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The impact of disability in survivors of critical illness
Purpose
To use the World Health Organisation’s International Classification of Functioning to measure disability following critical illness using patient-reported outcomes.
Methods
A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge. The primary outcome was measurement of disability using the World Health Organisation’s Disability Assessment Schedule 2.0. The secondary outcomes included the limitation of activities and changes to health-related quality of life comparing survivors with and without disability at 6 months after ICU.
Results
We followed 262 patients to 6 months, with a mean age of 59 ± 16 years, and of whom 175 (67%) were men. Moderate or severe disability was reported in 65 of 262 (25%). Predictors of disability included a history of anxiety/depression [odds ratio (OR) 1.65 (95% confidence interval (CI) 1.22, 2.23),
P
= 0.001]; being separated or divorced [OR 2.87 (CI 1.35, 6.08),
P
= 0.006]; increased duration of mechanical ventilation [OR 1.04 (CI 1.01, 1.08),
P
= 0.03 per day]; and not being discharged to home from the acute hospital [OR 1.96 (CI 1.01, 3.70)
P
= 0.04]. Moderate or severe disability at 6 months was associated with limitation in activities, e.g. not returning to work or studies due to health (
P
< 0.002), and reduced health-related quality of life (
P
< 0.001).
Conclusion
Disability measured using patient-reported outcomes was prevalent at 6 months after critical illness in survivors and was associated with reduced health-related quality of life. Predictors of moderate or severe disability included a prior history of anxiety or depression, separation or divorce and a longer duration of mechanical ventilation.
Trial registration: NCT02225938.
Journal Article
Japan : top sights, authentic experiences
\"Lonely Planet Best of Japan is your passport to the most relevant, up-to-date advice on what to see and skip, and what hidden discoveries await you. See traditional geisha in Kyoto, hike up Mt Fuji, or shop around the clock in Tokyo; all with your trusted travel companion.\"--Publisher.
Book
Drying Kinetics of Macroalgae as a Function of Drying Gas Velocity and Material Bulk Density, Including Shrinkage
Macroalgae have many potential applications and can make important contributions to sustainability and circular economy objectives. Macroalgae are degradable high-moisture biomaterials and drying is a necessary step, but drying is an energy and capital-intensive part of their production process. This study presents convective drying curves for commercially promising fresh and saltwater species (U. ohnoi and O. intermedium), obtained over a range of industry-relevant drying gas velocities (0.3–2 m/s) and material bulk densities (33–100 kg/m3). Pragmatic diffusion-based drying models that account for the influence of drying gas velocity, material bulk density, and material shrinkage are presented. Results provide critical insights into the validity of diffusion model assumptions for compressible biomaterials and new mechanisms describing gas penetration into such materials are proposed. The drying models provided in this work demonstrate a high degree of accuracy for both species.
Journal Article
Japan
Lonely Planet Japan is your passport to the most relevant, up-to-date advice on what to see and skip, and what hidden discoveries await you. Explore a bamboo grove in Arashiyama, marvel at Shinto and Buddhist architecture in Kyoto, or relax in the hot springs of Noboribetsu Onsen; all with your trusted travel companion.
Book
Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease
Peripheral arterial disease (PAD) is frequently diagnosed after permanent damage has occurred, resulting in a high rate of morbidity, amputation, and loss of life. Early and ongoing diagnosis and treatment is required for this progressive disease. Lifestyle modifications can prevent or delay disease progression and improve symptoms. Limb-sparing endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets, and intervention must occur as early as possible to ensure optimal clinical outcomes. An algorithm for the diagnosis and management of PAD was developed to enable a collaborative approach between the family practice and primary care physician or internist and various specialists that may include a diabetologist, endocrinologist, smoking cessation expert, hypertension and lipid specialist, endovascular interventionalist, vascular surgeon, orthopedist, neurologist, nurse practitioner, podiatrist, wound healing expert, and/or others. A multidisciplinary team working together has the greatest chance of providing optimal care for the patient with PAD and ensuring ongoing surveillance of the patient's overall health, ultimately resulting in better quality of life and increased longevity for patients with PAD.
