Long-Term Cognitive Impairment after Critical Illness Pandharipande, P.P; Girard, T.D; Jackson, J.C ...
New England journal of medicine/The New England journal of medicine,
10/2013, Letnik:
369, Številka:
14
Journal Article
Recenzirano
Odprti dostop
In this study, patients treated in ICUs were at high risk for new cognitive impairment during 12 months of follow-up, with 24% of patients having deficits similar in severity to those in Alzheimer's ...disease. A longer duration of delirium was associated with worse cognitive scores.
Survivors of critical illness frequently have a prolonged and poorly understood form of cognitive dysfunction,
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which is characterized by new deficits (or exacerbations of preexisting mild deficits) in global cognition or executive function. This long-term cognitive impairment after critical illness may be a growing public health problem, given the large number of acutely ill patients being treated in intensive care units (ICUs) globally.
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Among older adults, cognitive decline is associated with institutionalization,
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hospitalization,
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and considerable annual societal costs.
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Yet little is known about the epidemiology of long-term cognitive impairment after critical illness.
Delirium, a form of acute brain . . .
ABSTRACT
We characterize the extreme heartbeat star system MACHO 80.7443.1718 in the Large Magellanic Cloud using Transiting Exoplanet Survey Satellite (TESS) photometry and spectroscopic ...observations from the Magellan Inamori Kyocera Echelle (MIKE) and SOAR Goodman spectographs. MACHO 80.7443.1718 was first identified as a heartbeat star system in the All-Sky Automated Survey for SuperNovae (ASAS-SN) with $P_{\rm orb}=32.836\pm 0.008\, {\rm d}$. MACHO 80.7443.1718 is a young (∼6 Myr), massive binary, composed of a B0 Iae supergiant with $M_1 \simeq 35\, {\rm M}_\odot$ and an O9.5V secondary with $M_2 \simeq 16\, {\rm M}_\odot$ on an eccentric (e = 0.51 ± 0.03) orbit. In addition to having the largest variability amplitude amongst all known heartbeats stars, MACHO 80.7443.1718 is also one of the most massive heartbeat stars yet discovered. The Be supergiant has Balmer emission lines and permitted/forbidden metallic emission lines associated with a circumstellar disc. The disc rapidly dissipates at periastron that could indicate mass transfer to the secondary, but re-emerges immediately following periastron passage. MACHO 80.7443.1718 also shows tidally excited oscillations at the N = 25 and N = 41 orbital harmonics and has a rotational period of 4.4 d.
The astrophysical sources of the extraterrestrial, very high-energy neutrinos detected by the IceCube collaboration remain to be identified. Gamma-ray (γ-ray) blazars have been predicted to yield a ...cumulative neutrino signal exceeding the atmospheric background above energies of 100 TeV, assuming that both the neutrinos and the γ-ray photons are produced by accelerated protons in relativistic jets. As the background spectrum falls steeply with increasing energy, the individual events with the clearest signature of being of extraterrestrial origin are those at petaelectronvolt energies. Inside the large positional-uncertainty fields of the first two petaelectronvolt neutrinos detected by IceCube, the integrated emission of the blazar population has a sufficiently high electromagnetic flux to explain the detected IceCube events, but fluences of individual objects are too low to make an unambiguous source association. Here, we report that a major outburst of the blazar PKS B1424-418 occurred in temporal and positional coincidence with a third petaelectronvolt-energy neutrino event (HESE-35) detected by IceCube. On the basis of an analysis of the full sample of γ-ray blazars in the HESE-35 field, we show that the long-term average γ-ray emission of blazars as a class is in agreement with both the measured all-sky flux of petaelectronvolt neutrinos and the spectral slope of the IceCube signal. The outburst of PKS B1424-418 provides an energy output high enough to explain the observed petaelectronvolt event, suggestive of a direct physical association.
One of the most ubiquitous and long-lasting recent changes to the surface of our planet is the accumulation and fragmentation
of plastics. Within just a few decades since mass production of plastic ...products commenced in the 1950s, plastic debris has
accumulated in terrestrial environments, in the open ocean, on shorelines of even the most remote islands and in the deep
sea. Annual clean-up operations, costing millions of pounds sterling, are now organized in many countries and on every continent.
Here we document global plastics production and the accumulation of plastic waste. While plastics typically constitute approximately
10 per cent of discarded waste, they represent a much greater proportion of the debris accumulating on shorelines., Mega- and macro-plastics have accumulated in the highest densities in the Northern Hemisphere, adjacent to urban centres,
in enclosed seas and at water convergences (fronts). We report lower densities on remote island shores, on the continental
shelf seabed and the lowest densities (but still a documented presence) in the deep sea and Southern Ocean. The longevity
of plastic is estimated to be hundreds to thousands of years, but is likely to be far longer in deep sea and non-surface polar
environments. Plastic debris poses considerable threat by choking and starving wildlife, distributing non-native and potentially
harmful organisms, absorbing toxic chemicals and degrading to micro-plastics that may subsequently be ingested. Well-established
annual surveys on coasts and at sea have shown that trends in mega- and macro-plastic accumulation rates are no longer uniformly
increasing: rather stable, increasing and decreasing trends have all been reported. The average size of plastic particles
in the environment seems to be decreasing, and the abundance and global distribution of micro-plastic fragments have increased
over the last few decades. However, the environmental consequences of such microscopic debris are still poorly understood.
