Delirium in Frail Older Adults

Delirium and frailty are prevalent geriatric syndromes and important public health issues among older adults. The prevalence of delirium among hospitalized older adults ranges from 15% to 75%, while that of frailty ranges from 12% to 24%. The exact pathophysiology of these two conditions has not been clearly identified, although several hypotheses have been proposed. However, these conditions are considered to be multifactorial in etiology and are associated with inflammation related to aging, alterations in vascular systems, genetics, and nutritional deficiency. Furthermore, clinically, they are significantly associated with frailty, which increases the risk of delirium by almost two- to three-fold among hospitalized older adults. With their multifactorial etiology and unknown pathophysiology, current evidence supports more practical multicomponent patient-centered approaches to prevent and manage delirium with frailty among hospitalized older adults. These comprehensive and organized bundled approaches can identify high-risk patients with frailty and more effectively manage their delirium

COMPARATIVE ANALYSIS OF EARLY AND LATE TRACHEOSTOMY AMONG PATIENTS WITH ACUTE HEART FAILURE EXACERBATION, TRENDS, CLINICAL AND ECONOMIC OUTCOME ASSESSMENT, FROM 2005 TO 2014 NATIONWIDE

Heart failure is one of the leading causes of high morbidity and mortality. Acute exacerbation of heart failure may result in acute respiratory failure, which requires mechanical ventilator support. Despite supportive management, patients can fail extubation of the endotracheal tube and need a tracheostomy to continue mechanical ventilator support. However, optimal timing of tracheostomy has been controversial. Systemic study to assess the clinical and economic outcome of early tracheostomy among patients with acute heart failure exacerbation is lacking. The purpose of the study was to assess the national trend of tracheostomy among those who are admitted for acute respiratory failure with acute congestive heart failure exacerbation and to compare clinical and economic outcomes between the two groups (early and late tracheostomy) using national discharge data between from 2005 to 2014. We also conducted an economic evaluation comparing early and late tracheostomy among them using average cost and incremental costs with an outcome of length of stay. Among those who are admitted with acute heart failure exacerbation, 0.30% patients underwent the tracheostomy, and among them, 9.69% received early tracheostomy. There was no trend in the percentage of early tracheostomy. The length of stay in the hospital has decreased over time in late tracheostomy group, but it was stable in early tracheostomy group. Median total hospital length of stay (19 days) and total hospital cost ($52,158.23) in early tracheostomy group were significantly lower than late tracheostomy group (25 days and$68,037.40). Patients with coronary artery disease, pneumonia, and liver disease are less likely to receive early tracheostomy (OR 0.79, 0.63 and 0.64 respectively). After propensity score matching, it showed that the two groups did not show a significant difference in inhospital mortality (OR 0.91, p-value 0.676), or decannulation rate (OR 2.01, p-value 0.571). However, early tracheostomy was associated with higher likelihood of having a complication from tracheostomy with OR 2.08 (p-value 0.044) but was also associated with lower total hospital length of stay with coefficient factor -6.50 (p-value 0.000) from the linear regression model. From the economic evaluation, the early tracheostomy dominates the late tracheostomy with the outcome of total hospital length of stay and post-procedural length of stay with lower cost and higher effectiveness. The incremental cost-effectiveness ratio (ICER) is negative, meaning it costs $3,492.65 for each additional day in the hospital for late tracheostomy compared to early tracheostomy. ICER with the outcome of post-procedural length of stay was again negative, showing$2,032.67 per extra day in the hospital after the procedure among late tracheostomy group. Early tracheostomy among patients with acute heart failure exacerbation had no significant difference in mortality but had significant economic benefit with lower cost and less total hospital length of stay

The Correlation between Climate Change and Corporate Performance

38-43The purpose of the study is to verify the correlation of the climate change risk focusing on the influence of carbon emission on the corporate performance and discriminative response of corporate contingent upon the publishment of Sustainability Report. The results of this study show that there is a negative (-) relationship between Carbon emission intensity and corporate performance. And the negative influence of carbon emission intensity on corporate performance was found to be smaller for companies that published sustainability reports than for those that did not. This study provided empirical evidences on why corporate’s active reactive activities according to the climate change is essential for sustainable development

Enhancement of seawater corrosion resistance in copper using acetone-derived graphene coating

We show that acetone-derived graphene coating can effectively enhance the corrosion efficiency of copper (Cu) in a seawater environment (0.5-0.6 M (???3.0-3.5%) sodium chloride). By applying a drop of acetone (???20 ??l cm-2) on Cu surfaces, rapid thermal annealing allows the facile and rapid synthesis of graphene films on Cu surfaces with a monolayer coverage of almost close to ???100%. Under optimal growth conditions, acetone-derived graphene is found to have a relatively high crystallinity, comparable to common graphene grown by chemical vapor deposition. The resulting graphene-coated Cu surface exhibits 37.5 times higher corrosion resistance as compared to that of mechanically polished Cu. Further, investigation on the role of graphene coating on Cu surfaces suggests that the outstanding corrosion inhibition efficiency (IE) of 97.4% is obtained by protecting the underlying Cu against the penetration of both dissolved oxygen and chlorine ions, thanks to the closely spaced atomic structure of the graphene sheets. The increase of graphene coating thickness results in the enhancement of the overall corrosion IE up to ???99%, which can be attributed to the effective blocking of the ionic diffusion process via grain boundaries. Overall, our results suggest that the acetone-derived graphene film can effectively serve as a corrosion-inhibiting coating in the seawater level and that it may have a promising role to play for potential offshore coating.close0

