Complications of care in a pediatric intensive care unit: a prospective study

OBJECTIVES: (a) To examine the frequency, type, and severity of complications occurring in a pediatric intensive care unit; (b) to identify populations at risk; and (c) to study the impact of complications on morbidity and mortality. DESIGN: Prospective survey. SETTING: Pediatric intensive care unit (PICU) of a university-affiliated hospital. PATIENTS: 1035 consecutive admissions over an 18-month period. RESULTS: 115 complications occurred during 83 (8.0%) admissions, for 2.7 complications per 100 PICU-days; 48 (42%) complications were major, 45 (39%) moderate, and 22 (19%) minor. Sixty complications (52%) were ventilator-related, 14 were drug-related, 13 procedure-related, 24 infectious, and 22 involved invasive devices (18 vascular catheters). Human error was involved in 41 (36%) cases, 21 of which were major (18%). Treatments included reintubation < 24 h (28), intravenous antimicrobials (24), and invasive bedside procedures (14). Cardiopulmonary resuscitation was required in 6 patients. Thirteen patients with complications died (15.7%); 2 deaths were directly due to complications. Patients with complications were younger, had longer lengths of stay, and had a higher mortality. Length of stay was a positive risk factor for complication risk (odds ratio = 1.09, 95% confidence interval: 1.05 to 1.13; p = 0.0001); other patient characteristics had no predictive effect. Kaplan-Meier estimates showed that the most severe complications occurred early in the PICU stay. The best indicators of patient mortality were number of complications (odds ratio = 2.96, 95% confidence interval 1.72 to 5.08; p = 0.0001), and mortality risk derived from the Pediatric Risk of Mortality Score (odds ratio = 1.08, 95% confidence interval 1.06 to 1.10; p = 0.0001). Mortality was correlated with increasing severity of complications. CONCLUSION: Complications have a significant impact on patient care. Patients may be at increased risk earlier in their PICU course, when the number of interventions may be greatest. Complications may increase patient mortality and predict patient death better than other patient variables.     

Using two factor structures of the Mental Adjustment to Cancer (MAC) scale for assessing adaptation to breast cancer

The validity and reliability of two factor structures of the Mental Adjustment to Cancer (MAC) scale for assessing coping style was assessed by examining the relationship between the subscales, psychological distress, and quality of life (QOL) among Stage II and Stage IV breast cancer patients in four phases. First, MANOVAs assessed differences in coping, distress, and QOL across disease stages. Second, for each MAC factor structure, canonical correlation analyses assessed the relationship between coping styles, distress, and QOL, for each disease-stage group separately. Third, structural equation modeling (SEM) assessed the relationship among coping styles, distress, and QOL for all participants. Finally, the internal consistency of both MAC factor structures was assessed using Chronbach's alpha. The results were as follows: (1) significant differences across disease stages were found for coping styles using either the Watson or the Schwartz MAC subscales, but there were no differences in levels of distress or QOL; (2) for both MAC factor structures, coping style was found to be highly related to emotional distress and QOL, however, the strengths of the correlations between individual coping styles and distress/QOL indicators varied across disease stages; (3) SEM indicated that coping style was significantly related to distress and QOL when stage of disease was not considered, and that coping style and indicators of distress/QOL are separate, but highly correlated factors, as opposed to a single latent construct; and, (4) the Watson MAC subscales showed slightly better internal consistency than the Schwartz MAC subscales. Taken together, these findings highlight: (i) the validity of both MAC factor structures for clinical and research use with American breast cancer patients; (ii) the role of coping style as a mediator between disease stage and psychological distress and QOL; and, (iii) the need for refinement of certain Watson and Schwartz subscales.     

Synthesis method for testable electrical networks using 1st order building blocks

This work presents a method for synthesizing testable continuous-time linear time-invariant electrical networks using 1st order blocks for the implementation of analog linear circuits. A functional-structural fault model for the block, and a fault dictionary are proposed together with a simple set of test vectors. The method allows, also, the fault grade evaluation for the modeled faults. The results obtained from the two application examples have shown the suitability of the approach as a design for test method for analog circuits.     

Evaluation of the accuracy of real-time ultrasonic measurements of backfat and loin muscle area in swine using multiple statistical analysis procedures

Real-time ultrasonic measurements of 10th-rib backfat (BF10) and loin muscle area (LMA) were made by a single technician at four mean BW (67.4, 80.3, 93.4, and 104.9 kg) on live hogs to assess the accuracy of predicting carcass measurements before and at slaughter weight. Records were evaluated on 655 purebred barrows and 472 purebred gilts in two tests. Residual correlations-accounting for test, sex, and breed effects, among and between scans and carcass measurements--were moderate to high for BF10 (r=.69 to .82) and LMA (r=.57 to .68), with the largest correlations at 104.9 kg of live weight. Ultrasonic BF10 and LMA were within +/-4 mm and +/-6.45 cm2, respectively, of the corresponding carcass measurement 75.9 and 89.8% of the time. Sex differences for LMA bias were significant (P < .001); ultrasonic LMA was overestimated in barrows by .75 cm2 and underestimated in gilts by .91 cm2. Breed differences were significant (P < .001) for BF10 and LMA bias. Standard errors of prediction (SEP) for BF10 and LMA across the two tests were 3.46 mm and 4.04 cm2, respectively. The SEP for BF10 were 3.60 mm for barrows and 3.19 mm for gilts. The SEP for LMA were 3.77 cm2 for barrows and 4.22 cm2 for gilts. The SEP for BF10 within breeds ranged from 3.25 to 3.72 mm, and for LMA, ranged from 2.98 cm2 to 4.90 cm2. Ultrasound measurements overestimated the carcass measurement by .57 mm for carcasses measuring < 24.1 mm and underestimated by 2.81 mm carcasses with BF10 > 30.3 mm. Ultrasonic LMA overestimated the carcass by 2.35 cm2 in carcasses measuring < 32.5 cm2 and underestimated by 2.29 cm2 in carcasses measuring greater than 37.9 cm2. Results indicate that the magnitude of the carcass measurement affects bias and accuracy of prediction for real-time ultrasonic measurements of BF10 and LMA. The SEP statistic is more consistent in evaluating accuracy of ultrasonic measurement than bias, absolute deviations, and percentage of absolute deviation.     

