A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes

Introduction: Despite recommendations from professional societies and patient safety organizations, the majority of ICU patients worldwide are not routinely monitored for delirium, thus preventing timely prevention and management. The purpose of this systematic review is to summarize what types of implementation strategies have been tested to improve ICU clinicians' ability to effectively assess, prevent and treat delirium and to evaluate the effect of these strategies on clinical outcomes. Method: We searched PubMed, Embase, PsychINFO, Cochrane and CINAHL (January 2000 and April 2014) for studies on implementation strategies that included delirium-oriented interventions in adult ICU patients. Studies were suitable for inclusion if implementation strategies' efficacy, in terms of a clinical outcome, or process outcome was described. Results: We included 21 studies, all including process measures, while 9 reported both process measures and clinical outcomes. Some individual strategies suc

L'intégration agriculture-élevage améliore-t-elle l'efficience, le recyclage et l'autonomie énergétique brute des exploitations familiales mixtes au Burkina Faso ?

Face au défi majeur de la croissance démographique mondiale, le secteur agricole se doit de concilier une augmentation de la production alimentaire et une diminution de son impact environnemental. L'intégration agriculture-élevage (IAE) mise en oeuvre dans les exploitations familiales mixtes à faible niveau d'intrants peut être un moyen d'y parvenir. L'un des grands principes de l'IAE est l'utilisation de ressources produites par les différents ateliers de l'exploitation pour la conduite des autres ateliers. L'IAE se construit autour de trois grandes pratiques : la traction animale, le stockage de fourrage et la production de fumure organique. L'objectif de cette étude a été d'analyser l'effet de ces pratiques sur l'autonomie, le recyclage et l'efficience énergétique des exploitations familiales mixtes. Pour ce faire, les flux d'énergie brute de huit exploitations familiales mixtes de la zone cotonnière de l'ouest du Burkina Faso, suivies sur une période de 20 mois, ont été analysés grâce à la méthode d'analyse de réseau écologique (ecological network analysis [ENA]). Les résultats ont montré que le stockage de fourrage et la production de fumure organique ont permis aux exploitations d'augmenter leur recyclage et leur autonomie, et d'acquérir une meilleure efficience énergétique. La méthode ENA met en lumière les caractéristiques et les performances d'exploitations de différents types (agriculteurs, éleveurs, agroéleveurs) et évalue l'apport des pratiques de l'IAE sur ces performances. Il apparaît cependant qu'il existe des marges de manoeuvre sur le niveau de mise en oeuvre des pratiques d'IAE dans les exploitations familiales mixtes de la zone cotonnière de l'ouest du Burkina Faso permettant d'améliorer le recyclage de l'énergie. (Résumé d'auteur

Robustness testing in the determination of seven drugs in animal muscle by liquid chromatography–tandem mass spectrometry

In this work, the robustness of the sample preparation procedure for the determination of six tranquilizers (xylazine, azaperone, propionylpromazine, chlorpromazine, haloperidol, and azaperol) and a beta-blocker (carazolol) in animal muscle by LC/MS–MS was assessed through the experimental design methodology. A 2III7 − 4 fractional factorial design was performed to evaluate the influence of seven variables on the final concentration of the seven drugs in the samples, in accordance with what is laid down in Commission Decision No 2002/657/EC. The variation considered for each of those seven factors is likely to happen when preparing the samples, being the values chosen as level − 1, the nominal operating conditions. The results of the experimentation were evaluated from different statistical strategies, such as hypothesis testing using an external variance previously estimated, Lenth's method, and Bayesian analysis. Both Lenth's and Bayes' approaches enabled to determine the effect of every variable even though no degrees of freedom were left to estimate the residual error. The same conclusion about the robustness of the extraction step was reached from the three methodologies, namely, none of the seven factors examined influenced on the method performance significantly, so the sample preparation procedure was considered to be robust.Ministerio de Ciencia e Innovación (CTQ2011-26022) and MINECO (CTQ2014- 53157-R)

A multicentre epidemiological study on sunbed use and cutaneous melanoma in Europe