Persistence of Influenza on Surfaces Thompson, Katy-Anne; Bennett, Allan
The Journal of hospital infection,
02/2017, Letnik:
95, Številka:
2
Journal Article
Recenzirano
Summary Background Close contact transmission (either direct or large droplet/droplet nuclei) is considered the main driver of influenza outbreaks but there is limited information regarding the role ...of fomites in transmission. Aim To investigate the surface stability of influenza strains to investigate the role of fomites in transmission. Methods In this study both the viability and qt-RT-PCR signal of five influenza strains (A/PR/08/34/H1N1, A/Cal/07/09/H1N1, A/Cal/04/09/H1N1, A/Sol/54/6/H1N1, and A/Bris/59/7/H1N1) seeded onto 3 surfaces (cotton, microfibre and stainless steel) was assessed over time. Coupons of material were seeded with 10μl of a 106 -108 pfu/ml suspension of cell culture derived virus stock supplemented with 0.3% bovine serum albumin. Coupons were assayed by plaque assay and qt-RT-PCR at 1, 24 hours and weekly for 7 weeks using a vortex mixing elution method. Findings Viable virus was detected from coupons for up to 2 (stainless steel) and 1 (cotton and microfibre) weeks, whereas detection of viruses by PCR could be made for the entire 7 week study period. No strain differences were found. Ninety-nine % reduction values (as a function of the seeding stock) were determined to be 17.7 hours for cotton (R2 = 0.86), 34.3 hours for microfibre (R2 = 0.80) and 174.9 hours for stainless steel (R2 = 0.98). Conclusion Viable influenza was recovered from surfaces for up to 2 weeks. In contrast influenza could be detected by PCR for >7 weeks. These results have important implications for determining infection control protocols, cleaning regimes and sampling methods in health-care settings.
The objective of this study was to identify and appraise evidence on the direct and indirect impacts of high indoor temperatures on health; the indoor temperature threshold at which the identified ...health impacts are observed; and to summarise the evidence for establishing a maximum indoor temperature threshold for health.
This is a systematic literature review and narrative synthesis.
A review of the published literature using MEDLINE, EMBASE, Global Health, PsycINFO, Maternity and Infant Care, Cochrane Library, CINAHL and GreenFILE databases was conducted. The search criteria were kept broad to capture evidence from all countries and contexts; no date or study design limits were applied, except English language limits. We included studies that specifically measured indoor temperature and examined its effect on physical or mental health outcomes. Evidence was graded using the National Institutes of Health framework.
Twenty-two articles were included in the review, including 11 observational, seven cross-sectional and three longitudinal cohort studies and one prospective case–control study. Eight main health effects were described: respiratory, blood pressure, core temperature, blood glucose, mental health and cognition, heat-health symptoms, physical functioning and influenza transmission. Five studies found respiratory symptoms worsened in warm indoor environments, with one reporting indoor temperatures higher than 26 °C, which was associated with increased respiratory distress calls being made to paramedics (odds ratio = 1.63, P = 0.056). Core symptoms of schizophrenia and dementia were found to be significantly exacerbated by indoor heat (the latter above a 26 °C cumulative exposure threshold). The absorption of insulin doses in people with type one diabetes was also significantly accelerated in hot indoor environments. Only five studies reported the temperatures at which health outcomes worsened, with thresholds ranging between 26 °C and 32 °C. However, owing to insufficient data and the heterogeneity of the included studies (design, population, setting, exposure measures, outcomes and location), meta-analysis and an upper threshold determination was not feasible.
High indoor temperatures affect aspects of human health, with the strongest evidence for respiratory health, diabetes management and core schizophrenia and dementia symptoms. Exacerbation of symptoms in warm indoor environments has clinical relevance to at-risk groups and those caring for them. Care staff and facility managers need to be vigilant of high temperatures in care environments and should incorporate indoor overheating into their risk management and sustainability and/or climate change adaptation plans. The indoor temperature threshold at which adverse effects begin to occur remains unclear as studies seldom report the exposure–response relationship over a temperature continuum. Until there is extensive scientific data to support a maximum indoor temperature threshold, 26 °C may be the most suitable indoor temperature for at-risk groups in keeping with the existing guidance documents.
•Significant gaps in understanding the impact of indoor heat on health are addressed.•The strongest evidence found exists for increased respiratory morbidity in high indoor temperatures.•Symptoms of mental health disorders are exacerbated by high indoor temperatures.•Insulin absorption in people with type one diabetes is accelerated by heat, potentially affecting medication regimes.•Sparse and heterogeneous data limited the ability to define a robust maximum indoor temperature threshold for health.
