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Nursing in Critical Care Sep 2023Delirium, which is frequently encountered in intensive care patients, can be prevented with multicomponent nursing interventions, and thus the negative consequences can... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Delirium, which is frequently encountered in intensive care patients, can be prevented with multicomponent nursing interventions, and thus the negative consequences can be reduced.
AIM
To examine the effect of using eye masks and earplugs in preventing delirium in intensive care units (ICUs).
STUDY DESIGN
A randomized, controlled, single-blind intervention study. This study was conducted in the medical and surgical ICUs of a tertiary hospital, and nurses were given pre-study training on delirium risks, diagnosis, prevention, and management. Data were collected using the patient information form, the Nursing Delirium Screening Scale, the Richard-Campbell Sleep Scale, and the daily follow-up form. Various environmental modifications were made in the ICUs for all patients, and evidence-based nonpharmacological nursing interventions were applied to the patients in both groups during the day and night shifts for 3 days. In addition, the patients in the intervention group were provided with eye masks and earplugs for three nights.
RESULTS
The study included a total of 60 patients (30 in the intervention group and 30 in the control group). There was a statistically significant difference in the development of delirium between the intervention and control groups (night of the 2nd day, p = .019; day of the 3rd day p < .001; night of the 3rd day p ≤ .001). The average total sleep quality score of the intervention group was found to be significantly higher than the control group (p ≤ .001 for three nights). Staying in the internal medicine ICU affected (odds ratio [OR], 11.84; 95% confidence interval [CI], 3.00-46.66; p = .017) more on the development of delirium than in coronary ICU, being in the age group of 65 and over, having a hearing impairment, coming to ICU from the operating room, and education level had an effect.
CONCLUSIONS
The earplugs and eye masks used by the intensive care patients overnight were found to be effective in increasing sleep quality and preventing delirium.
RELEVANCE TO CLINICAL PRACTICE
The use of eye masks and earplugs is recommended for ICUs in preventing delirium.
Topics: Humans; Aged; Ear Protective Devices; Single-Blind Method; Sleep; Critical Care; Intensive Care Units; Delirium
PubMed: 37138379
DOI: 10.1111/nicc.12901 -
Epidemiology and Infection Nov 2023We examined the association between face masks and risk of infection with SARS-CoV-2 using cross-sectional data from 3,209 participants in a randomized trial exploring...
We examined the association between face masks and risk of infection with SARS-CoV-2 using cross-sectional data from 3,209 participants in a randomized trial exploring the effectiveness of glasses in reducing the risk of SARS-CoV-2 infection. Face mask use was based on participants' response to the end-of-follow-up survey. We found that the incidence of self-reported COVID-19 was 33% (aRR 1.33; 95% CI 1.03-1.72) higher in those wearing face masks often or sometimes, and 40% (aRR 1.40; 95% CI 1.08-1.82) higher in those wearing face masks almost always or always, compared to participants who reported wearing face masks never or almost never. We believe the observed increase in the incidence of infection associated with wearing a face mask is likely due to unobservable and hence nonadjustable differences between those wearing and not wearing a mask. Observational studies reporting on the relationship between face mask use and risk of respiratory infections should be interpreted cautiously, and more randomized trials are needed.
Topics: Humans; COVID-19; SARS-CoV-2; Cross-Sectional Studies; Masks; Respiratory Tract Infections
PubMed: 37952983
DOI: 10.1017/S0950268823001826 -
The Cochrane Database of Systematic... Oct 2023The Neonatal Task Force of the International Liaison Committee on Resuscitation (ILCOR) makes practice recommendations for the care of newborn infants in the delivery... (Review)
Review
BACKGROUND
The Neonatal Task Force of the International Liaison Committee on Resuscitation (ILCOR) makes practice recommendations for the care of newborn infants in the delivery room (DR). ILCOR recommends that all infants who are gasping, apnoeic, or bradycardic (heart rate < 100 per minute) should be given positive pressure ventilation (PPV) with a manual ventilation device (T-piece, self-inflating bag, or flow-inflating bag) via an interface. The most commonly used interface is a face mask that encircles the infant's nose and mouth. However, gas leak and airway obstruction are common during face mask PPV. Nasal interfaces (single and binasal prongs (long or short), or nasal masks) and laryngeal mask airways (LMAs) may also be used to deliver PPV to newborns in the DR, and may be more effective than face masks.
OBJECTIVES
To determine whether newborn infants receiving PPV in the delivery room with a nasal interface compared to a face mask, laryngeal mask airway (LMA), or another type of nasal interface have reduced mortality and morbidity. To assess whether safety and efficacy of the nasal interface differs according to gestational age or ventilation device.
