Quetiapine in refractory hyperactive and mixed intensive care delirium: a case series

IntroductionDelirium affects up to 80% of patients admitted to intensive care units (ICUs) and contributes to increased morbidity and mortality. Haloperidol is the gold standard for treatment, although quetiapine has been successfully used in the management of delirium.MethodsWe conducted a retrospective study of patients admitted to the ICU between February 2008 and May 2010 who were prescribed quetiapine by the attending clinician. Data collected included demographics, history of drug and/or alcohol dependence, ICU and hospital length of stay, length of mechanical ventilation and the duration of treatment with sedatives and medications for delirium. The daily dose of quetiapine was recorded. Hyperactive or mixed delirium was identified by a validated chart review and a Richmond Agitation Sedation Scale (RASS) score persistently greater than 1 for 48 hours despite therapy.ResultsSeventeen patients were included. Delirium onset occurred after a median of five days. Patients were being given at least four agents for delirium prior to the introduction of quetiapine, and they had a median RASS score of 3. Quetiapine was initiated at a 25 mg daily dose and titrated to a median daily dose of 50 mg. The median duration of delirium prior to quetiapine therapy was 15 days. Quetiapine commencement was associated with a reduction in the need for other medications (within 0 to 6 days) and resolution of delirium within a median of four days. Adverse events included somnolence and transient hypotension.ConclusionsThis case series provides an initial effort to explore a possible role for quetiapine in the management of refractory hyperactive and mixed ICU delirium

Effects of Deepwater Horizon oil on feather structure and thermoregulation in gulls: Does rehabilitation work?

Impacts of large-scale oil spills on avian species are far-reaching.While media attention often focuses on lethal impacts, sub-lethal effects and the impacts of rehabilitation receive less attention. The objective of our study was to characterize effects of moderate external oiling and subsequent rehabilitation on feather structure and thermoregulation in gulls. We captured 30 wild ring-billed gulls (Larus delawarensis) and randomly assigned each individual to an experimental group: 1) controls, 2) rehabilitated birds (externally oiled, rehabilitated by washing), or 3) oiled birds (externally oiled, not rehabilitated). We externally oiled birds with weathered MC252 Deepwater Horizon oil (water for controls) and collected feathers and thermography imagery (FLIR) approximately weekly for four weeks to investigate feather structure (quantified using a barbule clumping index) and thermoregulatory ability (characterized by internal body temperature and external surface temperature). Post-oiling feather clumping was significantly higher in oiled and rehabilitated birds compared to controls, but steadily declined over time in both groups. However, feather microstructure in rehabilitated birds was indistinguishable from controls within three weeks of washing whereas the feathers of oiled birds were still significantly clumped a month post oiling. Internal body temperatures didn\u27t differ in any of the groups, suggesting birds maintain thermoregulatory homeostasis in spite of moderate external oiling. External temperatures for rehabilitated birds didn\u27t differ from controls within a week of rehabilitation. Overall, rehabilitation procedures were effective and washed birds were in better condition compared to non-rehabilitated, oiled birds. This study provides evidence that the benefits of rehabilitation for moderately oiled birds likely outweigh the costs with regard to feather structure and thermoregulation.While feather preening and time were insufficient to reestablish baseline fine scale feather structure in moderately oiled birds, the significant clumping reduction over time may indicate that rehabilitation of lightly oiled birds may not be necessary and deserves further study

Heat Capacity Evidence for the Suppression of Skyrmions at Large Zeeman Energy

Measurements on a multilayer two-dimensional electron system (2DES) near Landau level filling $\nu$=1 reveal the disappearance of the nuclear spin contribution to the heat capacity as the ratio $\tilde{g}$ between the Zeeman and Coulomb energies exceeds a critical value $\tilde{g}_c \approx$0.04. This disappearance suggests the vanishing of the Skyrmion-mediated coupling between the lattice and the nuclear spins as the spin excitations of the 2DES make a transition from Skyrmions to single spin-flips above $\tilde{g}_c$. Our experimental $\tilde{g}_c$ is smaller than the calculated $\tilde{g}_c$=0.054 for an ideal 2DES; we discuss possible origins of this discrepancy.Comment: Experimental paper, 6 figure

A case report and genetic characterization of a massive acinic cell carcinoma of the parotid with delayed distant metastases.

We describe the presentation, management, and clinical outcome of a massive acinic cell carcinoma of the parotid gland. The primary tumor and blood underwent exome sequencing which revealed deletions in CDKN2A as well as PPP1R13B, which induces p53. A damaging nonsynonymous mutation was noted in EP300, a histone acetylase which plays a role in cellular proliferation. This study provides the first insights into the genetic underpinnings of this cancer. Future large-scale efforts will be necessary to define the mutational landscape of salivary gland malignancies to identify therapeutic targets and biomarkers of treatment failure

