OBJECTIVE:The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and ...safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice.
DESIGN:Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012.
SETTING:Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center.
PATIENTS:Two hundred ninety-six patients (146 prebundle and 150 postbundle implementation), who are 19 years old or older, managed by the institutions’ medical or surgical critical care service.
INTERVENTIONS:Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle.
MEASUREMENTS AND MAIN RESULTS:For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Patients in the postimplementation period spent three more days breathing without mechanical assistance than did those in the preimplementation period (median interquartile range, 24 7–26 vs 21 0–25; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle experienced a near halving of the odds of delirium (odds ratio, 0.55; 95% CI, 0.33–0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (odds ratio, 2.11; 95% CI, 1.29–3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates.
CONCLUSIONS:Critically ill patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.
We prove the first nontrivial reconstruction theorem for modular tensor categories: the category associated to any twisted Drinfeld double of any finite group, can be realised as the representation ...category of a completely rational conformal net. We also show that any twisted double of a solvable group is the category of modules of a completely rational vertex operator algebra. In the process of doing this, we identify the 3-cocycle twist for permutation orbifolds of holomorphic conformal nets: unexpectedly, it can be nontrivial, and depends on the value of the central charge modulo 24. In addition, we determine the branching coefficients of all possible local (conformal) extensions of any finite group orbifold of holomorphic conformal nets, and identify their modular tensor categories.
The quantum double of the Haagerup subfactor, the first irreducible finite depth subfactor with index above 4, is the most obvious candidate for exotic modular data. We show that its modular data
...fits into a family
, where
n
≥ 0 and
. We show
is related to the subfactors Izumi hypothetically associates to the cyclic groups
. Their modular data comes equipped with canonical and dual canonical modular invariants; we compute the corresponding alpha-inductions, etc. In addition, we show there are (respectively) 1, 2, 0 subfactors of Izumi type
and
, and find numerical evidence for 2, 1, 1, 1, 2 subfactors of Izumi type
(previously, Izumi had shown uniqueness for
and
), and we identify their modular data. We explain how
(more generally
) is a
graft
of the quantum double
(resp. the twisted double
) by affine so(13) (resp. so
) at level 2. We discuss the vertex operator algebra (or conformal field theory) realisation of the modular data
. For example we show there are exactly 2 possible character vectors (giving graded dimensions of all modules) for the Haagerup VOA at central charge
c
= 8. It seems unlikely that any of this twisted Haagerup-Izumi modular data can be regarded as exotic, in any reasonable sense.
This paper is part of a sequence interpreting quantities of conformal field theories K-theoretically. Here we give geometric constructions of the associated module categories (modular invariants, ...nimreps, etc). In particular, we give a KK-theory interpretation of all modular invariants for the loop groups of tori, as well as most known modular invariants of loop groups. In addition, we find unexpectedly that the Tambara-Yamagami fusion category has an elegant description as bundles over a groupoid, and use that to interpret its module categories as KK-elements. We establish reconstruction for the doubles of all Tambara-Yamagami categories, generalising work of Bischoff to even-order groups. We conclude by relating the modular group representations coming from finite groups and loop groups to the Chern character and to the Fourier-Mukai transform respectively.
Previous studies from our laboratory have suggested that degenerin proteins contribute to myogenic constriction, a mechanism of blood flow regulation and protection against pressure-dependent organ ...injury, in renal vessels. The goal of the present study was to determine the importance of one family member, acid-sensing ion channel 2 (ASIC2), in myogenic constriction of renal interlobar arteries, myogenic regulation of whole kidney blood flow, renal injury, and blood pressure using ASIC2(+/+), ASIC2(+/-), and ASIC2(-/-) mice. Myogenic constriction in renal interlobar arteries was impaired in ASIC2(+/-) and ASIC2(-/-) mice, whereas constriction to KCl/phenylephrine was unchanged. Correction of whole kidney renal vascular resistance (RVR) during the first 5 s after a 10- to 20-mmHg step increase in perfusion pressure, a timeframe associated with myogenic-mediated correction of RVR, was slowed (4.2 ± 0.9, 0.3 ± 0.7, and 2.4 ± 0.3 resistance units/s in ASIC2(+/+), ASIC2(+/-), and ASIC2(-/-) mice). Although modest reductions in function were observed in ASIC2(-/-) mice, greater reductions were observed in ASIC2(+/-) mice, which may be explained by protein-protein interactions of ASIC2 with other degenerins. Isolated glomeruli from ASIC2(+/-) and ASIC2(-/-) mice had modest alterations in the expression of inflammation and injury markers (transforming growth factor-β, mouse anti-target of antiproliferative antibody-1, and nephrin), whereas ASIC2(+/-) mice had an increase in the remodeling marker collagen type III. Consistent with a more severe loss of function, mean arterial pressure was increased in ASIC2(+/-) mice (131 ± 3 mmHg) but not in ASIC2(-/-) mice (122 ± 3 vs. 117 ± 2 mmHg in ASIC2(+/+) mice). These results suggest that ASIC2 contributes to transduction of the renal myogenic response and are consistent with the protective role of myogenic constriction against renal injury and hypertension.