A large European case-control study investigated the association between sunbed use and cutaneous melanoma in an adult population aged between 18 and 49 years. Between 1999 and 2001 sun and sunbed exposure was recorded in 597 newly diagnosed melanoma cases and 622 controls in Belgium, France, The Netherlands, Sweden and the UK. Fifty three precent of cases and 57% of controls ever used sunbeds. The overall adjusted odds ratio (OR) associated with ever sunbed use was 0.90 (95% CI: 0.71-1.14). There was a South-to-North gradient with high prevalence of sunbed exposure in Northern Europe and lower prevalence in the South (prevalence of use in France 20%, OR: 1.19 (0.68-2.07) compared to Sweden, prevalence 83%, relative risk 0.62 (0.26-1.46)). Dose and lag-time between first exposure to sunbeds and time of study were not associated with melanoma risk, neither were sunbathing and sunburns (adjusted OR for mean number of weeks spent in sunny climates >14 years: 1.12 (0.88-1.43); adjusted OR for any sunburn >14 years: 1.16 (0.9-1.45)). Host factors such as numbers of naevi and skin type were the strongest risk indicators for melanoma. Public health campaigns have improved knowledge regarding risk of UV-radiation for skin cancers and this may have led to recall and selection biases in both cases and controls in this study. Sunbed exposure has become increasingly prevalent over the last 20 years, especially in Northern Europe but the full impact of this exposure on skin cancers may not become apparent for many years

Implementation of a science-action partnership to manage a threatened ecosystem in an urban context

Abstract: The gap between scientific knowledge and implementation of such knowledge in the fields of biodiversity conservation, environmental management and climate change adaptation, is widely recognized. The state of knowledge of urban ecosystems is generally quite poor, and there is a shortage of human capacity to implement scientifically-sound management practices at the local level, especially within institutions having the mandate of regulating land use planning. The need to bridge the science-action gap to improve decision-making for local land use planning and management, and thereby reduce the impacts of urbanization on ecosystems, has been recognized by eThekwini Municipality in the city of Durban, South Africa..

Identification and quantification of carbamate pesticides in dried lime tree flowers by means of excitation-emission molecular fluorescence and parallel factor analysis when quenching effect exists

A non-separative, fast and inexpensive spectrofluorimetric method based on the second order calibration of excitation-emission fluorescence matrices (EEMs) was proposed for the determination of carbaryl, carbendazim and 1-naphthol in dried lime tree flowers. The trilinearity property of three-way data was used to handle the intrinsic fluorescence of lime flowers and the difference in the fluorescence intensity of each analyte. It also made possible to identify unequivocally each analyte. Trilinearity of the data tensor guarantees the uniqueness of the solution obtained through parallel factor analysis (PARAFAC), so the factors of the decomposition match up with the analytes. In addition, an experimental procedure was proposed to identify, with three-way data, the quenching effect produced by the fluorophores of the lime flowers. This procedure also enabled the selection of the adequate dilution of the lime flowers extract to minimize the quenching effect so the three analytes can be quantified. Finally, the analytes were determined using the standard addition method for a calibration whose standards were chosen with a D-optimal design. The three analytes were unequivocally identified by the correlation between the pure spectra and the PARAFAC excitation and emission spectral loadings. The trueness was established by the accuracy line “calculated concentration versus added concentration” in all cases. Better decision limit values (CCα), in x0 = 0 with the probability of false positive fixed at 0.05, were obtained for the calibration performed in pure solvent: 2.97 μg L−1 for 1-naphthol, 3.74 μg L−1 for carbaryl and 23.25 μg L−1 for carbendazim. The CCα values for the second calibration carried out in matrix were 1.61, 4.34 and 51.75 μg L−1 respectively; while the values obtained considering only the pure samples as calibration set were: 2.65, 8.61 and 28.7 μg L−1, respectively.theMinisteriodeEconomíayCompetitividad(CTQ2011-26022) and JuntadeCastillayLeón(BU108A11-2

Determination of dichlobenil and its major metabolite (BAM) in onions by PTV–GC–MS using PARAFAC2 and experimental design methodology

