260 research outputs found
Exploring, analgesia, sedation, and paralysis (ASP) utilisation in severe Covid19 pneumonia – a retrospective cohort study
No full textSupplemental Material - Methadone as an opioid and sedative weaning strategy in adults receiving extracorporeal membrane oxygenation
No full textSupplemental Material for Methadone as an opioid and sedative weaning strategy in adults receiving extracorporeal membrane oxygenation by Christopher Remmington, Victor Liew, Fraser Hanks, Luigi Camporota, Oliver Stubbs, Angelo Sousa, and Nicholas A Barrett in Perfusion</p
Extracorporeal membrane oxygenation and diurnal analgosedation:A comparative retrospective study in ventilated patients
No full textBackground: Diurnal variation of analgosedation may worsen patient outcomes. However, there is no data reporting diurnal variation in patients receiving extracorporeal membrane oxygenation (ECMO). Objectives: To compare diurnal variation of analgosedation doses in mechanically ventilated adult patients and those receiving ECMO. Setting: Five ICUs (65 beds) including an ECMO unit, with patient recruitment from July 2021 to July 2023. Methods: Retrospective single-centre cohort study including patients aged ≥ 16 years receiving continuous intravenous (IV) opioid (fentanyl) and/or sedative (midazolam and/or propofol), receiving mechanical ventilation with or without ECMO. We collected data on all intravenous analgosedation doses (excluding boluses) from 07:00 to 18:59 (day) or from 19:00 to 06:59 (nighttime) for 48 h. Results: We identified 1277 patients; of whom 166 (13.0 %) received ECMO and 1111 (87.0 %) received no ECMO. Most were male 815 (63.8 %), median (interquartile range (IQR)) age 58 (42–70) years. We found no diurnal variation of analgosedation doses in ECMO patients. However, we found higher doses of fentanyl (mean difference 1.7 µg/kg, 95 % Confidence Interval (CI): 1.0, 2.4 μg/kg, p < 0.001) and propofol (mean difference 2.3 mg/kg, 95 % CI: 1.7, 2.9 mg/kg, p < 0.001) at nighttime compared to daytime in non-ECMO patients. A higher proportion of ECMO patients received neuromuscular blocking drugs compared to non-ECMO group 120 (72.3 %) vs 138 (12.4 %); p < 0.001. Conclusions: We found higher doses of fentanyl and propofol IV infusion doses at nighttime in non-ECMO patients. However, we found no diurnal variation of analgosedation doses in ECMO patients, most likely due to deep sedation and use of neuromuscular blocking medicines. Implications for clinical practice: Patient factors, critical illness factors and type of ICU admission are likely contributory factors to differences in diurnal variation of analgosedation doses in ECMO and non-ECMO populations.</p
Intravenous thiamine as a potential therapy for agitation and delirium in critically ill patients: a survey of clinicians perspectives
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Albumin Protein Impact on Early-Stage In Vitro Biodegradation of Magnesium Alloy (WE43)
No full textMg and its alloys are promising biodegradable materials for orthopedic implants and cardiovascular stents. The first interactions of protein molecules with Mg alloy surfaces have a substantial impact on their biocompatibility and biodegradation. We investigate the early-stage electrochemical, chemical, morphological, and electrical surface potential changes of alloy WE43 in either 154 mM NaCl or Hanks’ simulated physiological solutions in the absence or presence of bovine serum albumin (BSA) protein. WE43 had the lowest electrochemical current noise (ECN) fluctuations, the highest noise resistance (Zn = 1774 Ω·cm2), and the highest total impedance (|Z| = 332 Ω·cm2) when immersed for 30 min in Hanks’ solution. The highest ECN, lowest Zn (1430 Ω·cm2), and |Z| (49 Ω·cm2) were observed in the NaCl solution. In the solutions containing BSA, a unique dual-mode biodegradation was observed. Adding BSA to a NaCl solution increased |Z| from 49 to 97 Ω·cm2 and decreased the ECN signal of the alloy, i.e., the BSA inhibited corrosion. On the other hand, the presence of BSA in Hanks’ solution increased the rate of biodegradation by decreasing both Zn and |Z| while increasing ECN. Finally, using scanning Kelvin probe force microscopy (SKPFM), we observed an adsorbed nanolayer of BSA with aggregated and fibrillar morphology only in Hanks’ solution, where the electrical surface potential was 52 mV lower than that of the Mg oxide layer.Materials Science and EngineeringTeam Yaiza Gonzalez GarciaTeam Arjan Mo
Éducation, ethnicité et pratiques reproductives au Cameroun
No full textJohnson-Hanks Jennifer.- Education, Ethnicity, and Reproductive Practice in Cameroon It is often observed that educated women have lower birth rates than do the less educated, inviting a causal interpretation. However, educated women also differ from those who have never attended school in a variety of other ways: the two factors are multiply related. This article analyzes the relationship between schooling and fertility in contemporary Cameroon as both a statistical and a social phenomenon, using data from the 1998 Cameroon DHS alongside ethnographic field data collected by the author. These data show that educated Cameroonian women marry later and bear fewer children than their uneducated counterparts, in keeping with patterns established comparatively However, educated women have higher annual premarital fertility rates than do the uneducated, in opposition to the predictions of most causal models. The article argues that these statistical patterns result from the high degree of selection into school. Educated girls come from communities that are more tolerant of premarital sex, place greater emphasis on the importance of developing individual character, and accord a less central role to marriage in women's lives. Together, these social differences matter as much for reproductive outcomes as does schooling.Johnson-Hanks Jennifer.- Éducation, ethnicité et pratiques reproductives au Cameroun On observe souvent que les femmes instruites ont moins d'enfants que les femmes moins instruites, ce qui appelle une interprétation en termes de lien de cause à effet. Toutefois, les femmes instruites diffèrent de bien d'autres façons des femmes n'ayant jamais fréquenté l'école : les deux facteurs sont liés de façon multiple. Le présent article analyse la relation entre instruction et fécondité dans le Cameroun d'aujourd'hui en tant que phénomène à la fois statistique et social, à l'aide de données tirées de l'enquête démographique et de santé (EDS) de 1998 au Cameroun, ainsi que des données ethnographiques collectées sur le terrain par l'auteur. Ces données montrent que les femmes camerounaises instruites se marient plus tardivement et ont moins d'enfants que leurs consœurs non instruites, conformément à des schémas déjà établis. Toutefois, les femmes instruites ont des taux de fécondité prénuptiale annuelle plus élevés que les femmes non instruites, contrairement à ce que prédisent la plupart des modèles causaux. Il est affirmé ici que ces schémas statistiques résultent du niveau élevé de la sélectivité de l'accès à l'école. Les filles instruites viennent de communautés plus tolérantes à l'égard des relations sexuelles prénuptiales, qui accordent une plus grande importance au développement de la personnalité de l'individu, et un rôle moins primordial au mariage. Ensemble, ces différences sociales ont autant d'importance que l'instruction sur la fécondité.Johnson-Hanks Jennifer.- Educación, etnia y practice reproductiva en Camerún La constatación de que las mujeres educadas tienen indices de fecundidad más bajos que las menos educadas ha suscitado interpretaciones causales Sin embargo, las mujeres con educación difieren de las que no han ido a la escuela en muchos otros aspectos: entre ambas variables existe una multiplicidad de relaciones. Este artículo analiza la relación existente entre escolanzación y fecundidad en el Camerún contemporáneo desde un punto de vista estadístico y social, basándose tanto en datos de la Encuesta Demográfica y de Salud (EDS) de Camerún 1998 como en datos etnográficos recogidos por la autora. Estos datos muestran que, en Camerún, las mujeres educadas se casan más tarde y tienen menos hijos que las mujeres sin educación, manteniendo otros factores constantes. No obstante, a pesar de lo que predice la mayoria de mo- delos causales, la tasa de fecundidad prematnmomal anual es más elevada entre las mujeres educadas Este artículo prétende demostrar que estas diferencias estadisticas son debidas al alto nivel de selección entre las escolanzadas. Las jóvenes educadas provienen de comunidades más tolérantes en lo relativo a las relaciones sexuales antes del matnmonio, de medios que dan mayor importancia al desarrollo de la personahdad individual y un papel menos fundamental al papel del matrimomo en la vida de las mujeres. El conjunto de taies diferencias sociales tiene tanta influencia como la escolanzación en los comportamientos reproductivos.Johnson-Hanks J. Éducation, ethnicité et pratiques reproductives au Cameroun. In: Population, 58ᵉ année, n°2, 2003. pp. 171-200
Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit: retrospective cohort analyses
No full textBackground: thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence.Aim: to establish whether a deficiency in whole blood thiamine and/or intravenous thiamine supplementation within 72 hours of intensive care admission is associated with delirium occurrence.Method: the first dataset was secondary analysis of a previous study in an intensive care unit in the Netherlands, reported in 2017. The second dataset contained consecutive intensive care admissions 2 years before (period 1: October 2014 to October 2016) and after (period 2: April 2017 to April 2019) routine thiamine supplementation was introduced within 72 hours of admission. Delirium was defined as a positive Confusion Assessment Method-Intensive Care Unit score(s) in 24 hours.Results: analysis of the first dataset (n=57) using logistic regression showed no relationship between delirium and sepsis or whole blood thiamine, but a significant association with age (p=0.014). In the second dataset (n=3074), 15.1% received IV thiamine in period 1 and 62.6% during period 2. Hierarchical regression analysis reported reduction in delirium occurrence in the second period; this did not reach statistical significance, OR =0.81 (95% CI: 0.652 – 1.002); p=0.052.Conclusion: no relationship was detected between whole blood thiamine and delirium occurrence on admission, at 24 and 48 hours. It remains unclear whether routine intravenous thiamine supplementation during intensive care admission impacts delirium occurrence. Further prospective randomised clinical trials are needed
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