Relationship between Delirium and Night-Time Interruptions in ICU

Background: This dissertation examined the phenomenon of delirium in the intensive care unit (ICU) setting. Delirium is a form of cognitive disturbance with a physiologic etiology and complex, multifactorial mechanisms of causation and risk. Delirium in the ICU patient presents a significant risk for adverse outcomes including increased mortality, length of stay, falls, and restraint use. ICU delirium can lead to persistent cognitive impairment beyond discharge and frequent skilled nursing placement. Identifying delirium requires accurate diagnosis that is optimized when validated instruments are used. Sleep deprivation has been linked to adverse health consequences including delirium. Previous studies investigating the relationship between sleep and delirium have focused on the effects of light, noise, medications, and mechanical ventilation. Limited knowledge existed on the role night-time interruptions caused by routine hospital processes played in the prevalence of delirium. Objectives: This body of work aimed to determine the prevalence of ICU delirium in a sample of ICU patients and discover if there was a relationship between night-time sleep interruptions and delirium in a subset of patients undergoing cardiac surgery. A secondary purpose was to study the relationship between delirium, falls, and restraint use in adult cardiac surgery patients in ICU. The work will be presented in three manuscripts. Methods: A data-based retrospective cross-sectional design was used to describe the documentation of delirium in three acute care hospitals with mixed medical, surgical, and trauma ICU\u27s. A descriptive design using a subset of patients from the pre-collected data was used to identify relationships between independent risk variables and delirium in a sample of cardiovascular surgical ICU patients. Results: The first manuscript titled Preventing ICU Delirium: A Patient-Centered Approach to Reducing Sleep Disruption was published in Dimensions of Critical Care Nursing with the purpose of describing the state of the science regarding sleep as a risk factors for developing delirium and research evidence on the ill health effects of sleep loss. A patient centered approach was introduced to improve sleep in ICU by re-evaluating the necessity of routine processes that disrupt sleep in the critically ill. The second manuscript titled Delirium Assessment and Prevalence in Critical Care Patients. The article presents the frequency of delirium assessment and the prevalence of ICU delirium. The differences among amongst the three hospitals regarding ICU length of stay and assessment percent were also presented. In order to treat delirium, it must first be recognized. This study indicated the clinicians may be missing the delirium diagnosis because the assessment was not being done. The third manuscript is titled The Relationship Between Night-time Interruptions in ICU. The final manuscript describes the results of an observational study using retrospective data on the frequency ICU patients are awakened at night for routine laboratory and diagnostic tests. In addition, the relationship between the frequencies of sleep interruptions and delirium prevalence was presented. While no relationship was found, the results suggest ICU patients are awoken frequently at night and more studies are needed to understand if sleep deprivation in critically ill patients leads to poor health outcomes

Compensation in undoped and halogen doped CdTe crystals

A theoretical model is proposed which allows the calculation of the concentration of defects in pure and halogen compensated cadmium telluride grown by the THM method. All associations and ionization reactions are described in terms of the law of mass action. The ionization energies of the defects are taken from the energy level diagram established by taking into account the latest experimental data. The concentrations of the different defects calculated for chlorine doped material are in good agreement with that measured using a time of flight method

Recuit laser de cellules solaires fonctionnant sous concentration

La résistance série élevée des cellules conventionnelles au silicium rend leur fonctionnement difficile sous concentration. Nous montrons ici que l'irradiation de la couche superficielle diffusée par un faisceau laser pulsé de grande intensité permet de réduire notamment la résistance série, de sorte que des rendements de conversion de 15 % sous 30 soleils et de 12,5 % sous 100 soleils (10 W/cm2) sont prévus par le calcul

SOLUBILITY LIMIT OF DOPANTS IN SILICON IRRADIATED BY RUBY LASER

The solubility of several dopants (Sb, Ga, Bi, In) in laser treated silicon has been investigated. The dopants were introduced by vacuum deposition followed by a ruby laser irradiation. Their solubility was determined by Rutherford backscattering spectrometry measurements in channeling and random conditions. In all cases a solubility limit Cmℓ higher than the equilibrium solubility was found and a simple correlation with the equilibrium distribution coefficient kO could be established : Cmℓ = 8.6 × 1021 k0.51O cm-3

