Background Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is ...associated with an increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear. Methods Patients (n = 66) undergoing coronary artery bypass or valve operations, or both, were enrolled in a nested cohort study. Rigorous delirium assessments were conducted using the Confusion Assessment Method. LOS-ICU and LOS were obtained from the medical record, and hospital charges were obtained from administrative data reported to the state. Because of the skewed distribution of outcome variables, outcomes were compared using rank-sum tests, as well as median regression incorporating propensity scores. Results Patients who developed delirium (56%) versus no delirium (43%) had increased median LOS-ICU (75.6 hours interquartile range (IQR): 43.6 to 136.8 vs. 29.7 hours IQR: 21.7 to 46.0; p = 0.002), increased median LOS (9 days IQR: 6 to 16 vs. 7 days IQR: 5 to 8; p = 0.006), and increased median hospital charges ($51,805 IQR: $44,041 to $80,238 vs. $41,576 IQR: $35,748 to $43,660; p = 0.002). In propensity score models adjusted for patient-related and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated on the basis of the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and increased charges in a dose-response manner. Conclusions Delirium after cardiac surgical procedures is independently associated with both increased LOS-ICU and higher hospital charges. Because delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.
Situated Meaning Bachnik, Jane M; Quinn, Charles J
2019, 20190115, 1994, 2019-10-04, 19940101, Letnik:
5263
eBook
Situated Meaning adds a new dimension, both literal and metaphoric, to our understanding of Japan. The essays in this volume leave the vertical axis of hierarchy and subordination-an organizing trope ...in much of the literature on Japan-and focus instead on the horizontal, interpreting a wide range of cultural practices and orientations in terms of such relational concepts as uchi ("inside") and soto ("outside"). Evolving from a shared theoretical focus, the essays show that in Japan the directional orientations inside and outside are specifically linked to another set of meanings, denoting "self" and "society." After Donald L. Brenneis's foreward, Jane M. Bachnick, Charles J. Quinn, Jr., Patricia J. Wetzel, Nancy R. Rosenberger, and Robert J. Sukle discuss "Indexing Self and Social Context." "Failure to Index: Boundary Disintegration and Social Breakdown" is the topic of Dorinne K. Kondo, Matthews M. Hamabata, Michael S. Molasky, and Jane Bachnik. Finally, Charles Quinn explores "Language as a Form of Life." Jane M. Bachnik is Associate Professor of Anthropology at the University of North Carolina at Chapel Hill. She is presently pursuing research in Japan under a Senior Fellowship Grant from the Japan Foundation. Charles J. Quinn, Jr., is Associate Professor of East Asian Languages and Literatures at the Ohio State University.
Originally published in 1994.
ThePrinceton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.
Ocular light exposure has important influences on human health and well-being through modulation of circadian rhythms and sleep, as well as neuroendocrine and cognitive functions. Prevailing patterns ...of light exposure do not optimally engage these actions for many individuals, but advances in our understanding of the underpinning mechanisms and emerging lighting technologies now present opportunities to adjust lighting to promote optimal physical and mental health and performance. A newly developed, international standard provides a SI-compliant way of quantifying the influence of light on the intrinsically photosensitive, melanopsin-expressing, retinal neurons that mediate these effects. The present report provides recommendations for lighting, based on an expert scientific consensus and expressed in an easily measured quantity (melanopic equivalent daylight illuminance (melaponic EDI)) defined within this standard. The recommendations are supported by detailed analysis of the sensitivity of human circadian, neuroendocrine, and alerting responses to ocular light and provide a straightforward framework to inform lighting design and practice.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cumulative human impacts across the world's oceans are considerable. We therefore examined a single model taxonomic group, the penguins (Spheniscidae), to explore how marine species and communities ...might be at risk of decline or extinction in the southern hemisphere. We sought to determine the most important threats to penguins and to suggest means to mitigate these threats. Our review has relevance to other taxonomic groups in the southern hemisphere and in northern latitudes, where human impacts are greater. Our review was based on an expert assessment and literature review of all 18 penguin species; 49 scientists contributed to the process. For each penguin species, we considered their range and distribution, population trends, and main anthropogenic threats over the past approximately 250 years. These threats were harvesting adults for oil, skin, and feathers and as bait for crab and rock lobster fisheries; harvesting of eggs; terrestrial habitat degradation; marine pollution; fisheries bycatch and resource competition; environmental variability and climate change; and toxic algal poisoning and disease. Habitat loss, pollution, and fishing, all factors humans can readily mitigate, remain the primary threats for penguin species. Their future resilience to further climate change impacts will almost certainly depend on addressing current threats to existing habitat degradation on land and at sea. We suggest protection of breeding habitat, linked to the designation of appropriately scaled marine reserves, including in the High Seas, will be critical for the future conservation of penguins. However, large‐scale conservation zones are not always practical or politically feasible and other ecosystem‐based management methods that include spatial zoning, bycatch mitigation, and robust harvest control must be developed to maintain marine biodiversity and ensure that ecosystem functioning is maintained across a variety of scales.