Doubly Enhanced Skyrmions in ν=2\nu =2 Bilayer Quantum Hall States

By tilting the samples in the magnetic field, we measured and compared the Skyrmion excitations in the bilayer quantum Hall (QH) state at the Landau-level filling factor $\nu =2$ and in the monolayer QH state at $\nu =1$. The observed number of flipped spins is $N_s=14$ in the bilayer system with a large tunneling gap, and $N_s=7$ in the bilayer system with a small tunneling gap, while it is $N_s=7$ in the monolayer system. The difference is interpreted due to the interlayer exchange interaction. Moreover, we have observed seemingly preferred numbers $N_s=14,7,1$ for the flipped spins by tilting bilayer samples.Comment: 4 pages, 4 figure

Experimental infections of Norway rats with avian‑derived low‑pathogenic influenza A viruses

Influenza A viruses (IAVs) are a public-health, veterinary, and agricultural concern. Although wild birds are considered the primary reservoir hosts for most IAVs, wild-bird IAV strains are known to spill over into poultry, domestic or wild mammals, and humans. Occasionally, spillover events may result in adaptation or reassortment with other strains. Moreover, some IAV strains found in wild waterfowl mutate into highly pathogenic forms in poultry, causing tremendous economic losses. When domestic animals, wildlife, and humans dwell in close proximity to each other, such as may be the case with agricultural operations, wildlife may represent a potential risk for interspecies pathogen transmission. Understanding the pathways through which IAV strains could spillover from waterfowl reservoirs into humans and domestic animals is important for limiting the spread of IAVs, as well as developing biosecurity and containment procedures in livestock and poultry production. Experimental studies of common wild mammals in the U.S., bank voles (Myodes glareolus) in Europe and Asia, and black rats (Rattus rattus) in Japan have shown varying degrees of IAV susceptibility and/or transmission in these synanthropic species. While Norway rats (Rattus norvegicus) are ubiquitous throughout rural and urban areas of the world and have the ability to range between these areas, only limited investigations of this species have been conducted, and their role in IAV transmission has not been clearly established. The main objective of this study was to further characterize IAV infection in Norway rats using IAV strains derived from poultry and wild water birds

The Effects of Disorder on the ν=1\nu=1 Quantum Hall State

A disorder-averaged Hartree-Fock treatment is used to compute the density of single particle states for quantum Hall systems at filling factor $\nu=1$. It is found that transport and spin polarization experiments can be simultaneously explained by a model of mostly short-range effective disorder. The slope of the transport gap (due to quasiparticles) in parallel field emerges as a result of the interplay between disorder-induced broadening and exchange, and has implications for skyrmion localization.Comment: 4 pages, 3 eps figure

Kassiopeia: A Modern, Extensible C++ Particle Tracking Package

The Kassiopeia particle tracking framework is an object-oriented software package using modern C++ techniques, written originally to meet the needs of the KATRIN collaboration. Kassiopeia features a new algorithmic paradigm for particle tracking simulations which targets experiments containing complex geometries and electromagnetic fields, with high priority put on calculation efficiency, customizability, extensibility, and ease of use for novice programmers. To solve Kassiopeia's target physics problem the software is capable of simulating particle trajectories governed by arbitrarily complex differential equations of motion, continuous physics processes that may in part be modeled as terms perturbing that equation of motion, stochastic processes that occur in flight such as bulk scattering and decay, and stochastic surface processes occuring at interfaces, including transmission and reflection effects. This entire set of computations takes place against the backdrop of a rich geometry package which serves a variety of roles, including initialization of electromagnetic field simulations and the support of state-dependent algorithm-swapping and behavioral changes as a particle's state evolves. Thanks to the very general approach taken by Kassiopeia it can be used by other experiments facing similar challenges when calculating particle trajectories in electromagnetic fields. It is publicly available at https://github.com/KATRIN-Experiment/Kassiopei

Coping with environmental eukaryotes; identification of pseudomonas syringae genes during the interaction with alternative hosts or predators

Understanding the molecular mechanisms underpinning the ecological success of plant pathogens is critical to develop strategies for controlling diseases and protecting crops. Recent observations have shown that plant pathogenic bacteria, particularly Pseudomonas, exist in a range of natural environments away from their natural plant host e.g., water courses, soil, non-host plants. This exposes them to a variety of eukaryotic predators such as nematodes, insects and amoebae present in the environment. Nematodes and amoeba in particular are bacterial predators while insect herbivores may act as indirect predators, ingesting bacteria on plant tissue. We therefore postulated that bacteria are probably under selective pressure to avoid or survive predation and have therefore developed appropriate coping mechanisms. We tested the hypothesis that plant pathogenic Pseudomonas syringae are able to cope with predation pressure and found that three pathovars show weak, but significant resistance or toxicity. To identify the gene systems that contribute to resistance or toxicity we applied a heterologous screening technique, called Rapid Virulence Annotation (RVA), for anti-predation and toxicity mechanisms. Three cosmid libraries for P. syringae pv. aesculi, pv. tomato and pv. phaseolicola, of approximately 2000 cosmids each, were screened in the susceptible/non-toxic bacterium Escherichia coli against nematode, amoebae and an insect. A number of potential conserved and unique genes were identified which included genes encoding haemolysins, biofilm formation, motility and adhesion. These data provide the first multi-pathovar comparative insight to how plant pathogens cope with different predation pressures and infection of an insect gut and provide a foundation for further study into the function of selected genes and their role in ecological success