Intracellular study of interaction of paired-pulse facilitation and late phase of hippocampal long-term potentiation]

Presynaptic paired-pulse facilitation (PPF) rate decreased in most CA1 pyramidal neurones following the long-term potantiation (LTP) induction. The decrease correlated with the LTP magnitude as well as with the initial (pretetanic) PPF rate. The data obtained suggests an involvement of presynaptic mechanisms in maintaining the early and the delayed LTPs.     

Defaults in stereoscopic and kinetic depth perception

This study presents three findings concerning the mechanisms of depth perception. First, the shape of the three-dimensional percept evoked by two-frame motion is defined solely by the rotation component around an axis in the frontoparallel plane; the visual system assigns a default value to this rotation component to arrive at a unique solution. Second, when the visual axes of two eyes are almost parallel, the visual system uses a default vergence value to reconstruct stereoscopic depth. Third, the default vergence and default rotation angles are highly correlated across subjects. This correlation implies that the two modalities share a common scaling default at an internal level.     

Prevalence of renal stones in a population-based study with dietary calcium, oxalate, and medication exposures

Little is known about the epidemiology of renal stones, in spite of the relative frequency of this painful condition. This population-based study examined reported renal stone diagnosis in 1,309 women aged 20-92 years to determine whether renal stones are associated with 1) food or water exposures or 2) lower bone mineral density and an increased likelihood of fractures. Results indicated a renal stone prevalence of 3.4%. The average age at diagnosis was 42 years. Renal stone formation was not associated with community of residence, hypertension, bone mineral density, fractures, high-oxalate food consumption, or ascorbic acid from food supplements. Women with renal stones consumed almost 250 mg/day less dietary calcium (p < 0.01) than did women without stones and had a lower energy intake (p < 0.04). The authors' findings do not support the hypothesis that increased dietary calcium is associated with a greater prevalence of renal stones, nor do they identify renal stones as a risk factor for low bone mineral density. Furthermore, lack of other identifiable environmental correlates and the relatively young age at initial diagnosis suggest that genetic components of renal stone formation need further study.     

On the relationship between the mitochondrial inner membrane anion channel and the adenine nucleotide translocase

The mitochondrial inner membrane anion channel (IMAC) is a transport pathway which is believed to be involved in mitochondrial volume homeostasis. The protein, however, has not been identified. In this paper, we examine the relationship between IMAC and the adenine nucleotide translocator. Many inhibitors of the adenine nucleotide translocase are shown to block IMAC, including Cibacron blue 3GA, bromcresol green, alizarin red S, agaric acid, palmitoyl-CoA, and the fluorescein derivatives erythrosin B, erythrosin isothiocyanate, rose bengal, and eosin Y. The following evidence suggests that Cibacron blue, agaric acid, and palmitoyl-CoA inhibit by binding to a common site. 1) They all only partially block the transport of small anions such as Cl-, NO3-, and HCO3-, but completely block the transport of larger anions such as malonate. 2) They decrease the IC50 values of each other in a manner consistent with competitive binding. 3) N-Ethylmaleimide decreases their IC50 values by a similar extent. 4) Inhibition by all shows no dependence on matrix pH and only a small dependence on medium pH. It is suggested that these agents may selectively bind to an open state of IMAC and inhibit by decreasing its conductance. The physiological nucleotides CoA, NAD+, NADH, NADP+, NADH, and ATP do not inhibit; in fact, IMAC is shown to transport ATP. Despite these similarities between IMAC and the adenine nucleotide translocase, IMAC appears to be a separate entity, since some of the IC50 values differ by up to 8-fold, and carboxyatracyloside, the most selective inhibitor of the adenine nucleotide translocase, has no effect on IMAC. In addition, IMAC is also able to transport AMP, while the adenine nucleotide translocase does not.     

Native valve infective endocarditis in elderly and younger adult patients: comparison of clinical features and outcomes with use of the Duke criteria and the Duke Endocarditis Database

The effect of age on the presentation and outcome of infective endocarditis (IE) is unclear. Many of the available data are based on analyses of mixed populations of patients including intravenous drug users or those with prosthetic valve endocarditis or native valve IE. We used the Duke criteria to compare the characteristics of 44 episodes of definite native valve IE in elderly patients (> 64 years old) with the characteristics of 64 similarly defined episodes of native valve IE in younger, nonintravenous-drug-using adult patients (> 29 years and < 60 years old). Our data suggest that the clinical presentation, characteristics, and outcome of native valve IE are similar for elderly patients and younger adult patients, although elderly patients were hospitalized an average of 12 days longer. Although we found that the occurrence of renal failure and cerebral embolism during an episode of IE was associated with higher rates of death (odds ratios, 4.8 and 4.0, respectively), age was not a significant contributor to mortality.