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We have developed the bispectral electroencephalography (BSEEG) method for detection of delirium and prediction of poor outcomes.
Aims
To improve the BSEEG method by introducing a new EEG device.
Method
In a prospective cohort study, EEG data were obtained and BSEEG scores were calculated. BSEEG scores were filtered on the basis of standard deviation (s.d.) values to exclude signals with high noise. Both non-filtered and s.d.-filtered BSEEG scores were analysed. BSEEG scores were compared with the results of three delirium screening scales: the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Delirium Rating Scale-Revised-98 (DRS) and the Delirium Observation Screening Scale (DOSS). Additionally, the 365-day mortalities and the length of stay (LOS) in the hospital were analysed.
Results
We enrolled 279 elderly participants and obtained 620 BSEEG recordings; 142 participants were categorised as BSEEG-positive, reflecting slower EEG activity. BSEEG scores were higher in the CAM-ICU-positive group than in the CAM-ICU-negative group. There were significant correlations between BSEEG scores and scores on the DRS and the DOSS. The mortality rate of the BSEEG-positive group was significantly higher than that of the BSEEG-negative group. The LOS of the BSEEG-positive group was longer compared with that of the BSEEG-negative group. BSEEG scores after s.d. filtering showed stronger correlations with delirium screening scores and more significant prediction of mortality.
Conclusions
We confirmed the usefulness of the BSEEG method for detection of delirium and of delirium severity, and prediction of patient outcomes with a new EEG device.
This paper explores dependencies between operational risks and between operational risks and other risks such as market, credit and insurance risk. The paper starts by setting the regulatory context and then goes into practical aspects of operational risk dependencies. Next, methods of modelling operational risk dependencies are considered with a simulation study exploring the sensitivity of diversification benefits arising from dependency models. The following two sections consider how correlation assumptions may be set, highlighting some generic dependencies between operational risks and with non-operational risks to assist in the assessment of dependencies and correlation assumptions. Supplementary appendices provide further detail on generic dependencies as well as a case study of how business models can lead to operational risks interacting with other risks. Finally, the paper finishes with a literature review of operational risk dependency papers including correlation studies and benchmark reports.
Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.
Methods:
We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.
Results:
A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.
Conclusion:
Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.
Several studies have reported evidence of interference between respiratory viruses: respiratory viruses rarely reach their epidemic peak concurrently and there appears to be a negative association between infection with one respiratory virus and co-infection with another. We used results spanning 16 years (2002–2017) of a routine diagnostic multiplex panel that tests for nine respiratory viruses to further investigate these interactions in Victoria, Australia. Time series analyses were used to plot the proportion positive for each virus. The seasonality of all viruses included was compared with respiratory syncytial virus (RSV) and influenza A virus using cross-correlations. Logistic regression was used to explore the likelihood of co-infection with one virus given infection with another. Seasonal peaks were observed each year for influenza A and RSV and less frequently for influenza B, coronavirus and parainfluenza virus. RSV circulated an average of 6 weeks before influenza A. Co-infection with another respiratory virus was less common with picornavirus, RSV or influenza A infection. Our findings provide further evidence of a temporal relationship in the circulation of respiratory viruses. A greater understanding of the interaction between respiratory viruses may enable better prediction of the timing and magnitude of respiratory virus epidemics.
The Pacific oyster Crassostrea gigas contributes significantly to global aquaculture; however, C. gigas culture has been affected by ostreid herpesvirus-1 (OsHV-1) and variants. The dynamics of how the virus maintains itself at culture sites is unclear and the role of carriers, reservoirs or hosts is unknown. Both wild and cultured mussels Mytilus spp. (Mytilus edulis, Mytilus galloprovincialis and hybrids) are commonly found at C. gigas culture sites. The objective of this study was to investigate if Mytilus spp. can harbour the virus and if viral transmission can occur between mussels and oysters. Mytilus spp. living at oyster trestles, 400–500 m higher up the shore from the trestles and up to 26 km at non-culture sites were screened for OsHV-1 and variants by all the World Organization for Animal Health (OIE) recommended diagnostic methods including polymerase chain reaction (PCR), quantitative PCR (qPCR), histology, in situ hybridization and confirmation using direct sequencing. The particular primers that target OsHV-1 and variants, including OsHV-1 microVar (μVar), were used in the PCR and qPCR. OsHV-1 μVar was detected in wild Mytilus spp. at C. gigas culture sites and more significantly the virus was detected in mussels at non-culture sites. Cohabitation of exposed wild mussels and naïve C. gigas resulted in viral transmission after 14 days, under an elevated temperature regime. These results indicate that mussels can harbour OsHV-1 μVar; however, the impact of OsHV-1 μVar on Mytilus spp. requires further investigation.