Smoking and passive smoking are collectively the biggest preventable cause of death in Bangladesh, with major public health burden of morbidity, disability, mortality and community costs. The ...available studies of tobacco use in Bangladesh, however, do not necessarily employ nationally representative samples needed to monitor the problem at a national scale. This paper examines the prevalence and patterns of tobacco use among adults in Bangladesh and the changes over time using large nationally representative comparable surveys.
Using data from two enumerations of the International Tobacco Control (ITC) Bangladesh Project conducted in 2009 and 2012, prevalence estimates are obtained for all tobacco products by socio-economic determinants and sample types of over 90,000 individuals drawn from over 30,000 households. Household level sample weights are used to obtain nationally representative prevalence estimates and standard errors. Statistical tests of difference in the estimates between two time periods are based on a logistic regression model that accounts for the complex sampling design. Using a multinomial logit model, the time trend in tobacco use status is identified to capture the effects of macro level determinants including changes in tobacco control policies.
Between 2009 and 2012, overall tobacco use went down from 42.4% to 36.3%. The decline is more pronounced with respect to smokeless tobacco use than smoking. The prevalence of exclusive cigarette smoking went up from 7.2% to 10.6%; exclusive bidi smoking remained stable at around 2%; while smoking both cigarette and bidi went down from 4.6% to 1.8%; exclusive smokeless tobacco use went down from 20.2% to 16.9%; and both smokeless tobacco use and smoking went down from 8.4% to 5.1%. In general, the prevalence of tobacco use is higher among men, increases from younger to older age groups, and is higher among poorer people. Smoking prevalence is the highest among the slum population, followed by the tribal population, the national population and the border area population, suggesting greater burden of tobacco use among the disadvantaged groups.
The overall decline in tobacco use can be viewed as a structural shift in the tobacco market in Bangladesh from low value products such as bidi and smokeless tobacco to high value cigarettes, which is expected with the growth in income and purchasing power of the general population. Despite the reduction in overall tobacco use, the male smoking prevalence in Bangladesh is still high at 37%. The world average of daily smoking among men is 31.1%. The Tobacco Control Act 2005 and the Amendment have yet to make a significant impact in curbing tobacco usage in Bangladesh. The findings in this paper further suggest that the tobacco control policies in Bangladesh need to include targeted interventions to restrain the use of particular types of tobacco products among specific demographic and socio-economic groups of the population, such as smoked tobacco among men, smokeless tobacco among women, and both smoked and smokeless tobacco among those living in rural areas, those in low socio-economic status and those belonging to the tribal and the slum population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control ...measures, and prevent nosocomial transmission.
The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays.
SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed.
Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.
Current materials used for in vitro 3D cell culture are often limited by their poor similarity to human tissue, batch-to-batch variability and complexity of composition and manufacture. Here, we ...present a “blank slate” culture environment based on a self-assembling peptide gel free from matrix motifs. The gel can be customised by incorporating matrix components selected to match the target tissue, with independent control of mechanical properties. Therefore the matrix components are restricted to those specifically added, or those synthesised by encapsulated cells. The flexible 3D culture platform provides full control over biochemical and physical properties, allowing the impact of biochemical composition and tissue mechanics to be separately evaluated in vitro. Here, we demonstrate that the peptide gels support the growth of a range of cells including human induced pluripotent stem cells and human cancer cell lines. Furthermore, we present proof-of-concept that the peptide gels can be used to build disease-relevant models. Controlling the peptide gelator concentration allows peptide gel stiffness to be matched to normal breast (<1 kPa) or breast tumour tissue (>1 kPa), with higher stiffness favouring the viability of breast cancer cells over normal breast cells. In parallel, the peptide gels may be modified with matrix components relevant to human breast, such as collagen I and hyaluronan. The choice and concentration of these additions affect the size, shape and organisation of breast epithelial cell structures formed in co-culture with fibroblasts. This system therefore provides a means of unravelling the individual influences of matrix, mechanical properties and cell-cell interactions in cancer and other diseases.
•We propose an optimised self-assembling peptide gel for defined 3D cell culture.•Peptide gels support growth of multiple cell types, including stromal co-culture.•Gels allow independent control of matrix stiffness and ECM functionalisation.•Stiffness, ECM and stromal cells affect growth of breast cancer progression models.•We show proof-of-concept utilising peptide gels to build disease-relevant models.
An energy gap can be opened in the spectrum of graphene reaching values as large as 0.2 eV in the case of bilayers. However, such gaps rarely lead to the highly insulating state expected at low ...temperatures. This long-standing puzzle is usually explained by charge inhomogeneity. Here we revisit the issue by investigating proximity-induced superconductivity in gapped graphene and comparing normal-state measurements in the Hall bar and Corbino geometries. We find that the supercurrent at the charge neutrality point in gapped graphene propagates along narrow channels near the edges. This observation is corroborated by using the edgeless Corbino geometry in which case resistivity at the neutrality point increases exponentially with increasing the gap, as expected for an ordinary semiconductor. In contrast, resistivity in the Hall bar geometry saturates to values of about a few resistance quanta. We attribute the metallic-like edge conductance to a nontrivial topology of gapped Dirac spectra.
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