Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis

GRADE Summary of Findings for Primary Outcomes – Overall quality of evidence by GRADE criteria. (PDF 47 kb

Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis

Appendix: Electronic search strategies. (DOC 72 kb

Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19).

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy. CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new recommendations in further releases of these guidelines

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Anthropogenic enhancement of Egypt\u27s Mediterranean fishery

The highly productive coastal Mediterranean fishery off the Nile River delta collapsed after the completion of the Aswan High Dam in 1965. But the fishery has been recovering dramatically since the mid-1980s, coincident with large increases in fertilizer application and sewage discharge in Egypt. We use stable isotopes of nitrogen (δ15N) to demonstrate that 60%–100% of the current fishery production may be from primary production stimulated by nutrients from fertilizer and sewage runoff. Although the establishment of the dam put Egypt in an ideal position to observe the impact of rapid increases in nutrient loading on coastal productivity in an extremely oligotrophic sea, the Egyptian situation is not unique. Such anthropogenically enhanced fisheries also may occur along the northern rim of the Mediterranean and offshore of some rapidly developing tropical countries, where nutrient concentrations in the coastal waters were previously very low

A marked gradient in δ\u3csup\u3e13\u3c/sup\u3eC values of clams Mercenaria mercenaria across a marine embayment may reflect variations in ecosystem metabolism

Although stable isotopes of organic carbon (δ13C) are typically used as indicators of terrestrial, intertidal, andoffshore organic carbon sources to coastal ecosystems, there is evidence that δ13C values are also sensitive to in situecosystem metabolism. To investigate this phenomenon, we examined δ13C values of filter-feeding hard clams Mercenaria mercenaria from 13 locations in Greenwich Bay, a sub-estuary of Narragansett Bay, Rhode Island (USA). The δ13C values ofthe clams showed a marked linear gradient of 2‰ over the 4 kmlength of Greenwich Bay (-19 to -17‰), from lower δ13C values in the inner bay to higher values at the mouth, where Greenwich Bay joins Narragansett Bay proper (R2 = 0.94, p \u3c 0.0001). This is in contrast to previous work that has shown that δ13C values of clams in Narragansett Bay proper (over 40 km long) are homogenous (mean × SD, -16.8 × 0.6 ‰, n = 247). Mean daily pH, temperature, and salinitydata from 2 fixed monitoring stations were used to estimate aqueous CO2(CO2(aq)) concentrations in the surroundingwater. CO2(aq) concentrations were higher in inner Greenwich Bay than immediately outside of the bay, suggesting that the dissolved inorganic carbon sources supporting phytoplankton production are quite different across the bay. The outer Greenwich Bay clams appear to feed on Narragansett Bay phytoplankton with higher δ13C values that are grown in a higher pH, more bicarbonate-rich environment. In contrast, the inner Greenwich Bay clams may feedon phytoplankton grown in lower pH water with a greater availabilityof CO2(aq). The lower δ13C of CO2(aq) relative to HCO3 - is reflected in the phytoplankton and in the clams that feed on them. Our work suggests that δ13C values may be sensitive to changes in inorganic C in estuarine systems, which may confound attempts to use stable isotopesto identify organic carbon sources. © Inter-Research 2010

Charge Traps in Ce-Doped CaF2\text{}_{2} and BaF2\text{}_{2}

Thermoluminescence of CaF$\text{}_{2}$:Ce, BaF$\text{}_{2}$, and BaF$\text{}_{2}$:Ce irradiated at room temperature is reported. X-ray induced emission spectra of the samples show that both excitonic (due to e$\text{}^{-}$+V$\text{}_{K}$ recombination) and Ce$\text{}^{3+}$ d-f luminescence may contribute to thermoluminescence signal. The simple Randall-Wilkins model is used to deconvolute glow curves into seven to eight first-order peaks. Parameters of all traps are calculated and correlations between peaks in the curves of the examined materials are discussed