From the Queue to the Quality of Service Policy: A Middleware Implementation

The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-642-02481-8_61Quality of service policies in communications is one of the current trends in distributed systems based on middleware technology. To implement the QoS policies it is necessary to define some common parameters. The aim of the QoS policies is to optimize the user defined QoS parameters. This article describes how to obtain the common QoS parameters using message queues for the communications and control components of communication. The paper introduces the Queue-based Quality of Service Cycle concept for each middleware component. The QoS parameters are obtained directly from the queue parameters, and Quality of Service Policies controls directly the message queues to obtain the user-defined parameters values.The middleware architecture described in this article is a part of the coordinated project SIDIRELI: Distributed Systems with Limited Resources. Control Kernel and Coordination. Education and Science Department, Spanish Government. CICYT: MICINN: DPI2008-06737-C02-01/02.Poza-Lujan, J.; Posadas-Yagüe, J.; Simó Ten, JE. (2009). From the Queue to the Quality of Service Policy: A Middleware Implementation. En Distributed Computing, Artificial Intelligence, Bioinformatics, Soft Computing, and Ambient Assisted Living. Springer Verlag (Germany). 432-437. doi:10.1007/978-3-642-02481-8_61S432437Aurrecoechea, C., Campbell, A.T., Hauw, L.: A Survey of QoS Architectures. Multimedia Systems Journal, Special Issue on QoS Architecture 6(3), 138–151 (1998)OMG. Data Distribution Service for Real-Time Systems, v1.1. Document formal/2005-12-04 (December 2005)Botts, M., Percivall, G., Reed, C., Davidson, J.: OGC®. Sensor Web Enablement: Overview And High Level Architecture, OpenGIS Consortium Inc (2006)Poza, J.L., Posadas, J.I., Simó, J.E.: QoS-based middleware architecture for distributed control systems. In: International Symposium on Distributed Computing and Artificial Intelligence, Salamanca (2008)Vogel, A., Kerherve, B., von Bochmann, G., Gecsei, J.: Distributed Multi-media and QoS: A Survey 2(2), 10–19 (1995)Crawley, E., Nair, R., Rajagopalan, B.: RFC 2386: A Framework for QoS-based Routing in the Internet, pp. 1–37, XP002219363 (August 1998)ITU-T Recommendation E.800 (0894). Terms and Definitions Related to Quality of Service and Network Performance Including Dependability (1994)Stuck, B.W., Arthurs, E.: A Computer & Communications Network Performance Analysis Primer. Prentice Hall, Englewood Cliffs (1984)Jain, R.: The art of Computer Systems Performance Analysis. John Wiley & Sons Inc., New york (1991)Coulouris, G., Dollimore, J., Kindberg, T.: Distributed Systems. Concepts and Design, 3rd edn. Addison Wesley, Madrid (2001)Jung, J.-l.: Quality of Service in Telecommunications Part II: Translation of QoS Pa-rameters into ATM Performance Parameters in B-ISDN. IEEE Comm. Mag., pp. 112–117 (August 1996)Wohlstadter, E., Tai, S., Mikalsen, T., Rouvellou, I., Devanbu, P.: GlueQoS: Middleware to Sweeten Quality-of-Service Policy Interactions. In: ICSE, 26th International Conference on Software Engineering (ICSE 2004) (2004

Performance of a Novel Handheld Bioelectrical Impedance Device for Assessing Muscle Mass in Older Inpatients.

OBJECTIVES To investigate practicality and repeatability of a handheld compared to a state-of-the-art multisegmental bioelectrical impedance analysis (BIA) device to facilitate screening of sarcopenia in older inpatients. DESIGN AND SETTING Cross-sectional study in a geriatric rehabilitation hospital. PARTICIPANTS 207 inpatients aged 70+. MEASUREMENTS In a first phase, appendicular skeletal muscle mass index (ASMI) was measured using the handheld Biody xpertZm II BIA device (n=100). In a second phase, ASMI was obtained using the multisegmental Biacorpus RX 4004M device (n=107). Repeatability of BIA devices was compared in subgroups of patients (handheld BIA device: n=36, multisegmental BIA device: n=46) by intra-class correlation (ICC) and Bland-Altman plots. RESULTS Overall, measurement failure was seen in 31 patients (31%) tested with the handheld BIA device compared to one patient (0.9%) using the multisegmental BIA device (p<0.001). Main reasons for measurement failure were inability of patients to adopt the position necessary to use the handheld BIA device and device failure. The mean difference of two ASMI measurements in the same patient was 0.32 (sd 0.85) using the handheld BIA device compared to 0.02 kg/m2 (sd 0.07) using the multisegmental device (adjusted mean difference between both groups -0.35, 95% confidence interval (CI) -0.61 to -0.09 kg/m2). Congruently, Bland-Altman plots showed poor agreement with the handheld compared to the multisegmental BIA device. CONCLUSION The handheld BIA device is neither a practical nor reliable device for assessing muscle mass in older rehabilitation inpatients

AMPA Receptor Phosphorylation and Synaptic Colocalization on Motor Neurons Drive Maladaptive Plasticity below Complete Spinal Cord Injury.

