Sedation and Analgesia in Intensive Care: A Comparison of Fentanyl and Remifentanil

Optimal sedation and analgesia are of key importance in intensive care. The aim of this study was to assess the quality of sedoanalgesia and outcome parameters in regimens containing midazolam and either fentanyl or remifentanil. A prospective, randomized, open-label, controlled trial was carried out in the ICU unit of a large teaching hospital in Istanbul over a 9-month period. Thirty-four patients were randomly allocated to receive either a remifentanil-midazolam regimen (R group, n = 17) or a fentanyl-midazolam regimen (F group, n = 17). A strong correlation between Riker Sedation-Agitation Scale (SAS) and Ramsey Scale (RS) measurements was observed. Comparatively, remifentanil provided significantly more potent and rapid analgesia based on Behavioral-Physiological Scale (BPS) measurements and a statistically nonsignificantly shorter time to discharge. On the other hand, remifentanil also caused a significantly sharper fall in heart rate within the first six hours of treatment

A SEPALLATA gene is involved in the development and ripening of strawberry (Fragaria xananassa Duch.) fruit, a non-climacteric tissue

Climacteric and non-climacteric fruits have traditionally been viewed as representing two distinct programmes of ripening associated with differential respiration and ethylene hormone effects. In climacteric fruits, such as tomato and banana, the ripening process is marked by increased respiration and is induced and co-ordinated by ethylene, while in non-climacteric fruits, such as strawberry and grape, it is controlled by an ethylene-independent process with little change in respiration rate. The two contrasting mechanisms, however, both lead to texture, colour, and flavour changes that probably reflect some common programmes of regulatory control. It has been shown that a SEPALLATA(SEP)4-like gene is necessary for normal ripening in tomato. It has been demonstrated here that silencing a fruit-related SEP1/2-like (FaMADS9) gene in strawberry leads to the inhibition of normal development and ripening in the petal, achene, and receptacle tissues. In addition, analysis of transcriptome profiles reveals pleiotropic effects of FaMADS9 on fruit development and ripening-related gene expression. It is concluded that SEP genes play a central role in the developmental regulation of ripening in both climacteric and non-climacteric fruits. These findings provide important information to extend the molecular control of ripening in a non-climacteric fruit beyond the limited genetic and cultural options currently available

A sub-group of patients with hospital-acquired pneumonia do not require broad-spectrum gram-negative antimicrobial coverage

C.D.R. is supported by an Edinburgh Clinical Academic Track (ECAT)/Wellcome Trust PhD Training Fellowship for Clinicians award (214178/Z/18/Z).Among 200 patients developing hospital-acquired pneumonia (HAP) outside the intensive care unit, 61% were treated empirically without broad-spectrum Gram-negative coverage, with clinical cure in 69.7%. Lower disease severity markers (systemic inflammatory response syndrome, hypoxia, tachypnoea, neutrophilia) and the absence of diabetes mellitus and prior doxycycline treatment (but not the time to HAP onset) identified patients not requiring broad-spectrum Gram-negative coverage.Publisher PDFPeer reviewe

Source apportionment of fine particulate matter in Houston, Texas: insights to secondary organic aerosols

Online and offline measurements of ambient particulate matter (PM) near the urban and industrial Houston Ship Channel in Houston, Texas, USA, during May 2015 were utilized to characterize its chemical composition and to evaluate the relative contributions of primary, secondary, biogenic, and anthropogenic sources. Aerosol mass spectrometry (AMS) on nonrefractory PM1 (PM  ≤  1&thinsp;µm) indicated major contributions from sulfate (averaging 50&thinsp;% by mass), organic aerosol (OA, 40&thinsp;%), and ammonium (14&thinsp;%). Positive matrix factorization (PMF) of AMS data categorized OA on average as 22&thinsp;% hydrocarbon-like organic aerosol (HOA), 29&thinsp;% cooking-influenced less-oxidized oxygenated organic aerosol (CI-LO-OOA), and 48&thinsp;% more-oxidized oxygenated organic aerosol (MO-OOA), with the latter two sources indicative of secondary organic aerosol (SOA). Chemical analysis of PM2.5 (PM  ≤  2.5&thinsp;µm) filter samples agreed that organic matter (35&thinsp;%) and sulfate (21&thinsp;%) were the most abundant components. Organic speciation of PM2.5 organic carbon (OC) focused on molecular markers of primary sources and SOA tracers derived from biogenic and anthropogenic volatile organic compounds (VOCs). The sources of PM2.5 OC were estimated using molecular marker-based positive matric factorization (MM-PMF) and chemical mass balance (CMB) models. MM-PMF resolved nine factors that were identified as diesel engines (11.5&thinsp;%), gasoline engines (24.3&thinsp;%), nontailpipe vehicle emissions (11.1&thinsp;%), ship emissions (2.2&thinsp;%), cooking (1.0&thinsp;%), biomass burning (BB, 10.6&thinsp;%), isoprene SOA (11.0&thinsp;%), high-NOx anthropogenic SOA (6.6&thinsp;%), and low-NOx anthropogenic SOA (21.7&thinsp;%). Using available source profiles, CMB apportioned 41&thinsp;% of OC to primary fossil sources (gasoline engines, diesel engines, and ship emissions), 5&thinsp;% to BB, 15&thinsp;% to SOA (including 7.4&thinsp;% biogenic and 7.6&thinsp;% anthropogenic), and 39&thinsp;% to other sources that were not included in the model and are expected to be secondary.This study presents the first application of in situ AMS-PMF, MM-PMF, and CMB for OC source apportionment and the integration of these methods to evaluate the relative roles of biogenic, anthropogenic, and BB-SOA. The three source apportionment models agreed that  ∼ &thinsp;50&thinsp;% of OC is associated with primary emissions from fossil fuel use, particularly motor vehicles. Differences among the models reflect their ability to resolve sources based upon the input chemical measurements, with molecular marker-based methods providing greater source specificity and resolution for minor sources. By combining results from MM-PMF and CMB, BB was estimated to contribute 11&thinsp;% of OC, with 5&thinsp;% primary emissions and 6&thinsp;% BB-SOA. SOA was dominantly anthropogenic (28&thinsp;%) rather than biogenic (11&thinsp;%) or BB-derived. The three-model approach demonstrates significant contributions of anthropogenic SOA to fine PM. More broadly, the findings and methodologies presented herein can be used to advance local and regional understanding of anthropogenic contributions to SOA.</p