Background
The PODs (potential operational delineations) concept is an adaptive framework for cross-boundary and collaborative land and fire management planning. Use of PODs is increasingly ...recognized as a best practice, and PODs are seeing growing interest from federal, state, local, tribal, and non-governmental organizations. Early evidence suggests PODs provide utility for planning, communication, coordination, prioritization, incident response strategy development, and fuels mitigation and forest restoration. Recent legislative action codifies the importance of PODs by devoting substantial financial resources to their expansion. The intent of this paper is to explore new horizons that would help land and fire management organizations better address risks and capitalize on opportunities. Specifically, we focus on how PODs are a natural platform for improvement related to two core elements of risk management: how we leverage preparation and foresight to better prepare for the future; and how we learn from the past to better understand and improve performance and its alignment with strategy.
Results
We organize our exploration of new horizons around three key areas, suggesting that PODs can enable climate-smart forest and fire management and planning, inform more agile and adaptive allocation of suppression resources, and enable risk-informed performance measurement. These efforts can be synergistic and self-reinforcing, and we argue that expanded application of PODs at local levels could enhance the performance of the broader wildland fire system. We provide rationales for each problem area and offer growth opportunities with attendant explanations and illustrations.
Conclusions
With commitment and careful effort, PODs can provide rich opportunities for innovation in both backward-looking evaluative and forward-looking anticipatory frameworks. In addition to continued improvement of core PODs elements, attention must be paid to being more inclusive and participatory in PODs planning, to building sufficient capacity to expand PODs applications in meaningful boundary spanning ways, to ensure their continuity and relevance over time through maintenance and updating, and to deliver necessary information to responders to inform the effective management of wildfires. Lastly, ongoing monitoring and evaluation of PODs and related initiatives is essential to support organizational learning and continual improvement.
Due to complex interactions between social and ecological systems, herbicide resistance has classic features of a “wicked problem”. Herbicide-resistant (HR) Poa annua poses a risk to sustainably ...managing U.S. turfgrass systems, but there is scant knowledge to guide its management. Six focus groups were conducted throughout the United States to gain understanding of socio-economic barriers to adopting herbicide-resistance management practices. Professionals from major turfgrass sectors (golf courses, sports fields, lawn care, and seed/sod production) were recruited as focus-group participants. Discussions emphasized challenges of the weed management of turfgrass systems as compared to agronomic crops. This included greater time constraints for managing weeds and more limited chemical control options. Lack of understanding about the proper use of compounds with different modes of action was identified as a threat to sustainable weed management. There were significant regional differences in perceptions of the existence, geographic scope, and social and ecological causes of HR in managing Poa annua. Effective resistance management will require tailoring chemical and non-chemical practices to the specific conditions of different turfgrass sectors and regions. Some participants thought it would be helpful to have multi-year resistance management programs that are both sector- and species-specific.
A near-group fusion category is a fusion category C where all but 1 simple objects are invertible. Examples of these include the Tambara–Yamagami categories and the even sectors of the D5(1) and E6 ...subfactors, though there are infinitely many others. We classify the near-group fusion categories, and compute their doubles and the modular data relevant to conformal field theory. Among other things, we explicitly construct over 40 new finite depth subfactors, with Jones index ranging from around 6.85 to around 14.93. We expect all of these doubles to be realised by rational conformal field theories.
We realise non-unitary fusion categories using subfactor-like methods, and compute their quantum doubles and modular data. For concreteness we focus on generalising the Haagerup–Izumi family of ...Q-systems. For example, we construct endomorphism realisations of the (non-unitary) Yang–Lee model, and non-unitary analogues of one of the even subsystems of the Haagerup subfactor and of the Grossman–Snyder system. We supplement Izumi's equations for identifying the half-braidings, which were incomplete even in his Q-system setting. We conjecture a remarkably simple form for the modular S and T matrices of the doubles of these fusion categories. We would expect all of these doubles to be realised as the category of modules of a rational VOA and conformal net of factors. We expect our approach will also suffice to realise the non-semisimple tensor categories arising in logarithmic conformal field theories.
PDF