SEARCH METHODS
Searches were conducted in September 2022 in CENTRAL, MEDLINE, Embase, Epistemonikos, and two trial registries. We searched conference abstracts and checked the reference lists of included trials and related systematic reviews identified through the search.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCT's that compared the use of nasal interfaces to other interfaces (face masks, LMAs, or one nasal interface to another) to deliver PPV to newborn infants in the DR.
DATA COLLECTION AND ANALYSIS
Each review author independently evaluated the search results against the selection criteria, screened retrieved records, extracted data, and appraised the risk of bias. If they were study authors, they did not participate in the selection, risk of bias assessment, or data extraction related to the study. In such instances, the study was independently assessed by other review authors. We contacted trial investigators to obtain additional information. We completed data analysis according to the standards of Cochrane Neonatal, using risk ratio (RR) and 95% confidence Intervals (CI) to measure the effect of the different interfaces. We used fixed-effect models and the GRADE approach to assess the certainty of the evidence.
MAIN RESULTS
We included five trials, in which 1406 infants participated. They were conducted in 13 neonatal centres across Europe and Australia. Each of these trials compared a nasal interface to a face mask for the delivery of respiratory support to newborn infants in the DR. Potential sources of bias were a lack of blinding to treatment allocation of the caregivers and investigators in all trials. The evidence suggests that resuscitation with a nasal interface in the DR, compared with a face mask, may have little to no effect on reducing death before discharge (typical risk ratio (RR) 0.72, 95% CI 0.47 to 1.13; 3 studies, 1124 infants; low-certainty evidence). Resuscitation with a nasal interface may reduce the rate of intubation in the DR, but the evidence is very uncertain (RR 0.68, 95% CI 0.54 to 0.85; 5 studies, 1406 infants; very low-certainty evidence). The evidence is very uncertain for the rate of intubation within 24 hours of birth (RR 0.97, 95% CI 0.85 to 1.09; 3 studies, 749 infants; very low-certainty evidence), endotracheal intubation outside the DR during hospitalisation (RR 1.15, 95% CI 0.93 to 1.42; 1 study, 144 infants; very low-certainty evidence) and cranial ultrasound abnormalities (intraventricular haemorrhage (IVH) grade ≥ 3, or periventricular leukomalacia; RR 0.94, 95% CI 0.55 to 1.61; 3 studies, 749 infants; very low-certainty evidence). Resuscitation with a nasal interface in the DR, compared with a face mask, may have little to no effect on the incidence of air leaks (RR 1.09, 95% CI 0.85 to 1.09; 2 studies, 507 infants; low-certainty evidence), or the need for supplemental oxygen at 36 weeks' corrected gestational age (RR 1.06, 95% CI 0.8 to 1.40; 2 studies, 507 infants; low-certainty evidence). We identified one ongoing study, which compares a nasal mask to a face mask to deliver PPV to infants in the DR. We did not identify any completed trials that compared nasal interfaces to LMAs or one nasal interface to another.
AUTHORS' CONCLUSIONS
Nasal interfaces were found to offer comparable efficacy to face masks (low- to very low-certainty evidence), supporting resuscitation guidelines that state that nasal interfaces are a comparable alternative to face masks for providing respiratory support in the DR. Resuscitation with a nasal interface may reduce the rate of intubation in the DR when compared with a face mask. However, the evidence is very uncertain. This uncertainty is attributed to the use of a new ventilation system in the nasal interface group in two of the five trials. As such, it is not possible to differentiate separate, specific effects related to the ventilation device or to the interface in these studies.
Topics: Infant, Newborn; Humans; Resuscitation; Positive-Pressure Respiration; Respiration, Artificial; Intermittent Positive-Pressure Ventilation; Intubation, Intratracheal
PubMed: 37787113
DOI: 10.1002/14651858.CD009102.pub2 -
Zentralblatt Fur Chirurgie Jun 2024This article aims to review the current anaesthetic management of tracheal resections.Apart from the "traditional" approach of induction of general anaesthesia with... (Review)
Review
This article aims to review the current anaesthetic management of tracheal resections.Apart from the "traditional" approach of induction of general anaesthesia with conventional tracheal intubation and cross-field intubation or jet ventilation during the resection phase, there has lately been a trend towards less invasive techniques.Regional anaesthesia, laryngeal mask airways and preservation of spontaneous ventilation are among the new anaesthetic approaches. Current data suggest potential advantages compared with conventional tracheal intubation.Extracorporeal membrane oxygenation may provide adequate gas exchange and/or cardiovascular support for complex resections and reconstructions. In addition, it may serve as a reliable "backup" technique, in case of oxygenation difficulties with the use of other devices.Given the vast spectrum of different anaesthetic approaches to tracheal surgery, interdisciplinary planning is essential to identify the optimal technique on a case-by-case basis. During that process, the localisation and consistency of the airway lesion, comorbidities and the functional status of the respiratory system and specific surgical approach need to be taken into account.As there is a lack of high-quality data, evidence-based comparisons of different anaesthetic techniques are not possible.