Family history is a long-standing and readily obtainable risk factor for schizophrenia (SCZ). Low-cost genotyping technologies have enabled large genetic studies of SCZ, and the results suggest the utility of genetic risk scores (GRS, direct assessments of inherited common variant risk). Few studies have evaluated family history and GRS simultaneously to ask whether one can explain away the other.
Methods
We studied 5959 SCZ cases and 8717 controls from four Nordic countries. All subjects had family history data from national registers and genome-wide genotypes that were processed through the quality control procedures used by the Psychiatric Genomics Consortium. Using external training data, GRS were estimated for SCZ, bipolar disorder (BIP), major depression, autism, educational attainment, and body mass index. Multivariable modeling was used to estimate effect sizes.
Results
Using harmonized genomic and national register data from Denmark, Estonia, Norway, and Sweden, we confirmed that family history of SCZ and GRS for SCZ and BIP were risk factors for SCZ. In a joint model, the effects of GRS for SCZ and BIP were essentially unchanged, and the effect of family history was attenuated but remained significant. The predictive capacity of a model including GRS and family history neared the minimum for clinical utility.
Conclusions
Combining national register data with measured genetic risk factors represents an important investigative approach for psychotic disorders. Our findings suggest the potential clinical utility of combining GRS and family history for early prediction and diagnostic improvements.
We are trying to reduce the largest uncertainties in using white dwarf stars as Galactic chronometers by understanding the details of carbon crystalliazation that currently result in a 1–2 Gyr uncertainty in the ages of the oldest white dwarf stars. We expect the coolest white dwarf stars to have crystallized interiors, but theory also predicts hotter white dwarf stars, if they are massive enough, will also have some core crystallization. BPM 37093 is the first discovered of only a handful of known massive white dwarf stars that are also pulsating DAV, or ZZ Ceti, variables. Our approach is to use the pulsations to constrain the core composition and amount of crystallization. Here we report our analysis of 4 hours of continuous time series spectroscopy of BPM 37093 with Gemini South combined with simultaneous time-series photometry from Mt. John (New Zealand), SAAO, PROMPT, and Complejo Astronomico El Leoncito (CASLEO, Argentina).
Principal challenges to direct fabrication of high performance a-Si:H transistor arrays on flexible substrates include automated handling through bonding-debonding processes, substrate-compatible low temperature fabrication processes, management of dimensional instability of plastic substrates, and planarization and management of CTE mismatch for stainless steel foils. In collaboration with our industrial and academic partners, we have developed viable solutions to address these challenges, as described in this paper.
Freshwater biodiversity is the over-riding conservation priority during the International Decade for Action – ‘Water for Life’ – 2005 to 2015. Fresh water makes up only 0.01% of the World's water and approximately 0.8% of the Earth's surface, yet this tiny fraction of global water supports at least 100000 species out of approximately 1.8 million – almost 6% of all described species. Inland waters and freshwater biodiversity constitute a valuable natural resource, in economic, cultural, aesthetic, scientific and educational terms. Their conservation and management are critical to the interests of all humans, nations and governments. Yet this precious heritage is in crisis. Fresh waters are experiencing declines in biodiversity far greater than those in the most affected terrestrial ecosystems, and if trends in human demands for water remain unaltered and species losses continue at current rates, the opportunity to conserve much of the remaining biodiversity in fresh water will vanish before the ‘Water for Life’ decade ends in 2015. Why is this so, and what is being done about it? This article explores the special features of freshwater habitats and the biodiversity they support that makes them especially vulnerable to human activities. We document threats to global freshwater biodiversity under five headings: overexploitation; water pollution; flow modification; destruction or degradation of habitat; and invasion by exotic species. Their combined and interacting influences have resulted in population declines and range reduction of freshwater biodiversity worldwide. Conservation of biodiversity is complicated by the landscape position of rivers and wetlands as ‘receivers’ of land-use effluents, and the problems posed by endemism and thus non-substitutability. In addition, in many parts of the world, fresh water is subject to severe competition among multiple human stakeholders. Protection of freshwater biodiversity is perhaps the ultimate conservation challenge because it is influenced by the upstream drainage network, the surrounding land, the riparian zone, and – in the case of migrating aquatic fauna – downstream reaches. Such prerequisites are hardly ever met. Immediate action is needed where opportunities exist to set aside intact lake and river ecosystems within large protected areas. For most of the global land surface, trade-offs between conservation of freshwater biodiversity and human use of ecosystem goods and services are necessary. We advocate continuing attempts to check species loss but, in many situations, urge adoption of a compromise position of management for biodiversity conservation, ecosystem functioning and resilience, and human livelihoods in order to provide a viable long-term basis for freshwater conservation. Recognition of this need will require adoption of a new paradigm for biodiversity protection and freshwater ecosystem management – one that has been appropriately termed ‘reconciliation ecology’.
