Nighttime intensivist staffing and the timing of death among ICU decedents: A retrospective cohort study

Introduction: Intensive care units (ICUs) are increasingly adopting 24-hour intensivist physician staffing. Although nighttime intensivist staffing does not consistently reduce mortality, it may affect other outcomes such as the quality of end-of-life care.Methods: We conducted a retrospective cohort study of ICU decedents using the 2009-2010 Acute Physiology and Chronic Health Evaluation clinical information system linked to a survey of ICU staffing practices. We restricted the analysis to ICUs with high-intensity daytime staffing, in which the addition of nighttime staffing does not influence mortality. We used multivariable regression to assess the relationship between nighttime intensivist staffing and two separate outcomes potentially related to the quality of end-of-life care: time from ICU admission to death and death at night.Results: Of 30,456 patients admitted to 27 high-intensity daytime staffed ICUs, 3,553 died in the hospital within 30 days. After adjustment for potential confounders, admission to an ICU with nighttime intensivist staffing was associated with a shorter duration between ICU admission and death (adjusted difference: -2.5 days, 95% CI -3.5 to -1.5, p-value < 0.001) and a decreased odds of nighttime death (adjusted odds ratio: 0.75, 95% CI 0.60 to 0.94, p-value 0.011) compared to admission to an ICU without nighttime intensivist staffing.Conclusions: Among ICU decedents, nighttime intensivist staffing is associated with reduced time between ICU admission and death and reduced odds of nighttime death. © 2013 Reineck et al.; licensee BioMed Central Ltd

Seafloor character and sedimentary processes in eastern Long Island Sound and western Block Island Sound

Author Posting. © The Author(s), 2006. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Geo-Marine Letters 26 (2006): 59-68, doi: 10.1007/s00367-006-0016-4.Multibeam bathymetric data and seismic-reflection profiles collected in eastern Long Island and western Block Island Sounds reveal previously unrecognized glacial features and modern bedforms. Glacial features include an ice-sculptured bedrock surface, a newly identified recessional moraine, exposed glaciolacustrine sediments, and remnants of stagnant-ice-contact deposits. Modern bedforms include fields of transverse sand waves, barchanoid waves, giant scour depressions, and pockmarks. Bedform asymmetry and scour around obstructions indicate that net sediment transport is westward across the northern par of the study area near Fishers Island and eastward across the southern par near Great Gull Island.This work was supported by the Coastal and Marine Geology Program of the U.S. Geological Survey, the Connecticut Department of Environmental Protection, and the Atlantic Hydrographic Branch of the National Oceanic and Atmospheric Administration

Glaciolacustrine deposits formed in an ice-dammed tributary valley in the south-central Pyrenees: new evidence for late Pleistocene climate

Combined geomorphic features, stratigraphic characteristics and sedimentologic interpretation, coupled with optically stimulated luminescence (OSL) dates, of a glacio-fluvio-lacustrine sequence (Linás de Broto, northern Spain) provide new information to understand the palaeoenvironmental significance of dynamics of glacier systems in the south-central Pyrenees during the Last Glacial Cycle (≈130 ka to 14 ka). The Linás de Broto depositional system consisted of a proglacial lake fed primarily by meltwater streams emanating from the small Sorrosal glacier and dammed by a lateral moraine of the Ara trunk glacier. The resulting glacio-fluvio-lacustrine sequence, around 55 m thick, is divided into five lithological units consisting of braided fluvial (gravel deposits), lake margin (gravel and sand deltaic deposits) and distal lake (silt and clay laminites) facies associations. Evolution of the depositional environment reflects three phases of progradation of a high-energy braided fluvial system separated by two phases of rapid expansion of the lake. Fluvial progradation occurred during short periods of ice melting. Lake expansion concurred with ice-dam growth of the trunk glacier. The first lake expansion occurred over a time range between 55 ± 9 ka and 49 ± 11 ka, and is consistent with the age of the Viu lateral moraine (49 ± 8 ka), which marks the maximum areal extent of the Ara glacier during the Last Glacial Cycle. These dates confirm that the maximum areal extent of the glacier occurred during Marine Isotope Stages 4 and 3 in the south-central Pyrenees, thus before the Last Glacial Maximum. The evolution of the Linás de Broto depositional system during this maximum glacier extent was modulated by climate oscillations in the northern Iberian Peninsula, probably related to latitudinal shifts of the atmospheric circulation in the southern North-Atlantic Ocean, and variations in summer insolation intensity

Biomarkers of stroke recovery: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable

The most difficult clinical questions in stroke rehabilitation are ‘‘What is this patient’s potential for recovery?’’ and ‘‘What is the best rehabilitation strategy for this person, given her/his clinical profile?’’ Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke