Long-term outcomes after treatment of delirium during critical illness with antipsychotics (MIND-USA): a randomised, placebo-controlled, phase 3 trial.

Background: Delirium is common during critical illness and is associated with long-term cognitive impairment and disability. Antipsychotics are frequently used to treat delirium, but their effects on long-term outcomes are unknown. We aimed to investigate the effects of antipsychotic treatment of delirious, critically ill patients on long-term cognitive, functional, psychological, and quality-of-life outcomes.

New Capabilities in MT3D-USGS for Simulating Unsaturated-Zone Heat Transport.

Changes in climate and land use will alter groundwater heat transport dynamics in the future. These changes will in turn affect watershed processes (e.g.

A Simple Method for Simulating Groundwater Interactions with Fens to Forecast Development Effects.

Protection of fens-wetlands dependent on groundwater discharge-requires characterization of groundwater sources and stresses. Because instrumentation and numerical modeling of fens is labor intensive, easy-to-apply methods that model fen distribution and their vulnerability to development are desirable. Here we demonstrate that fen areas can be simulated using existing steady-state MODFLOW models when the unsaturated zone flow (UZF) package is included.

Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness.

Background: There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU).

Methods: In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention.

A Semi-Structured MODFLOW-USG Model to Evaluate Local Water Sources to Wells for Decision Support.

In order to better represent the configuration of the stream network and simulate local groundwater-surface water interactions, a version of MODFLOW with refined spacing in the topmost layer was applied to a Lake Michigan Basin (LMB) regional groundwater-flow model developed by the U.S. Geological.

Glycemic control in a medical intensive care setting: revision of an intensive care unit nurse-driven hyperglycemia protocol.

The purpose of this study was to determine whether the addition of rapid-acting insulin bolus for enteral feed coverage and a reduction in basal insulin improve glycemic control and decrease hypoglycemia in a medical intensive care unit. A quasi-experimental posttest design assessing glucose control postimplementation of a revised nurse-driven ICU hyperglycemia protocol was conducted on a 16-bed medical intensive care unit at a multicenter hospital system. A daily report of all patients on the ICU hyperglycemia protocol was automated for the inpatient diabetes management team, and pertinent data were collected.

Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study.

Introduction: Data are sparse as to whether obesity influences the risk of death in critically ill patients with septic shock. We sought to examine the possible impact of obesity, as assessed by body mass index (BMI), on hospital mortality in septic shock patients.

Methods: We performed a nested cohort study within a retrospective database of patients with septic shock conducted in 28 medical centers in Canada, United States and Saudi Arabia between 1996 and 2008.

Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis.

Unlabelled: It is unclear whether practice-related aspects of antimicrobial therapy contribute to the high mortality from septic shock among patients with cirrhosis. We examined the relationship between aspects of initial empiric antimicrobial therapy and mortality in patients with cirrhosis and septic shock. This was a nested cohort study within a large retrospective database of septic shock from 28 medical centers in Canada, the United States, and Saudi Arabia by the Cooperative Antimicrobial Therapy of Septic Shock Database Research Group between 1996 and 2008.

Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis.

Background: Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broadening coverage when resistant pathogens are a concern.

Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.

Objective: To determine the prevalence and impact on mortality of delays in initiation of effective antimicrobial therapy from initial onset of recurrent/persistent hypotension of septic shock.

Design: A retrospective cohort study performed between July 1989 and June 2004.

Setting: Fourteen intensive care units (four medical, four surgical, six mixed medical/surgical) and ten hospitals (four academic, six community) in Canada and the United States.

The vertical hydraulic conductivity of an aquitard at two spatial scales.

Aquitards protect underlying aquifers from contaminants and limit recharge to those aquifers. Understanding the mechanisms and quantity of ground water flow across aquitards to underlying aquifers is essential for ground water planning and assessment. We present results of laboratory testing for shale hydraulic conductivities, a methodology for determining the vertical hydraulic conductivity (K(v)) of aquitards at regional scales and demonstrate the importance of discrete flow pathways across aquitards.

Simulating ground water-lake interactions: approaches and insights.

Approaches for modeling lake-ground water interactions have evolved significantly from early simulations that used fixed lake stages specified as constant head to sophisticated LAK packages for MODFLOW. Although model input can be complex, the LAK package capabilities and output are superior to methods that rely on a fixed lake stage and compare well to other simple methods where lake stage can be calculated. Regardless of the approach, guidelines presented here for model grid size, location of three-dimensional flow, and extent of vertical capture can facilitate the construction of appropriately detailed models that simulate important lake-ground water interactions without adding unnecessary complexity.

Stepwise use of GFLOW and MODFLOW to determine relative importance of shallow and deep receptors.

A stepwise modeling approach is implemented in which a regional one-layer analytic element model is used to simulate the flow system and to furnish boundary conditions for an extracted local three-dimensional model. In this case study the stepwise approach is used to evaluate the fate of recharge in the Menomonee Valley adjacent to Lake Michigan. Two major receptors exist for recharge that flows through contaminated valley fill: the surface water estuary and a tunnel system constructed approximately 75 to 110 m below land surface to store storm runoff.

Novel therapies for sepsis: antiendotoxin therapies.

Severe sepsis and septic shock is a common problem encountered in the critical care unit with an estimated incidence in the US of 750,000 cases/year and a mortality rate of 30-50%. Sepsis involves a complex interaction between bacterial factors and the host immune system producing a systemic inflammatory state that may progress to multiple organ failure and death. Endotoxin (a lipopolysaccharide) released from Gram-negative bacteria has been implicated as a potent, prototypical stimulus of the immune response to bacterial infection.