Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness

BACKGROUND: There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU). METHODS: In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge. Safety end points included extrapyramidal symptoms and excessive sedation. RESULTS: Written informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differences with respect to the secondary end points or the frequency of extrapyramidal symptoms. CONCLUSIONS: The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium. (Funded by the National Institutes of Health and the VA Geriatric Research Education and Clinical Center; MIND-USA ClinicalTrials.gov number, NCT01211522 .)

Novel Collective Effects in Integrated Photonics

Superradiance, the enhanced collective emission of energy from a coherent ensemble of quantum systems, has been typically studied in atomic ensembles. In this work we study theoretically the enhanced emission of energy from coherent ensembles of harmonic oscillators. We show that it should be possible to observe harmonic oscillator superradiance for the first time in waveguide arrays in integrated photonics. Furthermore, we describe how pairwise correlations within the ensemble can be measured with this architecture. These pairwise correlations are an integral part of the phenomenon of superradiance and have never been observed in experiments to date.Comment: 7 pages, 3 figure

Elucidating the role of Agl in bladder carcinogenesis by generation and characterization of genetically engineered mice

Amylo-\u3b1-1,6-glucosidase,4-\u3b1-glucanotransferase (AGL) is an enzyme primarily responsible for glycogen debranching. Germline mutations lead to glycogen storage disease type III (GSDIII). We recently found AGL to be a tumor suppressor in xenograft models of human bladder cancer (BC) and low levels of AGL expression in BC are associated with poor patient prognosis. However, the impact of low AGL expression on the susceptibility of normal bladder to carcinogenesis is unknown. We address this gap by developing a germline Agl knockout (Agl-/-) mouse that recapitulates biochemical and histological features of GSDIII. Agl-/- mice exposed to N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) had a higher BC incidence compared with wild-type mice (Agl+/+). To determine if the increased BC incidence observed was due to decreased Agl expression in the urothelium specifically, we developed a urothelium-specific conditional Agl knockout (Aglcko) mouse using a Uroplakin II-Cre allele. BBN-induced carcinogenesis experiments repeated in Aglcko mice revealed that Aglcko mice had a higher BC incidence than control (Aglfl/fl) mice. RNA sequencing revealed that tumors from Agl-/- mice had 19 differentially expressed genes compared with control mice. An 'Agl Loss' gene signature was developed and found to successfully stratify normal and tumor samples in two BC patient datasets. These results support the role of AGL loss in promoting carcinogenesis and provide a rationale for evaluating Agl expression levels, or Agl Loss gene signature scores, in normal urothelium of populations at risk of BC development such as older male smokers

Electroweak Radiative Corrections to Neutral-Current Drell-Yan Processes at Hadron Colliders

We calculate the complete electroweak O(alpha) corrections to pp, pbar p -> l+l- X (l=e, mu) in the Standard Model of electroweak interactions. They comprise weak and photonic virtual one-loop corrections as well as real photon radiation to the parton-level processes q bar q -> gamma,Z -> l+l-. We study in detail the effect of the radiative corrections on the l+l- invariant mass distribution, the cross section in the Z boson resonance region, and on the forward-backward asymmetry, A_FB, at the Fermilab Tevatron and the CERN Large Hadron Collider. The weak corrections are found to increase the Z boson cross section by about 1%, but have little effect on the forward-backward asymmetry in the Z peak region. Threshold effects of the W box diagrams lead to pronounced effects in A_FB at m(l+l-) approx 160 GeV which, however, will be difficult to observe experimentally. At high di-lepton invariant masses, the non-factorizable weak corrections are found to become large.Comment: Revtex3 file, 39 pages, 2 tables, 12 figure