Topics: Humans; Intubation, Intratracheal; Trachea; Anesthesia, General; Extracorporeal Membrane Oxygenation; Laryngeal Masks; Anesthesia, Conduction; Tracheotomy
PubMed: 38122803
DOI: 10.1055/a-2222-7797 -
JAMA Network Open May 2024Repetitive transcranial magnetic stimulation (rTMS) has emerged as a safe and promising intervention for Alzheimer disease (AD). (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Repetitive transcranial magnetic stimulation (rTMS) has emerged as a safe and promising intervention for Alzheimer disease (AD).
OBJECTIVE
To investigate the effect of a 4-week personalized hippocampal network-targeted rTMS on cognitive and functional performance, as well as functional connectivity in AD.
DESIGN, SETTING, AND PARTICIPANTS
This randomized clinical trial, which was sham-controlled and masked to participants and evaluators, was conducted between May 2020 and April 2022 at a single Korean memory clinic. Eligible participants were between ages 55 and 90 years and had confirmed early AD with evidence of an amyloid biomarker. Participants who met the inclusion criteria were randomly assigned to receive hippocampal network-targeted rTMS or sham stimulation. Participants received 4-week rTMS treatment, with assessment conducted at weeks 4 and 8. Data were analyzed between April 2022 and January 2024.
INTERVENTIONS
Each patient received 20 sessions of personalized rTMS targeting the left parietal area, functionally connected to the hippocampus, based on fMRI connectivity analysis over 4 weeks. The sham group underwent the same procedure, excluding actual magnetic stimulation. A personalized 3-dimensional printed frame to fix the TMS coil to the optimal target site was produced.
MAIN OUTCOMES AND MEASURES
The primary outcome was the change in the AD Assessment Scale-Cognitive Subscale test (ADAS-Cog) after 8 weeks from baseline. Secondary outcomes included changes in the Clinical Dementia Rating-Sum of Boxes (CDR-SOB) and Seoul-Instrumental Activity Daily Living (S-IADL) scales, as well as resting-state fMRI connectivity between the hippocampus and cortical areas.
RESULTS
Among 30 participants (18 in the rTMS group; 12 in the sham group) who completed the 8-week trial, the mean (SD) age was 69.8 (9.1) years; 18 (60%) were female. As the primary outcome, the change in ADAS-Cog at the eighth week was significantly different between the rTMS and sham groups (coefficient [SE], -5.2 [1.6]; P = .002). The change in CDR-SOB (-4.5 [1.4]; P = .007) and S-IADL (1.7 [0.7]; P = .004) were significantly different between the groups favoring rTMS groups. The fMRI connectivity analysis revealed that rTMS increased the functional connectivity between the hippocampus and precuneus, with its changes associated with improvements in ADAS-Cog (r = -0.57; P = .005).
CONCLUSIONS AND RELEVANCE
This randomized clinical trial demonstrated the positive effects of rTMS on cognitive and functional performance, and the plastic changes in the hippocampal-cortical network. Our results support the consideration of rTMS as a potential treatment for AD.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04260724.
Topics: Humans; Alzheimer Disease; Female; Male; Aged; Hippocampus; Transcranial Magnetic Stimulation; Middle Aged; Magnetic Resonance Imaging; Aged, 80 and over; Treatment Outcome
PubMed: 38709534
DOI: 10.1001/jamanetworkopen.2024.9220 -
IEEE Transactions on Pattern Analysis... Aug 2023Nested dropout is a variant of dropout operation that is able to order network parameters or features based on the pre-defined importance during training. It has been...
