Telemedicine coverage for post-operative ICU patients.

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47-69) versus 58 (IQR 44-70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7-14) versus 15 (IQR 11-21), p \u3c 0.001). The average amount of time patients spent in the VICU was 13.7 + /-9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation

Probing Very Bright End of Galaxy Luminosity Function at z >~ 7 Using Hubble Space Telescope Pure Parallel Observations

We report the first results from the Hubble Infrared Pure Parallel Imaging Extragalactic Survey, which utilizes the pure parallel orbits of the Hubble Space Telescope to do deep imaging along a large number of random sightlines. To date, our analysis includes 26 widely separated fields observed by the Wide Field Camera 3, which amounts to 122.8 sq.arcmin in total area. We have found three bright Y098-dropouts, which are candidate galaxies at z >~ 7.4. One of these objects shows an indication of peculiar variability and its nature is uncertain. The other two objects are among the brightest candidate galaxies at these redshifts known to date L>2L*. Such very luminous objects could be the progenitors of the high-mass Lyman break galaxis (LBGs) observed at lower redshifts (up to z~5). While our sample is still limited in size, it is much less subject to the uncertainty caused by "cosmic variance" than other samples because it is derived using fields along many random sightlines. We find that the existence of the brightest candidate at z~7.4 is not well explained by the current luminosity function (LF) estimates at z~8. However, its inferred surface density could be explained by the prediction from the LFs at z~7 if it belongs to the high-redshift tail of the galaxy population at z~7.Comment: ApJL in press (accepted Dec. 27, 2010); minor corrections and one figure added to address referee's comment

On the Conditional and Unconditional Type I Error Rates and Power of Tests in Linear Models with Heteroscedastic Errors

Preliminary tests for homoscedasticity may be unnecessary in general linear models. Based on Monte Carlo simulations, results suggest that when testing for differences between independent slopes, the unconditional use of weighted least squares regression and HC4 regression performed the best across a wide range of conditions

Diesel exhaust particulate induces pulmonary and systemic inflammation in rats without impairing endothelial function ex vivo or in vivo

<p>Abstract</p> <p>Background</p> <p>Inhalation of diesel exhaust impairs vascular function in man, by a mechanism that has yet to be fully established. We hypothesised that pulmonary exposure to diesel exhaust particles (DEP) would cause endothelial dysfunction in rats as a consequence of pulmonary and systemic inflammation.</p> <p>Methods</p> <p>Wistar rats were exposed to DEP (0.5 mg) or saline vehicle by intratracheal instillation and hind-limb blood flow, blood pressure and heart rate were monitored <it>in situ </it>6 or 24 h after exposure. Vascular function was tested by administration of the endothelium-dependent vasodilator acetylcholine (ACh) and the endothelium-independent vasodilator sodium nitroprusside (SNP) <it>in vivo </it>and <it>ex vivo </it>in isolated rings of thoracic aorta, femoral and mesenteric artery from DEP exposed rats. Bronchoalveolar lavage fluid (BALF) and blood plasma were collected to assess pulmonary (cell differentials, protein levels & interleukin-6 (IL-6)) and systemic (IL-6), tumour necrosis factor alpha (TNFα) and C-reactive protein (CRP)) inflammation, respectively.</p> <p>Results</p> <p>DEP instillation increased cell counts, total protein and IL-6 in BALF 6 h after exposure, while levels of IL-6 and TNFα were only raised in blood 24 h after DEP exposure. DEP had no effect on the increased hind-limb blood flow induced by ACh <it>in vivo </it>at 6 or 24 h. However, responses to SNP were impaired at both time points. In contrast, <it>ex vivo </it>responses to ACh and SNP were unaltered in arteries isolated from rats exposed to DEP.</p> <p>Conclusions</p> <p>Exposure of rats to DEP induces both pulmonary and systemic inflammation, but does not modify endothelium-dependent vasodilatation. Other mechanisms <it>in vivo </it>limit dilator responses to SNP and these require further investigation.</p

VUV Testing of Science Cameras at MSFC: QE Measurement of the CLASP Flight Cameras

The NASA Marshall Space Flight Center (MSFC) has developed a science camera suitable for sub-orbital missions for observations in the UV, EUV and soft X-ray. Six cameras were built and tested for the Chromospheric Lyman-Alpha Spectro-Polarimeter (CLASP), a joint National Astronomical Observatory of Japan (NAOJ) and MSFC sounding rocket mission. The CLASP camera design includes a frame-transfer e2v CCD57-10 512x512 detector, dual channel analog readout electronics and an internally mounted cold block. At the flight operating temperature of -20 C, the CLASP cameras achieved the low-noise performance requirements (less than or equal to 25 e- read noise and greater than or equal to 10 e-/sec/pix dark current), in addition to maintaining a stable gain of approximately equal to 2.0 e-/DN. The e2v CCD57-10 detectors were coated with Lumogen-E to improve quantum efficiency (QE) at the Lyman- wavelength. A vacuum ultra-violet (VUV) monochromator and a NIST calibrated photodiode were employed to measure the QE of each camera. Four flight-like cameras were tested in a high-vacuum chamber, which was configured to operate several tests intended to verify the QE, gain, read noise, dark current and residual non-linearity of the CCD. We present and discuss the QE measurements performed on the CLASP cameras. We also discuss the high-vacuum system outfitted for testing of UV and EUV science cameras at MSFC

Thermodynamics of the MJO in the Suppressed Phase

No abstract availabl

Does It Matter Who Writes Medical News Stories?

David Henry and colleagues review Australian news stories over a five-year period to assess whether quality is associated with who wrote the story: a specialist health journalist or a non-specialist