Recognition of delirium in ICU patients: a diagnostic study of the NEECHAM confusion scale in ICU patients

BACKGROUND: A delirium, is a serious, high-frequency complication in intensive care unit (ICU) patients. The consequences of this complication range from high morbidity and mortality to greater need for nursing care. Despite these, delirium is often not recognized and there for not treated. In this study a nursing screening instrument, the NEECHAM confusion scale, was studied for early recognition of delirium ICU patients. This scale proved valid and reliable in several studies in the general hospital population. METHODS: In this study validity and reliability were tested in a prospective cohort of 105 patients. Gold standard for delirium was an independent DSM-IV diagnosis. User friendliness was tested by structured evaluation of nurses' experiences working with the scale. RESULTS: The NEECHAM confusion scale showed high internal consistency (Cronbach's alpha 0.88) and an interrater reliability of Cohen's Kappa 0.60. The concurrent validity with the DSM-IVcriteria showed a strong link (chi-square 67.52, p [less than or equal to] 0.001). Sensitivity was high, 97% and specificity was good 83%. ICU nurses completed the NEECHAM confusion rating in 3.69, ± 1.21 minutes average. In general the nurses were positive about the NEECHAM confusion scale. They were able to collect data during regular care, but experienced problems in rating the scale in intubated patients. The items in themselves were clear, the content validity, measured by the language used was rated good. CONCLUSION: The psychometric characteristics of the NEECHAM confusion scale of this ICU study are generally consistent with validity research previously reported for the general hospital population. The psychometric characteristics and the ease of use of the NEECHAM confusion scale enables ICU nurses to early recognize delirium. Further study, especially in intubed patients is recommended

A vision on the application of incident management to the highways network in the Netherlands

Much progress has been made in the past decade in applying Incident Management (IM) on the main roads in the Netherlands. This paper examines the impact of a list of measures that could be taken to improve Incident Management. These measures were scored according to their contribution to reducing drive times, safety and difficulties in introducing the measure. In the second part of the paper the IM policy vision for the nearfuture is presented. The list of ambitions shows that progress in improvement is not limited to purely technical measures, but that a broad range of technical, organisational, political, legal and financial measures is required

Biogeography of Aegagropila linnaei (Cladophorophyceae, Chlorophyta): a widespread freshwater alga with low effective dispersal potential shows a glacial imprint in its distribution

Aim:Aegagropila linnaei is a freshwater macroalga that is generally regarded as a rare species. It is apparently absent from large but seemingly suitable areas of the Northern Hemisphere, implying a limited dispersal potential and an imprint of Pleistocene glaciations in its biogeography. However, despite the popularity of its enigmatic lake ball-form, detailed biogeographical studies of A. linnaei have never been conducted. The main means of reproduction of A. linnaei is fragmentation and akinetes are not formed, supporting the assumption of limited dispersal capacity. The aim of this study was to reconstruct the biogeography of A. linnaei, and to identify possible refugia during glaciations, as well as to evaluate dispersal potential by quantitative desiccation experiments. Location: Palaearctic. Methods: The current distribution of A. linnaei was inferred from herbarium specimens, literature data and recent field observations. All herbarium specimens were morphologically re-examined. Desiccation experiments were performed with vegetative filaments of three isolates of A. linnaei, as no specialized resistant stages are known. For comparison, the widespread freshwater algae Cladophora glomerata and Rhizoclonium sp. were included. Internal transcribed spacer (ITS) ribosomal DNA sequences were generated and a ribotype network was constructed. Results:Aegagropila linnaei was recorded from 283 locations in freshwater and brackish environments. The majority of locations were in central and northern Europe in previously glaciated areas. Desiccation experiments showed that A. linnaei is very susceptible to desiccation. Based on ITS sequences of 34 samples, five different ribotypes were identified. Four of these ribotypes had a restricted distribution. Aegagropila linnaei represents a single species with little genetic variation (0.1–0.5%). Main conclusions This is the most comprehensive study of this species so far, reporting many new locations and tackling several taxonomic problems. Few additional finds were made from North America, and the origin of A. linnaei is inferred to be in Asia. The highest density of its present-day locations is in previously glaciated areas in Europe, where glacial ice-dammed lakes might have functioned as refugia. Low effective long-distance dispersal capacity is inferred, based on high susceptibility to desiccation and its modes of dispersal