Nested dropout is a variant of dropout operation that is able to order network parameters or features based on the pre-defined importance during training. It has been explored for: I. Constructing nested nets Cui et al. 2020, Cui et al. 2021: the nested nets are neural networks whose architectures can be adjusted instantly during testing time, e.g., based on computational constraints. The nested dropout implicitly ranks the network parameters, generating a set of sub-networks such that any smaller sub-network forms the basis of a larger one. II. Learning ordered representation Rippel et al. 2014: the nested dropout applied to the latent representation of a generative model (e.g., auto-encoder) ranks the features, enforcing explicit order of the dense representation over dimensions. However, the dropout rate is fixed as a hyper-parameter during the whole training process. For nested nets, when network parameters are removed, the performance decays in a human-specified trajectory rather than in a trajectory learned from data. For generative models, the importance of features is specified as a constant vector, restraining the flexibility of representation learning. To address the problem, we focus on the probabilistic counterpart of the nested dropout. We propose a variational nested dropout (VND) operation that draws samples of multi-dimensional ordered masks at a low cost, providing useful gradients to the parameters of nested dropout. Based on this approach, we design a Bayesian nested neural network that learns the order knowledge of the parameter distributions. We further exploit the VND under different generative models for learning ordered latent distributions. In experiments, we show that the proposed approach outperforms the nested network in terms of accuracy, calibration, and out-of-domain detection in classification tasks. It also outperforms the related generative models on data generation tasks.
PubMed: 37027650
DOI: 10.1109/TPAMI.2023.3241945 -
Journal of Imaging Sep 2023The problem of gathering sufficiently representative data, such as those about human actions, shapes, and facial expressions, is costly and time-consuming and also...
The problem of gathering sufficiently representative data, such as those about human actions, shapes, and facial expressions, is costly and time-consuming and also requires training robust models. This has led to the creation of techniques such as transfer learning or data augmentation. However, these are often insufficient. To address this, we propose a semi-automated mechanism that allows the generation and editing of visual scenes with synthetic humans performing various actions, with features such as background modification and manual adjustments of the 3D avatars to allow users to create data with greater variability. We also propose an evaluation methodology for assessing the results obtained using our method, which is two-fold: (i) the usage of an action classifier on the output data resulting from the mechanism and (ii) the generation of masks of the avatars and the actors to compare them through segmentation. The avatars were robust to occlusion, and their actions were recognizable and accurate to their respective input actors. The results also showed that even though the action classifier concentrates on the pose and movement of the synthetic humans, it strongly depends on contextual information to precisely recognize the actions. Generating the avatars for complex activities also proved problematic for action recognition and the clean and precise formation of the masks.
PubMed: 37888311
DOI: 10.3390/jimaging9100204 -
Acta Crystallographica. Section A,... Mar 2024The bulk solvent is a major component of biomacromolecular crystals that contributes significantly to the observed diffraction intensities. Accurate modelling of the...
The bulk solvent is a major component of biomacromolecular crystals that contributes significantly to the observed diffraction intensities. Accurate modelling of the bulk solvent has been recognized as important for many crystallographic calculations. Owing to its simplicity and modelling power, the flat (mask-based) bulk-solvent model is used by most modern crystallographic software packages to account for disordered solvent. In this model, the bulk-solvent contribution is defined by a binary mask and a scale (scattering) function. The mask is calculated on a regular grid using the atomic model coordinates and their chemical types. The grid step and two radii, solvent and shrinkage, are the three parameters that govern the mask calculation. They are highly correlated and their choice is a compromise between the computer time needed to calculate the mask and the accuracy of the mask. It is demonstrated here that this choice can be optimized using a unique value of 0.6 Å for the grid step irrespective of the data resolution, and the radii values adjusted correspondingly. The improved values were tested on a large sample of Protein Data Bank entries derived from X-ray diffraction data and are now used in the computational crystallography toolbox (CCTBX) and in Phenix as the default choice.
PubMed: 38334174
DOI: 10.1107/S2053273324000299 -
Current Opinion in Insect Science Dec 2023Predicting how insects will respond to stressors through time is difficult because of the diversity of insects, environments, and approaches used to monitor and model.... (Review)
Review
Predicting how insects will respond to stressors through time is difficult because of the diversity of insects, environments, and approaches used to monitor and model. Forecasting models take correlative/statistical, mechanistic models, and integrated forms; in some cases, temporal processes can be inferred from spatial models. Because of heterogeneity associated with broad community measurements, models are often unable to identify mechanistic explanations. Many present efforts to forecast insect dynamics are restricted to single-species models, which can offer precise predictions but limited generalizability. Trait-based approaches may offer a good compromise that limits the masking of the ranges of responses while still offering insight. Regardless of the modeling approach, the data used to parameterize a forecasting model should be carefully evaluated for temporal autocorrelation, minimum data needs, and sampling biases in the data. Forecasting models can be tested using near-term predictions and revised to improve future forecasts.
Topics: Animals; Insecta; Forecasting
PubMed: 37858790
DOI: 10.1016/j.cois.2023.101133