number $a$ ($a = 3\omega_q + 2$) to solve the orbital equation of photon. The photon's potentials become higher with the decrease of $\omega_q$. The behavior of bending light depends on the state parameter $\omega_q$ sensitively. In particular, for the case of $\omega_q = -1$, there is no influence on the deflection of light by quintessence. Else, according to the H-masers of GP-A redshift experiment and the long-baseline interferometry, the constraints on the quintessence field in Solar system are presented here.Comment: 12 pages, 2 figures, 4 tables. European Physical Journal C in pres

Phantom Field with O(N) Symmetry in Exponential Potential

In this paper, we study the phase space of phantom model with O(\emph{N}) symmetry in exponential potential. Different from the model without O(\emph{N}) symmetry, the introduction of the symmetry leads to a lower bound $w>-3$ on the equation of state for the existence of stable phantom dominated attractor phase. The reconstruction relation between the potential of O(\textit{N}) phantom system and red shift has been derived.Comment: 5 pages, 3 figures, replaced with the version to appear on Phys. Rev.

Cosmology With Non-Minimally Coupled K-Field

We consider non-minimally coupled (with gravity) scalar field with non-canonical kinetic energy. The form of the kinetic term is of Dirac-Born-Infeld (DBI) form.We study the early evolution of the universe when it is sourced only by the k-field, as well as late time evolution when both the matter and k-field are present. For the k-field, we have considered constant potential as well as potential inspired from Boundary String Field Theory (B-SFT). We show that it is possible to have inflationary solution in early time as well as late time accelerating phase. The solutions also exhibit attractor property in a sense that it does not depend on the initial conditions for a certain values of the parameters.Comment: 10 pages, Revtex style, 14 eps figures, to appear in General Relativity and Gravitatio

Planet Hunters Tess I: TOI 813, a subgiant hosting a transiting Saturn-sized planet on an 84-day orbit

We report on the discovery and validation of TOI 813 b (TIC55525572b), a transiting exoplanet identified by citizen scientists in data from NASA's Transiting Exoplanet Survey Satellite (TESS) and the first planet discovered by the Planet Hunters TESS project. The host star is a bright (V = 10.3 mag) subgiant (R* = 1.94 R☉, M☉ = 1.32 M☉). It was observed almost continuously by TESS during its first year of operations, during which time four individual transit events were detected. The candidate passed all the standard light curve-based vetting checks, and ground-based follow-up spectroscopy and speckle imaging enabled us to place an upper limit of 2 MJup (99 per cent confidence) on the mass of the companion, and to statistically validate its planetary nature. Detailed modelling of the transits yields a period of 83.8911+0.0027-0.0031 d, a planet radius of 6.71 ± 0.38 R⊕ and a semimajor axis of 0.423+0031-0.037 AU. The planet's orbital period combined with the evolved nature of the host star places this object in a relatively underexplored region of parameter space. We estimate that TOI 813 b induces a reflex motion in its host star with a semi-amplitude of ∼6 m s−1, making this a promising system to measure the mass of a relatively long-period transiting planet

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd