Incidence of delirium in the Intensive Care Unit before and after implementation of the Confusion Assessment Method for the ICU (CAM-ICU)

Background: Delirium is a serious condition that affects patients in the intensive care unit (ICU) that can lead to worse outcomes and increased length of ICU stay. Delirium was not assessed at Oklahoma State University Medical Center (OSUMC) but the implementation of the Confusion Assessment Method for the ICU (CAM-ICU) has changed that. This study looks to determine the incidence of delirium before and after implementation of the CAM-ICU. The objective of this study is to improve recognition of delirium at this hospital to improve patient outcomes and reduce length of stay in the ICU.Methods: This study has been approved by the institutional review board. It evaluates all patients in the ICU before and after implementation of the CAM-ICU. This four-question assessment will be performed by nurses on their regular shift assessment. The assessment will be modified to fit the institution's use of the Ramsay Score instead of the Richmond Agitation and Sedation Scale. A positive result will be recorded in the patient's electronic medical record (EMR) as well as verbally communicated to the doctor and pharmacist. Diagnosis codes for delirium from January 1st, 2019 through June 30, 2019 will be used to determine the incidence of delirium before the implementation of the CAM-ICU. This study will analyze patients from 10/29/2019 through 3/31/2020 who have undergone the CAM-ICU at least once. Once the study period is complete, a report from the EMR will be performed to identify each patient with a positive CAM-ICU. The patient's age, past medical history, assessment results, medication lists, length of stay in the ICU and hospital will be obtained from the electronic medical record. All data will be maintained and analyzed in a secure database to which only the researchers will have access.Results: From January 1st, 2019 until June 30th, 2019, there were 4 patients in the ICU with a diagnosis code of delirium that was associated with their time in the ICU. From 10/29/19 through 12/31/2019, 153 patients underwent testing by the CAM-ICU. Since then, 19/153 patients (12.4%) have tested positive for delirium. 13/19 (68.4%) of patients were male and 11/19 (57.9%) were older than 65. 10/19 (52.6%) patients had a history of substance abuse. The average length of stay in the intensive care unit was 6 days (1-15). 10/19 (52.6%) patients were on a ventilator. The most common intervention performed in 13/19 (68.4%) was to open the blinds. 9/19 patients were never in a room with a window.Conclusion: This study is currently ongoing. Preliminary results show the CAM-ICU does improve recognition of delirium in patients. Currently it shows that white males >65 who have respiratory failure requiring ventilation have a high incidence of delirium as well as patients with a history of substance abuse

Christine Jacobs-Wagner: Drawing the bacterial organizational chart

Jacobs-Wagner has been at the forefront of a revolution in bacterial cell biology

Super-orbital re-entry in Australia - laboratory measurement, simulation and flight observation

There are large uncertainties in the aerothermodynamic modelling of super-orbital re-entry which impact the design of spacecraft thermal protection systems (TPS). Aspects of the thermal environment of super-orbital re-entry flows can be simulated in the laboratory using arc- and plasma jet facilities and these devices are regularly used for TPS certification work [5]. Another laboratory device which is capable of simulating certain critical features of both the aero and thermal environment of super-orbital re-entry is the expansion tube, and three such facilities have been operating at the University of Queensland in recent years[10]. Despite some success, wind tunnel tests do not achieve full simulation, however, a virtually complete physical simulation of particular re-entry conditions can be obtained from dedicated flight testing, and the Apollo era FIRE II flight experiment [2] is the premier example which still forms an important benchmark for modern simulations. Dedicated super-orbital flight testing is generally considered too expensive today, and there is a reluctance to incorporate substantial instrumentation for aerothermal diagnostics into existing missions since it may compromise primary mission objectives. An alternative approach to on-board flight measurements, with demonstrated success particularly in the ‘Stardust’ sample return mission, is remote observation of spectral emissions from the capsule and shock layer [8]. JAXA’s ‘Hayabusa’ sample return capsule provides a recent super-orbital reentry example through which we illustrate contributions in three areas: (1) physical simulation of super-orbital re-entry conditions in the laboratory; (2) computational simulation of such flows; and (3) remote acquisition of optical emissions from a super-orbital re entry event

Confinement and edge effects on atomic collapse in graphene nanoribbons

Atomic collapse in graphene nanoribbons behaves in a fundamentally different way as compared to monolayer graphene, due to the presence of multiple energy bands and the effect of edges. For armchair nanoribbons we find that bound states gradually transform into atomic collapse states with increasing impurity charge. This is very different in zig-zag nanoribbons where multiple quasi-one-dimensional \emph{bound states} are found that originates from the zero energy zig-zag edge states. They are a consequence of the flat band and the electron distribution of these bound states exhibits two peaks. The lowest energy edge state transforms from a bound state into an atomic collapse resonance and shows a distinct relocalization from the edge to the impurity position with increasing impurity charge

Management of trypanosomiasis and leishmaniasis

<p>Background: The current treatments for human African trypanosomiasis (HAT), Chagas disease and leishmaniasis (collectively referred to as the kinetoplastid diseases) are far from ideal but, for some, there has been significant recent progress. For HAT the only advances in treatment over the past two decades have been the introduction of an eflornithine/nifurtimox co-administration and a shorter regime of the old standard melarsoprol.</p> <p>Sources of data: PubMed.</p> <p>Areas of Agreement: There is a need for new safe, oral drugs for cost-effective treatment of patients and use in control programmes for all the trypanosomatid diseases.</p> <p>Areas of controversy: Cutaneous leishmaniasis is not on the agenda and treatments are lagging behind.</p> <p>Growing points: There are three compounds in development for the treatment of the CNS stage of HAT: fexinidazole, currently due to entry into phase II clinical studies, a benzoxaborole (SCYX-7158) in phase I trials and a diamidine derivative (CPD-0802), in advanced pre-clinical development. For Chagas disease, two anti-fungal triazoles are now in clinical trial. In addition, clinical studies with benznidazole, a drug previously recommended only for acute stage treatment, are close to completion to determine the effectiveness in the treatment of early chronic and indeterminate Chagas disease. For visceral leishmaniasis new formulations, therapeutic switching, in particular AmBisome, and the potential for combinations of established drugs have significantly improved the opportunities for the treatment in the Indian subcontinent, but not in East Africa.</p> <p>Areas timely for developing research: Improved diagnostic tools are needed to support treatment, for test of cure in clinical trials and for monitoring/surveillance of populations in control programmes.</p&gt

Using Knock-Out Mutants to Investigate the Adhesion of Staphylococcus aureus to Abiotic Surfaces

The adhesion of Staphylococcus aureus to abiotic surfaces is crucial for establishing device related infections. With a high number of single-cell force spectroscopy measurements with geneti cally modified S. aureus cells, this study provides insights into the adhesion process of the pathogen to abiotic surfaces of different wettability. Our results show that S. aureus utilizes different cell wall molecules and interaction mechanisms when binding to hydrophobic and hydrophilic surfaces. We found that covalently bound cell wall proteins strongly interact with hydrophobic substrates, while their contribution to the overall adhesion force is smaller on hydrophilic substrates. Teichoic acids promote adhesion to hydrophobic surfaces as well as to hydrophilic surfaces. This, however, is to a lesser extent. An interplay of electrostatic effects of charges and protein composition on bacterial surfaces is predominant on hydrophilic surfaces, while it is overshadowed on hydrophobic surfaces by the influence of the high number of binding proteins. Our results can help to design new models of bacterial adhesion and may be used to interpret the adhesion of other microorganisms with similar surface properties

Non-destructive characterization of thin layer resonant tunnelling diodes

We present an advanced nondestructive characterization scheme for high current density AlAs/InGaAs resonant tunneling diodes pseudomorphically grown on InP substrates. We show how low-temperature photoluminescence spectroscopy (LT-PL) and high-resolution X-ray diffractometry (HR-XRD) are complementary techniques to increase the confidence of the characterized structure. The lattice-matched InGaAs is characterized and found to be of high quality. We discuss the inclusion of an undoped “copy” well (C-well) in terms of enhancements to HR-XRD and LT-PL characterization and quantify the improved precision in determining the structure. As a consequence of this enhanced precision in the determination of physical structure, the AlAs barriers and quantum well (QW) system are found to contain nonideal material interfaces. Their roughness is characterized in terms of the full width to half-maximum of the split LT-PL emission peaks, revealing a ±1 atomic sheet variance to the QW width. We show how barrier asymmetry can be detected through fitting of both optical spectra and HR-XRD rocking curves

Front Stability in Mean Field Models of Diffusion Limited Growth

We present calculations of the stability of planar fronts in two mean field models of diffusion limited growth. The steady state solution for the front can exist for a continuous family of velocities, we show that the selected velocity is given by marginal stability theory. We find that naive mean field theory has no instability to transverse perturbations, while a threshold mean field theory has such a Mullins-Sekerka instability. These results place on firm theoretical ground the observed lack of the dendritic morphology in naive mean field theory and its presence in threshold models. The existence of a Mullins-Sekerka instability is related to the behavior of the mean field theories in the zero-undercooling limit.Comment: 26 pp. revtex, 7 uuencoded ps figures. submitted to PR

External quality assessment of malaria microscopy in the Democratic Republic of the Congo

<p>Abstract</p> <p>Background</p> <p>External quality assessments (EQA) are an alternative to cross-checking of blood slides in the quality control of malaria microscopy. This study reports the findings of an EQA of malaria microscopy in the Democratic Republic of the Congo (DRC).</p> <p>Methods</p> <p>After validation, an EQA slide panel and a questionnaire were delivered to diagnostic laboratories in four provinces of DRC. The panel included three samples for diagnosis (sample 1: <it>Plasmodium falciparum</it>, 177,000/μl, sample 2: <it>P. falciparum</it>, 2,500/μl, sample 3: no parasites seen), one didactic sample (Howell-Jolly bodies) and one sample for assessing the quality of staining. Participating laboratories were addressed and selected through the network of the National Tuberculosis Control Programme. Participants were asked to return the responses together with a stained thin and thick blood film for evaluation of Giemsa stain quality.</p> <p>Results</p> <p>Among 174 participants (response rate 95.1%), 26.2% scored samples 1, 2 and 3 correctly and 34.3%, 21.5% and 5.8% of participants reported major errors in one, two or three samples respectively. Major errors included reporting "no malaria" or "non-<it>falciparum </it>malaria" for <it>Plasmodium falciparum</it>-positive samples 1 and 2 (16.1% and 34.9% of participants respectively) and "<it>P. falciparum</it>" for <it>Plasmodium </it>negative sample 3 (24.0%). Howell-Jolly bodies (didactic sample) were not recognized by any of the participants but reported as "<it>P. falciparum</it>" by 16.7% of participants. With parasite density expressed according to the "plus system", 16.1% and 21.5% of participants scored one "+" different from the reference score for samples 1 and 2 respectively and 9.7% and 2.9% participants scored more than two "+" different. When expressed as counts of asexual parasites/μl, more than two-thirds of results were outside the mean ± 2SD reference values. The quality of the Giemsa stain was poor, with less than 20% slides complying with all criteria assessed. Only one quarter of participants purchase Giemsa stain from suppliers of documented reliability and half of participants use a buffered staining solution. One third of participants had participated in a formal training about malaria diagnosis, half of them earlier than 2007.</p> <p>Conclusion</p> <p>The present EQA revealed a poor quality of malaria microscopy in DRC.</p