From von Neumann architecture and Atanasoff’s ABC to Neuromorphic Computation and Kasabov’s NeuCube. Part II: Applications

Spatio/Spector-Temporal Data (SSTD) analyzing is a challenging task, as temporal features may manifest complex interactions that may also change over time. Making use of suitable models that can capture the “hidden” interactions and interrelationship among multivariate data, is vital in SSTD investigation. This chapter describes a number of prominent applications built using the Kasabov’s NeuCube-based Spiking Neural Network (SNN) architecture for mapping, learning, visualization, classification/regression and better understanding and interpretation of SSTD

Crimean-Congo hemorrhagic fever: epidemiological trends and controversies in treatment

Crimean-Congo hemorrhagic fever (CCHF) virus has the widest geographic range of all tick-borne viruses and is endemic in more than 30 countries in Eurasia and Africa. Over the past decade, new foci have emerged or re-emerged in the Balkans and neighboring areas. Here we discuss the factors influencing CCHF incidence and focus on the main issue of the use of ribavirin for treating this infection. Given the dynamics of CCHF emergence in the past decade, development of new anti-viral drugs and a vaccine is urgently needed to treat and prevent this acute, life-threatening disease

Effect of harvest time on physicochemical quality parameters, oxidation stability, and volatile compounds of extra virgin olive oil

The aim of this study was to determine the changes in some physicochemical properties of olives (fruit weight, water content and oil content) and olive oils (total chlorophyll, carotenoid, pheophytin a, peroxide value and free acidity), and in the chemical properties (fatty acids, tocopherols, phenolics, oxidation stability and volatile profiles) of oils during ripening.Ripening indices (RI) of olive samples were 1.93 (unripe), 4.28 (ripe) and 5.89 (overripe). Most of the mentioned features changed with ripening. During ripening there was a sharp decrease in total chlorophyll, carotenoid and pheophytin a contents. An increase in oleic and linoleic acids and a decrease in palmitic acid were found in the fatty acid composition. Olive oils showed strong relations among oxidation stability, tocopherol content, total phenols content, and antiradical actvity of phenol extracts and these parameters decreased with maturation. Nevertheless, higher amounts of trans-2-hexenal were found in the oil from ripe olives than from unripe and overripe olives. On the other hand, the highest concentration of hexanal was found in the oil from overripe olives.In general, significant differences were observed in fruit weight, pigments, free acidity, fatty acid, tocopherol, and total phenolics contents, radical scavenger activity, oxidation stability, phenolic profile and volatile profile between the olive oils from the Gemlik cultivar at different stages of maturation

Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol.

Background: This study sought to establish the long-term effects of Covid-19 following hospitalisation. Methods: 327 hospitalised participants, with SARS-CoV-2 infection were recruited into a prospective multicentre cohort study at least 3 months post-discharge. The primary outcome was self-reported recovery at least ninety days after initial Covid-19 symptom onset. Secondary outcomes included new symptoms, disability (Washington group short scale), breathlessness (MRC Dyspnoea scale) and quality of life (EQ5D-5L). Findings: 55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age. Interpretation: Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females. Funding: National Institute for Health Research, UK Medical Research Council, Wellcome Trust, Department for International Development and the Bill and Melinda Gates Foundation