Stress Ulcer Prophylaxis use in the Intensive care Unit before and after House Staff Education

PURPOSE

We hypothesize that stress ulcer prophylaxis with acid suppressant medications (ASM) is overused and educating house-staff will decrease this.

METHODS

Retrospective chart review in two six-month phases. House staff was educated prior to phase II. Rates of SUP were calculated for ICU stay, medicine floor, and at discharge.

RESULTS

There were 625 ICU admissions. Analysis was done on 106 and 118 patients in each phase. SUP use decreased from 62% to 37% in patients with no indications (p value < 0.01).

CONCLUSION

Education can have a significant impact on the appropriate use of medications. Even after this significant decrease, rates of inappropriate usage could be considered unacceptable.

Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients

INTRODUCTION

Thrombocytopenia is a common complication in many disorders (such as aplastic anemia, ITP, dengue fever,), the etiology being multifactorial. Immature platelet fraction (IPF) is a new parameter which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. We tried to evaluate IPF as an indicator to predict the recovery of platelets in patients with dengue.

METHODS

A total of 32 patients suffering from dengue fever (as confirmed by NS1 antigen or IgM antibody positivity for dengue) were taken for the study. The platelet count and IPF value of all these patients were evaluated on a daily basis.

RESULTS

It was found out that IPF has a strong correlation with the recovery of platelet counts in patients with dengue. 84.3% patients showed recovery within 24 h after attaining the peak IPF, 93.75% of the patients showed recovery within 24-48 h of the rise of the IPF compared with the previous day's value, and 100% patients showed a recovery within 24 h of the fall of the IPF compared with the previous days. It was also observed that 93.75% of the patients show platelet recovery within 24-48 h if the IPF was more than 10%.

CONCLUSION

Based on our study, we concluded that IPF can be used to evaluate the recovery of platelets in patients with dengue. It holds a great promise of becoming a reliable future guide for decisions concerning platelet transfusions.

The impact of vaccination on influenza-related respiratory failure and mortality in hospitalized elderly patients over the 2013-2014 season

BACKGROUND

Seasonal Influenza ("the flu") is a respiratory illness caused by influenza viruses. Yearly influenza vaccination is considered to be protective against illness and/or severity of illness and is recommended by CDC for all individuals > 6 months of age. However, the effectiveness of influenza vaccine in older individuals has come under question.

OBJECTIVES

To describe the clinical characteristics and treatment outcomes of patients admitted to an academic tertiary care Veterans Administration hospital with influenza during the 2013-2014 influenza season and determine the impact, if any, of prior influenza vaccination upon patient outcomes.

METHODS

Medical electronic records were searched for all patients admitted to the Little Rock Veterans Administration Hospital with proven influenza during the 2013-2014 influenza season. Cohorts of vaccinated and non-vaccinated patients were then compared to determine the impact of prior influenza vaccination upon respiratory-failure and mortality.

RESULTS

Seventy patients met selection criteria. Mean age was 66 years. Sixty-four (91%) patients had at least one underlying co-morbid condition; these conditions included COPD, congestive heart failure, diabetes, and cancer. 60/70 (85%) tested positive for Influenza A, and 43 tested positive for H1N1. Oseltamivir was initiated in 55 (78%) patients. Forty-four percent of the patients had been vaccinated. When separated by vaccination status, those who had been vaccinated had higher rates of ICU admission, need for mechanical or non-invasive ventilation, and mortality. All but mortality reached statistical significance.

CONCLUSION

The data suggest that there was no protective effect from prior vaccination in preventing hospital admission, respiratory failure, and mortality in this population of older men admitted to the hospital with influenza.

Study of indoor radon distribution using measurements and CFD modeling

Measurement and/or prediction of indoor radon ((222)Rn) concentration are important due to the impact of radon on indoor air quality and consequent inhalation hazard. In recent times, computational fluid dynamics (CFD) based modeling has become the cost effective replacement of experimental methods for the prediction and visualization of indoor pollutant distribution. The aim of this study is to implement CFD based modeling for studying indoor radon gas distribution. This study focuses on comparison of experimentally measured and CFD modeling predicted spatial distribution of radon concentration for a model test room. The key inputs for simulation viz. radon exhalation rate and ventilation rate were measured as a part of this study. Validation experiments were performed by measuring radon concentration at different locations of test room using active (continuous radon monitor) and passive (pin-hole dosimeters) techniques. Modeling predictions have been found to be reasonably matching with the measurement results. The validated model can be used to understand and study factors affecting indoor radon distribution for more realistic indoor environment.

