Reducing Unplanned Extubations in a Pediatric Intensive Care Unit: A Systematic Approach

Objective. To prospectively determine the rate of unplanned extubations and contributing factors and determine whether a targeted intervention program would be successful in decreasing the rate of unplanned extubations. Design. Prospective, observational study. Setting. A 10-bed Pediatric Intensive Care Unit (PICU). Patients. All intubated pediatric patients during two time periods: September 1, 2000–March 31, 2001 and November 1, 2001–April 30, 2002. Interventions. After determining the rate and causes of unplanned extubation, a program was developed consisting of education and a formalized endotracheal tube taping policy. Data were then collected after implementation of the program. Measurements and Main Results. Prior to the implementation of the program, there were 10 (14.7%) unplanned extubations for a rate of 6.4 unplanned extubations per 100 ventilated days. Of the ten unplanned extubations, reintubation was required in 2 (20%). Inadequate sedation, poor taping, and improper position of the endotracheal tube were the items most frequently cited as causing an unplanned extubation. Following the program, there were two (3.4%) unplanned extubations for 1.0 unplanned extubations per 100 ventilated days. Neither patient required reintubation. There were no significant differences (P > .05) in age, weight, endotracheal tube size, or duration of intubation in the two time periods. However, there was a significant decrease in both the number (P = .03) and the rate (P = .04) of unplanned extubations after the implementation of the quality improvement program. Conclusions. The rate of unplanned extubation in a PICU can be decreased with a quality improvement program that targets the institution's specific needs

DNA repair systems and the pathogenesis of Mycobacterium tuberculosis: varying activities at different stages of infection

Mycobacteria, including most of all MTB (Mycobacterium tuberculosis), cause pathogenic infections in humans and, during the infectious process, are exposed to a range of environmental insults, including the host's immune response. From the moment MTB is exhaled by infected individuals, through an active and latent phase in the body of the new host, until the time they reach the reactivation stage, MTB is exposed to many types of DNA-damaging agents. Like all cellular organisms, MTB has efficient DNA repair systems, and these are believed to play essential roles in mycobacterial pathogenesis. As different stages of infection have great variation in the conditions in which mycobacteria reside, it is possible that different repair systems are essential for progression to specific phases of infection. MTB possesses homologues of DNA repair systems that are found widely in other species of bacteria, such as nucleotide excision repair, base excision repair and repair by homologous recombination. MTB also possesses a system for non-homologous end-joining of DNA breaks, which appears to be widespread in prokaryotes, although its presence is sporadic within different species within a genus. However, MTB does not possess homologues of the typical mismatch repair system that is found in most bacteria. Recent studies have demonstrated that DNA repair genes are expressed differentially at each stage of infection. In the present review, we focus on different DNA repair systems from mycobacteria and identify questions that remain in our understanding of how these systems have an impact upon the infection processes of these important pathogens

Cytological and transcript analyses reveal fat and lazy persister-like bacilli in tuberculous sputum

As nonreplicating tubercle bacilli are tolerant to the cidal action of antibiotics and resistant to multiple stresses, identification of this persister-like population of tubercle bacilli in sputum presents exciting and tractable new opportunities to investigate both responses to chemotherapy and the transmission of tuberculosis

Intrusive memories and depression following recent non-traumatic negative life events in adolescents

Background: Research in adults suggests that intrusive memories are not just found in individuals with post-traumatic stress disorder (PTSD), yet there is little evidence concerning the phenomenology of intrusive memories in children and adolescents. The present study investigated the frequency of intrusive memories following a recent negative event in an adolescent school sample, and considered the application of cognitive theory to understanding the maintenance of intrusive memories of recent negative events, and their role in maintaining depression. Methods: High school students (aged 11-18 years; n = 231) completed questionnaires concerning affect experienced during a recent negative event, the frequency of subsequent intrusive memories, memory quality, thought suppression, post-traumatic stress and depressive symptoms. Results: Most participants had experienced at least one intrusive memory in the previous week, at similar rates for traumatic events and life events. In non-trauma exposed youth, peri-event affect and memory quality accounted for unique variance in a regression model of intrusive memory frequency, while peri-event affect, memory quality, and intrusive memory frequency accounted for unique variance in a regression model of depression. Limitations: The study needs replication in younger children. Interview methods may be required to ensure that intrusive memories are being assessed and not intrusive thoughts or ruminations. Conclusions: Intrusive memories are common reaction to negative events in adolescents, and may be involved in maintaining subsequent depressed mood. The nature of event memories may have a role in the maintenance of such psychopathology, and may be a target for psychological interventions in this age group

A randomized controlled trial comparing EMDR and CBT for obsessive–compulsive disorder

Background: This study aimed to evaluate eye movement desensitization and reprocessing (EMDR) as a treatment for obsessive–compulsive disorder (OCD), by comparison to cognitive behavioural therapy (CBT) based on exposure and response prevention. Method: This was a pragmatic, feasibility randomized controlled trial in which 55 participants with OCD were randomized to EMDR (n = 29) or CBT (n = 26). The Yale‐Brown obsessive– compulsive scale was completed at baseline, after treatment and at 6 months follow‐up. Treatment completion and response rates were compared using chi‐square tests. Effect size was examined using Cohen's d and multilevel modelling. Results: Overall, 61.8% completed treatment and 30.2% attained reliable and clinically significant improvement in OCD symptoms, with no significant differences between groups (p > .05). There were no significant differences between groups in Yale‐Brown obsessive–compulsive scale severity post‐treatment (d = −0.24, p = .38) or at 6 months follow‐up (d = −0.03, p = .90). Conclusions: EMDR and CBT had comparable completion rates and clinical outcomes

Goathead and Land Cover Classification

Goathead, Tribulus Terrestris, is an invasive plant species in Idaho. Previous research from Trevor Caughlin’s Lab at BSU found bareground cover to consistently increase their abundance, emergence, and persistence. Additionally, low-valued properties were found to have a higher risk of goathead occurrence on peripheral plots along the road network (i.e. cul-de-sacs, dead-end streets). Through mentorship, work in QGIS and R programming we analyzed satellite imagery with segmentation and classification. The classification algorithm showed a higher Overall Accuracy value with Asphalt, BareGround, BuiltEnvironment, Herbaceous, Tree, and Water. Compared to doing classification with PavedGround as well. Results indicate a more accurate classification that can be used to generate an updated mapping of Goathead susceptibility in Boise. A version of the map is currently utilized for goathead elimination efforts by the public, including the City of Boise’s Weed Warriors program and the non-profit, Boise Bicycle Project. At least yearly land cover analysis will need to be conducted to update goathead susceptibility mapping. Urban planning efforts can benefit from subsequent research with urban field scholars and ecologists to analyze the socio-ecological impacts on urban infrastructure. This research further demonstrated how urban infrastructure facilitates inequitable conditions for bicyclists, human traffic, and dog walkers. Ultimately, we found community collaboration can reconstruct a more resilient, equitable, and sustainable urban ecosystem

Value of Manual Plant Identification in an Age of Drone Technology

In our research, we are training and optimizing a learning algorithm to predict plant species using drone and plant survey data. Drones collect images to produce both RGB photos and multi-spectral data that can be utilized in a variety of ways depending on application. Complimenting the drone imagery, surveying collects basic plant characteristics and GPS locations. When both of these are then given to a learning algorithm as training data it has more information than only a picture to distinguish plants. We have seen promising success in the past getting past the proof of concept. This work serves as an example of how manual plant Identification is still commonly used. With the development of AI, it’s likely that in the near future we could be identifying plants with photos alone. For now, researchers still rely on traditional methods to support these emerging technologies