Dietary studies are often conducted as longitudinal intervention or crossover trials using multiple days of measurement on each subject during each of several measurement periods, and determining the required numbers of days and subjects is important in designing these studies. Linear mixed statistical models were used to derive equations for precision, statistical power and sample size (number of days and number of subjects) and to obtain estimates of between-subject, period-to-period, and day-to-day variation needed to apply the equations. Two cohorts of an on-going exercise intervention study, and a crossover study of Olestra, each with 14 d of measurement/subject per period, were used to obtain estimates of variability for energy and macronutrient intake. Numerical examples illustrate how the equations for calculating the number of days or number of subjects are applied in typical situations, and sample SAS code is given. It was found that between-subject, period-to-period, and day-to-day variation all contributed significantly to the variation in energy and macronutrient intake. The ratio of period-to-period and day-to-day standard deviations controls the trade-off between the number of days and the number of subjects, and this remained relatively stable across studies and energy and macronutrient intake variables. The greatest gains in precision were seen over the first few measurement days. Greater precision and fewer required days were noted in the study (Olestra) that exerted greater control over the subjects and diets during the feeding protocol.
Guillotine tonsillectomy was the widely practised technique of tonsillectomy in the late 19th century as it was considered a quick and reliable method of removing tonsils. It fell into disrepute in the early 20th century. This paper reviews the history of the origin of the tonsillotome and traces the various modifications over the last few centuries. The current practice of guillotine tonsillectomy is examined by means of a postal questionnaire surveyof all UK consultants.
Tribochemical studies of the effect of lubricant bonding on the tribology of the head/disk interface (HDI) were conducted using hydrogenated (CHx) carbon disk samples coated with perfluoropolyether ZDOL lubricant. The studies involved drag tests with uncoated and carbon-coated A1203-TiC sliders and also thermal desorption experiments in an ultra-high vacuum (UHV) tribochamber. We observed that a larger mobile lubricant portion significantly enhances the wear durability of the (head/disk interface) HDI by providing a reservoir to constantly replenish the lubricant displaced in the wear track during drag tests. In the thermal desorption tests we observed two distinct temperatures of desorption. The mobile ZDOL layer is desorbed at the lower thermal desorption temperature and the residual bonded ZDOL layer is desorbed at the higher thermal desorption temperature. We also observed that the hydrogen evolution from CHx overcoats initiates lubricant catalytic decomposition with uncoated A1203/TiC sliders, forming CF3 (69) and C2F5(119). The generation of Hydroflouric acid (HF) during thermal desorption experiments provides the formation mechanism of Lewis acid, which is the necessary component for catalytic reaction causing Z-DOL lube degradation
Electrochemical impedance in H2SO4 solutions and kinetics of redox reactions in the Fe(CN)63-/4- system were studied on amorphous nitrogenated diamond-like carbon (a-C:N:H) thin-film electrodes. Parameters of point defects (trapping centers) were also measured by the Deep Level Transient Spectroscopy techniques. The films have been fabricated on p- and i-type silicon and quartz substrates, using direct ion beam deposition from an RF inductively coupled N2+ CH4 plasma source. The increase in N2/CH4 ratio in the gas mixture lead to a decrease in the electrical resistivity and optical bandgap of the films from 3×1010to 5×106 Ω cm and from 1.3 to 0.6 eV, respectively. Simultaneously, the concentration of electrically active point defects increased significantly and the charge transfer at the a-C:N:H film/redox electrolyte interface was facilitated
New preparative methods for the synthesis of nanoporous carbons using silica particles as templates will be presented. Gellation of resorcinol and formaldehyde in the presence of silica sol particles generated RF gel-silica nanocomposite. Carbonization followed by HF etching of silica templates generated nanoporous carbons with pore size ranging 10 ∼ 100 nm. When silica particles stabilized with surfactant were used as templates, uniform ∼ 10 nm pore-sized carbons have been formed. These nanoporous carbons exhibited excellent adsorption capacity for dyes.