The optimization of a GC–MS analytical procedure which includes derivatization, Quick Easy Cheap Effective Rugged and Safe (QuEChERS) and programmed temperature vaporization (PTV) using design of experiments is performed to determine 2,6-dichlorobenzonitrile (dichlobenil) and 2,6-dichlorobenzamide (BAM) in onions, using 3,5-dichlorobenzonitrile and 2,4-dichlorobenzamide as internal standards. The use of a central composite design and two D-optimal designs, together with the desirability function, makes it possible to significantly reduce the economic, time and environmental cost of the study. The usefulness of PARAFAC2 for solving problems as the interference of unexpected derivatization artifacts unavoidably linked to some derivatization agents, or the presence of coeluents from the complex matrix, which share m/z ratios with the target compounds, is shown. The limits of decision (CCα) of the optimized procedure, 5.00 μg kg− 1 for dichlobenil and 1.55 μg kg− 1 for BAM (α = 0.05), are below the maximum residue limit (MRL) established by the EU for dichlobenil (20 μg kg− 1) in this commodity.Ministerio de Economía y Competitividad (CTQ2011-26022) and Junta de Castilla y León (BU108A11-2

Standard addition method based on four-way PARAFAC decomposition to solve the matrix interferences in the determination of carbamate pesticides in lettuce using excitation–emission fluorescence data

The simultaneous determination of two carbamate pesticides (carbaryl and carbendazim) and of the degradation product of carbaryl (1-naphthol) in iceberg lettuce was achieved by means of PARAFAC decomposition and excitation–emission fluorescence matrices. A standard addition method for a calibration based on four-way data was applied using different dilutions of the extract from iceberg lettuce as a fourth way that provided the enough variation of the matrix to carry out the four-way analysis. A high fluorescent overlapping existed between the three analytes and the fluorophores of the matrix. The identification of two fluorescent matrix constituents through the four-way model enabled to know the matrix contribution in each dilution of the extract. This contribution was subtracted from the previous signals and a subsequent three-way analysis was carried out with the tensors corresponding to each dilution. The PARAFAC decomposition of these resulting tensors showed a CORCONDIA index equal to 99%. For the identification of the analytes, the correlation between the PARAFAC spectral loadings and the reference spectra has been used. The trueness of the method, in the concentration range studied, was guaranteed because there was neither constant nor proportional bias according to the appropriate hypothesis tests. The best recovery percentages were obtained with the data from the most diluted extract, being the results: 127.6% for carbaryl, 125.55% for carbendazim and 87.6% for 1-naphthol. When the solvent calibration was performed, the decision limit (CCα) and the capability of detection (CCβ) values, in x0=0, were 2.21 and 4.38 μg L−1 for carbaryl, 4.87 and 9.64 μg L−1 for carbendazim; and 3.22 and 6.38 μg L−1 for 1-naphthol, respectively, for probabilities of false positive and false negative fixed at 0.05. However, these values were 5.30 and 10.49 μg L−1 for carbaryl, 18.05 and 35.73 μg L−1 for carbendazim; and 1.92 and 3.79 μg L−1 for 1-naphthol, respectively, when the matrix-matched calibration using the most diluted extract was carried out in the recovery study.Ministerio de Economía y Competitividad(CTQ2011-26022) and JuntadeCastillayLeón(BU108A11-2)

Induced hypertension for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage a randomized clinical trial

Background and Purpose-Induced hypertension is widely used to treat delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage, but a literature review shows that its presumed effectiveness is based on uncontrolled caseseries only. We here report clinical outcome of aneurysmal subarachnoid hemorrhage patients with DCI included in a randomized trial on the effectiveness of induced hypertension. Methods-Aneurysmal subarachnoid hemorrhage patients with clinical symptoms of DCI were randomized to induced hypertension or no induced hypertension. Risk ratios for poor outcome (modified Rankin Scale score >3) at 3 months, with 95% confidence intervals, were calculated and adjusted for age, clinical condition at admission and at time of DCI, and amount of blood on initial computed tomographic scan with Poisson regression analysis. Results-The trial aiming to include 240 patients was ended, based on lack of effect on cerebral perfusion and slow recruitment, when 21 patients had been randomized to induced hypertension, and 20 patients to no hypertension. With induced hypertension, the adjusted risk ratio for poor outcome was 1.0 (95% confidence interval, 0.6-1.8) and the risk ratio for serious adverse events 2.1 (95% confidence interval, 0.9-5.0). Conclusions-Before this trial, the effectiveness of induced hypertension for DCI in aneurysmal subarachnoid hemorrhage patients was unknown because current literature consists only of uncontrolled case series. The results from our premature halted trial do not add any evidence to support induced hypertension and show that this treatment can lead to serious adverse events