CFD based simulation of thoron ((220)Rn) concentration in a delay chamber for mitigation application

The release of (220)Rn gas (conventionally referred to as thoron) is an issue of concern from the radiological point of view for occupational environments pertaining to the thorium fuel cycle. Studies for understanding its release and developing systems to control it are crucial for exposure control research. A thorough study of the "Delay Volume Technique" for mitigation of (220)Rn has been carried out. Experiments have been carried out with (220)Rn source and associated measurement system in a cubical chamber (delay chamber) of 0.5 m(3) volume. For different flow conditions and inlet-outlet positions, (220)Rn transmission factor has been obtained. Computational Fluid Dynamics (CFD) technique has been employed for these experimental conditions and the simulated transmission factors have been compared. The results show that the flow and the position of the inlet and outlet play an imperative role in the transportation, mixing and subsequent mitigation of thoron inside the chamber. Predictive capability of CFD technique for such delay volume experiments has been validated in this work. A comparison has been made with uniform mixing model and it is found that the results of simulation differ appreciably from that of uniform mixing model at the tested flow regime.

OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder

INTRODUCTION

A prespecified pooled analysis of two placebo-controlled, phase 3 trials evaluated whether the number of prior anticholinergics used or reason for their discontinuation affected the treatment response to onabotulinumtoxinA 100U in overactive bladder (OAB) patients with urinary incontinence (UI).

METHODS

Patients with symptoms of OAB received intradetrusor injections of onabotulinumtoxinA 100U or placebo, sparing the trigone. Change from baseline at week 12 in UI episodes/day, proportion of patients reporting a positive response ('greatly improved' or 'improved') on the treatment benefit scale (TBS), micturition and urgency were evaluated by number of prior anticholinergics (1, 2 or ≥ 3) and reason for their discontinuation (insufficient efficacy or side effects). Adverse events (AE) were assessed.

RESULTS

Patients had taken an average of 2.4 anticholinergics before study enrolment. OnabotulinumtoxinA reduced UI episodes/day from baseline vs. placebo, regardless of the number of prior anticholinergics (-2.82 vs. -1.52 for one prior anticholinergic; -2.58 vs. -0.58 for two prior anticholinergics; and -2.92 vs. -0.73 for three or more prior anticholinergics; all p < 0.001). The proportion of TBS responders was higher with onabotulinumtoxinA vs. placebo (69.0% vs. 37.2% for one prior anticholinergic; 58.8% vs. 24.8% for two prior anticholinergics and 56.4% vs. 22.5% for three or more prior anticholinergics; all p < 0.001). Similar results were observed regardless of the reason for discontinuation. OnabotulinumtoxinA reduced the episodes of urgency and frequency of micturition vs. placebo in all groups. AEs were well tolerated, with a comparable incidence in all groups.

CONCLUSION

In patients with symptoms of OAB who were inadequately managed by one or more anticholinergics, onabotulinumtoxinA 100U provided significant and similar treatment benefit and safety profile regardless of the number of prior anticholinergics used or reason for inadequate management of OAB. ClinicalTrials.gov: NCT00910845, NCT00910520.

Educational barriers of nurses caring for sick and at-risk infants in India

AIM

To gain ideas and information from healthcare providers to optimize the education and clinical practices of nurses caring for sick or at-risk newborns in India.

BACKGROUND

Improving infant survival has been identified as a Millennium Development Goals; however, India still faces many challenges with 3.1 million neonatal deaths and 2.6 million stillbirths annually. Skilled nursing care has been associated with decreased morbidity and mortality in newborns. However, core competencies in newborn care education and training are lacking for nurses.

METHODS

Qualitative data were collected from 12 focus groups with 101 newborn care providers from three areas of India as well as from a 2-day stakeholders' meeting. Data analysis was undertaken using descriptive and thematic content analysis.

RESULTS

Perceived challenges included limited manpower and high nurse turnover, lack of access to evidence-based orientation to newborn care and problems with access to appropriate learner-based, neonatal training. Relevant, ongoing education opportunities, led by nursing leaders were identified to be important solutions.

CONCLUSION

Findings provide insight into the current healthcare system in India with specific reference to the nursing care of at-risk newborns. There is a lack of existing resources to provide standardized and specific orientation curricula for nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policy makers in health and education need to: support and enact learner-based orientation and continuing educational opportunities as well as ongoing competency-based education programmes; encourage nurse leader involvement and support; and provide sustainable system-related supports. Nurses and other health providers need to work together to influence government policy.

