Perioperative Risk Factors for Postoperative Delirium in Patients Undergoing Esophagectomy

Background Postoperative delirium affects up to 50% of patients undergoing esophagectomy and is associated with negative outcomes. The perioperative risk factors for delirium in this population are not well understood. We conducted this study to assess perioperative risk factors for postoperative delirium among esophagectomy patients. Methods We performed a secondary data analysis of patients enrolled in a randomized controlled trial evaluating the efficacy of haloperidol prophylaxis postoperatively in reducing delirium among esophagectomy patients. Postoperative delirium was assessed twice daily using the Confusion Assessment Method for the ICU. Univariate and logistic regression analyses were performed to examine the association between perioperative variables and development of postoperative delirium. Results Of 84 consecutive esophagectomy patients, 27 (32%) developed postoperative delirium. Patients who developed postoperative delirium had higher APACHE II scores [22.1 (6.5) versus 17.4 (6.8); p=0.003], longer mechanical ventilation days [1.7 (1.4) versus 1.0 (1.1); p=0.001], and longer ICU days [5.1 (2.6) versus 2.6 (1.6); p<0.001]. In a logistic regression model, only ICU length of stay was found to have significant association with postoperative delirium [OR 1.65; 95% CI 1.21-2.25]. Conclusions ICU length of stay was significantly associated with postoperative delirium. Other perioperative factors including duration of surgery, blood loss, and hemoglobin levels were not significantly associated with postoperative delirium

Association of Cigarette Smoking with Thickness of Intimal Layer of Carotid Arteries on Color Doppler Ultrasound Study and Its Surgical Management

Objectives:&nbsp;&nbsp;Aim of this study is to evaluate the intimal vessel wall thickness in smoker and their co-relation with non-smoker and also surgical management of stenosis. Material and Methods:&nbsp;&nbsp;It is a prospective study of 55 cases. Study span and follow up duration were 4 months. Our patients were presented with the history of CVA (Cerebrovascular accident), hypertension, diabetes, and headache. Results:&nbsp;&nbsp;In all patients, the carotid doppler ultrasound was done and their intimal vessel wall thickness was noted. Our 78% patients were smoker and non-smoker was 22%. In our study, 52% patients had CVA, 41% patients had hypertension, 30% patients had headache and 9% patients were also obese. Forty three smokers used to take 15 – 25 cigarettes daily. Among 43 patients, 5 patients were females. In carotid Doppler study, intimal thickness was increased in 87%, the plaque was observed in 49% and stenosis was observed in 38% cases. In 18 % patients, who had stenosis &gt; 70%, carotid endarterectomy was performed and in rest of the patients medical treatment done.Patients who were chronic smokers and had medical co-morbidities showed greater thickness of intimal layer of vessels on carotid Doppler. In 6 patients, post-operative headache occurred. Conclusion:&nbsp;&nbsp;Smokers had more thickness of intimal layer of carotid vessels. Carotid endarterectomy yields good results in case of stenosis more than 70%. Keywords:&nbsp;&nbsp;Cerebrovascular accident, Intimal layer thickness, Carotid doppler ultrasound, Cigarette smokin

Cohort-based kernel principal component analysis with Multi-path Service Routing in Federated Learning

Federated Learning (FL) is a machine learning (ML) strategy that is performed in a decentralized environment. The training is performed locally by the client on the global model shared by the server. Federated learning has recently been used as a service (FLaaS) to provide a collaborative training environment to independent third-party applications. However, the widespread adoption in distributed settings of FL has opened venues for a number of security attacks. A number of studies have been performed to prevent multiple FL attacks. However, sophisticated attacks, such as label-flipping attacks, have received little or no attention. From the said perspective, this research is focused on providing a defense mechanism for the aforesaid attack. The proposed approach is based on Type-based Cohorts (TC) with Kernel Principal Component Analysis (KPCA) to detect and defend against label-flipping attacks. Moreover, to improve the performance of the network, we will deploy Multi-path Service Routing (MSR) for edge nodes to work effectively. The KPCA will be used to secure the network from attacks. The proposed mechanism will provide an effective and secure FL system. The proposed approach is evaluated with respect to the following measures: execution time, memory consumption, information loss, accuracy, service request violations, and the request’s waiting time

A Context-aware and Intelligent Framework for the Secure Mission Critical Systems

Recent technological advancements in pervasive systems have shown the poten-tial to address challenges in the military domain. Research developments in mili-tary-based mission-critical systems have refined a lot as in autopilot, sensing true target behavior, battle damage conditions, acquiring and manipulating command control information. However, the application of pervasive systems in the military domain is still evolving. In this paper, an intelligent framework has been pro-posed for mission-critical systems to incorporate advanced heterogeneous com-munication protocols; service-oriented layered structure and context-aware infor-mation manipulation. The proposed framework addresses the limitation of “time-space” constraints in Mission-critical systems that have been improved signifi-cantly. This improvement is courtesy to enhancing situation-aware tactical capa-bilities such as localization, decision significance, strategic span, strategic inten-tions, resource coordination and profiling concerning the situation. A comprehen-sive use case model has been presented for a typical battle-field scenario followed by a comparison of the proposed framework with existing techniques. It is evi-dent from experiments and analyses that the proposed framework provides more effective and seamless interaction with contextual resources to improve tactical capabilities. This is the peer reviewed version of the following article: A Context-aware and Intelligent Framework for the Secure Mission Critical Systems, which has been published in final form in Transactions on Emerging Telecommunications Technologies. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Version