We have recently discovered self-assembled chains of C60 molecules contained within single wall carbon nanotubes (SWNTs). Using in situ transmission electron microscopy studies, we show a route by which such ‘peapod’ structures can be synthesized. The results indicate that exterior C60 molecules arrive at the nanotubes from the vapor phase and subsequently enter, presumably through open ends or sidewall defects. The methods discussed in this work provide a means for the bulk production of these molecular assemblies.
A triple Langmuir probe measurement has been implemented to investigate plasma plume character in low fluence (∼ 3.0 J/cm2) pulsed laser evaporation (PLE) discharges and has been found to be an extremely valuable tool. Absolute plasma plume density estimates are found to reside in the range 1.0 × 1013–2.0 × 1014 cm−3 for vacuum pulses. A simple heavy particle streaming model for vacuum pulses allows estimates of the plume ionization fraction of ∼ 10%. This is consistent with typical deposition inventory suggesting that high kinetic energy ions play an important role in DLC film deposition. Electron temperature is found to consistently reside in the range 0.5-3.0 eV, and appears to be uninfluenced by operating conditions and large variations in Ar and N2 fill gas pressure. Consistent with strong plume ion and neutral particle coupling to the background fill, constancy of Te suggests expulsion of background gas by the energetic plume. The leading edge ion plume speed is measured via temporal displacement of spatially separated probe signals on consecutive PLE pulses. Flow speeds as high as 5.0 × 104 m/s are observed, corresponding to ∼ 156 eV in C+. The ion flow speed is found to be a strongly decreasing function of fill pressure from an average high of ∼ 126 eV in vacuum to ∼ 0.24 eV at 600 mTorr N2. Raman scattering spectroscopy indicates DLC film quality also degrades with fill pressure suggesting the importance of high ion kinetic energy in producing good quality films. Optical emission indicates an increase in C2 molecular light intensity with fill gas pressure implying a reduced, if any, role of these species in DLC production. Ion current signal anomalies in high pressure pulses indicate the formation of high mass carbon clusters during plume evolution in the presence of background gas. Mass diffusivity estimates, based on density decay, suggest the presence of under these conditions. Demonstration and control of such cluster formation may provide method(s) for controlling novel advanced materials properties.
Electron field emission measurements have been performed on thin film cold cathode materials grown, on molybdenum, by a modified MPACVD diamond process. Specifically the modification is due to the addition of nitrogen and oxygen, in varying ratios, during the diamond growth phase. Characterization using Raman spectroscopy shows features at 1190, 1330 and 1550 cm−1. A simple triode device was fabricated for electron emission characterization. KAPTON® film is used as the insulating layer and a Mo mesh is used as the extraction gate electrode. The collector is an indium tin oxide (ITO) coated glass plate which is positively biased with respect to the gate electrode. Field emission characteristics have shown current measurements of greater than I microamp for fields of 40 V/micron. Gate currents are typically 1000 times greater than the emitted current. Issues currently being addressed include improvement in the total emitted current, current stability and device failure. We also present field emission measurements on diamond films grown by HFCVD.
Pure diamondlike carbon thin films largely bonded by four-fold coordination suffer from a large internal compressive stress that gives rise to a serious adhesion problem. In this work, functionally gradient (FG) diamondlike carbon thin coatings were prepared by pulsed laser deposition in a high vacuum chamber as an alternative approach to address the adhesion problem of diamondlike films. Copper, silver and titanium were incorporated into the growing films with their concentration as a function of the distance from the substrate surface. The top of the thin coating is pure DLC of about 400 nm in thickness. The total thickness of the functionally graded superhard DLC coatings can exceed 1.0 μm without buckling. Visible micro-Raman spectroscopy was used to characterize the bonding structure of the layers which contain alloy atoms. High resolution transmission electron microscopy was employed to study the microstructure of the coatings. Nanoscale mechanical characterizations using Nanoindenter XPTM were carried out to study the mechanical behavior of the functionally gradient DLC films.