Origins of the Ambient Solar Wind: Implications for Space Weather

The Sun's outer atmosphere is heated to temperatures of millions of degrees, and solar plasma flows out into interplanetary space at supersonic speeds. This paper reviews our current understanding of these interrelated problems: coronal heating and the acceleration of the ambient solar wind. We also discuss where the community stands in its ability to forecast how variations in the solar wind (i.e., fast and slow wind streams) impact the Earth. Although the last few decades have seen significant progress in observations and modeling, we still do not have a complete understanding of the relevant physical processes, nor do we have a quantitatively precise census of which coronal structures contribute to specific types of solar wind. Fast streams are known to be connected to the central regions of large coronal holes. Slow streams, however, appear to come from a wide range of sources, including streamers, pseudostreamers, coronal loops, active regions, and coronal hole boundaries. Complicating our understanding even more is the fact that processes such as turbulence, stream-stream interactions, and Coulomb collisions can make it difficult to unambiguously map a parcel measured at 1 AU back down to its coronal source. We also review recent progress -- in theoretical modeling, observational data analysis, and forecasting techniques that sit at the interface between data and theory -- that gives us hope that the above problems are indeed solvable.Comment: Accepted for publication in Space Science Reviews. Special issue connected with a 2016 ISSI workshop on "The Scientific Foundations of Space Weather." 44 pages, 9 figure

Numerical Modeling of Flow Control in a Boundary-Layer-Ingesting Offset Inlet Diffuser at Transonic Mach Numbers

This paper will investigate the validation of the NASA developed, Reynolds-averaged Navier-Stokes (RANS) flow solver, OVERFLOW, for a boundary-layer-ingesting (BLI) offset (S-shaped) inlet in transonic flow with passive and active flow control devices as well as a baseline case. Numerical simulations are compared to wind tunnel results of a BLI inlet experiment conducted at the NASA Langley 0.3-Meter Transonic Cryogenic Tunnel. Comparisons of inlet flow distortion, pressure recovery, and inlet wall pressures are performed. The numerical simulations are compared to the BLI inlet data at a free-stream Mach number of 0.85 and a Reynolds number of approximately 2 million based on the fanface diameter. The numerical simulations with and without tunnel walls are performed, quantifying tunnel wall effects on the BLI inlet flow. A comparison is made between the numerical simulations and the BLI inlet experiment for the baseline and VG vane cases at various inlet mass flow rates. A comparison is also made to a BLI inlet jet configuration for varying actuator mass flow rates at a fixed inlet mass flow rate. Overall, the numerical simulations were able to predict the baseline circumferential flow distortion, DPCP avg, very well within the designed operating range of the BLI inlet. A comparison of the average total pressure recovery showed that the simulations were able to predict the trends but had a negative 0.01 offset when compared to the experimental levels. Numerical simulations of the baseline inlet flow also showed good agreement with the experimental inlet centerline surface pressures. The vane case showed that the CFD predicted the correct trends in the circumferential distortion levels for varying inlet mass flow but had a distortion level that was nearly twice as large as the experiment. Comparison to circumferential distortion measurements for a 15 deg clocked 40 probe rake indicated that the circumferential distortion levels are very sensitive to the symmetry of the flow and that a misalignment of the vanes in the experiment could have resulted in this difference. The numerical simulations of the BLI inlet with jets showed good agreement with the circumferential inlet distortion levels for a range of jet actuator mass flow ratios at a fixed inlet mass flow rate. The CFD simulations for the jet case also predicted an average total pressure recovery offset that was 0.01 lower than the experiment as was seen in the baseline. Comparisons of the flow features for the jet cases revealed that the CFD predicted a much larger vortex at the engine fan-face when compare to the experiment

Effects of watershed land use on nitrogen concentrations and δ15 Nitrogen in groundwater

Author Posting. © The Authors, 2005. 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 Biogeochemistry 77 (2006): 199-215, doi:10.1007/s10533-005-1036-2.Eutrophication is a major agent of change affecting freshwater, estuarine, and marine systems. It is largely driven by transportation of nitrogen from natural and anthropogenic sources. Research is needed to quantify this nitrogen delivery and to link the delivery to specific land-derived sources. In this study we measured nitrogen concentrations and δ15N values in seepage water entering three freshwater ponds and six estuaries on Cape Cod, Massachusetts and assessed how they varied with different types of land use. Nitrate concentrations and δ15N values in groundwater reflected land use in developed and pristine watersheds. In particular, watersheds with larger populations delivered larger nitrate loads with higher δ15N values to receiving waters. The enriched δ15N values confirmed nitrogen loading model results identifying wastewater contributions from septic tanks as the major N source. Furthermore, it was apparent that N coastal sources had a relatively larger impact on the N loads and isotopic signatures than did inland N sources further upstream in the watersheds. This finding suggests that management priorities could focus on coastal sources as a first course of action. This would require management constraints on a much smaller population.This work was supported by funds from the Woods Hole Oceanographic Institution Sea Grant Program, from the Cooperative Institute for Coastal and Estuarine Environmental Technology, from Massachusetts Department of Environmental Protection to Applied Science Associates, Narragansett, RI, as well as from Palmer/McLeod and NOAA National Estuarine Research Reserve Fellowships to Kevin Kroeger. This work is the result of research sponsored by NOAA National Sea Grant College Program Office, Department of Commerce, under Grant No. NA86RG0075, Woods Hole Oceanographic Institution Sea Grant Project No. R/M-40