Estimating Tobins Q for Listed Firms in Korea (1980-2005): Comparing Alternative Approaches and an Experiment with Investment Functions

Tobins Q is the most common measurement of firm value and performance. However, estimating Tobins Q accurately is not easy. Researchers have used book values of debts or assets rather than the market values. We estimate Tobins Q for listed firms in Korea from 1980 to 2005 based on replacement costs of assets as well as market values of debts and common and preferred stocks. We compare the estimates using the modified annual average depreciation rates and economic depreciation rates. In sum, we present and compare four alternative series of Tobins Q measures. We then estimate investment functions with alternative Tobins Q values as regressors to compare the reliability of alternative estimates. We find that the simple measure of using book values of both debts and assets is the most unreliable

The effect of heating insufflation gas on acid-base alterations and core temperature during laparoscopic major abdominal surgery

BACKGROUND: Carbon dioxide (CO(2)) has different biophysical properties under different thermal conditions, which may affect its rate of absorption in the blood and the related adverse events. The present study was aimed to investigate the effects of heating of CO(2) on acid-base balance using Stewart's physiochemical approach, and body temperature during laparoscopy. METHODS: Thirty adult patients undergoing laparoscopic major abdominal surgery were randomized to receive either room temperature CO(2) (control group, n = 15) or heated CO(2) (heated group, n = 15). The acid-base parameters were measured 10 min after the induction of anesthesia (T1), 40 min after pneumoperitoneum (T2), at the end of surgery (T3) and 1 h after surgery (T4). Body temperature was measured at 15-min intervals until the end of the surgery. RESULTS: There were no significant differences in pH, PaCO(2), the apparent strong ion difference, the strong ion gap, bicarbonate ion, or lactate between two groups throughout the whole investigation period. At T2, pH was decreased whereas PaCO(2) was increased in both groups compared with T1 but these changes were not significantly different. Body temperatures in the heated group were significantly higher than those in the control group from 30 to 90 min after pneumoperitoneum. CONCLUSIONS: The heating of insufflating CO(2) did not affect changes in the acid-base status and PaCO(2) in patients undergoing laparoscopic abdominal surgery when the ventilator was set to maintain constant end-tidal CO(2). However, the heated CO(2) reduced the decrease in the core body temperature 30 min after the pneumoperitoneum.ope

The effect of palonosetron on rocuronium-induced withdrawal movement

AbstractBackgroundRocuronium causes pain and withdrawal movement during induction of anesthesia. In this study, palonosetron was investigated to have analgesic effect on the reduction of rocuronium-induced withdrawal movement.Methods120 patients were randomly assigned to one of three groups to receive either saline, lidocaine 20mg, or palonosetron 0.075mg with a tourniquet applied two minutes before thiopental sodium (5mg·kg−1) was given intravenously. After loss of consciousness, rocuronium (0.6mg·kg−1) was injected and the withdrawal movement was estimated by 4-point scale in a double-blind manner.ResultsThe overall incidence of rocuronium withdrawal movement was 50% with lidocaine (p=0.038), 38% with palonosetron (p=0.006) compared with 75% for saline. The incidence of no pain to mild pain was significantly lower in the lidocaine and palonosetron groups (85% and 92% respectively) than in the saline group (58%). However, there was no significant difference in withdrawal movement between the lidocaine and palonosetron groups. There was no severe movement with palonosetron.ConclusionPretreatment of palonosetron with venous occlusion may attenuate rocuronium-induced withdrawal movement as effective as the use of lidocaine. It suggested that peripheral action of palonosetron was effective to reduce rocuronium-induced withdrawal movement

Interrupted aortic arch diagnosed with loss of femoral pulse in a patient undergoing patent ductus arteriosus ligation -A case report-

A 12-year-old boy with ventricular septal defect and patent ductus arteriosus was presented to the operating room. Upon clamping the patent ductus arteriosus, the femoral arterial pressure curve was lost; however, it returned upon unclamping. Upon further dissection, an interrupted aortic arch was found between the left subclavian artery and patent ductus arteriosus. The surgery was discontinued for further evaluation

Definition of Polypharmacy in Heart Failure: A Scoping Review of the Literature

Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients. We conducted a scoping review searching Medline, Embase, CINAHL, and Cochrane using terms including polypharmacy, HF and deprescribing, which resulted in 7,949 articles. Articles without a definition of polypharmacy in HF patients and articles which included patients \u3c 18 years of age were excluded; only 59 articles were included. Of the 59 articles, 49% (n = 29) were retrospective, 20% (n = 12) were prospective, 10% (n = 6) were cross-sectional, and 27% (n = 16) were review articles. Twenty percent (n = 12) of the articles focused on HF with reduced ejection fraction, 10% (n = 6) focused on HF with preserved ejection fraction and 69% (n = 41) articles either focused on both diagnoses or did not clarify the specific type of HF. The most common cutoff for polypharmacy in HF was five medications (59%, n = 35). There was no consensus regarding the inclusion or exclusion of over-the-counter medications, supplements, or vitamins. Some newer studies used a cutoff of 10 medications (14%, n = 8), and this may be a more practical and meaningful definition for HF patients