The importance of planetary rotation period for ocean heat transport

The climate and, hence, potential habitability of a planet crucially depends on how its atmospheric and ocean circulation transports heat from warmer to cooler regions. However, previous studies of planetary climate have concentrated on modeling the dynamics of atmospheres, while dramatically simplifying the treatment of oceans, which neglects or misrepresents the effect of the ocean in the total heat transport. Even the majority of studies with a dynamic ocean have used a simple so-called aquaplanet that has no continental barriers, which is a configuration that dramatically changes the ocean dynamics. Here, the significance of the response of poleward ocean heat transport to planetary rotation period is shown with a simple meridional barrier--the simplest representation of any continental configuration. The poleward ocean heat transport increases significantly as the planetary rotation period is increased. The peak heat transport more than doubles when the rotation period is increased by a factor of ten. There are also significant changes to ocean temperature at depth, with implications for the carbon cycle. There is strong agreement between the model results and a scale analysis of the governing equations. This result highlights the importance of both planetary rotation period and the ocean circulation when considering planetary habitability.

Heat-Induced Changes in the Photochemical Centres and the Protein Secondary Structures of Photosystem II Studied by Variable Fluorescence and Difference FT-IR Spectroscopy

Variable fluorescence (Fv), i.e., Fv = Fm - F0 where F0 is the minimal fluorescence and Fm the maximum fluorescence, and difference Fourier transform infrared (FT-IR) spectroscopy were used to study the effect of heat stress in the 25-55 °C range on photosystem II (PSII) structure and function. First, the Fv intensity reflects accurately the changes in the number of open photochemical centers in PSII. Secondly, the use of Fv in combination with FT-IR spectroscopy can disclose structure-function correlations in the heat inactivation of the PSII complex. Analysis of the midpoint temperatures of thermal denaturation, i.e., 50% inactivation, reported so far in investigations of the thylakoid membrane components has revealed that most of the thermal transitions attributed to PSII are in the 39 -46 °C range. In this work, it is shown specifically that the midpoint temperature of PSII inactivation is at about 40 °C. Moreover, it was clearly demonstrated that the heat-induced changes above 40 °C are the result of a marked decrease in the number of open photochemical centers in PSII. It was also seen that above this same temperature the loss of photochemical centers has its structural counterpart in overall modifications of the secondary structures of the PSII proteins resulting from the decrease in the α-helix content concomitant with the increase in extended chain (β-strand) conformations. In brief, a novel finding reported here is that the number of open photochemical centers in PSII is dependent on a dynamic equilibrium between the contents of the PSII proteins in α-helix and extended chains (β-strands), but not in β-sheets and β-turn structures except for the antiparallel-β-sheet conformations. This therefore associates the thermal inactivation of the photochemical centers in photosystem II with distinct conformational changes in the proteins of the PSII supramolecular complex. In the particular context of the present study, these findings constitute a significant contribution to the investigation of structure-function correlations in the photosynthetic membrane. In a broader context, this information might be essential for the comprehension of the molecular arrangements or local structure order that are involved directly or indirectly in biological catalysis

NPHP3 mutations are associated with neonatal onset multiorgan polycystic disease in two siblings

Two siblings with a severe multiorgan polycystic disease presenting in the neonatal period were identified. Their genetic testing identified compound heterozygous NPHP3 gene mutations, parents being heterozygous carriers. The mutations included a splice-site (c.958-2A>G) and a missense mutation (c.2342G>A; p.G781D), both being extremely rare. NPHP3 encodes for nephrocystin 3 present on the cilia-centrosome complex. We hypothesize that these mutations lead to defective cilia-based signaling, required for normal development of the renal, pancreatic, biliary and portal system. This report outlines a rare neonatal ciliopathy presentation of NPHP3 mutations leading to severe multiorgan failure in two siblings.

Modeling of indoor radon concentration from radon exhalation rates of building materials and validation through measurements

Building materials are the second major source of indoor radon after soil. The contribution of building materials towards indoor radon depends upon the radium content and exhalation rates and can be used as a primary index for radon levels in the dwellings. The radon flux data from the building materials was used for calculation of the indoor radon concentrations and doses by many researchers using one and two dimensional model suggested by various researchers. In addition to radium content, the radon wall flux from a surface strongly depends upon the radon diffusion length (L) and thickness of the wall (2d). In the present work the indoor radon concentrations from the measured radon exhalation rate of building materials calculated using different models available in literature and validation of models was made through measurement. The variation in the predicted radon flux from different models was compared with d/L value for wall and roofs of different dwellings. The results showed that the radon concentrations predicted by models agree with experimental value. The applicability of different model with d/L ratio was discussed. The work aims to select a more appropriate and general model among available models in literature for the prediction of indoor radon.