Iron addition as a measure to restore water quality: Implications for macrophyte growth

Eutrophication of shallow lakes in North-West Europe has resulted in cyanobacterial blooms, turbid water, and a decline in submerged macrophytes. Even though external inputs of phosphorus (P) are declining, internal loading of P from the sediment may delay the recovery of these aquatic ecosystems. Iron can be a useful chemical binding agent to combat internal P loading in shallow lakes, but may potentially be harmful for macrophyte growth. We tested whether iron addition as a restoration measure harms the growth of submerged macrophytes. We hypothesized that this depends on the iron dosage and the rooting strategy of the macrophytes. We experimentally tested the effects of Fe (FeCl3) on the submerged macrophytes Potamogeton pectinatus L and Elodea nuttallii (Planch.) H. St. John. Iron was dosed at a concentration of 20 g Fe m(-2) and 40 g Fe m(-2) to the surface water or to both the surface water and sediment. E. nuttallii growth was not affected by iron addition, whereas P. pectinatus growth significantly decreased with increasing iron concentrations. Nonetheless, biomass of both species increased in all treatments relative to starting conditions. During the experiment, propagules sprouted from a propagule bank in the sediment including species with a high conservation value and this spontaneous emergence was not influenced by increasing iron concentrations. We conclude that adding iron(III)chloride in dosages of 20-40 g m(-2) may reduce growth of some macrophyte species, but does not prevent overall macrophyte recovery. It may however affect macrophyte community composition due to differential responses of macrophyte species to iron addition. (C) 2014 Elsevier B.V. All rights reserved

Ijzersuppletie in laagveenplassen: De resultaten

IJzersuppletie heeft zich bewezen als een effectieve en goedkope methode om het voormalige hoge ijzergehalte in waterbodems te herstellen. De interne eutrofiëring wordt hierdoor zeer sterk gereduceerd. De methode is toepasbaar in ondiepe meren en plassen waar geen zuurstofloosheid optreed en waar de externe belasting voldoende laag is. In twee jaar tijd kan voldoende ijzer worden toegediend voor een werkingsduur van 25-40 jaar. IJzersuppletie is ook een veilige methode gebleken.

Invasive crayfish threaten the development of submerged macrophytes in lake restoration

Submerged macrophytes enhance water transparency and aquatic biodiversity in shallow water ecosystems. Therefore, the return of submerged macrophytes is the target of many lake restoration projects. However, at present, north-western European aquatic ecosystems are increasingly invaded by omnivorous exotic crayfish. We hypothesize that invasive crayfish pose a novel constraint on the regeneration of submerged macrophytes in restored lakes and may jeopardize restoration efforts. We experimentally investigated whether the invasive crayfish (Procambarus clarkii Girard) affects submerged macrophyte development in a Dutch peat lake where these crayfish are expanding rapidly. Seemingly favourable abiotic conditions for macrophyte growth existed in two 0.5 ha lake enclosures, which provided shelter and reduced turbidity, and in one lake enclosure iron was added to reduce internal nutrient loading, but macrophytes did not emerge. We transplanted three submerged macrophyte species in a full factorial exclosure experiment, where we separated the effect of crayfish from large vertebrates using different mesh sizes combined with a caging treatment stocked with crayfish only. The three transplanted macrophytes grew rapidly when protected from grazing in both lake enclosures, demonstrating that abiotic conditions for growth were suitable. Crayfish strongly reduced biomass and survival of all three macrophyte species while waterfowl and fish had no additive effects. Gut contents showed that crayfish were mostly carnivorous, but also consumed macrophytes. We show that P. clarkii strongly inhibit macrophyte development once favourable abiotic conditions for macrophyte growth are restored. Therefore, expansion of invasive crayfish poses a novel threat to the restoration of shallow water bodies in north-western Europe. Prevention of introduction and spread of crayfish is urgent, as management of invasive crayfish populations is very difficult.