Clinical spinal cord injury (SCI) is accompanied by comorbid peripheral injury in 47% of patients. Human and animal modeling data have shown that painful peripheral injuries undermine long-term recovery of locomotion through unknown mechanisms. Peripheral nociceptive stimuli induce maladaptive synaptic plasticity in dorsal horn sensory systems through AMPA receptor (AMPAR) phosphorylation and trafficking to synapses. Here we test whether ventral horn motor neurons in rats demonstrate similar experience-dependent maladaptive plasticity below a complete SCI in vivo. Quantitative biochemistry demonstrated that intermittent nociceptive stimulation (INS) rapidly and selectively increases AMPAR subunit GluA1 serine 831 phosphorylation and localization to synapses in the injured spinal cord, while reducing synaptic GluA2. These changes predict motor dysfunction in the absence of cell death signaling, suggesting an opportunity for therapeutic reversal. Automated confocal time-course analysis of lumbar ventral horn motor neurons confirmed a time-dependent increase in synaptic GluA1 with concurrent decrease in synaptic GluA2. Optical fractionation of neuronal plasma membranes revealed GluA2 removal from extrasynaptic sites on motor neurons early after INS followed by removal from synapses 2 h later. As GluA2-lacking AMPARs are canonical calcium-permeable AMPARs (CP-AMPARs), their stimulus- and time-dependent insertion provides a therapeutic target for limiting calcium-dependent dynamic maladaptive plasticity after SCI. Confirming this, a selective CP-AMPAR antagonist protected against INS-induced maladaptive spinal plasticity, restoring adaptive motor responses on a sensorimotor spinal training task. These findings highlight the critical involvement of AMPARs in experience-dependent spinal cord plasticity after injury and provide a pharmacologically targetable synaptic mechanism by which early postinjury experience shapes motor plasticity

PULSED ELECTRON BEAM ANNEALING OF As AND B IMPLANTED SILICON

p-type (100) silicon wafers have been implanted either by As or B ions at 20 and 200 keV energies and doses of 1016cm-2. Pulsed electron beam annealing has been performed with fluences of 1.1 and 1.4 J/cm2 using a mean electron energy of 15 keV. The pulse duration was 50 ns. The annealed layers have been investigated by Rutherford backscattering under random and channeling conditions and by S.I.M.S. profiling. Good crystal regrowth and high dopant activation occur in all cases except for the 200 keV Boron implant. Impurities redistribution is observed but no significant segregation effects appear. The experimental profiles are in good agreement with a diffusion model using a modified green function solution and taking into account dopant diffusion in liquid phase and the computed melt front location. The deduced diffusion coefficient are in the 5.10-5cm2/s range for boron and 2.10-4cm2/s range for arsenic

What does your neighbourhood say about you? : a study of life expectancy in 1.3 million Swiss neighbourhoods

BACKGROUND: Switzerland had the highest life expectancy at 82.8 years among the Organisation for Economic Co-operation and Development (OECD) countries in 2011. Geographical variation of life expectancy and its relation to the socioeconomic position of neighbourhoods are, however, not well understood. METHODS: We analysed the Swiss National Cohort, which linked the 2000 census with mortality records 2000-2008 to estimate life expectancy across neighbourhoods. A neighbourhood index of socioeconomic position (SEP) based on the median rent, education and occupation of household heads and crowding was calculated for 1.3 million overlapping neighbourhoods of 50 households. We used skew-normal regression models, including the index and additionally marital status, education, nationality, religion and occupation to calculate crude and adjusted estimates of life expectancy at age 30 years. RESULTS: Based on over 4.5 million individuals and over 400,000 deaths, estimates of life expectancy at age 30 in neighbourhoods ranged from 46.9 to 54.2 years in men and from 53.5 to 57.2 years in women. The correlation between life expectancy and neighbourhood SEP was strong (r=0.95 in men and r=0.94 women, both p values &lt;0.0001). In a comparison of the lowest with the highest percentile of neighbourhood SEP, the crude difference in life expectancy from skew-normal regression was 4.5 years in men and 2.5 years in women. The corresponding adjusted differences were 2.8 and 1.9 years, respectively (all p values &lt;0.0001). CONCLUSIONS: Although life expectancy is high in Switzerland, there is substantial geographical variation and life expectancy is strongly associated with the social standing of neighbourhoods