Myelination is essential for rapid impulse conduction in the CNS, but what determines whether an individual axon becomes myelinated remains unknown. Here we show, using a myelinating coculture ...system, that there are two distinct modes of myelination, one that is independent of neuronal activity and glutamate release and another that depends on neuronal action potentials releasing glutamate to activate NMDA receptors on oligodendrocyte lineage cells. Neuregulin switches oligodendrocytes from the activity-independent to the activity-dependent mode of myelination by increasing NMDA receptor currents in oligodendrocyte lineage cells 6-fold. With neuregulin present myelination is accelerated and increased, and NMDA receptor block reduces myelination to far below its level without neuregulin. Thus, a neuregulin-controlled switch enhances the myelination of active axons. In vivo, we demonstrate that remyelination after white matter damage is NMDA receptor-dependent. These data resolve controversies over the signalling regulating myelination and suggest novel roles for neuregulin in schizophrenia and in remyelination after white matter damage.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
1. Fundamental ecological research is both intrinsically interesting and provides the basic knowledge required to answer applied questions of importance to the management of the natural world. The ...100th anniversary of the British Ecological Society in 2013 is an opportune moment to reflect on the current status of ecology as a science and look forward to high-light priorities for future work. 2. To do this, we identified 100 important questions of fundamental importance in pure ecology. We elicited questions from ecologists working across a wide range of systems and disciplines. The 754 questions submitted (listed in the online appendix) from 388 participants were narrowed down to the final 100 through a process of discussion, rewording and repeated rounds of voting. This was done during a two-day workshop and thereafter. 3. The questions reflect many of the important current conceptual and technical pre-occupations of ecology. For example, many questions concerned the dynamics of environmental change and complex ecosystem interactions, as well as the interaction between ecology and evolution. 4. The questions reveal a dynamic science with novel subfields emerging. For example, a group of questions was dedicated to disease and micro-organisms and another on human impacts and global change reflecting the emergence of new subdisciplines that would not have been foreseen a few decades ago. 5. The list also contained a number of questions that have perplexed ecologists for decades and are still seen as crucial to answer, such as the link between population dynamics and life-history evolution. 6. Synthesis. These 100 questions identified reflect the state of ecology today. Using them as an agenda for further research would lead to a substantial enhancement in understanding of the discipline, with practical relevance for the conservation of biodiversity and ecosystem function.
It has been suggested that the use of preimplantation genetic screening of cleavage-stage embryos for aneuploidies may improve pregnancy rates in women of advanced maternal age undergoing in vitro ...fertilization (IVF). In this multicenter, double-blind, randomized trial, women 35 through 41 years of age assigned to preimplantation genetic screening had lower rates of ongoing pregnancies and live births than those undergoing IVF alone. These results argue against the routine use of preimplantation genetic screening as an adjunct to IVF in women of advanced maternal age.
In this trial, women of advanced maternal age assigned to preimplantation genetic screening had lower rates of ongoing pregnancies and live births than those undergoing in vitro fertilization alone.
The use of in vitro fertilization (IVF) has steadily increased over the past decade. The American and European registries of assisted reproductive technology reported a total of 352,769 initiated IVF cycles in the year 2002.
1
,
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In about half of these cycles, the woman was 35 years of age or older,
1
,
2
reflecting the demographic trend toward postponement of the time to start a family.
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Unfortunately, IVF by itself cannot compensate for the lower fecundity associated with increasing age.
3
A potential cause of the low pregnancy rates in women of advanced maternal age undergoing IVF is the increased incidence of . . .
Prior to the implementation of arterial spin labeling (ASL) in clinical multi-center studies, it is important to establish its status quo inter-vendor reproducibility. This study evaluates and ...compares the intra- and inter-vendor reproducibility of pseudo-continuous ASL (pCASL) as clinically implemented by GE and Philips.
22 healthy volunteers were scanned twice on both a 3T GE and a 3T Philips scanner. The main difference in implementation between the vendors was the readout module: spiral 3D fast spin echo vs. 2D gradient-echo echo-planar imaging respectively. Mean and variation of cerebral blood flow (CBF) were compared for the total gray matter (GM) and white matter (WM), and on a voxel-level.
Whereas the mean GM CBF of both vendors was almost equal (p = 1.0), the mean WM CBF was significantly different (p<0.01). The inter-vendor GM variation did not differ from the intra-vendor GM variation (p = 0.3 and p = 0.5 for GE and Philips respectively). Spatial inter-vendor CBF and variation differences were observed in several GM regions and in the WM.
These results show that total GM CBF-values can be exchanged between vendors. For the inter-vendor comparison of GM regions or WM, these results encourage further standardization of ASL implementation among vendors.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We present 1.3 mm Atacama Large Millimeter/submillimeter Array observations of polarized dust emission toward the wide-binary protostellar system BHR 71 IRS1 and IRS2. IRS1 features what appears to ...be a natal, hourglass-shaped magnetic field. In contrast, IRS2 exhibits a magnetic field that has been affected by its bipolar outflow. Toward IRS2, the polarization is confined mainly to the outflow cavity walls. Along the northern edge of the redshifted outflow cavity of IRS2, the polarized emission is sandwiched between the outflow and a filament of cold, dense gas traced by N2D+, toward which no dust polarization is detected. This suggests that the origin of the enhanced polarization in IRS2 is the irradiation of the outflow cavity walls, which enables the alignment of dust grains with respect to the magnetic field-but only to a depth of ∼300 au, beyond which the dust is cold and unpolarized. However, in order to align grains deep enough in the cavity walls, and to produce the high polarization fraction seen in IRS2, the aligning photons are likely to be in the mid- to far-infrared range, which suggests a degree of grain growth beyond what is typically expected in very young, Class 0 sources. Finally, toward IRS1 we see a narrow, linear feature with a high (10%-20%) polarization fraction and a well-ordered magnetic field that is not associated with the bipolar outflow cavity. We speculate that this feature may be a magnetized accretion streamer; however, this has yet to be confirmed by kinematic observations of dense-gas tracers.
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