Implementing a Multicomponent Intervention to Prevent Delirium Among Critically Ill Patients.

BACKGROUND: Delirium is common among the critically ill. Nonpharmacologic interventions are reportedly effective in reducing incident delirium, but limited data specific to this population exist. OBJECTIVES: To assess the efficacy and describe the implementation strategy of a multicomponent intervention to prevent delirium in an intensive care unit. METHODS: A before-and-after study was conducted in an intensive care unit between May 2014 through August 2015. Adult participants were enrolled consecutively, excluding only those who refused to participate. Tailored interventions took available evidence into consideration. Components included early mobilization, physical therapy, reorientation, cognitive stimulation, drug reviews, environmental stimulation, avoidance of sensory deprivation, pain control, restraint use avoidance, and family participation. Incident delirium was assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit. Multivariate logistic regression was used to control for confounders. RESULTS: The study included 227 patients (54.7% male; mean [SD] age, 63.3 [18.3] years). Our strategy significantly reduced delirium (from 38% to 24%; relative risk, 0.62; 95% CI, 0.40-0.94; P = .02), an association that remained significant after adjusting for confounders. Adherence rates were more than 85% in all intervention domains (except daily reorientation) that were overseen by health care providers. CONCLUSIONS: The strategy was successful in reducing delirium. Self-removals of invasive implements decreased, an observation that has not been previously described. No difference in mortality rate was seen, as has been reported in other studies. Early participation of the whole team, shared leadership, and the provision of concrete tasks were key to the success of this multicomponent intervention.

mEosFP-based green-to-red photoconvertible subcellular probes for plants.

Photoconvertible fluorescent proteins (FPs) are recent additions to the biologists' toolbox for understanding the living cell. Like green fluorescent protein (GFP), monomeric EosFP is bright green in color but is efficiently photoconverted into a red fluorescent form using a mild violet-blue excitation. Here, we report mEosFP-based probes that localize to the cytosol, plasma membrane invaginations, endosomes, prevacuolar vesicles, vacuoles, the endoplasmic reticulum, Golgi bodies, mitochondria, peroxisomes, and the two major cytoskeletal elements, filamentous actin and cortical microtubules. The mEosFP fusion proteins are smaller than GFP/red fluorescent protein-based probes and, as demonstrated here, provide several significant advantages for imaging of living plant cells. These include an ability to differentially color label a single cell or a group of cells in a developing organ, selectively highlight a region of a cell or a subpopulation of organelles and vesicles within a cell for tracking them, and understanding spatiotemporal aspects of interactions between similar as well as different organelles. In addition, mEosFP probes introduce a milder alternative to fluorescence recovery after photobleaching, whereby instead of photobleaching, photoconversion followed by recovery of green fluorescence can be used for estimating subcellular dynamics. Most importantly, the two fluorescent forms of mEosFP furnish bright internal controls during imaging experiments and are fully compatible with cyan fluorescent protein, GFP, yellow fluorescent protein, and red fluorescent protein fluorochromes for use in simultaneous, multicolor labeling schemes. Photoconvertible mEosFP-based subcellular probes promise to usher in a much higher degree of precision to live imaging of plant cells than has been possible so far using single-colored FPs.

Olfactory or auditory stimulation and their hedonic valúes differentially modulate visual working memory

Working memory (WM) designates the retention of objects or events in conscious awareness when these are not present in the environment. Many studies have focused on the interference properties of distracter stimuli in working memory, but these studies have mainly examined the influence of the intensity of these stimuli. Little is known about the memory modulation of hedonic content of distracter stimuli as they also may affect WM performance or attentional tasks. In this paper, we have studied the performance of a visual WM task where subjects recollect from five to eight visually presented objects while they are simultaneously exposed to additional - albeit weak- auditory or olfactory distracter stimulus. We found that WM performance decreases as the number of items to remember increases, but this performance was unaltered by any of the distracter stimuli. However, when performance was correlated to the subject's perceived hedonic values, distracter stimuli classified as negative exhibit higher error rates than positive, neutral or control stimuli. We demonstrate that some hedonic content of otherwise neutral stimuli can strongly modulate memory processes.

Olfactory or auditory stimulation and their hedonic values differentially modulate visual working memory.

Working memory (WM) designates the retention of objects or events in conscious awareness when these are not present in the environment. Many studies have focused on the interference properties of distracter stimuli in working memory, but these studies have mainly examined the influence of the intensity of these stimuli. Little is known about the memory modulation of hedonic content of distracter stimuli as they also may affect WM performance or attentional tasks. In this paper, we have studied the performance of a visual WM task where subjects recollect from five to eight visually presented objects while they are simultaneously exposed to additional - albeit weak- auditory or olfactory distracter stimulus. We found that WM performance decreases as the number of Items to remember increases, but this performance was unaltered by any of the distracter stimuli. However, when performance was correlated to the subject's perceived hedonic values, distracter stimuli classified as negative exhibit higher error rates than positive, neutral or control stimuli. We demonstrate that some hedonic content of otherwise neutral stimuli can strongly modulate memory processes.