Formation of dense partonic matter in relativistic nucleus-nucleus collisions at RHIC: Experimental evaluation by the PHENIX collaboration

Extensive experimental data from high-energy nucleus-nucleus collisions were recorded using the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). The comprehensive set of measurements from the first three years of RHIC operation includes charged particle multiplicities, transverse energy, yield ratios and spectra of identified hadrons in a wide range of transverse momenta (p_T), elliptic flow, two-particle correlations, non-statistical fluctuations, and suppression of particle production at high p_T. The results are examined with an emphasis on implications for the formation of a new state of dense matter. We find that the state of matter created at RHIC cannot be described in terms of ordinary color neutral hadrons.Comment: 510 authors, 127 pages text, 56 figures, 1 tables, LaTeX. Submitted to Nuclear Physics A as a regular article; v3 has minor changes in response to referee comments. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

Aspects of χ\chi and ψ\psi Production in Polarized Proton-Proton Collisions

Several topics of relevance to low transverse momentum $\psi$ and $\chi_{1,2}(c\overline{c})$ production in polarized proton-proton collisions are discussed. The leading ${\cal O}(\alpha_S^3)$ contributions to the low $p_T$ $\chi_1$ production cross-sections via $gg$, $qg$, and $q\overline{q}$ initial states are calculated as well as the corresponding spin-spin asymmetries. We find that $\chi_1$ production increases relative to direct $\psi$ and $\chi_2$ production, providing up to $25\%$ of the observable $e^+e^-$ pairs arising from $\psi$ decays in $pp$ collisions at $\sqrt{s} = 500\,GeV$. The spin-dependence of $\chi_1$ production, however, is much smaller than for either direct $\psi$ or $\chi_2$ production and so will likely be far less useful than either process in probing the polarized gluon structure function of the proton. A subset of the ${\cal O}(\alpha_S^3)$ radiative corrections to $\chi_2$ production involving initial state quarks are also performed and compared to leading order $gg \rightarrow \chi_2$ predictions.Comment: 21 pages + 5 postscript figures (included), OCIP/C-94-

Wettability and corrosion of [NTf2] anion-based ionic liquids on steel and PVD (TiN, CrN, ZrN) coatings

Thewetting and corrosion behavior of three bis(trifluoromethylsulfonyl)imide-based ionic liquids: 1-Dodecyl-3- methylimidazolium bis(trifluoromethylsulfonyl)imide [C12MIM][NTf2], tributylmethylammonium bis(trifluoromethylsulfonyl)imide [N4441][NTf2] and methyltrioctylammonium bis(trifluoromethylsulfonyl)imide [N1888][NTf2] are tested in this research. The surface tension was measured for temperatures of 293–353 K resulting in the expected linearly decreasing behavior with temperature increase. In addition, contact angle measurements were made on AISI 52100 steel and three coatings (TiN, CrN and ZrN) obtained by PVD technique, finding the regular behavior in hydrophobic (non-polar) systems: high contact angles led to high surface tensions. Complementary parameters like spreading parameter and polarity fraction were calculated to enhance the wetting evaluation of these ionic liquids. [N1888][NTf2]/TiN resulted as the best IL-surface combination for a good wettability, due to the higher dispersion of the charge on the large size cation in this IL and the higher values of total and polar component of the surface free energy for this coating. Finally, SEM-EDS analysis determined that [N1888][NTf2]/ZrN was the best option in order to avoid corrosion problems. The evaporation of water, present as impurity in the ionic liquids, was found the main reason because of corrosion did not occur in the tests carried out at 100 °C