Diffusion of the Cu monomer and dimer on Ag(111): Molecular dynamics simulations and density functional theory calculations

We present results of molecular dynamics (MD) simulations and density functional theory (DFT) calculations of the diffusion of Cu adatom and dimer on Ag(111). We have used potentials generated by the embedded-atom method for the MD simulations and pseudopotentials derived from the projected-augmented-wave method for the DFT calculations. The MD simulations (at three different temperatures: 300, 500, and 700 K) show that the diffusivity has an Arrhenius behavior. The effective energy barriers obtained from the Arrhenius plots are in excellent agreement with those extracted from scanning tunneling microscopy experiments. While the diffusion barrier for Cu monomers on Ag(111) is higher than that reported (both in experiment and theory) for Cu(111), the reverse holds for dimers [which, for Cu(111), has so far only been theoretically assessed]. In comparing our MD result with those for Cu islets on Cu(111), we conclude that the higher barriers for Cu monomers on Ag(111) results from the comparatively large Ag-Ag bond length, whereas for Cu dimers on Ag(111) the diffusivity is taken over and boosted by the competition in optimization of the Cu-Cu dimer bond and the five nearest-neighbor Cu-Ag bonds. Our DFT calculations confirm the relatively large barriers for the Cu monomer on Ag(111)-69 and 75 meV-compared to those on Cu(111) and hint a rationale for them. In the case of the Cu dimer, the relatively long Ag-Ag bond length makes available a diffusion route whose highest relevant energy barrier is only 72 meV and which is not favorable on Cu(111). This process, together with another involving an energy barrier of 83 meV, establishes the possibility of low-barrier intercell diffusion by purely zigzag mechanisms

Effects of Bacillus subtilis on performance, immune system and gut in Salmonella-challenged broilers

The goal of this study was to compare the effects of Bacillus subtilis and the antibiotic enrofloxacin on growth performance, immune response, intestinal histomorphometry and cecal Salmonella numbers in broilers challenged with S. gallinarum. Salmonella-free chicks (n = 240) were allocated to four groups, comprising six replicates (n = 10) each. Group NN was not infected and received no treatment. Group SN was infected with Salmonella and received no treatment. Group SE was infected with Salmonella and treated with the antibiotic enrofloxacin. Group SP was infected with Salmonella and treated orally with the probiotic B. subtilis. Initially the groups that were infected with Salmonella had reduced growth performance compared with NN. By the fourth week, SE and SP had recovered and weighed as much as or more than NN. The SP group had greater cellular immunity and relative weights of the bursa and thymus than the other groups. SN had the lowest villus height in all the segments of the small intestine and a larger Salmonella population in the ceca. Probiotic supplementation reduced the pathological outcomes more than enrofloxacin. Prophylactic use of B. subtilis-type probiotics had similar effects to the use of antibiotics, alleviated the stress related to infection of S. gallinarum, and improved the growth performance, immune function, and gut mucosal development in broilers. Keywords: growth promoters, immunity, probiotics, poultry villi lengt

Effect of garlic supplementation on zootechnical performance and hepato-renal functions in nitrate-treated rabbits

The effect of garlic supplementation on zootechnical performance and hepato-renal functions of rabbits exposed to experimental nitrate poisoning was evaluated. Adult male 6-8 week-old albino rabbits (n= 24) were randomly divided into four groups (A - D) and subjected to nitrate intoxication through the oral administration of sodium nitrate solution at 2 ml/kg bodyweight per day for 40 days. Group A was a control that received no treatment except sodium nitrate. Rabbits in groups B and C were treated with 1% methylene blue solution (2 mg/kg bodyweight per day) and aqueous garlic extract (500 mg/kg bodyweight per day) through intraperitoneal and oral routes, respectively. Rabbits in group D were treated with both 1% methylene blue solution (2 mg/kg bodyweight per day, intraperitoneally) and aqueous garlic extract (500 mg/kg bodyweight per day, orally). On completion of the treatment period, the groups were compared in growth performance, biochemical profile and histopathological changes of hepato-renal tissues. Although the total feed consumption of the groups remained comparable, Group C showed relatively better weight gain and feed conversion ratio (FCR). Likewise, garlic extract significantly increased the serum bilirubin concentration and reduced the level of other biochemical attributes in comparison with control animals. The hepatic and renal tissues of Groups C and D remained normal, whereas those of the control group exhibited distinct histopathological alterations. It was concluded that garlic supplementation ameliorated the deleterious effects of nitrate intoxication on production performance and hepato-renal functions of rabbits

Effects of music intervention on inflammatory markers in critically ill and post-operative patients: A systematic review of the literature