Journal Article
Long-Term Impacts on Macroinvertebrates Downstream of Reclaimed Mountaintop Mining Valley Fills in Central Appalachia
Recent studies have documented adverse effects to biological communities downstream of mountaintop coal mining and valley fills (VF), but few data exist on the longevity of these impacts. We sampled 15 headwater streams with VFs reclaimed 11–33 years prior to 2011 and sampled seven local reference sites that had no VFs. We collected chemical, habitat, and benthic macroinvertebrate data in April 2011; additional chemical samples were collected in September 2011. To assess ecological condition, we compared VF and reference abiotic and biotic data using: (1) ordination to detect multivariate differences, (2) benthic indices (a multimetric index and an observed/expected predictive model) calibrated to state reference conditions to detect impairment, and (3) correlation and regression analysis to detect relationships between biotic and abiotic data. Although VF sites had good instream habitat, nearly 90 % of these streams exhibited biological impairment. VF sites with higher index scores were co-located near unaffected tributaries; we suggest that these tributaries were sources of sensitive taxa as drifting colonists. There were clear losses of expected taxa across most VF sites and two functional feeding groups (% scrapers and %shredders) were significantly altered. Percent VF and forested area were related to biological quality but varied more than individual ions and specific conductance. Within the subset of VF sites, other descriptors (e.g., VF age, site distance from VF, the presence of impoundments, % forest) had no detectable relationships with biological condition. Although these VFs were constructed pursuant to permits and regulatory programs that have as their stated goals that (1) mined land be reclaimed and restored to its original use or a use of higher value, and (2) mining does not cause or contribute to violations of water quality standards, we found sustained ecological damage in headwaters streams draining VFs long after reclamation was completed.
Journal Article
Early lactate clearance in septic patients with elevated lactate levels admitted from the emergency department to intensive care: Time to aim higher?
Septic patients with hyperlactatemia have increased mortality rates, irrespective of hemodynamic and oxygen-derived variables. The aims of the study are the following: (1) to ascertain whether lactate clearance (LC) (percentage change in lactate over unit time) predicts mortality in septic patients admitted to intensive care directly from the emergency department and (2) to calculate the optimal “cut-off” value for mortality prediction.
Three-year retrospective observational study of consecutive patients with severe sepsis and septic shock admitted to intensive care from the emergency department of a tertiary UK hospital. We calculated 6-hour LC, performed receiver operating characteristic analyses to calculate optimal cut-off values for initial lactate and LC, dichotomized patients according to the LC cut-off, and calculated hazard ratios using a Cox proportional hazards model.
One hundred six patients were identified; 78, after exclusions. Lactate clearance was independently associated with 30-day mortality (P < .04); optimal cut-off, 36%. Mortality rates were 61.1% and 10.7% for patients with 6-hour LC 36% or less and greater than 36%, respectively. Hazard ratio for death with LC 36% or less was 7.33 (95% confidence interval, 2.17-24.73; P < .001).
Six-hour LC was independently associated with mortality, and the optimal cut-off value was 36%, significantly higher than previously reported. We would support further research investigating this higher LC as a distinct resuscitation end point in patients with severe sepsis and septic shock.
Journal Article
Predictors of return to work in survivors of critical illness
To determine predictors of inability to return to work due to health six-months after intensive care admission; and compare functional recovery between patients who had not returned to work and employed patients.
Participants were working adults admitted to ICU who received >24 h of mechanical ventilation. Outcomes included inability to return to work due to health at six-months post-ICU admission, disability, health status, anxiety, depression and post-traumatic stress.
Of 107 patients, 31 (29%) were unable to return to work due to health at six-months after ICU admission. Predictors of inability to return to work included longer hospital stay (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02–1.08; P = .004); lower Glasgow Coma Scale (GCS) at admission (OR, 0.86; CI, 0.75–0.99; P = .03); and admission due to major trauma (OR, 8.83; CI, 2.57–30.38; P < .001). Compared to employed patients, those who had not returned to work reported higher levels of disability and psychological distress, and poorer health-related quality of life.
Major trauma, lower GCS and increased hospital length of stay predicted inability to return to work due to health at six-months post-ICU admission. Compared to employed patients, those who had not returned to work reported poorer functional recovery.
•One third of patients mechanically ventilated for >24 h had not returned to work at six months due to their health.•Predictors of being unable to return to work due to poor health included increased hospital length of stay, major trauma and lower Glasgow Coma Scale.•Inability to return to work due to health was associated with anxiety, depression, post-traumatic stress and reduced health related quality of life.
Journal Article
Observations of the Structure and Dynamics of the Inner M87 Jet
M87 is the best source in which to study a jet at high resolution in gravitational units because it has a very high mass black hole and is nearby. The angular size of the black hole is second only to Sgr A*, which does not have a strong jet. The jet structure is edge brightened with a wide opening angle base and a weak counterjet. We have roughly annual observations for 17 years plus intensive monitoring at three week intervals for a year and five day intervals for 2.5 months made with the Very Long Baseline Array (VLBA) at 43 GHz. The inner jet shows very complex dynamics, with apparent motions both along and across the jet. Speeds from zero to over 2c are seen, with acceleration observed over the first 3 milli-arcseconds. The counterjet decreases in brightness much more rapidly than the main jet, as is expected from relativistic beaming in an accelerating jet oriented near the line-of-sight. Details of the structure and dynamics are discussed. The roughly annual observations show side-to-side motion of the whole jet with a characteristic time scale of about 9 years.
Journal Article