BACKGROUND: Music listening has been shown to reduce anxiety, stress, and patient tolerance of procedures. Music may also have beneficial effects on inflammatory biomarkers in intensive care and post-operative patients, but the quality of evidence is not clear. OBJECTIVES: We conducted a systematic review to evaluate the effects of music on inflammatory biomarkers in intensive care, and post-operative patients. METHODS: A comprehensive search of the literature was performed. After screening 1570 references, full text review of 26 studies was performed. Fourteen studies were selected for inclusion. RESULTS: Seven studies showed a significant decrease in cortisol levels, but the level of evidence was low. Three studies had low risk of methodological bias, while 11 studies had high risk of bias. CONCLUSIONS: Music intervention may decrease cortisol levels, but other biomarkers remain unchanged. Given the low level of evidence, further research on music effects on inflammatory biomarkers is needed

Influence of β-galacto-oligosaccharide on growth performance and components of intestinal barrier in broilers during heat stress

This study aimed to investigate the influence of β-galacto-oligosaccharides (β-GOS) on growth performance, organ development and intestinal microarchitecture of broilers during heat stress. Day-old chicks (n = 125) were divided into five groups. The control or thermoneutral zone group (TNZ) was raised under standard management until the 35th day. Four groups were exposed to cyclic heat stress (35 °C 8 h/d) from the 22nd to the 35th day. The TNZ and heat stress control (HSCT) groups were fed a corn-based diet and HS + 0.1% β-GOS; HS + 0.2% β-GOS; and HS + 0.5% β-GOS were fed a corn-based diet supplemented with β-GOS (0.1%, 0.2%, and 0.5%), respectively. Exposure to heat stress reduced feed consumption, feed efficiency and the relative weight of the liver, bursa of Fabricius, and small intestine, compared with the TNZ group. Morphometric evaluation of the small intestine revealed reduced villus surface area, villus height to crypt depth ratio (VH : CD) and intraepithelial lymphocytes (IELs) in all segments, and reduced acidic goblet cells (AGCs) in the ileum of the HSCT group compared with the TNZ group. Compared with the HSCT group, dietary β-GOS (0.2% and 0.5%) improved the feed efficiency and relative weight of the small intestine. Furthermore, dietary β-GOS (0.1%) increased villus surface area in the duodenum and IEL count in the small intestine compared with the HSCT group. Dietary β-GOS 0.5% increased villi surface area (VSA) in the jejunum and ileum, whereas the IEL count in the small intestine and acidic goblet cells (AGCs) in the jejunum and ileum were reduced compared with the HSCT group. In conclusion, dietary supplementation of β-GOS (0.2% and 0.5%) improved the growth performance and intestinal microarchitecture of broilers during heat exposure, along with partial immune stimulation. Keywords: Feed efficiency, goblet cell, intraepithelial lymphocytes, mucosal architecture, prebiotics, poultry, villus morphometr

Deprescribing in the Pharmacologic Management of Delirium (de-PMD): A Randomized Trial in the Intensive Care Unit

OBJECTIVE: Benzodiazepines and anticholinergics are risk factors for delirium in the intensive care unit (ICU). We tested the impact of a deprescribing intervention on short-term delirium outcomes. DESIGN: Multi-site randomized clinical trial SETTING: ICU’s of three large hospitals PARTICIPANTS: Two hundred adults aged ≥ 18 years admitted to an ICU with delirium according to the Richmond Agitation Severity Scale and the Confusion Assessment Method for the ICU (CAM-ICU). Participants had a contraindication to haloperidol (seizure disorder or prolonged QT interval) or preference against haloperidol as a treatment for delirium, and were excluded for serious mental illness, stroke, pregnancy or alcohol withdrawal. Participants were randomized to a deprescribing intervention or usual care. The intervention included electronic alerts combined with pharmacist support to deprescribe anticholinergics and benzodiazepines. MEASUREMENTS: Primary outcomes were delirium duration measured by the CAM-ICU, and severity measured by the Delirium Rating Scale Revised-98 (DRS-R-98) and the CAM-ICU-7; secondary outcomes included adverse events and mortality. RESULTS: Participants had a mean age of 61.8 (standard deviation: 14.3) years, 59% female, and 52% African American with no significant differences in baseline characteristics between groups. No differences between groups were identified in the number exposed to anticholinergics (p=0.219) or benzodiazepines (p=0.566), the median total anticholinergic score (p=0.282), or the median total benzodiazepine dose in lorazepam equivalents (p=0.501). Neither median delirium/coma-free days (p=0.361) nor median change in delirium severity scores (p=0.582 for DRS-R-98; p=0.333 for CAM-ICU-7) were different between groups. No differences in adverse events or mortality were identified. CONCLUSIONS: When added to state-of-the-art clinical services, this deprescribing intervention had no impact on medication use in ICU participants. Given the age of the population, results of clinical outcomes may not be easily extrapolated to older adults. Nonetheless, improved approaches for deprescribing or preventing anticholinergics and benzodiazepines should be developed to determine the impact on delirium outcomes